REP Post Acute April 20

vol.28 no.2 • April 2020

POCT in post-acute care: It’s needed And your competition is already calling on these accounts

repertoiremag.com

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APRIL 2020 • VOLUME 28 • ISSUE 4

Going Green

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Going green at Augusta National means winning the coveted green jacket. For medical sales reps, it means sustainability, and responsibility for the environment and the people in it.

PUBLISHER’S LETTER Going Green..........................................4

PHYSICIAN OFFICE LAB Specialty Testing Opportunities How to position your lab solutions with specialty practice types.......................6

POST-ACUTE CARE Staffing: Post-acute-care’s pain point Low wages, demographics add up to post-acute staffing shortages......... 26

OBRA: One thing the feds got right Study shows 1987 law has led to improved nursing home care.............. 30

MTMC expands its post-acute presence................... 34

Post-Acute Care

POCT in post-acute care: It’s needed And your competition is already calling on these accounts

24

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

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

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

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APRIL 2020 • VOLUME 28 • ISSUE 4

TRENDS Diabetes

Talking points that Repertoire readers can share with their physician customers....... 38

WINDSHIELD TIME Automotive-related news........46

HEALTHY REPS Health news and notes...............52

HIDA GOVERNMENT AFFAIRS UPDATE

IDN Opportunities

How Well Do You Know Your Customers? Part III

42

Quickbytes

51

New Communications Tool Helps Standardize Shortage Communications New shortages and backorders report is based on a successful model already widely used by healthcare providers and the military....... 54

INDUSTRY NEWS Coronavirus and the healthcare supply chain A snapshot of supply chain-related headlines of the global outbreak.............58

News ........................................................60

Technology news

REP Corner

Caught by Sales Tim Morris didn’t pursue medical sales. Medical sales pursued him. And he couldn’t be happier.

48

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Sales

The 3 Biggest Sales Mistakes You Should Never Make Unproductive strategies so common we think it’s normal

56

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PUBLISHER’S LETTER

Going Green Going green at Augusta National means winning one of the greatest golf tournaments

in the world. The winner of the tournament (as of press time postponed due to concerns over the coronavirus) wins the coveted green jacket.

Going green in this issue of Repertoire means sustainability, and responsibility for the environment and the people in it.

Back in December (while dodging the coronavirus) I made the long trip to Thailand to visit several glove factories and write a story for the magazine. What I didn’t know was that I would learn what sustainability looks like in the real world. While over there I was able to meet with the Chairman of Sri Trang, one of the largest rubber companies in the world. During my meeting with Dr. Viyavood Sincharoenkul, he steered the conversation toward the importance of sustainability.

I have to say he inspired me, as he talked about what sustainability meant to him. The statement that hit home was, “Scott, taking care of our people and the environment is not a human responsibility; it’s simply human.”

To really grasp this quote, you need to know what sustainability means to Dr. Viyavood.

Sustainability is the act of taking care of the environment of course, but it is also taking care of the workforce in the factory, and the population surrounding his factories. When Sri Trang goes into an area to build a factory, their number one goal is to make the entire province better than it was before they arrived. I don’t want to give the whole story away, but I did want to give you enough info here to entice you to read it.

On a completely different note, I wanted to say thank you to every one of you who are out calling on practices and making sure they have the infection control and testing products they need in the face of this nasty virus. By not panicking and continuing to show up and do your job you are saving lives.

Scott Adams

Have a great April!

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

publisher

Scott Adams

editor

Mark Thill mthill@sharemovingmedia.com managing editor

Graham Garrison ggarrison@sharemovingmedia.com

vice president of sales

Katie Educate

keducate@sharemovingmedia.com (800) 536.5312 x5271

editor-in-chief, Dail-eNews

Alan Cherry acherry@sharemovingmedia.com art director

Brent Cashman bcashman@sharemovingmedia.com

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sales executive

Amy Cochran

acochran@sharemovingmedia.com (800) 536.5312 x5279

www.repertoiremag.com

sadams@ sharemovingmedia.com (800) 536.5312 x5256

Subscriptions

www.repertoiremag.com/subscribe or (800) 536-5312 x5259

2020 editorial board

founder

Richard Bigham: IMCO

Brian Taylor

Eddie Dienes: McKesson Medical-Surgical

btaylor@ sharemovingmedia.com

Joan Eliasek: McKesson Medical-Surgical

circulation

Laura Gantert lgantert@ sharemovingmedia.com

Ty Ford: Henry Schein Doug Harper: NDC Homecare Mark Kline: NDC Bob Ortiz: Medline Keith Boivin: IMCO Home Care

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PHYSICIAN OFFICE LAB

Specialty Testing Opportunities How to position your lab solutions with specialty practice types With the wide range of potential customers for lab products and the increasing number of new, in-

By Jim Poggi

novative lab products we have available, the experienced distributor account manager needs to target wisely. This strategy includes understanding which customer prospects are most likely to consider adding or expanding a lab and which specialties benefit most clinically, financially or from a workflow viewpoint.

Most of us know the typical internal medicine, pediatric and cardiac practices well and understand the impact of a proper lab solution. Over time we have learned how to tailor lab solutions to oncology practices also. In pediatrics, respiratory testing for flu, strep and other common upper respiratory illnesses have become a large part of every well-established distributor account manager’s lab business.

But, some practice types present unique needs or have diagnostic and treatment practices very different from our mainstream physician customer. So, sometimes we avoid calling on them rather than taking the time to understand their needs and the unique nature of their practice of medicine.

As always, managing time and focus are challenges for the busy distributor account manager. In this column, I plan to look at three specialty practice types we sometimes overlook and provide some insight on their needs and how we can assist them in improving patient outcomes and their practice by offering the right lab products. Hopefully, this overview will provide you with 6

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enough information to work with your key manufacturing partners to effectively position lab solutions for these practice types.

Rheumatology There are about 8,300 practicing rheumatologists in the United States managing clinical arthritis and rheumatology conditions that affect over 54 million American adults. The CDC estimates that more than 27 million Americans suffer from osteoarthritis and more than 1.3 million have rheumatoid arthritis. Annual cost estimates of arthritis are over $300 billion, with $140 billion spent annually on diagnosis and treatment. These diseases are

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PHYSICIAN OFFICE LAB recognized as the sixth most common chronic conditions in the United States. In recent years, treatment improvements have provided better, more effective relief from the pain and mobility issues arising from these conditions.

Rheumatology practices are excellent prospects for hematology testing, and often require 5-part differentials to properly diagnose the complex range of autoimmune, arthritis and even Lyme disease patients they see. But, for many of us, once we get past the typical screening tests including RF, ANA, CRP, ESR and CBC we tend to get lost in the more specialized immunoassay tests, including thyroid antibodies, DS-DNA and others.

With approximately 50 million Americans believed to have allergies or asthma, the annual cost of diagnosis and treatment exceeds $18 billion per year.

This is where your reliance on your key supplier partner comes into play. Companies that specialize in autoimmune and rheumatology testing are experts in this area and can carry the conversation on your behalf to understand the customer’s needs and develop a solid lab solution.

Your role, as always, is to identify prospects and pre-qualify them for an in-depth discussion with your supplier expert.

Allergy and asthma Allergy and asthma have both chronic and acute onsets and are treated by internal medicine, hospital ER and urgent care clinicians as well as by about 6,000 allergists.

It is estimated that 30% of U.S. adults and 40% of United States children suffer from allergies including those related to food, pets and environmental causes. Food allergies alone account for over 200,000 ER visits annually. ER visits due to asthma add another 1.8 million ER visits each year. With approximately 50 million Americans believed to have allergies or asthma, the annual cost of diagnosis and treatment exceeds $18 billion per year.

While “skin tests” have been common practice among allergists for many years, the exceptional benefits of highly specific lab tests for allergy are making an impact. Quick screens for IgE by immunoassay are often the gateway to a remarkable number of specific lab allergen tests. One of the leading allergy testing manufacturers offers more than 50 allergy panels and specific tests. This broad test menu 8

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creates excellent clinical and patient value. Your key manufacturer partners can help you tailor a proper lab solution to aid in diagnosis and management of these conditions.

The typical allergy practice benefits both clinically and economically from offering these useful tests.

Infertility There are many known causes of infertility in males and females and include hormone imbalance, nutritional deficit, stress, underlying diseases, smoking and medications.

It is estimated that 10-15% of United States couples experience infertility, defined as the inability to conceive after 12 months of actively trying to conceive. There are about 500 infertility clinics and over 1,700 clinicians specializing in the practice of infertility. The annual cost of infertility diagnosis and treatment is estimated at $5.8 billion. This estimate is probably low since many couples pay for infertility treatments out of pocket, particularly for in vitro fertilization. Once mostly private pay, the landscape is changing due to state regulations.

Today, 15 states including New York, California and Illinois require some level of insurance coverage for infertility. Once low sperm count, tubal and uterine issues are ruled out, there is a range of immunoassay tests available to diagnose infertility and manage timing to optimize the ability to conceive. These tests include hormones such as testosterone, LH, FSH, prolactin, estradiol and estriol.

Anti-Mullerian hormone testing is a fairly recent new test that provides information to understand a woman’s ability to produce eggs. It is often described as “ovarian reserve” and often used with older women seeking to conceive.

Your key manufacturer partner is well equipped to guide the clinical and technical discussion for you with your prospects once you identify and prequalify them.

Putting it all together Each of these specialty practices has their own unique vocabulary and lab testing needs. Working alongside the right lab manufacturing partner is a key to holding a meaningful and productive discussion to create the right specialty testing solution. But, don’t forget these practices often treat a broader range of patient conditions and may well need other solution elements also. I often think of oncology. While we know they have a key need for tumor marker and hematology tests, we often forget the importance of chemistry tests in keeping track of the overall health of their patients. Use the same thinking with these specialty practices and make sure to create a comprehensive solution. You will be glad you did.

Going Green Going green at Augusta National means winning the coveted green jacket.

For medical sales reps, it means sustainability, and responsibility for the environment and the people in it.

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It’s true that cost, effectiveness and patient outcomes are top of mind among your customers. But all things be-

ing equal, many healthcare professionals are opting for the more ecologically friendly option, according to those with whom Repertoire spoke.

By practicing environmentally friendly habits, including environmentally preferable purchasing, physician practices can save money and build a sense of mission and teamwork among the staff, says gastroenterologist Todd Sack, editor of My Green Doctor, a healthcare practice management service and newsletter with more than 60,000 U.S. physician readers.

Launched in 2008 by the Florida Medical Association, My Green Doctor is used by 550 offices and is adding a few each week, says Sack. Twelve professional societies offer My Green Doctor to their members as a moneysaving benefit. The program adds just five minutes to each office management meeting, he says. Gradually, the staff makes ecologically friendly changes and encourages their patients to do the same. “Each staff meeting is scripted, so there is nothing for the office manager to study or prepare,” he adds.

“Environmental health has always been Todd Sack part of the agenda for health professionals.

What’s different here is that we have taken the next step, actually helping physician practices implement these practices.”

