mckesson medical-surgicalrepconnectdocuments.s3.amazonaws.com/mdsi/repmay15.pdf · • may 2015 3...

vol.23 no.5 • May 2015 repertoiremag.com

Market-readyMedical-Surgical: McKesson

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www.repertoiremag.com • May 2015 3

MAY 2015 • VOLUME 23 • ISSUE 5

repertoire magazine (ISSN 1520-7587) is published monthly by Medical Distribution Solutions Inc., 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2015 by Medical Distribution Solutions Inc. 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.

The Face of Your Company .....................................6

PUBLISHER’S LETTER

HIDA Health Reform Update ............................ 14

HIDA

Shout it OutDistributors have a lot to offer, and they should let others know ................................... 10

HIDA EXECUTIVE CONFERENCE

10

Subtle Shifts in the EHR Conversation ..........8

PRACTICE POINTS

Living Long and ProsperingAs the world’s population of people 60 and over increases, health care providers must meet the increased needs ................................. 24

LONG-TERM CARE

22

TRENDS

Monitoring Measles

Sales reps kept an eye on market trends and headlines during the winter’s measles outbreaks .... 2616

Contracting Executive profileBob Taylor, Assistant vice president of supply chain, UAB Health System, Birmingham, Ala. ....... 22

IDN OPPORTUNITIES

Market-ready

Medical-Surgical: McKesson

4 May 2015 • www.repertoiremag.com

MAY 2015 • VOLUME 23 • ISSUE 5

HEALTHY REPS

A Custom FitDiabetes care involves a patient-centered approach .... 28

EHR IsolationAccording to one study, some doctors have been slow to implement EHR ......................... 32

Physicians grapple with new payment models

Even so, most practices are doing OK with pay-for-performance and other models ......... 34

Not Enough NumbersAccording to one report, the demand for physicians exceeds supply ................................... 36

Upward trend for internal medicine residencies .............................................. 40

Digital health ‘More than a gleam in investors’ eyes ................................... 44

TRENDS

Quick BytesTechnology news

50

58

REP CORNER

Prepared for Each Moment

For David Kohlstedt, following his passion has paid off in the form of a rewarding career

PEOPLE

Mike Barnaba:Passionate about sales

Automotive-related news ....................................52

WINDSHIELD TIME

Unplug and unwind

48

54Midmark announces addition of new casework project managers to medical division

Welch Allyn names second winner of Ripple Effect Contest ........................ 60

NEWS / CLASSIFIEDS

Focus on Your Leadership Strengths ............................................................................... 62

LEADERSHIP

42

Don’t Overdo ItAmerican College of Physicians advises that some cardiac screening may be excessive

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6 May 2015 • www.repertoiremag.com

PUBLISHER’S LETTER

The Face of Your Company

Scott Adams

editorial staffeditor

Mark [email protected]

managing editorGraham [email protected]

senior editorLaura Thill

[email protected]

associate editorAlan Cherry

[email protected]

art directorBrent Cashman

[email protected]

publisherScott Adams [email protected]

(800) 536.5312 x5256

director of business developmentMicah McGlinchey [email protected](800) 536.5312 x5268

director of business developmentKatie [email protected] (800) 536.5312 x5255

founder

Brian Taylor [email protected]

circulation

Laura [email protected]

Wai Bun [email protected]

Product and

Marketing Manager

Alicia O’[email protected]

Subscriptionswww.repertoiremag.com/

subscribe.aspor (800) 536-5312 x5259

2015 editorial boardTracy Howard : Cardinal Health

Bill McLaughlin Jr. : IMCO

Bob Miller : Gericare Medical Supply

Linda Rouse O’Neill : HIDA

Jim Poggi : McKesson Medical Surgical

Brad Thompson : NDC

Chris Verhulst : Henry Schein

repertoire is published monthly by mdsi 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043, Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: [email protected]; www.medicaldistribution.com

At least once a week, I see the same quote reposted on LinkedIn, “The bitterness of poor quality remains long after the sweetness of low price is forgotten.” We can all get caught up in the price conversation. Yet, talking price verses selling value is a slippery slope. Especially when the time, effort, quality services and products provided by distribution sales profession-als are worth every dime.

In this month’s cover story, McKesson’s Stanton McComb emphasizes that the key value in their organization is the salesforce. Yes, sales teams create revenue, which provide the funds to help deliver all the services, products and additional jobs in every organization. But I believe the sales representatives in our industry do far more. As a medical distribution representative, you are the face of your company.

Every company, regardless of their products or service, is only as good as its people. For ex-ample, I use two banks. One is purely transactional, because the services make it easy for me to pay

bills online even though the bank’s staff drive me crazy. Therefore, they receive as little of my business as possible. The second bank financed my last home, which I have since sold. Due to the individuals in the second bank, I have taken out three additional loans with them, opened up two different accounts and give them all my profitable business. All because the organization’s people have gone out of their way to win my trust and business.

Never forget your value. In a time when Internet sales and large online organizations threaten your business, be bold with your customers and remind them of the solutions you bring, as well as the times you are there when they need you the most.

Distribution salespeople are the gateway to providers, regardless of the market they serve. To echo Stanton’s point in the McKesson article, the Cardinal/Henry Schein deal took place due to changes in our industry and customers still needing to be taken care of in each market differently. Some customers need to be served as acute care, some as alternate site, and some as extended care. As a distribution sales professional you are at the forefront of this change and your clients expect you to help them through it. They should also understand you are worth a little margin along the way.

It will be exciting to watch each market over the next 24 months as distribution reps help shape the future.

Please enjoy the May issue of Repertoire and remember next month is our first annual infection prevention issue.

Dedicated to Distribution

R. Scott AdamsPublisher

PS: Please scan you Repertoire Calendar for updates.

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May 2015 • www.repertoiremag.com8

By Laurie Morgan, Capko & Morgan

Editor’s note: Welcome to Practice Points, by physician practice management experts Capko & Morgan. It is their belief – and ours too – that the more education sales reps receive on the issues facing their customers, the better prepared they are to provide solutions. Their emphasis is on helping physicians build patient-centered strategies and valuing staff’s contributions.

PRACTICE POINTS

Even as recently as five years ago, many of our clients were still considering whether to implement an EHR. Some even considered retiring early as an alternative to what they perceived as a tedious and thankless journey from paper to electronic re-cords. When we visited practices that had already implemented an EHR, it was often a source of aggravation to physicians and staff alike.

What was usually missing from the conversation about EHRs was their potential to help the practices themselves. Practices implemented EHRs mainly to earn government incentives – incentives designed to persuade doctors to use the technol-ogy for the greater good, not for the good of their own practices.

Lately, though, my partners and I have noticed an encouraging shift in how our clients perceive their EHRs.

Now when first we visit a practice site, providers and staff usually have several years’ experience using their EHR. Resistance to using the system was once an expected source of in-efficiency in practice workflows, but this is no longer typical. It’s often the case that our client physicians even like their system! They’ve often come to see the value in tools like e-prescribing and messaging tools that save time tracking down staff.

Maximizing the potentialDespite this shift, practices are still often not using their EHR technol-ogy to its fullest advantage. Industry media seem to perceive this missed opportunity, too. The conversation is shifting to the strategic potential of EHR technology for physicians and their businesses – and we view this as a very good thing.

Many of the tools that practices don’t regularly use are like second nature to those of us that worked in corporate environments – and espe-cially to sales professionals. Can you imagine managing a client base with-out having information immediately at your fingertips about recent pur-chases? Without being able to search

Subtle Shifts in the EHR Conversation

Not that long ago, the EHR conversation was mainly about surviving the implementation process – and whether to go through it at all. Government incentives were weighed against acquisition and conversion costs. “How to” articles focused on choosing a system, meeting Meaningful Use, and converting to electronic records without destroying practice productivity.

and segment your clients by size, location, or other criteria? Without a system to quickly look up what your clients had told you about their changing needs?

These everyday tasks that might take you a mo-ment to complete on your laptop have never been simple or routine for many physicians and their staff. Decades of working with paper charts, plus a disdain for any activities that look like “selling,” have codi-fied siloed work patterns that would be considered odd and inefficient outside of medicine. This key cultural difference may have even prevented physi-cians from understanding the benefits EHR systems could offer to them – not just to the government and the industry as a whole.