There are tremendous economic benefits for physician practices and the community, he says.

“Physicians can save a lot of money by adopting environmental sustainability, for example, using energy wisely, choosing efficient equipment or setting thermostats appropriately. And you can calculate further savings in water, telephone and other resources. Plus, there are benefits in terms of decreased air pollution, better water quality, etc.”

Practice perspective Physician practices are interested in products that can help them reduce their expenses, even if those products come with an upfront cost, says Andrew Hajde, assistant director, association content, Medical Group Management Association (MGMA). That includes replacing light bulbs with LED lighting and choosing energy-efficient equipment.

Ten reasons for physician practices to ‘go green’ 1. Leads to wiser and more responsible use of resources.

2. “Going Green” saves money by lowering office expenses.

3. Creates a healthier work environment.

4. Green Teams encourage teamwork and finding better ways to do things.

5. Green Teams generate ideas from every member of the office or clinic.

6. Improves job satisfaction.

7. Enhances the office’s public image and the trust of patients.

8. Decreases air pollution, water consumption and waste.

9. Builds a healthier community.

10. Helps to make environmental sustainability part of everyone’s life!

Source: My Green Doctor, www.mygreendoctor.org

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Going Green “Physicians and medical providers in general prefer using sustainable products, just as other folks do,” he says. “If they can choose products that are sustainable – for example, that were created from recycled content or can be recycled – and the cost is comparable, they’ll pick them.” Obviously, that’s not possible with many medical supplies, especially sterile ones, he adds. “Still, practices appreciate knowing that those products were produced in manufacturing facilities that use sustainable practices, and are made from sustainable sources, if possible.”

Cristy Good, MGMA’s senior industry advisor, adds that practices prefer suppliers who economize on packaging materials, as that leads to lower waste disposal costs.

Selling sustainability Distributor reps would be well-advised to identify the environmentally friendly features of their products and services, and to emphasize them to their physician practice customers, says Sack. “Offices might even be impressed to learn about My Green Doctor from their reps,” he adds.

“Sure, their products are primarily serving another function – patient care. But reps can look for that environmental angle – maybe it’s energy-savings or pounds of carbon dioxide averted – and highlight it as one more reason why the practice should buy their product.”

If the rep can make the case that manufacturers incorporate energy-savings and environmental stewardship into the development, assembly and ultimate disposal of their products, so much the better, he says.

Sustainability is a full-time job IDNs such as Virginia Mason Medical Center are serious about sustainability. John Leigh is proof.

In December 2019, eight major health systems in Washington state formed the Washington Health Care Climate

Alliance, whose mission is to advocate for “climate-smart” policies. The participating systems represent 40 hospitals and more than 1,000 healthcare facilities. Specific policy areas the coalition plans to take on include energy, transportation, food, waste, infrastructure and community resilience.

John Leigh is director of sustainability for one of the participating systems – Virginia Mason Medical Center in Seattle. Repertoire presented Leigh with some questions about healthcare providers’ concerns and goals regarding sustainability, and how distributors can address them.

Repertoire: Please talk about your role as director of sustainability at Virginia Mason. What are your days/weeks like?

John Leigh: In general, they’re full of variety. But one constant element is that I am frequently urging my colleagues within the organization to find ways, with my help, to reduce the environmental footprint of their department or operational area. Another is that I am regularly interacting with my counterparts at other organizations regarding best practices, learning what others are up to in the sustainability space, and sharing what we are doing.

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Repertoire: You have been involved in sustainability all the way back to 1990, when you went to work for the United States Environmental Protection Agency. Thirty years later, what makes you optimistic about where we are today as a society in general, and healthcare providers specifically?

Leigh: One thing that gives me hope in the face of the climate crisis is the rapidly growing awareness of its importance, especially among younger generations and among healthcare providers, which is spurring a desire for action. I’ve noticed that many more clinicians are recognizing that climate change is already occurring, and that it will have dramatic public health and wellbeing impacts. There is a quickly growing sentiment that we have an ethical obligation to act on this knowledge and reduce greenhouse gas emissions in a variety of ways.

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Going Green Trends that will help with this are the declining cost and improving efficiency of renewable energy technologies and electric vehicles.

Another trend that gives me hope are plant-based materials being used to make medical supplies in place of single-use plastics.

Repertoire: We have read that buyers might be more interested in “environmentally preferable purchasing” if they had access to life cycle analyses of medical products or equipment – that is, analyses that account for raw material consumption, cost of manufacturing and distribution, actual usage by the provider, and disposal. Are healthcare providers capable of performing such analyses?

Leigh: No. True life cycle analyses are too involved and complicated for health systems to perform ourselves. But there is environmental attribute information short of a life cycle analysis that can be useful in getting a feel for the environmental preferability of many products, such as durability, reusability or added chemicals of concern.

Repertoire: If the vendor were to perform such an analysis, how can the provider ensure that the analysis is accurate?

Leigh: By relying on the establishment of accepted standards and on independent, third party organizations to perform verification, certification or comparison services.

Some of those exist and more continue to emerge.

Repertoire: It seems that the difficulty of performing life cycle analyses is the fact that there are so many players involved in the manufacturing, distribution, usage and disposal of a medical device or supply. Just as providers struggle to create a “continuum of care” for their patients (encompassing preventive care, pre-admission, acute-care stay, post-acute care), are the various supply chain players collaborating on conducting reliable life cycle analyses regarding the sustainability of their products and equipment?

Leigh: The short answer is “No, I don’t believe such collaboration is taking place, unfortunately.” But I also believe what you’re describing is very similar to Extended Producer Responsibility, a concept that has been around since my time at the EPA in the 1990s. This has been far more widely accepted and regulated within the European Union, but only barely in some product areas in North 14

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America (like rechargeable batteries), and certainly not in the healthcare products industry, to my knowledge.

Extended Producer Responsibility laws shift the responsibility for the treatment or disposal of post-consumer products to producers. This gives them a strong incentive to design with environmental impact in mind, prevent wastes at the source, and integrate the cost of treatment, reuse, recycling or disposal into the purchase price. It’s an approach that we’d greatly benefit from adopting, from the sustainability perspective.

Repertoire: The readers of Repertoire tend to believe that other things – especially cost and outcomes – are far more important to their customers than sustainability. How should “sustainability” fit into their sales pitch?

Leigh: Even if cost and product effectiveness are top of mind for buyers, environmental impact is growing as another important concern, especially as climate change and the proliferation of chemicals become understood as public health threats. To the degree that vendors can demonstrate their products also minimize greenhouse gas emissions and/or chemicals of concern, the more they will stand out as forward-thinking and the better the sales pitch, even to those buyers who aren’t yet asking such questions.

Repertoire: Please talk about the Washington Health Care Climate Alliance. Can you elaborate about what your eight members can do better than each of you could do on your own?

Leigh: First, we are already talking about climate issues across our own health systems as well as with other Washington Health Care Climate Alliance members in ways that we had not done before. We are talking about climate mitigation and resilience legislation with our government affairs directors, and about energy conservation targets among our facilities directors. We’ve already succeeded in fostering much greater engagement and agreement on climate and energy topics within our industry in Washington. This has been valuable.

Second, by speaking with one collective voice, representing 40% of the hospitals in the state, we are a more powerful advocate for climate and health, using our trusted role in the community along with our influence as large employers who serve more than 8 million patients each year. The Alliance structure will help us be more effective on policy issues as well as technical issues, with the goal of protecting people from the worst health impacts of climate change.

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Going Green

Sustainability: A core value Together with innovation and efficiency, B. Braun views sustainability as an organizational priority Repertoire asked Rick Williamson, vice president of marketing, channel development, B. Braun, about the impor-

tance of sustainability for the organization.

Repertoire: Has sustainability become a point of emphasis? Is it more part of the conversation with customers? And if so, how?

Rick Williamson: Sustainability has become a major area of focus with our stakeholders. Customers are becoming more aware of the importance of sustainability and environmental health factors overall. They are requesting such information to drive purchasing decisions as they are looking to fulfill legislative requirements, decrease environmental impact within their communities, and meet patient demands for healthy and environmentally safe choices.

operations where there is an emphasis on reducing fuel consumption and packaging waste. These practices helped B. Braun attain ISO 14001:2015 (Environmental Management System) certification for all of our manufacturing and distribution sites in the U.S. in 2019.

Repertoire: What initiatives do you currently employ? Any future goals or vision for sustainability in the future?

Williamson: More than 40 years ago, B. Braun recognized the environmental and patient risks posed by products containing PVC and DEHP. We were the first medical device manufacturer to remove these harmful substances from many of our products, including IV solution containers and IV sets, and we remain the only supplier that offers a full line of IV solution containers that are PVC and DEHP-free. B. Braun is currently investing more than $1 billion in new and enhanced IV fluid manufacturing capacity in the U.S. which is completely devoted to producing PVC and DEHP-free products. These long-term investments in the sustainability of our health care system will protect both patients and the environment by eliminating the use of phthalates and other toxic chemicals. At the same time, we are working with a broad range of stakeholders, including health systems, consumer and patient organizations, and suppliers to increase awareness of the health and environmental risks posed by phthalates and other chemicals of concern, and to encourage the use of safer alternatives.

B. Braun is currently investing more than $1 billion in new and enhanced IV fluid manufacturing capacity in the U.S. which is completely devoted to producing PVC and DEHP-free products.

Repertoire: How is your company making sustainability a priority?

Williamson: Sustainability is one of B. Braun’s three core values, together with innovation and efficiency. At B. Braun, we don’t view sustainability as a trend or an initiative; rather, it is one of the principles that define who we are as a company. B. Braun’s environmental management system addresses the entire value chain. We continually work to minimize our environmental impact from the design and development of our products, to the use of sustainable manufacturing methods, to our distribution

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Safety first Creating safer healthcare environments for physician offices Repertoire asked Mark Steele, executive vice president

of Nuance Medical, how safety fits into customer conversations about the environment.

Repertoire: Is safety and the impact products and services have on the environment more part of the conversation with customers? And if so, how?

Mark Steele: Yes, reducing chemical exposure to healthcare workers, patients and the environment is an absolute point of emphasis to Nuance Medical and our customers. Our product, CryoDose TA provides a clinically and therapeutically equivalent alternative that is also lower in cost, resulting in an effective solution to eliminating a hazardous product.

Repertoire: How is your company making safety a priority?

Steele: Nuance Medical is making safety a priority by providing an alternative to hazardous Ethyl Chloride.

CryoDose TA is non-HAZMAT, non-flammable, nontoxic, topical anesthetic that requires no special storage or handling, and is disposed of with normal trash. We have partnered with MTMC to work with distributor representatives and their customers to know that a safer topical anesthetic alternative exists.

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SPONSORED:

SRI TRANG

Sustaining a Family Tradition Passion, excellence, responsibility and sustainability have driven glove producer Sri Trang since its inception. As the next generation takes leadership, its core values will continue to fuel the company.

Nineteen years ago, Repertoire traveled to Thailand and Malaysia for a feature story on the production of gloves

– one of the healthcare industry’s leading categories, and a key part of any healthcare distributor’s business.