This knowledge gap hits a sweet spot for those of us with corporate experience and represents a big opportunity. When we show our clients how they can get more from their EHR, it’s an eye-opening experience for them – and fun and rewarding for us. Sales reps can add value in a similar way, simply by sharing some of the basics of what you know about using data. For example, your clients may sim-ply not know their EHRs can segment their patients for special programs like PCMH or group visits, and for communicating with patients about services that can help them stay healthy (while also strengthening the practice’s finances). Introduce them to ideas like this, and that’s a win-win-win for your clients, their patients, and your own business.

Sales reps can add value in a similar way, simply by

sharing some of the basics of what you know about

using data.

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Distributors have much to be proud of. They offer

valuable services to their customers and manufacturer partners, and it’s time to proclaim their value. That’s a message Mark Zacur wants to convey to the industry this year as he serves as chairman of the Health Industry Distributors Association.

“We should stand up straight, be proud, and proclaim our value,” said Zacur, who spoke with Repertoire Publisher Scott Adams at the recent HIDA Executive Conference in Bonita Springs, Fla. “We can walk in to providers’ offices with the bold message, ‘We can help you drive your initiatives.’”

Zacur is vice president and general manager for Fisher Health-Care, part of Thermo Fisher Scien-tific, a supplier of clinical diagnos-tics products to hospitals, reference laboratories, and physicians’ of-fices. He joined Thermo Fisher Scientific in 2004 as vice president of marketing and product manage-ment for Fisher Safety. Prior to that, he worked for Raytheon Company, Monsanto, and Bayer.

Shout it OutDistributors have a lot to offer, and they should let others know

Beyond buy/sellIn order to demonstrate their value, distributors need to move beyond the traditional buy/sell mentality, says Zacur. “We can help reduce hospital-acquired infections, achieve shorter stays through proper diag-nostics,” among other things, he says. “These are is-sues that resonate in every single hospital board room throughout the country.”

Zacur knows something about hospital board rooms, as he joined the board of directors of Pittsburgh, Pa.-based St. Clair Hospital in December 2014.

Key competenciesDistribution used to be all about logistics. And it still is. But dis-tributors have much more to offer customers – and manufacturers – today, says Zacur.

For example, they have deep ex-posure to a wide set of products, and they know which ones are most effec-tive in certain situations. Lab distri-bution – with which he is so familiar – is an example. “Our reps are highly

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straight, be proud, and

proclaim our value.”

Mark Zacur

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trained. We can go to the customer and say, ‘If you use Test B instead of Test A, you could increase accuracy, you will have fewer moms calling to say, ‘My kid is still sick; what hap-pened?’ You’ll have better diagnoses, your patients will get in and out, and they won’t come back for the same condition.”

Distributors hold another key competency that they can share with their provider customers. “By the nature of the business, we are incredibly lean,” he says. “We are lean on processes, and we know how to function in that environment. I think we can share that mentality with our customers. We can focus on what we’re good at.”

Distributors have much to offer providers who are busy consolidating different care sites, he continues. In

fact, consolidation – for example, hospital systems acquir-ing physician practices – is not a challenge for distributors so much as an opportunity.

“It’s an opportunity to drive standardization across the continuum,” he says. “We have relationships at the IDN level; we can go in and have a discussion with one person and drive product usage across hundreds and sometimes thousands of users in that network.

“It’s about helping our customers manage their ex-penses,” he adds. “It’s about driving standardized processes – same tests, same results, same degree of confidence.” And for the patient, standardization means having a similar experience regardless of which IDN facility he or she visits.

But it also calls for a new way of selling. In the tra-ditional approach, the rep (whom everybody knows by name) goes in; customers tell him or her what they need; and the rep makes sure they get it.

But today, “It takes a community to drive a sale,” he says. That community includes the supply chain executive, finance, and other departments. Using lab as an example, Zacur says the Fisher rep may begin his or her call in the lab, but then may visit the ER, infection control, or the pharmacy. And the same holds true for reps representing other product categories.

The hospital board roomServing on a hospital board has helped Zacur gain valu-able insight into his customers.

“First and foremost, [serving on the board is] an op-portunity for me to give back to my community,” he says.

But it also gives him an opportunity to learn firsthand what’s on his cus-tomers’ minds, and how distributors can help. “It’s about walking a mile in their shoes and understanding how you can help them.

“Every single conversation the board has circles back to the pa-tient,” he says. Exemplary clinical outcomes, patient satisfaction, etc., are uppermost in the minds of hos-pital administrators. The hospital on whose board he sits – St. Clair Hos-pital – has responded a number of ways, including implementing lean principles in its emergency depart-ment. There’s no waiting area; in-

stead, patients are escorted into a treatment area imme-diately upon arrival. And St. Clair closely monitors how long they wait before receiving treatment.

“St. Clair is a nonprofit, independent – which isn’t easy these days,” he says. “They’re successful because it’s about the patient.” But St. Clair Hospital – like all hospi-tals – is a business too, he adds.

“It’s important for a nonprofit to make money so they can reinvest. Making money isn’t a bad thing for them, because it allows them to do that. As a member of the board, I’m a steward of the community; I help make sure they do the right things to represent the community.

“One of the huge takeaways I’ve had is that there are so many ways in which distributors and manufactur-ers can help. When you have the ability to hear what your customers deal with day in and day out, you get that true understanding.”

“ We are lean on processes, and we know how to function in that environment. I think we can share that mentality with our customers. We can focus on what we’re good at.”

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This year, HIDA is launching three strategic Innovation Pa-vilions in Skin and Wound Care, Infection Prevention, and Home Care Solutions at its Streamlining Healthcare Conference in Dal-las, Texas, Sept. 8-10, 2015. The pavilions will provide attendees unique product solutions and education surrounding these distinct supply chain issues and markets in a conference setting, according to HIDA.

“Infection prevention and home healthcare are two areas in which our members are well versed and craving more informa-tion on developing trends,” says Ian Fardy, HIDA executive vice president. “Skin and wound care is a natural addition to our educa-tion offerings, as it’s a topic that spans the entire continuum of care – from hospitals and rehab facilities to nursing homes and home care.”

“Last year, our conference featured two new education summits on Patient Experience and Value Analysis in Infection Control,” Fardy continues. “We are pleased to build upon the positive reception these sessions elicited from our members, who specifically asked us to develop and grow this format with new content and topics.”

HIDA announces new Streamlining

Healthcare Conference Innovation Pavilions


HIDA HEALTH REFORM UPDATE

SGR winners, losers become much clearerLast month, HIDA’s Health Reform Update speculated that it would be difficult at best for Congress to agree on repeal and replacement legislation for the physician sus-tainable growth rate (SGR) payment formula before April 1, mainly due to difficulties finding offsets amenable to both political parties.

While it is true that the April 1 deadline passed with-out permanent SGR repeal legislation signed into law, the resolve of congressional leaders to pass a permanent solution was stronger than anticipated. In rare bipartisan fashion, the House overwhelmingly approved a $214 bil-lion bill (by a vote of 329-37) in early spring that repeals the SGR formula and replaces it with a system that in-centivizes quality. This allowed the Senate to follow the House’s lead and approve the bill the week of April 13, which the president said he would sign into law.

What broke the logjam was the deal between Speaker Boehner (R-OH) and Minority Leader Pelosi (D-CA) to only partially pay for the package. Specifically, only $70 billion of the approximately $200 billion bill is offset — half of it will come from other providers and half will come from wealthy seniors. Specific provider cuts include:

• Hospital Update: Hospital customers will receive a 3.2 percent base payment rate phased in starting in FY 2018.

• Medicaid Disproportionate Share Hospital (DSH) Savings: Any Medicaid DSH changes are delayed until FY 2018; the policy also will now be extended through 2025.

• 1% Market Basket Update for Post-Acute Provider Customers: Replaces the current 2018 market basket update with a 1 percent update for long-term care hospitals (LTCHs), skilled nursing facilities (SNFs), inpatient

HIDA Health Reform UpdateCongress kicks off 2015 with bipartisan, bicameral collaboration

rehabilitation facilities (IRFs), home health providers (HH), and hospice providers.

• Income-Related Premium Adjustment: Starting in 2018, the percentage that beneficiaries must pay toward their Part B and D premiums will increase for two specific income brackets (2% of beneficiaries).

• Medigap Reform: Limits first dollar coverage on certain Medigap plans by prohibiting plans from covering the Part B deductible. This change applies only for future retirees beginning in 2020.

The new Medicare physician payment formula will take several years to implement through a rigorous regu-latory process so the full extent of its impact remains to be seen. Apart from physicians, the immediate winners with the passage of permanent SGR repeal and replace legislation are community health centers (CHCs). CHC funding was set to expire in September 2015 but these centers and the National Health Service Corps can expect approximately $8 billion in additional funds.