At the time, Thailand was the world’s leading producer of natural latex rubber, which was used to produce exam and surgical gloves, among other things. Malaysia was close behind in production capacity, although it was in the process of converting much of its latex production to palm oil. As you would expect, many of the world’s leading glove manufacturers had factories in this part of the world in order to be close to the source of the raw materials.

At the time, natural latex rubber was the dominant material in the production of gloves, followed by vinyl. Of course the United States has moved to nitrile, but many of the production lines used to manufacture latex gloves then are being used to manufacture nitrile gloves today.

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One of the core issues almost two decades ago which prompted the trip was the wide variety of quality in the finished products coming to the United States.

One of the companies Repertoire visited on that trip was Sri Trang, the top producer of rubber in the world at that time, whose Chairman, Dr. Viyavood Sincharoenkul, Ph.D., was running the business he and his father started back in 1987.

Sri Trang was a fully integrated company at that time, producing products for many of the healthcare industry’s leading companies. It had 7,000 employees, annual revenues of $600M and a joint venture in place with an Austrian company (which was dissolved a couple of years ago). Today it is a stand-alone company, and

Rubber Production The process of capturing rubber and its effect on the environment can leave permanent scars if not done properly.

Natural rubber latex is a product that comes from rubber trees and is Thailand’s main crop. The life cycle of a rubber tree is about 35 years, and once the tree is mature it can be tapped for approximately 30 years. When it stops producing, it is taken down and then turned into wood chips that are used to power the factories that produce latex, and nitrile gloves. Since its inception, Sri Trang has planted and farmed over 2.5 million rubber trees.

remains one of the world’s largest producers of natural latex rubber and produces over 25 billion gloves per year, making it one of the top glove manufacturers in the world.

Sustainability as a core value While a lot has changed in 19 years, with his father moving into retirement, Dr. Viyavood remains as the Chairman, and has three sons that have joined him in the business: ʯ Veerasith Sincharoenkul, Director ʯ Vitchaphol Sincharoenkul, Director ʯ Vitanath Sincharoenkul, Marketing and Brand Management What is evident is that the behaviors that drove the business on Repertoire’s last visit are still in place today.

Dr. Viyavood’s passion for sustainability that he displayed years ago remains a guiding principle. “Taking care of our people and the environment is not a human responsibility; it’s simply human,” says Dr. Viyavood. With nearly 420 employees farming over 18,000 acres, with well over 2.5 million rubber trees planted and farmed, Sri Trang is dedicated to protecting the farmers, factory workers and local population, as well as the environment.

“Sri Trang participates in numerous community and society development initiatives through various activities and projects,” says Vitanath. “Of course, we focus on producing high quality products, but do it using environmentally friendly technology, green energy such as biomass, natural

resources and energy conservation. And our employees participate in various ways from community projects to finding unique ways to reduce waste internally.”

His brother Veerasith is in agreement, stating, “Yes, we are very focused on the environment, but we are just as passionate about our people and local culture.

For example, when we build a new factory, we strive to

Sri Trang Group has received multiple FSCTM (Forest Stewardship Council ™) certifications for international standards including: FSC-FM (Forest Management Certification), FSC-COC (Chain-of-Custody certification), and product chain management. Sri Trang Group became the first fully integrated rubber company in the world to receive the FSC certification in the entire latex product chain, which includes the upstream rubber plantation business through to the downstream medical rubber glove business. Sri Trang Group is proud to act as a leader in pushing the Thai rubber industry and the Thai rubber glove industry to become the premier sustainable rubber industries.

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SPONSORED:

SRI TRANG

Leadership Dr. Viyavood has had an interesting career.

After obtaining his doctorate in chemistry at the University of London, he returned to his native Thailand, planning to visit just five months before beginning work as a college professor in the United States. Those plans never materialized, however, as he began working for a local rubber company in the city of Hatyai in Southern Thailand.

Although he was bright, well-educated and had a lot to contribute, Dr. Viyavood realized he would not control his own destiny or achieve success at the business that employed him. When his father was forced to leave that same company at the mandatory retirement age of 60, they decided to start their own company. They began with a small, rented rubber factory in Hatyai. That was in 1987. Today, 23 years later, they are the No. 1 producer of rubber in Thailand, with top notch sourcing, trading and manufacturing capabilities. They are also one of the world’s largest glove producers.

Dr. Viyavood Sincharoenkul

Sri Trang leadership ʯ Dr. Viyavood Sincharoenkul, Chairman ʯ Kitichai Sincharoenkul, Director ʯ Somwang Sincharoenkul, Honorary Advisor ʯ Veerasith Sincharoenkul, Director ʯ Vitchaphol Sincharoenkul, Director ʯ Vitanath Sincharoenkul, Director & CBO ʯ Jarinya Jirojkul, CEO ʯ Thanawan Sa-Ngiamsak, CFO ʯ Chia Chee Ping, CMO

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make sure the surrounding area is better than before we arrived.” That can be accomplished through the proper building of infrastructure, including schools, hospitals, recreational areas and more, he says. “We understand people don’t always welcome change, but when they look at the affect our company has had on the quality of life in the communities in which we invest, they tend to support our development efforts. Our desire is to allow them to live better, fuller lives.”

Planning for the future With infection prevention efforts on the rise, and as best practices spread across the globe to prevent diseases like the coronavirus from spreading, the market for gloves is growing. In the developed world, demand for gloves is increasing. And as third world countries become more developed, the demand for gloves will continue rising as well. Today the global glove market is an estimated 330 billion pieces.

Sri Trang currently has seven glove manufacturing facilities on three campuses across Thailand, manufacturing 25 billion pieces of latex and nitrile gloves on an annual basis. As new facilities are brought on board, technology has enabled Sri Trang to greatly increase its production capacity, and that is expected to continue.

Sri Trang is fully integrated, and therefore controls the raw latex coming into its factories. This allows Sri Trang to coordinate the collection of the latex, control the quality of the latex used, and get it stabilized and purified quickly in order to support the glove production process. The components of the nitrile products they produce are managed the same way. Their goal is to control every step in the process, allowing the company to eliminate waste and control its destiny.

“We have been applying AI and machine learning to increase our capacity and speed up automation,” says Vitchaphol. “We are an engineering company driven by production metrics. One of those is to get a single production line producing over 1,000 pieces per minute. Of course it’s a stretch goal, but we believe in time, with patience and the proper application of technology, we will get there.”

In a connected world, with customers relying on Sri Trang for a critical component to outsmart infection, Dr. Viyavood and his family intend to deliver to all of their constituents; customers, workers and the local communities they inhabit, all while being good stewards of the environment.

Keep germs out of reach.

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Ventyv® is the premier brand of Sri Trang USA, Inc., a member of the Sri Trang Group – a proven glove producer protecting the world against infection since 1991. We look forward to protecting your customers and their patients.

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POST-ACUTE CARE

POCT in post-acute care: It’s needed And your competition is already calling on these accounts

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There’s opportunity in selling point-of-care testing to post-acute facilities. But as with any sale, it calls for initiative,

persistence, and an understanding of the customer’s pain points.

Spending among skilled nursing facilities and home overlook point-of-care testing. Flu testing offers an health agencies is expected to grow from 5.4% and 7% excellent example. over the next eight years, according to the Centers for “As we know, the flu is very hard on the elderly popuMedicare & Medicaid Services Office of the Actuary, lation and can have drastic effects on the health not only points out Raquel Beckett, senior marketing manager, of the patient, but the nursing home,” he says. “Patients Point of Care and Non-Acute Channel, BD. should be tested and if positive, possibly quarantined These groups have a reputation for being price/costfrom the other patients in the home to prevent the spread focused, which in the past may have turned off traditional to already immune-compromised people. distributors from servicing them, she says. But that’s not “Most flu testing is CLIA-waived, which means these the case anymore. facilities could do the testing with a simple CLIA license, “As the overall provider system focuses on quality of and they can be run by almost any staff member with care, these providers are turning to solutions that help them minimal training,” he adds. “The cost of running these comply with regulations and avoid penalties – not just the tests is much lower than the cost of having to quarantine cheapest alternative. [They are] much more sophisticated the nursing home facility due to undiagnosed flu.” Flu in their evaluation of services and products, and they are testing can be done for less than $15 per patient, he says. looking at the impact of their services and solutions across their systems.”

Beckett recommends that reps ‘ Treating accurately and quickly address the post-acute market by keeps other costs down and improves first understanding the pain points of providers and then recommendthe general wellbeing of the nursing ing overarching solutions to help home patients.’ them systematically address them.

“For example, effectively containing seasonal infections, such as But flu isn’t the only condition influenza, may be an area of intercalling for point-of-care testing. Sexest,” she says. “But rather than proual health, iFOBT and other infecvide one specific product solution, tious diseases are others, he says. distribution reps must be prepared “Testing should be done because to discuss overall staff practices and of the higher cost of infection or the patient handling in periods of high spread of infection,” says Overbey. infection potential.”

“Treating accurately and quickly keeps As in the physician office, pointother costs down [and improves] the of-care testing in the post-acute-care general wellbeing of the nursing home environment enables staff to make patients. The cost of a hospital stay is much more than the rapid triage and treatment decisions when diagnosing a cost of any testing. Besides, most people would pay for patient’s condition or monitoring a treatment response, these testing services outside of their monthly fees.” she says. “By simplifying the testing process, healthcare Distributor reps already call on post-acute accounts, providers can focus on what matters most – providing selling gloves, gowns, table paper and other products and effective, quality patient care.” services, says Overbey. They need to include point-of-care POCT as a means of keeping costs down testing to the list.

Jonathan Overbey, corporate alliances and channel man“All medical treatments and testing are moving closer to agement, Sekisui Diagnostics, believes that neither postthe patient,” he says. “[Point-of-care testing] is needed, and acute providers nor distributor reps can afford to your competition is already calling on these accounts.” www.repertoiremag.com

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POST-ACUTE CARE

Staffing: Post-acute-care’s pain point Low wages, demographics add up to post-acute staffing shortages A recently released report points to a crisis in the direct care workforce, that is, nursing assistants, home care

workers and residential care aides.

Long-term-care employers are struggling to recruit and retain enough workers to fill vacant positions, while existing workers are shouldering the burden of growing demand without enough resources or support, according to the report, “It’s Time to Care: A Detailed Profile of America’s Direct Care Workforce,” by Bronx, New Yorkbased advocacy firm PHI. Meanwhile, consumers are struggling to access the care they need, piecing together support from family and friends; waiting months or even years to receive formal 26

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services; moving into nursing homes sooner than necessary; or simply going without.

Some facts from the report: ʯ Nearly 20 million adults in the United States require assistance completing self-care and other daily tasks due to physical, cognitive, developmental, and/or behavioral conditions. This number includes about 17 million individuals living in the community, 1.5 million residing in nursing homes,

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POST-ACUTE CARE Nearly 20 million adults in the United States require assistance completing self-care and other daily tasks due to physical, cognitive, developmental, and/or behavioral conditions. This number includes about 17 million individuals living in the community, 1.5 million residing in nursing homes, and nearly 1 million in residential care. and nearly 1 million in residential care. ʯ Individuals with personal assistance needs rely first and foremost on family members, friends, and neighbors – an estimated 43 million caregivers. But for those with limited local caregiving networks, or with more complex needs, paid direct care workers are a lifeline. ʯ The direct care workforce is expanding rapidly as our population grows older, as people live longer with disabilities and chronic conditions, and as the supply of potential family caregivers dwindles. The workforce has already nearly doubled within a decade, from 2.9 million workers in 2008 to almost 4.5 million in 2018. In fact, the longterm care sector is expected to add 1.3 million direct care jobs, primarily personal care aide positions, from 2018 to 2028. That’s more new jobs than any other occupation in the U.S. economy.

Yet retaining qualified people in all those positions is challenging, according to the researchers. Part of the reason is, direct care workers don’t get paid much.

The median wage for all direct care workers is $12.27 per hour, according to the Bureau of Labor Statistics. Due to high rates of part-time employment as well as low wages, median annual earnings are just $20,200.

Among direct care workers, home care workers earn the least, at $11.52 per hour and $16,200 per year; residential care aides earn $12.07 per hour and $20,200 annually; and nursing assistants in nursing homes earn $13.38 per hour and $22,200 annually.

Little relief in sight The report suggests that the need for direct care workers will only increase in the next few decades: ʯ From 2016 to 2060, the number of adults in the United States aged 65 and over will nearly double, from 49.2 million to 94.7 million, and the number of those aged 85 and over will triple, from 6.4 million to 19 million. During the same period, the number of adults aged 18 to 64 is projected to increase by only 15%. ʯ Population aging is significant because the need for personal assistance and formal long-term service support increase with age. More than 21% of adults in the community who are aged 85 years and above require assistance with activities of daily living, compared to 8% of those 75 to 84, just under 4% of those 65 to 74, and just 3% of those 18 to 64. ʯ The caregiver support ratio (that is, the ratio of those aged 18 to 64 years old, who are most likely to provide care, to those aged 85 and above, who are most likely to need care) is projected to fall from 31 to 1 in 2016 to only 12 to 1 by 2060.

The researchers point out there are numerous ways to improve job quality and thereby build the direct care workforce, but the bottom line is, workers must be better compensated, in line with the value of their contribution.

If they are not, the long-term service and support sector will continue to struggle to recruit and retain a strong workforce, especially given the fierce competition for entry-level workers across the labor market.

Editor’s note: “It’s Time to Care: A Detailed Profile of America’s Direct Care Workforce” is the first in a year-long series that will provide a current-day analysis of the direct care workforce and its role in the long-term-care system of the United States. It was made possible through support from the W. K. Kellogg Foundation and the Woodcock Foundation. To view the first report, go to https://phinational.org/ caringforthefuture/ 28

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POST-ACUTE CARE

OBRA: One thing the feds got right Study shows 1987 law has led to improved nursing home care In 1987, the Omnibus Reconciliation Act (OBRA) called for a dramatic overhaul of the nursing home quality assur-

ance system, following published reports about resident abuse, neglect and a lack of regulation and oversight.

In retrospect, it looks like the feds made the right call.

An analysis published in the February 2020 Journal of Post-Acute and Long-Term-Care Medicine indicates that between 1985 and 2015, the quality of nursing home care improved, even as physical and cognitive function among residents decreased. Findings from the study, by researchers at Brown University and the U.S. Department of Veterans Affairs Medical Center in Providence, Rhode Island, include the following: 30

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Facility characteristics

ʯ The nursing home industry decreased in size, from 19,068 facilities in 1985 to 15,686 in 2016. ʯ There has also been an increase in the percentage of facilities that are nonprofit (25% in 1985 and 31% in 2015) and that are dually certified by both Medicare and Medicaid (33% in 1985 and up to 97% in 2015). ʯ Between 1995 and 2015, chain membership increased from 51% to 57%, the percentage of

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POST-ACUTE CARE facilities with an Alzheimer’s special care unit increased from 11% to 15%, and overall nursing home occupancy rates declined from 87% to 81%.

Resident composition

ʯ Data suggest that although the average age of residents remained constant, the percentage of those who were racial and ethnic minorities increased from 7.8% in 1985 to 20.7% in 2015. ʯ The average percentage of females decreased from 72% of residents in 1985 to 67% in 2015. ʯ The prevalence of long-stay residents within nursing homes remained stable at 69% of all residents between 1985 and 2015. ʯ The percentage of residents admitted from the hospital increased from 67% in 2000 to 85% in 2015.

“ Older adults without financial resources – disproportionality, minority older adults – are becoming an increasing proportion of nursing home residents, as they may not be able to as readily access these care alternatives. “ ʯ There has also been a shift of payer types over time. Between 1992 and 2015, the average percentage of residents with Medicaid as a primary payer decreased from 64% to 58%, whereas the average percentage of residents with Medicare as the primary payer rose from 9% to 15%. ʯ Resident physical and cognitive function decreased over the years. The average ADL (activities of daily living) dependency score among nursing home residents increased slightly, from 15 to 17, between 2000 and 2015. ʯ Residents who required assistance in bathing increased from a national average of 89% in 1985 to an average facility average of 96% in 2015. ʯ Assistance with dressing rose from 74% to 92%, assistance with transferring from 60% to 85%, assistance with toileting from 49% to 88%, and assisting with eating from 38% to 56%.

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ʯ There was a decrease in the percentage of residents who were bed-bound, from 6% in 1985 to 4% in 2015, but an increase in the percentage of those who were chair-bound, from 39% to 64%. ʯ The percentage of residents with dementia increased from an average of 39% in 1995 to an average of 45% across the facilities in 2015.

Quality of care Overall, quality process and outcome measures have improved since the passage of OBRA 1987, according to the researchers: ʯ Average direct care staffing hours have increased over time, with the greatest increases observed among certified nursing assistants. ʯ The average proportion of residents being physically restrained decreased dramatically from 19% to 1%, and the percentage of residents receiving antipsychotic medications inappropriately, as a chemical restraint, decreased from 16% in 2000 to 12% in 2015 (although there was a peak of 22% in 2005). ʯ There was not much change in the proportion of facilities cited for medication errors over this time period. ʯ The proportion of residents with pressure ulcers decreased from 8% to 6%. ʯ Congruent with an increased need for assistance, bowel and bladder incontinence increased from 42% to 44%, and 49% to 62%, respectively.

In addition to helping bring about quality-of-care improvements, OBRA 1987 was also successful in implementing and enforcing the MDS (Minimum Data Set) resident assessment survey, which is required for all residents in Medicare or Medicaid certified nursing homes, the researchers report.

“Because of the aging-in-place movement, we are seeing lower occupancy rates in nursing homes,” they write. “Older adults without financial resources – disproportionality, minority older adults – are becoming an increasing proportion of nursing home residents, as they may not be able to as readily access these care alternatives.

“Current and future policies should focus on expanding equitable access to the remaining long-term care services and supports in the continuum of care, particularly given the policies and initiatives focused on decreasing nursing home utilization through support of home and community-based alternatives.”

POST-ACUTE CARE

MTMC expands its post-acute presence

MTMC’s November 2019 acquisition of Invacare Interior Design and a follow-up post-acute national sales meeting

point to the national rep group’s desire to expand its presence in the post-acute market.

“This segment of healthcare is enjoying nice growth due to demographics, life expectancy and payers,” said managing partners Jack Moran and Dennis Snedden. “We are always looking to support our distributors and vendor partners in healthcare segments that are growing.”

The move makes sense for many reasons, according to Moran.

“For several years, many of our vendor partners have had products that could be sold into the post-acute market but have primarily been sold into the acute and ambulatory segments,” he says. In fact, 90% of the suppliers at MTMC’s recent post-acute national sales meeting were already represented by the firm in the ambulatory or acute markets.

While MTMC’s acute-care sales team has supported and inserviced products for the post-acute market, volumes have been relatively low, and the MTMC sales team has primarily been supportive of the customer needs, Moran continues. That is expected to change.

“We plan on growing our post-acute sales team, supplier portfolio and distributor partners in 2020,” he 34

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says. “We have the capacity to add more vendor partners and plan on investing in more dedicated post-acute sales resources.

“Our goal is to keep our sales force focused on their current customer base and our vendor partners in these segments of healthcare,” he adds. “In the interim a few of our reps may have some post-acute responsibilities. However, the long-term goal is to have a totally separate post-acute sales team.”

Interior Design The acquisition of Invacare Interior Design – since renamed MTMC Interior Design – deepens MTMC’s position in post-acute care and brings expertise in interior design to its acute and ambulatory care partners and customers, according to Moran and Snedden.

“Under the Invacare ownership, the focus was strictly on post-acute,” they said. “Under MTMC, we are expanding into the ambulatory care, IDN and acute-care spaces.” MTMC’s 28 post-acute reps are

supporting Interior Design’s efforts, and the firm’s inside sales team is generating project leads for the sales team and distributor partners.

“Currently the growth on the post-acute side is in independent living and assisted living with memory care,” says Director of Interior Design Jacki Zumsteg. And the demand should only increase for the next five years. “From a marketing perspective, offering different levels of care on one campus can be appealing. As the resident’s level of care changes, they are able to transition easier.”

From a design standpoint, today’s post-acute care providers are seeking a hospitality vibe to their facilities, with furnishings appropriate for the level of care, rather than an institutional one, she says.

“Marketability is critical for post-acute providers. We often say you have five seconds to make that first impression.”

Moreover, it is important for residents to feel at home and that they live in a facility they will benefit from, she adds. “You will often see media rooms, beauty salons, coffee bars, fitness areas – anything to promote active, engaging lifestyles.

“When it comes to long-term care, we definitely want to look at how the right selection of equipment and furnishings can have an impact on the outcome of the residents.

“We are excited about the additional products MTMC Interior Design now has from the large MTMC supplier offering,” says Zumsteg. “We will continue to stay focused on providing a turnkey solution for the post-acute market.”

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TRENDS

Diabetes Talking points that Repertoire readers can share with their physician customers.

Editor’s note: Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue.

Cardiovascular disease and diabetes Cardiovascular disease is the leading cause of morbidity and mortality for people with diabetes. The 2020 Standards of Medical Care in Diabetes, published in December 2019 by the American Diabetes Association, offers recommendations for screening, testing and treating people with diabetes to reduce the occurrence of cardiovascular disease. The recommendations have been individualized based on patients’ risk, including the presence of atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk factors, diabetic kidney disease or heart failure.

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The Standards say that in asymptomatic patients, routine screening for coronary artery disease is not recommended, as it does not improve outcomes as long as ASCVD risk factors are treated. However, providers should consider investigating for coronary artery disease in the presence of atypical cardiac symptoms (e.g., unexplained dyspnea, chest discomfort); signs or symptoms of associated vascular disease, including transient ischemic attack or stroke; or electrocardiogram abnormalities (e.g., Q waves).