The lab market is not expected to receive much of an impact from SGR reform as lab reimbursement is being revamped as part of last year’s SGR patch, which requires Medicare rates to be reset based on private plan rates. Ex-perts anticipate up to a 26 percent Medicare rate reduc-tion for many lab tests over the next several years.

2015 is already shaping up to be a busier year for healthcare policy than expected! The next significant healthcare policy milestone will be the highly anticipated Supreme Court decision in June on the validity of Afford-able Care Act tax subsidies.

HIDA Government affairs will continue to monitor these and other developments to further educate our in-dustry. For more information, visit us at www.HIDA.org or contact us at [email protected].

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

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Market-ready

Medical-Surgical: McKesson

T wo years after McKesson Medical-Sur-gical’s acquisition of PSS World Medi-cal, President Stanton McComb is con-

fident about the future. The integration with PSS is almost complete; the market demand for expertise in the non-acute-care supply chain has never been greater; and the company is making plans to move into a new, state-of-the-art headquarters building in Richmond. Through it all, its sales reps remain a strategic advantage in the market, he says. Repertoire recently posed some questions about the com-pany, the market and the role of sales reps to McComb. Here are his responses.

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COVER STORY

Repertoire: You were named president of McKes-son Medical-Surgical, after serving as president of McKesson Automation, a provider of hospital pharmacy automation products and services. What are the two or three most important – or surpris-ing – things you have learned about the med-surg distribution market in the four years you’ve been at Medical-Surgical?Stanton McComb: I am most surprised by the complex-ity of our industry – which, quite frankly, affords us the opportunity to do more for our customers, by helping them succeed in a rather daunting environment. I am also pleasantly surprised at the talent of our sales force. I am constantly impressed with their knowledge, their relation-ships and their pure commitment to our customers. Re-ally, across all of McKesson Med-Surg, it is an incredible team – from sales to our distribution center teams.

Repertoire: McKesson com-pleted its acquisition of PSS in February 2013. When will you consider the integra-tion process to be complet-ed? What are the challeng-es facing your company as you go through that pro-cess? What is your vision for your company when the integration is complete?McComb: We are more than two-thirds of the way through our integration, and we are on schedule to com-plete it by spring of 2016. We faced the challenge of adapting pre-existing prac-tices and aspects of compa-ny culture that had worked well in the past for PSS or McKesson, respectively, but needed to be evolved and made consistent for our continued success. Becom-ing one team has been good and healthy, but reconciling and harmonizing long-held practices has not been easy. So, I’m proud of what we have accomplished as a team.

We have a strong vision for the future of our com-pany. As the industry leader, we can offer our customers more efficiency, more innovative products and services, and more value by operating on a single distribution net-work platform and using the same systems. Together, we can offer more than either historical company could have on its own.

Repertoire: In 2006, McKesson sold its acute-care busi-ness to Owens & Minor. Now, we see Cardinal exiting the non-hospital market. What do these two events tell us about the compatibility of acute- and non-acute-care businesses in one distribution company?McComb: We believe the recent Cardinal announcement validates the alternate site strategy we have been pursu-ing since 2006 and the value our dedicated delivery model provides to customers outside the hospital. The physi-cian office market requires a different model than acute care, and we have focused on providing the excellence and value that has earned us a leading ambulatory market position. Applying the deep knowledge and relationships we have with healthcare providers and manufacturers, we can provide value through distribution excellence, a high-touch service model and unparalleled product choices.

Repertoire: In the eight years since McKesson divest-ed its acute-care business, the industry has contin-ued to see consolidation among providers. Particu-larly, we see hospital systems and IDNs acquiring physician practices. Had McKesson foreseen these developments eight years ago, do you think the com-pany would have made the same decision? Why or why not?McComb: While we exited acute care, we never stopped serving health systems. We have great relationships with many hospitals and health systems, where we provide value to the unique needs of their ambulatory sites across the continuum of care.