The Standards of Care is available online at https://care.diabetesjournals.org, and is published as a supplement to the January 2020 issue of “Diabetes Care.”

focusing on special considerations for older adults with type 1 diabetes in the 2020 Standards of Medical Care in Diabetes. Some points for doctors and their patients to keep in mind: ʯ In order to avoid diabetic ketoacidosis, older adults with type 1 diabetes need some form of basal insulin even when they are unable to ingest meals. Insulin may be delivered through insulin pump or injections. ʯ Continuous glucose monitoring (CGM) is approved for use by Medicare and can play a critical role in improving A1C, reducing glycemic variability, and reducing risk of hypoglycemia. ʯ Administration of insulin may become more difficult as complications, cognitive impairment, and functional impairment arise in older people with type 1 diabetes. This increases the importance of caregivers in the lives of these patients.

Diabetes and heart failure Diabetes is an independent risk factor and is associated with the development of heart failure over time, conclude researchers at Mayo Clinic, who reported their findings in January 2020 “Mayo Clinic Proceedings.”

Approximately 21% (22 of 116) of patients with diabetes mellitus developed heart failure over a 10-year period, which is significantly elevated when compared with patients without diabetes (12% [24 of 232]). In the study, researchers say they have also shown that participants with diabetes – even in the absence of diastolic dysfunction (that is, abnormal pumping of the heart) – are more likely than those without diabetes to develop heart failure. Future research should be focused on whether aggressive management of risk factors such as BMI and glucose and cholesterol levels will decrease the development of heart failure in patients with diabetes.

The elderly and type 1 diabetes People with type 1 diabetes are living longer. Hence the American Diabetes Association has added a subsection

To assess recent trends in incidence of diabetes in youths (defined as persons under age 20), researchers analyzed 2002–2015 data from the SEARCH for Diabetes in Youth Study, a U.S. populationbased registry study with surveillance of 69.5 million youths in five states. ʯ Many older patients with type 1 diabetes require placement in long-term care settings. Unfortunately, these patients may encounter providers who are unfamiliar with insulin pumps or CGM. Some providers may be unaware of the distinction between type 1 and type 2 diabetes. In these instances, the patient or the patient’s family may be more familiar with diabetes management than the providers. ʯ Education of relevant support staff and providers in rehabilitation and LTC settings regarding insulin dosing and use of pumps and CGM is recommended as part of general diabetes education. www.repertoiremag.com

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TRENDS The Standards of Care is available online at https://care.diabetesjournals.org, and is published as a supplement to the January 2020 issue of Diabetes Care.

Young people and types 1 and 2 diabetes The incidence of type 1 and type 2 diabetes among young people in the United States is on the rise, and has been since at least 2002, especially among racial and ethnic minority populations, according to the Centers for Disease Control and Prevention.

Diabetes complications often share the same risk factors, and one complication can make other complications worse, says the Centers for Disease Control and Prevention.

From 2002 to 2012, type 1 and type 2 diabetes incidence increased 1.4% and 7.1%, respectively, among U.S. youths. To assess recent trends in incidence of diabetes in youths (defined as persons under age 20), researchers analyzed 2002–2015 data from the SEARCH for Diabetes in Youth Study, a U.S. population-based registry study with surveillance of 69.5 million youths in five states. Among all youths, the incidence of type 1 diabetes increased from 19.5 per 100,000 in 2002–2003 to 22.3 in 2014–2015.

Among persons aged 10–19 years, type 2 diabetes incidence increased from 9.0 per 100,000 in 2002–2003 to 13.8 in 2014–2015. For both type 1 and type 2 diabetes, the rates of increase were generally higher among racial/ ethnic minority populations than among whites.

Diabetes is a chronic disease that requires lifelong treatment and management, point out CDC researchers. Better understanding of the number of new cases of diabetes among youths helps in planning for healthcare needs and resources.

Statins and diabetes Several studies have reported a modestly increased risk of incident diabetes with statin use, which may be limited to those with diabetes risk factors, according to the 2020 Standards of Medical Care in Diabetes, published in December 2019 by the American Diabetes Association. However, an analysis of one of the initial studies suggested that although 40

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statin use was associated with diabetes risk, the reduction in cardiovascular events far outweighed the risk of incident diabetes even for patients at highest risk for diabetes. The absolute risk increase was small: Over five years of followup, 1.2% of participants on placebo developed diabetes, and 1.5% on rosuvastatin developed diabetes. A meta-analysis of 13 randomized statin trials with 91,140 participants showed that (on average) treatment of 255 patients with statins for four years resulted in one additional case of diabetes while simultaneously preventing 5.4 vascular events among those 255 patients.

Here’s the bottom line for patients, researchers concluded in a study published in October 2019 in the “British Journal of Clinical Pharmacology”: Clinicians should be aware of the association between statins and skin and soft-tissue infections (which are associated with diabetes), and, where appropriate, monitor blood glucose levels of statin users.

The financial cost of diabetes The Centers for Medicare & Medicaid Services estimates that Medicare spent $42 billion more in the single year of 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes. Per beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes. (Estimates based on fee-for-service, nondual eligible, over-age-65 beneficiaries.)

Diabetes complications can snowball Diabetes complications often share the same risk factors, and one complication can make other complications worse, says the Centers for Disease Control and Prevention.

Some examples: ʯ Heart disease and stroke: People with diabetes are two times more likely than people without diabetes to have heart disease or a stroke. ʯ Blindness and other eye problems: Diabetes can lead to blood vessels in the retina, cataracts, glaucoma. ʯ Kidney disease: High blood sugar levels can damage the kidneys and cause chronic kidney disease. ʯ Nerve damage (neuropathy): Nerve damage most often affects the feet and legs but can also affect digestion, blood vessels, and heart.

ʯ Amputation: Diabetes-related damage to blood vessels and nerves, especially in the feet, can lead to serious, hard-to-treat infections. Amputation can be necessary to stop the spread of infection. ʯ Gum disease: Gum disease can lead to tooth loss and increased blood sugar, making diabetes harder to manage. It can also increase the risk of type 2 diabetes. ʯ Depression: Diabetes increases the risk of depression, and that risk grows as more diabetesrelated health problems develop. ʯ Gestational diabetes: Diagnosed during pregnancy, gestational diabetes can lead to preeclampsia (high blood pressure caused by pregnancy), injury from giving birth, and birth defects.

Complications usually develop over a long time without any symptoms. That’s why it’s so important for patients to make and keep doctor and dentist appointments, even if they feel fine.

Life insurance for people with diabetes Half of Americans with diabetes lack an adequate amount of life insurance, or don’t have any life insurance at all, reports insurance company John Hancock. Many worry they won’t qualify for life insurance because they have diabetes, or that a life insurance policy would be unaffordable. John Hancock – in collaboration with Verily, an Alphabet company, and Onduo, a virtual “clinic” for people with type 2 diabetes – now offers a life insurance policy specifically for Americans with diabetes. Clients of John Hancock Aspire™ will receive a blood glucose monitoring device which, when used in conjunction with the Onduo app, provide insights into the user’s diabetes management. Onduo’s “virtual care team,” made up of dieticians, diabetes educators and doctors, offers personalized guidance and support regarding diet, activity, lifestyle habits and medication management. Those using Onduo to manage and improve their health can earn points to further boost their overall Vitality rewards and lower their premiums.

Bionic pancreas gets FDA “Breakthrough Device” designation Beta Bionics Inc. (Boston, Massachusetts) received Breakthrough Device designation in December 2019 from the U.S. Food and Drug Administration for its automated bionic pancreas. The iLet Bionic Pancreas System is a pocket-sized, wearable device designed to

autonomously control blood-sugar levels. The on-body wear is similar to that of an insulin pump. Unlike insulin pump therapy, however, the iLet system allows users to enter only their body weight for the iLet to initialize therapy. Immediately thereafter, the iLet begins controlling blood-sugar levels automatically, without requiring the user to count carbohydrates, set insulin delivery rates, or deliver bolus insulin for meals or corrections.

Many worry they won’t qualify for life insurance because they have diabetes, or that a life insurance policy would be unaffordable. John Hancock – in collaboration with Verily, an Alphabet company, and Onduo, a virtual “clinic” for people with type 2 diabetes – now offers a life insurance policy specifically for Americans with diabetes.

Smart insulin patch UCLA bioengineers and colleagues at UNC School of Medicine and MIT have further developed a smart insulin-delivery patch that could one day monitor and manage glucose levels in people with diabetes and deliver the necessary insulin dosage. The adhesive patch, about the size of a quarter, is said to be simple to manufacture and intended for once-a-day use. The adhesive patch monitors blood sugar, or glucose. It has doses of insulin pre-loaded in tiny microneedles, less than one-millimeter in length, which deliver medicine quickly when the blood sugar levels reach a certain threshold. When blood sugar returns to normal, the patch’s insulin delivery also slows down. The researchers said the advantage is that it can help prevent overdosing of insulin, which can lead to hypoglycemia, seizures, coma or even death. A study, published in Nature Biomedical Engineering, describes research conducted on mice and pigs. www.repertoiremag.com

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IDN OPPORTUNITIES

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

John Thompson Position: Senior Vice President, Sourcing Operations, Vizient Inc., Irving, Texas

next-generation ideas grounded in historical knowledge. That approach and their coaching have helped me look for opportunities to more effectively engage internal and external stakeholders as the company and the industry have evolved. … I have also become a better listener, which has helped me understand how our stakeholders define value and has reshaped how I partner with them to achieve their goals.”

In the past two years: “I have been working with certain segments of the Vizient sourcing and consulting teams, such as purchased services and food, [to offer] contracts on the business side of care that can lower costs, and subject matter experts with data, insights and expertise to help with implementation, so that savings are realized and sustained.”

On the docket: “One of our bigger projects is building out our human resources and workforce solutions verticals. Vizient has a comprehensive offering of solutions, such as insurance products and employee benefits, contract labor and labor consulting/utilization.”

Thoughts about the supply chain management profession “I have been fortunate to have had some extraordinary leaders and mentors who have helped me understand that success in the healthcare supply chain requires a consistent focus on 42

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I have been fortunate to have had some extraordinary leaders and mentors who have helped me understand that success in the healthcare supply chain requires a consistent focus on next-generation ideas grounded in historical knowledge.

Future challenge for the profession: “It is critical that supply chain professionals coming into this industry understand how and why decisions are made in their organization, what data is required, who needs to be included in the process, and how to effectively communicate across the organization when decisions affecting supplies and products are made. I encourage supply chain professionals at every level to take advantage of the educational opportunities offered by various organizations to increase understanding of not just the latest technology, but also the strategies that are required to successfully lead change.”

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IDN OPPORTUNITIES Michael Gray Position: System Vice President and Chief Supply Chain Officer, SSM Health, St. Louis, Missouri In the past two years: Consolidated the master data management teams and non-pharma buyers under one management structure. “It has allowed us to be consistent and to provide comprehensive quality data into the Enterprise Resource Planning and Electronic Health Records systems.” Transformed a multiplepurchasing-organization structure within SAP into one systemwide structure, eliminating 124,000 duplicate items. (SSM Health had been operating as three different geographies when SAP was first deployed.)

On the docket: Continuing to work systemwide with physician leaders and others to reduce unnecessary variation in vendors, products, etc. “We should be able to measure which products are used where, and which products lead to favorable outcomes for the majority of patients. It’s exciting getting all these groups together. Rather than

calling them ‘value analysis groups,’ I call them ‘solution groups.’”

Thoughts about the supply chain management profession: “The old saying, ‘I know what I’m doing, so let me do it,’ isn’t effective. I’ve never seen an effort where end users, physicians and executive leaders were engaged, and we did not come up with a better result. The input, guidance and insights provided by end users, people in the field and suppliers always make the process better.”

I’ve never seen an effort where end users, physicians and executive leaders were engaged, and we did not come up with a better result.

Future challenge for the profession: “[The next generation of supply chain executives] will have to be operationally sound in order to understand the flow of information, products and cash. Managing ‘technology creep’ is probably the biggest challenge going forward. A number of my peers have told me, ‘We have gone through savings initiatives, but those savings instantly disappear when new, more expensive technologies are introduced and integrated into our systems as the ‘next shiny object.’”

Sparkle Barnes Position: Chief Strategy Officer, Health Center Partners of Southern California, San Diego In the past two years: Assisted Health Center Partners in the establishment of a clinically integrated network – Integrated Health Partners of Southern California – in June 2015, which is designed to help its community health center members be successful in a value-based model by managing population health, improving efficiencies and performances in managed care 44

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and care transitions, integrating data and improving clinical performance, and providing high-quality care to lower income and uninsured patients.

On the docket: Completing a threeyear strategic plan by June 30, 2020, which will position the organization to serve an estimated doubling of its membership to more than 10,000 organizations.

Thoughts about the supply chain management profession: “Taking

on an enterprise-wide role as chief strategy officer for the Family of Companies was transformational in how I lead CNECT. In the CSO role, I am on the front lines of policy, operational, and clinical decision support discussions in transitioning a care model from fee-for-service to value-based reimbursement, enabling me to bring a perspective and experience from the front-line into CNECT to better position our members.”

The future generation of supply chain professionals will need to be both experts in their fields and partners with their management teams.

Future challenge for the profession: “The transition to value-based care is not slowing down. If anything, it is accelerating. The future generation of supply chain professionals will need to be both experts in their fields and partners with their management teams as those organizations are more and more challenged to improve care quality and [achieve] cost reductions through value-based reimbursement models.”

Todd Larkin Position: Chief Operating Officer, Intalere, St. Louis, Missouri

the best way my team can support their strategic initiatives. I think the key is to view every day as an opportunity to reflect and learn something new. It’s also important to constantly focus on what value you can provide and how that’s aligned with the larger goals of the organization.”

In the past two years: “I joined Intalere in the second half of 2017, when the contracting organization was undergoing a transformation, primarily focused on adopting Intermountain’s best practices. One of the most rewarding aspects of that initiative was implementing changes to people, processes, and technology.”

On the docket: “We are constantly focused on improving the competitiveness of our portfolio. However, this doesn’t just mean reduction in the price of a market basket of SKUs. Rather, we’re pulling different value levers [and] capturing and sharing clinical best practices from across our membership. Given our broad and diverse membership, we’re finding that we can capture best practices from throughout the healthcare continuum and share that information across our client base.”

Future challenge for the profession: “The next generation will need to … be relentless in driving change.

There is a lot of resistance to change in healthcare, and it’s understandable

One of the key aspects I’ve focused on is building strategic plans across categories of spend and working with senior executives to find the best way my team can support their strategic initiatives. I think the key is to view every day as an opportunity to reflect and learn something new.

Thoughts about the supply chain management profession: “I’ve been fortunate to work with some very talented people I’ve learned from. One of the key aspects I’ve focused on is building strategic plans across categories of spend and working with senior executives to find

when you have potential impact on patients’ lives. However, the next generation [cannot] become frustrated as they try to implement these new concepts and innovations. They’ve got to be relentless in helping to transform healthcare and capture the value of these new approaches and innovations.” www.repertoiremag.com

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

Automotive-related news Offline maps Whether you are at home or traveling, it’s wise to download offline maps for the general area, points out The New York Times “Personal Tech.” If you drive into an area with no cell reception, Google Maps will switch to the offline maps to help you navigate to your destination.

Driverless vehicles? Not so fast.

The National Transportation Safety Board in late February held a public hearing to determine the probable

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cause of the March 23, 2018, fatal crash of a Tesla Model X in Mountain View, California. The crash on U.S. 101 killed its driver, Walter Huang, who was using Tesla Inc.’s advanced driver-assistance system known as Autopilot.

According to performance data downloaded from the vehicle, Huang was using traffic-aware cruise control and autosteer lane-keeping assist. The 38-year-old Apple Inc. software engineer had Autopilot engaged continuously in the last 18 minutes and 55 seconds before his car struck a highway barrier at approximately 71 mph. The vehicle

provided two visual and one auditory alerts for the driver to place his hands on the steering wheel, according to a preliminary report. The driver’s hands were not detected on the steering wheel in the six seconds before the crash, the NTSB said. Records reviewed by the board also found Huang was playing a video game on his iPhone before the crash, though it could not determine whether he was actively engaged with the game or just holding the device.

your hands hurt when gripping the steering wheel, use a steering wheel cover that makes holding and turning the wheel more comfortable. Ask your doctor for a referral to an occupational therapist.

Don’t let the wheels come off Ford says it has developed a 3D-printed locking wheel nut made using a biometric signature based on the driver’s recorded voice in a bid to prevent wheel and tire thefts, according to Autoblog. Engineers record the driv-

New to Google Maps Google Maps announced a major redesign for Android and iPhone, reports CNBC. The redesign focuses on five icons on the bottom of the screen, three of which are new: 1) “Saved” shows you the restaurants, bars, landmarks and other places you’ve bookmarked. 2) “Contribute” makes it faster to add reviews or post photos of the places you’ve been. 3) “Updates” is a quick way to see what’s popular around you based on recommendations from “local experts” or information outlets such as Infatuation.

Your parents should know

As you get older, you’ll likely notice physical changes that can make certain actions — such as turning your head to look for oncoming traffic or braking safely — more challenging.

Driver safety requires more than understanding road signs and traffic laws, says Mayo Clinic. As you get older, you’ll likely notice physical changes that can make certain actions — such as turning your head to look for oncoming traffic or braking safely — more challenging. Still, older drivers can remain safe on the road. A few tips: 1) Stay physically active. It improves your strength and flexibility, which in turn can improve safety by making it easier to turn the steering wheel, look over your shoulder, and make other movements while driving and parking. 2) Schedule regular vision and hearing tests. 3) Know your medications. Many drugs, including pain medications, sleep medications, antihistamines and muscle relaxants can affect driver safety, even when you’re feeling fine. 4) Understand your limitations. For example, if

er’s voice for at least one second, then use software to convert the resulting soundwave into a physical pattern that can be 3D printed. They then convert the pattern into a circle and use the design for the indentation and key on the locking nut. The nut and key are designed as a single piece, then 3D printed using acid and corrosionresistant stainless steel. What’s more, inside the nut are unevenly spaced ribs and indentations to prevent a thief from making a wax imprint of the pattern, since the wax breaks when it’s pulled from the nut.

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REP CORNER

Caught by Sales Tim Morris didn’t pursue medical sales.

Medical sales pursued him. And he couldn’t be happier.

McKesson Medical-Surgical account executive Tim Morris and his wife, Jessica, were youth ministers for about six

years after college. “People often ask me if I miss being in ministry,” he says today. “My response is always the same: ‘I never left it.’”

Instead, his experience in ministry helped Morris develop a servant attitude toward all people, including his physician customers in southeast Georgia. “I try to serve my customers so they can serve their patients.”

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Morris was born and raised in Pittsgrove, New Jersey, about 40 miles south of Philadelphia. His parents – Jake and Susan Morris – were teachers in the same school system. His dad sold swimming-pools on the side.

“My parents were both extremely hard workers and loved being teachers,” he says. “I cannot tell you how often we would run into former students who would come up and say hello. It was evident to me at a young age that my parents truly cared for their students and loved helping them see and fulfill their potential.”

He graduated from Asbury College (now University) in Wilmore, Kentucky, with a major in Christian ministry.

“My wife and I met at a very young age and were married young as well,” he says. “I would say my goal in college was to experience life with her, and to convince her to marry me. Toughest sale of my life. From the moment we met, we became best friends, and I just wanted to share life with her.”

After her youth ministry work, Jessica began graduate school to pursue a degree in education. (Today she is a professor of reading and literary education in the Teacher Preparation program at the Coastal College of Georgia in Brunswick.) Meanwhile, Tim took a job selling TV ads for a local news channel to earn some extra income.

“Long story short, I loved sales,” Tim Morris and family. he says.

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REP CORNER A phone call Six months later, Henry Stone, the owner of an Atlantabased distributor called Onesource Health, called the local church looking for a salesman in the area. “My motherin-law answered the phone, and the rest is history,” he says. “Quoting the old saying: ‘Do you want to make God laugh? Just tell God your plans.’ The saying is so true. I never would have guessed that I would be doing what I am doing.”

Two years after Morris joined Onesource, Stone sold the company to PSS, which in turn became part of McKesson Medical-Surgical. But to this day, Stone remains one of Morris’ best friends and a mentor.

provide a faster diagnosis makes me feel like I am making a difference in my territory.”

He gained something else from that first lab event.

“I developed a friendship with three other reps who encourage, teach and assist me through my job as an account manager – Matt Van Dam, Katie Dill and Jonathan Poulin. They have had an enormous impact on my view and understanding of lab.” The four colleagues collaborate daily via email, phone or text, he adds.

Love story Morris believes sales – like life in general – has a lot to do with love.

“I love my customers,” he says.

“I often joke that I see and speak with my customers more often than I speak or see my extended family. I would say that my customers have almost become family to me. The people of South Georgia are just amazing people. I feel like I am making a difference. I feel like this job has significance.”

He owes much to his manager, Chris Hopkins. “Five years ago, I got a call from Chris that another territory was opening up, and he asked if I would like to interview for it. That was the second phone call that changed my life.

“My family and I packed up and moved to Saint Simons Island, Georgia. Some would say we moved to paradise, and I wouldn’t disagree.

“Chris became my new manager and began to encourage and challenge me to grow in my career in medical sales. He pushed me to attend trainings, he invested in ride days with me, and most important, he became a leader and close friend to me. To this day, Chris and I speak almost daily. Most of the time it is about life, with a little bit of ‘work’ throughout the conversation.

“I wouldn’t say that I chose a career in medical sales, I would say that medical sales pursued me.”

The Morrises have two daughters: Sadie Bea, age 7; and Sally Beth, age 5.