Repertoire: Population health and accountable care organizations emphasize collaboration between acute- and non-acute providers. What impact are they having on McKesson Medical-Surgical? What impact do you foresee in the future?McComb: We know the industry is in the midst of trans-formation. We recognize the challenges these changes create for our customers, and we are better positioned to

“ We have great relationships with many hospitals and health systems, where we provide value to the unique needs of their ambulatory sites across the continuum of care.”


help them achieve success. That’s because we work across all segments and we have the capabilities to deliver more value through better outcomes, better cost and better connectivity. While these organizations strive to achieve more of a continuum of care as patients are treated in different sites, the fact remains that provision of care changes from primary to acute and to post-acute sites. McKesson’s breadth of experience in serving large and small customers in both ambulatory and post-acute seg-ments allows us to partner with these organizations and efficiently serve their broader needs, while also providing the more tailored services that each segment requires to achieve the best outcome for patients. Our access to the full McKesson technology and solutions portfolio will continue to give us an advantage in this area.

Repertoire: If it is true that con-solidation among providers is con-tinuing, how does the field sales rep maintain his or her significance in these accounts?McComb: Though there is significant change underway, we are 100 percent committed to our sales teams. They are a clear strategic advantage for us. Our sales teams have always helped our customers and our business through times of significant change. Our reps are constantly seeking to better understand our customers. They add value by helping customers solve their challenges and better serve their patients. That’s something cus-tomers will always appreciate.

Repertoire: We have read that McKesson Medical-Surgical is relocating its headquarters to another lo-cation in Richmond. Can you talk about the move and what it signifies?McComb: Our results and growth have given us the abil-ity to put capital back into our infrastructure. Over the past few years, we’ve invested significantly in our distri-bution network to better serve our customers. Now I am pleased that we will be investing in the workplace of those behind the scenes, who support our customer and sales teams. We have been in the Richmond area for more than 40 years, as General Medical and then McKesson

Medical-Surgical. This new, state-of-the-art headquarters is being designed from the start to facilitate better coor-dination and communication. That should help us attract and retain the top talent we need to grow our business and better serve our customers as we work to improve healthcare in the U.S.

Customer and market segmentsRepertoire: What are the market segments that you see growing in the next five years? What is the role your sales team will have in driving growth in these segments?McComb: The healthcare industry’s ongoing efforts to lower the cost of care should continue to drive growth to care environments outside of the acute segment and even into the home. Large physician practices, health systems

and home care providers should benefit from this. Strong relationships between our sales teams and their customers will be key to our ongoing success.

Repertoire: Recently, we reported on what some in the industry are referring to as physician “super-groups,” that is, groups of 20, 25 and all the way up to 150 doctors. Do you see this segment of your busi-ness growing? If so, how are you preparing to serve these supergroups?McComb: Consolidation is occurring not just vertically, but also horizontally. Large physician practices are already

“ Applying the deep knowledge and relationships we have with healthcare providers and manufacturers, we can provide value through distribution excellence, a high-touch service model and unparalleled product choices.”


COVER STORY

an important customer base for McKesson. The greater complexity and distribution volume of these customers makes McKesson’s overall value proposition even more appealing to these customers, many of whom do not have the more systematized capabilities of larger systems that have been around longer. We are collaborating with other McKesson business units, like McKesson Specialty, McKesson Business Performance Services and McKes-son Pharmaceutical, to bring superior and differentiated value to these larger players.

Repertoire: Please describe McKesson’s involve-ment with surgery centers. How important is this

segment of the market to your company? What are the unique needs of the surgery center, and how do those needs compare or contrast with those of the physician office? McComb: We have a leading position in the ambula-tory surgery center market. As reimbursement models shift, we think surgery centers will experience growth and we are excited to be well-positioned to grow in this market. Our customized solutions work well for sur-gery centers, which need orders delivered just-in-time. We have developed good relationships in this segment that help us understand its unique needs, and a strong service model and solutions to meet these needs. For example, we have just launched a solution to improve efficiency for ophthalmology surgery centers, called McKesson Implant Manager. This automated inventory

management system saves time and money for custom-ers by eliminating the burden of manually managing and tracking their intraocular lens inventory.

Repertoire: Do you see consolidation among your long-term-care customers? If so, what are the unique needs of large long-term-care customers?McComb: The number of short-term stay patients and the levels of patient acuity have been increasing in recent years, and, along with the shift in reimburse-ment, this is creating challenges for long-term-care providers. It is driving accelerated consolidation and growth in scale. Fortunately, we have been tracking this

change for years, and we are pre-pared with the scale and the tools to help our customers adapt and win in a changing environment.