“I never thought I would be a ‘girl dad,’ but I love it,” he says. “I couldn’t imagine life any other way. I love finding princess stickers and notes on my ‘work stuff.’ As my wife likes to say, ‘Our hearts are full.’”

“ Knowing that I am able to give a doctor the tools necessary to provide a faster diagnosis makes me feel like I am making a difference in my territory.”

“I can never express how grateful I am for this man,” he says. “For the first four months of my career in medical sales, I rode in the car with Henry. We would talk about products, selling techniques and how to serve customers. Henry has coached me through medical sales, buying a home, being married, starting a 401(k) and even the birth of my two amazing daughters. Henry and I are both fortunate to each have two daughters, and he has been an amazing life coach through everything.

“I would say one of the most valuable lessons Henry has taught me is one that I think about everyday – ‘You can never go wrong with doing what’s right.’”

Several years ago, after attending a McKesson lab event, Morris discovered a new passion in his work.

“It was like a light switched on when I realized the benefit of fast and accurate testing in the medical field,” he says. “I can see the doctors I serve provide better medicine when we bring lab testing inhouse. Knowing that I am able to give a doctor the tools necessary to

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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 Invisible trackers Invisible trackers embedded inside many websites and apps are collecting data about you, including your location, browsing activities and search queries, according to an article in The New York Times. This data eventually gets into the hands of advertisers. Some third-party apps let you see the trackers that load and block them from

usually have lower liability for fraud. In addition, getting money returned to your debit card can take some time. Another tip: Use a virtual credit card. Some banks and credit card companies offer the option to create a unique credit card number to be used for specific transactions. If this number is compromised, other charges will be declined.

Alexa unleashed!

Alexa can do a lot of things besides acting as a glorified cooking timer, says an article in Fast Company. For example, you can rename the device (especially useful if someone in your house is named Alexa). If you’ve got multiple Alexa devices spread around the house, you can link them together for better-sounding music playback. And you can turn Alexa into an intercom by broadcasting your message via all Alexa devices in your house. Use Alexa’s Drop In feature for actual back-and-forth conversations.

Foldables anyone?

collecting your data. One of the newspaper’s favorites is Fyde, a free app for Android devices and iPhones. After activating the app, open a third-party app, then return to Fyde, tap on the Activity tab, and see which trackers are loading and being blocked. Repeat with other apps to determine which ones are trying to suck up lots of your data.

Samsung, Motorola and Huawei are among tech companies that think we are willing to spend $1,500 or more for a foldable cellphone. Are we? Foldables come with a lot of cons, according to an article in The New York Times. Among them: 1) Foldables rely on flexible OLED, a display technology that is much thinner than traditional screen panels and easier to scratch or penetrate with a sharp object, like a pen. 2) When unfolded, foldable screens have a visible crease – an eyesore compared with seamless displays on other phones. 3) Questions remain about the durability of the mechanical hinges.

Your pryin’ eyes E-skimmers are everywhere E-skimming, in which malware infects online checkout pages to steal shoppers’ payment and personal information, is getting more common, reports CNBC. Companies that have been hit by e-skimming attacks in the past two years include Macy’s, Puma and Ticketmaster. Consumers should use credit cards instead of debit cards when shopping online to lessen any inconvenience if their card is compromised, advises CNBC. Users of credit cards

Google will soon make it easier for you to protect your personal data, such as your location, from prying apps, reports Fast Company. Once the next Android release comes out later this year, users will get a new “Only this time” option when apps ask for access to your mic, camera or location data. Apple added a similar choice to iOS in 2019, and both Apple and Google introduced alerts last year that remind users when potentially forgotten apps are quietly slurping up location data in the background. www.repertoiremag.com

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HEALTHY REPS

Health news and notes Blood-pressure earbuds Raleigh, North Carolina-based health tech company Valencell introduced a prototype of an earbud that measures blood pressure. President Steven LeBoeuf told CNET at this winter’s CES technology show in Las Vegas that the ear is by far the best area to measure blood pressure compared to a finger or wrist. That’s because it has more blood flow and a richer heart rate reading, and ears stay the same distance from your heart (as long as you’re not bending over). The goal is to launch earbuds that use Valencell’s new tech as “general wellness” devices, not

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medical-grade ones, reports CNET. Valencell is already talking to several partners, and sees the earbuds as a way to screen for high blood pressure, and dovetail with meditation and calmness audio apps. These earbuds would skip the FDA clearance path for now, with a possible goal in the future of pursuing that extra level of approval.

Eye vitamins?

Don’t believe makers of dietary supplements marketed as eye vitamins, which they say can prevent glaucoma or reversing vision loss due to glaucoma, warns Mayo

implemented paid leave policies found a 20% reduction in the number of women leaving their jobs in the first year after welcoming a child, and up to a 50% reduction after five years. The study, shared in January 2020 at the American Economic Association Annual Meeting, analyzed labor market participation among women in California and New Jersey before and after each state implemented a paid family and medical leave system. Over the long term, paid leave nearly closes the gap in workforce participation between moms of young children and women without minor children. For women who do not have access to this leave, the study found that nearly 30% will drop out of the workforce within a year after welcoming a child, and one in five will not return for over a decade.

Read the label

Clinic. Few clinical trials of eye vitamins or supplements for glaucoma have been conducted, writes Alaina Softing Hataye, O.D., in a Mayo Clinic newsletter. “Some evidence suggests that a high intake of vitamin B through dietary sources, including green leafy vegetables, may reduce the risk of some types of glaucoma,” she writes. “But B complex supplements, including folic acid, vitamin B6 and vitamin B12, don’t appear to offer the same benefit.”

Paid family leave pays off Implementing paid leave policies after childbirth reduces the number of women leaving their jobs, according to a study funded by the March of Dimes Center for Social Science Research and conducted by the Institute for Women’s Policy Research. An analysis of states that have

You may have noticed that on Jan. 1, new FDA rules went into effect regarding how food nutrition labels look, reports Cleveland Clinic News Service. Flip over an updated food item, and you will now see two columns – one for a ‘serving size’ and one for how much is in the whole container. According to Cleveland Clinic’s Susan Albers, PsyD, the idea behind the change is to give Americans a more accurate reflection of how much they’re typically eating. Prior to the change, many people didn’t realize that they were actually eating perhaps two or three serving sizes in one sitting, she said. Other changes: 1) Types of fat, such as the less-healthy saturated fats and trans fats, will now be listed, in addition to the total amount of fat; 2) vitamin D and potassium totals have been added, while listing for vitamins C and A have been dropped (because deficiencies of C and A among Americans are rare); and 3) a new listing for “added sugars” has been added.

Tax on sugar worked What looked like an old-fashioned tax ploy actually led to some good things for the citizenry of Cook County, Illinois, according to research published in the “Annals of Internal Medicine.” Researchers from the University of Illinois at Chicago found that short-lived Cook County Sweetened Beverage Tax – one cent per ounce on sugarsweetened and artificially sweetened beverages – led to a 21% reduction in volume sold of taxed beverages in the county, even when counting for some cross-border shopping. Sugar-sweetened beverage consumption has been associated with adverse health outcomes. (The unpopular tax was short-lived, having lasted only a few months in 2017.)

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HIDA GOVERNMENT AFFIARS UPDATE

New Communications Tool Helps Standardize Shortage Communications New shortages and backorders report is based on a successful model already widely used by healthcare providers and the military David Forbes, program director of HIDA’s Healthcare Supply Chain Collaborative Supply chain executives have partnered to create a new Situation, Background, Assessment, Recommendation

report designed for manufacturers to communicate key information about product shortages and backorders. By sharing this critical information, distributors and provider organizations can better partner with each other and manufacturers by standardizing communications about shortages – or potential shortages.

HIDA’s Collaborative and the Strategic Marketplace Initiative (SMI) jointly released the “SBAR Report On Shortage/Backorder Event” to help better manage a current or expected backorder or shortage. The report is designed to facilitate communication between providers and distributors. It was developed with input from GPOs, manufacturers, distributors, and providers, capturing key perspectives from a broad cross-section of industry leaders.

“It’s a huge step toward standardizing communication channels during product disruptions,” said Chaun Powell, Group VP at Premier. “We applaud the effort by the teams at HIDA and SMI to bring this to reality.”

An SBAR communications tool already has been widely embraced throughout healthcare provider settings to achieve clear and concise transfer of patient clinical information from one healthcare provider or professional to another

SBAR originally was developed by the U.S. Navy as a communications technique to be used on nuclear submarines. In the late 1990s, it was adopted by the healthcare industry. The World Health Organization and the Agency for Healthcare Research and Quality are just two of the healthcare stakeholder groups that recognize SBAR as a reliable and validated communications tool.

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during patient handoff. Just like communication failure in a healthcare setting could lead to medical errors, lack of continuity in the supply chain could lead to weaknesses in product availability – and ultimately impact patient care.

Example of the SBAR Report in a Supply Chain Setting Situation: Manufactura Inc.’s disposable non-sterile apparel products are experiencing a product backorder.

The event impacts all catalog numbers and lots.

Background: Products are experiencing constriction in supply due to production labor constraints and foreign government supply sequestration. There is also a significant increase in demand, impacting existing inventory.

Both supply and demand pressures are a direct result of COVID-19.

Assessment: There will be limited product availability as domestic production is increased. The estimated duration of this disruption is 4-6 months.

Recommendation: Visit the Center for Disease Control & Prevention’s website for recommendations for healthcare providers specific to proper use of PPE during this event. At this time there are no known alternative therapies or products.

The SBAR Report On Shortage/Backorder Event is a free PDF download available to HIDA members and non-members. It’s available at HIDA.org/Distribution/ Advocacy/Collaborative/SBAR-Form.aspx.

To learn more about HIDA’s efforts to increase supply chain visibility, connect with me at forbes@HIDA.org.

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SALES

The 3 Biggest Sales Mistakes You Should Never Make Unproductive strategies so common we think it’s normal

By Sandler Training

Your strategies for interacting with prospects from the time you first meet them to the time you make a presentation

can have a greater impact on your likelihood of closing a sale than the actual aspects of the product or service you have to offer. Following are three unproductive strategies that are so commonplace in the sales arena that they’ve become accepted as the norm.

No. 1: Failing to provide value During initial meetings with prospective clients, some salespeople, whether by design or lack of proper preparation, don’t communicate anything of real value. Sure, they talk about their company’s capabilities. They talk about their products and services ... and the associated features, 56

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functions, benefits, and advantages. But they don’t convey any knowledge or insight about the prospects’ challenges or goals that the prospects didn’t already possess.

These salespeople are afraid that if they give away too much information, prospects will use it against them.

They believe that prospects, armed with the knowledge,

will figure out ways to accomplish the outcomes they desire without the salesperson’s product or service.

What they fail to recognize is the difference between discussing concepts and revealing the specifics of implementing those concepts. It’s OK to discuss concepts. In fact, it’s desirable, especially if it helps prospects develop new perspectives on their challenges. After all, prospects must buy into the concept before they’ll buy the product or service to implement it.