Repertoire: At one time, it seemed that IDN materials management executives were asking for one dis-tributor to service both acute- and non-acute-care sites. How would you describe the climate today?McComb: Some health systems still seek one distributor across all their care facilities. However, the reality is that no distributor today effectively services all the medical-surgical, Rx and laboratory needs for every setting, from the hospital

to a patient’s home. The service requirements are just very different. Instead, we see the more sophisticated health systems are opting for distribution solutions specifically designed to support their unique needs across the care continuum.

Repertoire: Among those IDNs who have settled on two prime distributors – one for acute care, one for non-acute care – do you find that materi-als executives are asking McKesson to work with or collaborate with your acute-care counterpart? If so, how?McComb: We do not see this as the norm. More often, the health system serves as a conduit of information to ensure they can standardize products across their network and leverage their volume for better pricing.

“ The physician office market requires a different model than acute care, and we have focused on providing the excellence and value that has earned us a leading ambulatory market position.”

• 5 second scrub time and 5 second dry time

• Randomized study1 has shown that disinfection of the devices with a Chlorhexidine/Alcohol solution appears to be most effective in reducing colonization as cited in the CDC Guidelines.2

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1Hayden, M. K., et. al. . A Randomized Cross-Over Clinical Trial to Compare 3.15% Chlorhexidine/70% Isopropyl Alcohol (CHG) vs 70% Isopropyl Alcohol Alone (Alcohol) and 5s vs 15s Scrub for Routine Disinfection of Needleless Connectors (NCs) on Central Venous Catheters (CVCs) in an Adult Medical Intensive Care Unit (ICU), Oral Abstract Presented at 2014 ID Week Conference, October 11, 2014, Philadelphia, PA. 22011 Guidelines for the Prevention of Intravascular Catheter-Related Infections, Healthcare Infection Control Practices Advisory Committee, US Centers for Disease Control and Prevention, 2011.

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IDN OPPORTUNITIES

Contracting Executive profileBob Taylor, Assistant vice president of supply chain, UAB Health System, Birmingham, Ala.

Since joining UAB Health System,

Bob Taylor’s responsibilities have evolved into total supply chain over-sight, including value analysis, pur-chasing, strategic sourcing, distribu-tion and logistics, and supply chain analytics for supplies, linen and equip-ment. In addition, he is responsible for UAB’s Critical Care Transport.

Repertoire: What has been the most challenging and rewarding project you have been involved in recently?Taylor: Building an end-to-end strate-gic supply chain infrastructure has been very exciting. We began with a small, established base of distribution and limited value analysis functions. Today, we have a dedicated purchasing depart-ment, strategic sourcing, supply chain informatics and a value analysis pro-

gram with nine standing active clinician-led teams. Our distribution and logistics function has expanded to include the outpatient enterprise and periopera-tive services, and we anticipate more to come. Not only have we connected all of the supply chain functions into an in-tegrated, high-functioning supply chain, we are now seen as a strategic element of our organization by both our clini-cians and non-clinicians.

Repertoire: Please describe a proj-ect you look forward to imple-menting in the next year or two.Taylor: We have begun to focus on im-proving our data quality and integration. Although our data quality and usage has been good, we need to make it great. To do so, we must apply significant rigor, focus and measurement in order to get fully organized around this initiative. It will require examination of current processes, application of lean and Six Sigma methodologies, and changes to our business processes to extract waste-ful steps, while increasing accuracy and validity. Accurate data will allow us to benchmark our spend to identify sav-ings through contract opportunities; categorize our spend to UNSPSC to better analyze spend and identify utili-zation opportunities and trends; enu-merate our data to GS1 standards to improve order accuracy and safety; and remove wasteful rework in the ordering process through attainment of lights-

out ordering. This will also enable us to connect spend and purchase data to clinical data; to better understand the relationship between cost, quality and outcomes; and help drive better evidence-based decision making when selecting/utilizing supplies.

Repertoire: What is the most im-portant quality you look for in a supplier partner?

Taylor: Integrity, mutual trust, alignment and respect must all be present. A sup-plier that can present opportunities that create value for both parties, and has risk for both parties, indicates a partnership.