If prospects don’t learn anything new by meeting with you, are you contributing any real value to the meeting? No. And, if you’re not contributing any real value to the meeting, will prospects have compelling reasons to do business with you? Again, the answer is “No.”

No. 2: Focusing presentations on “what” rather than on “how”

No. 3: Failing to present “elegant” solutions Some salespeople have a tendency to overcomplicate their offers. This occurs primarily for one of two reasons.

Some salespeople believe that they must present complex solutions in order to establish intrinsic value. That is, they believe that the greater the number of elements to the offer, the greater will be its perceived effectiveness ... and the more readily it will be accepted by the prospect.

Other salespeople overcomplicate their offers to establish financial value – to justify the attached “price tag.” They include a number of “value-added” elements which may be helpful, but are not essential to addressing the prospect’s needs. They are included for no other reason than to bolster the perceived value of the offer and thereby substantiate the required investment.

What these salespeople fail to recognize is that prospects actually appreciate “elegant” solutions. Elegant in that they are well-ordered, simple, and concise. Elegant solutions make it easy for prospects to connect your product or service to the outcomes they are after. The easier you make it for them to establish that connection, the more likely you are to make the sale.

For some salespeople, the vagueness of their initial prospect meetings carries through to their eventual presentations. They fail to establish clear connecting links between the elements of their proposed offer and the specific aspects of the prospect’s requirements. Instead, their presentations focus too narrowly on their product or service, their company’s Some salespeople believe that they capabilities, and in some cases, on must present complex solutions in themselves. Much like the magician order to establish intrinsic value. who waves a magic wand in the air That is, they believe that the greater and then, with a puff of smoke, produces a rabbit, the salesperson the number of elements to the offer, “waves” a rhetorical magic wand the greater will be its perceived (a long list of features and advaneffectiveness ... and the more readily tages) and then, with some verbal it will be accepted by the prospect. smoke, produces a solution.

On the surface, those sorts of presentations are impressive. They typically include lengthy proposal documents which are If you find yourself engaging in one or more of often accompanied by a host of multimedia presentations these “commonplace” strategies, consider this: comfilled not only with charts and graphs, but also illustramonplace strategies are for commonplace salespeople tions and animations – all designed to support what is who are satisfied with commonplace results. If your being presented. But on closer examination, they fall results have been all too commonplace, perhaps it’s time apart. Prospects want to know what you are going to to change your strategies. do, but more importantly, they want to know how you Send your questions about improving Sales Development are going to do it. You must be crystal clear about how in your industry with a proven, systematic approach to you are going to accomplish the outcome the prospect selling to SalesTips@repertoiremag.com. desires. If you don’t establish a clear and unambiguous © 2020 Sandler Systems, Inc. All rights reserved. connection between the “what” and the “how” during S Sandler Training (with design) and Sandler Selling System your presentation, you’ll lose the opportunity to the salesare registered service marks of Sandler Systems, Inc. person who does. www.repertoiremag.com

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NEWS

Coronavirus and the healthcare supply chain A snapshot of supply chain-related headlines of the global outbreak Editor’s note: On Jan. 30, 2020, the International Health Regulations Emergency Committee of the World Health Organization declared the coronavirus outbreak a “public health emergency of international concern” (PHEIC). On Jan. 31, 2020, Health and Human Services Secretary Alex M. Azar II declared a public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to COVID-19.

The disease has since been confirmed in more than 100 countries, and as of press time, had infected almost

110,000, with more than 3,800 deaths.

The following stories from the dail-enews offer a snapshot into how the coronavirus impacted the healthcare supply chain through just one window of time (early March). For regular updates on the coronavirus, subscribe to the dail-enews, visit http://dn.mdsi.org/.

Trump administration says testing for virus would ramp up quickly as 600+ U.S. cases confirmed March 10: The Trump administration said that testing for the coronavirus would ramp up quickly in the com58

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ing weeks. “There will be more cases,” said Vice President Mike Pence. “But we simply ask for the American people to engage in common sense practices.” President Donald Trump appeared briefly at the start of the news conference to announce that the administration was considering a relief package for American workers harmed by the outbreak.

More than 500 cases of coronavirus have been diagnosed in 35 states and the District of Columbia, not counting cases stemming from repatriation. But the number of cases could be much higher due to a lag in testing in the U.S.

U.S. healthcare conferences disrupted by coronavirus

U.S. government promises to buy all leftover face masks to encourage production

March 9: A growing number of conference organizers are cancelling, postponing or transitioning to virtual meetings as the coronavirus spreads across the globe and the U.S. This week’s HIMSS Conference (Orlando, FL) was canceled for the first time in its nearly 60-year history.

President Donald Trump was scheduled to speak at the healthcare IT conference set for March 9-13. The famed tech, film and music SXSW Conference (Austin, TX), scheduled for March 13-22, was also canceled.

March 3: The U.S. government was promising to buy all the leftover face masks and respirators manufacturers had on hand once the coronavirus scare subsides and demand dries up. A pre-solicitation issued to suppliers by HHS last week laid out its intention to procure up to 500 million N95 respirators and face masks during the next 18 months for its Strategic National Stockpile. The masks will be used to protect healthcare workers and first responders from airborne pathogens. Companies, though, are already The scarcity struggling to meet demand, which is outpacing supof gloves, medical masks, ply. The Strategic National Stockpile is made up of respirators, vitally important pharmagoggles and ceuticals, vaccines, antidotes face shields and other emergency supare leaving plies in strategic locations frontline across the country.

Hospitals keep close eye on supplies during coronavirus outbreak March 9: The coronavirus outbreak has hospitals keeping a close eye on their supplies. Washington state, for example, has seen the largest cluster of cases and has used a lot of protective equipment when treating patients with the virus. “I am concerned we will have some shortages of that,” said George Roberts, president of the National Association of County and City Health Officials, during a briefing at the National Press Club in Washington, D.C. “We certainly have our eyes on the supply chain,” Doug Allred, spokesperson for Cone Health (North Carolina), told Fierce Healthcare.

“Certain supplies are on allocation from distributors, which means we cannot get amounts over and above our normal usage. So it is important that staff are aware of the situation.”

World Health Organization urges for 40% in increased production on protective gear March 4: The World Health Organization (WHO) urged manufacturers to urgently increase the production of personal protective equipment (PPE) worldwide. The scarcity of gloves, medical masks, respirators, goggles and face shields are leaving frontline clinicians poorly equipped to encounter COVID-19 patients. According to WHO, PPE supplies need to be increased by 40% worldwide. “Without secure supply chains, the risk to healthcare workers around the world is real,” said Dr. Tedros Adhanom Ghebreyesus, director of WHO. “Industry and governments must act quickly to boost supply, ease export restrictions and put measures in place to stop speculation and hoarding. We can’t stop COVID-19 without protecting health workers first.” WHO is working with governments, industry and the Pandemic Supply Chain Network to boost production and provide PPEs for critically affected and at-risk countries.

clinicians poorly equipped to encounter COVID-19 patients.

Premier says 44% of N95 orders over past 45 days have yet to be fulfilled

March 2: Premier Inc. (Charlotte, NC) said that 44% of its members’ N95 orders over the past 45 days had yet to be fulfilled. Company officials describe this as very abnormal. Under normal circumstances, they would expect nearly all of their usual orders to be fulfilled within one or two days. Soumi Saha, senior director of advocacy for Premier, told CNN that the manufacturers of medical devices like N95s aren’t necessarily reporting shortages to the FDA, but unlike drug manufacturers, they don’t have to by law

President Trump asks pharmaceutical companies to accelerate efforts on vaccine March 2: President Donald Trump has asked pharmaceutical companies to accelerate efforts to create a coronavirus vaccine. President Trump said pharmaceutical representatives were scheduled to visit the White House Monday and the meeting would now focus on coronavirus and vaccines. “We’re going to have another subject, vaccines, and how they’re doing,” said President Trump.

“We’ve asked them to accelerate whatever they’re doing in terms of vaccines, absolutely.” www.repertoiremag.com

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NEWS

Industry News New Road Warriors episode features Mike Racioppi In this NEW episode of Road Warriors, Repertoire Publisher Scott Adams interviews Mike Racioppi of Henry Schein. Mike gives some great insight into the current state of the industry, what he looks for when hiring leaders, and sage advice about how to achieve success. And to top it all off, Mike’s story about John Moran and Welch Allyn is one of the best we’ve had on the podcast yet.

Visit www.repertoiremag.com/resources/podcasts.

Owens & Minor elects Gwendolyn Bingham to board of directors Owens & Minor, Inc. (Richmond, VA) has appointed Lieutenant General Gwendolyn Bingham to its board of directors, effective March 5, 2020. A retired 3-star US Army Lieutenant General, Lieutenant General Bingham served as Department of the Army Assistant Chief of Staff for Installation Management, where she provided policy, programs, and resourcing expertise for installation infrastructure and services for 156 Army installations worldwide.

Midmark announces retirement of chief administrative officer Sharyl Gardner Midmark Corp., announced the retirement of Sharyl Gardner, chief administrative officer. Gardner plans to retire at the end of March after 13 years with Midmark.

With more than three decades of managerial and leadership experience, Gardner started her career at Midmark in 2007 as vice presiSharyl Gardner dent of human resources and was promoted to her current role as chief administrative officer in 2009. As part of her planned transition, Gardner most recently directed senior executive level succession planning and served on the Midmark digital ecosystem advisory council. As the liaison between executive management and shareholders at Midmark, she also led management’s role in board administration and recruitment, serving as the senior management represen60

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tative to the nominating and governance committee and compensation committees of the board as well as secretary to the board. During her career at Midmark, she also led many of the shared services functions including IT, corporate communications, human resources, customer care and guest services.

Masimo expands partnership with MS Westfalia GmbH Masimo (Irvine, CA) and MS Westfalia GmbH (Germany) announced that MSW will integrate additional Masimo measurement technologies into MSW’s plugand-play hybrid Jenny platform, to help clinicians assess brain function, oxygenation, ventilation, and resuscitation status. After launching the Jenny modular pointof-care monitoring device with integrated Masimo noninvasive, continuous rainbow SET measurements (including total hemoglobin, SpHb) and Masimo sidestream and mainstream NomoLine capnography, MSW plans to add Masimo Next Generation SedLine Brain Function Monitoring, O3 Regional Oximetry, and Oxygen Reserve Index (ORi) to Jenny. The company says this will make the platform more versatile and comprehensive and suitable for use in a variety of care areas, including the ICU and the OR, as well as in EMS and military settings.

Urgent care industry grows to more than 9,000 centers nationwide According to the annual Benchmarking Report from the Urgent Care Association (UCA), the total number of urgent care centers in the U.S. reached 9,616 as of November 2019, representing growth of 9.6% from the prior year. The report also indicates that almost 97% of urgent care patient encounters lasted one hour or less.

Additional findings of the report include: ʯ 98% of all respondents indicate that they have at least one monitor in place to oversee antibiotic prescribing ʯ 30% of respondents who are not currently offering telemedicine services intend to do so within six to twelve months

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