Repertoire: What is the greatest change we can expect to see in healthcare contracting in the next five years?Taylor: We can expect to see the inclu-sion of product performance guaran-tees in contracts with financial metrics, measures and risk. Healthcare reform has changed how hospitals are reim-bursed, and this change will have to extend to everyone involved in patient care, including suppliers. Claims of better quality and improved outcomes will have to be substantiated with evi-dence, and outcomes will have to be measured and monitored across the care continuum. Products that truly provide incremental improvements in patient outcomes will thrive; products that only add cost will go away.

Claims of better quality and improved outcomes will have to be substantiated with evidence, and

outcomes will have to be measured and monitored across the care continuum.

UAB Health System consists of flagship UAB University Hospital, plus five affiliated community hospitals; University Hospital has 1,250 beds and over 50 outpatient clinics, with non-salary annual spend exceeding $600 million; $1.3 billion in net revenues.

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When we say we feel old, we’re not kidding. The

world’s population of people 60 years of age and older has doubled since 1980 and is forecast to reach 2 billion by 2050, according to The World Health Or-ganization (WHO). The good news is that the ageing of the world’s population – in both developing and developed countries – is an indicator of improving global health. Older people make important contribu-tions to society as family members, volunteers and as active participants in the work-force, WHO reminds us.

However, along with these ben-efits come special health challenges for the 21st century, and health pro-viders – including your long-term care customers – must be prepared to meet the specific needs of older populations. Health professionals re-quire more and more training on old-age care and chronic disease preven-tion and management, and society at large must be educated on sustain-able policies for long-term and pal-liative care. And, the development of age-friendly services and settings is becoming more important than ever, says WHO.

The need for long-term care is rising. The number of older people who are no longer able to look after themselves in developing countries is forecast to quadruple by 2050. The inability to live inde-pendently due to limited mobility,

frailty or other physical or mental health problems will mean that many of these individuals will require long-term care, including home-based nursing, community-, residential- and hospital-based care.

The main health burdens for older people are from non-communicable diseases, according to WHO. Today, even in the poorest countries, the biggest killers are heart disease, stroke and chronic lung disease, while the great-est causes of disability are visual impairment, dementia,

hearing loss and osteoarthritis. Older people in low- and middle-income countries carry a greater disease bur-den than those in wealthier coun-tries. In fact, older people in low- and middle-income countries lose about three times the number of years than their wealthier counterparts due to premature death from heart disease, stroke, and chronic lung disease. They also have much higher rates of visual impairment and hearing loss – problems that often can be easily prevented.

Good care is important for promoting older people’s health, preventing disease and managing chronic illnesses, and in years to come, WHO predicts health work-ers will spend increasingly more time caring for this section of the popula-tion. Yet, currently, most training for health professionals does not include instruction about specific care for older people.

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Society needs to break stereotypes and develop new models of ageing for the 21st century, says WHO. This means creating age-friendly physical and social environ-ments, which can have a big impact on improving the ac-tive participation and independence of older people. It also means encouraging healthy behaviors in earlier stages of life, including what we eat, how physically active we are and our levels of exposure to health risks, such as smoking, harmful consumption of alcohol, or exposure to toxic substances. And, it’s never too late to start. Giv-ing up smoking – even later in life, between 60 and 75 years of age – can help lower the risk of premature death by 50 percent.

A lot will change over the next 35 years, ac-cording to The World Health Organization, which predicts the following trends affecting the world’s ageing population:

Between 2000 and 2050, the proportion of the world’s population over 60 years will double, from about 11 percent to 22 percent. Over the same period, the number of people aged 60 years and over is expected to in-crease from 605 million to 2 billion.

Between 2000 and 2050, the number of people aged 80 and older will quadruple. By 2050, the world will have almost 400 million people aged 80 years or older. Never before will the majority of middle-aged adults have living parents.

By 2050, 80 percent of older people will live in low- and middle-income countries. For instance, Chile, China and the Islamic Repub-lic of Iran will have a greater proportion of older people than the United States. And, the number of older people in Africa will grow from 54 million to 213 million.

For more information visit www.who.int/features/factfiles/ageing/en/.

A new world


TRENDS

This winter’s measles outbreaks appear to have got-

ten more attention in the press than they did among sales reps calling on primary care physicians.

“Physicians are making their own decisions,” says Darrell Rawlings, vice president, Rx Category and Pro-gram Management, McKesson Medical-Surgical. “They frequently look to their rep for product information or supplier information, but they are not looking for clinical opinions.”

“From a distributor’s stand-point, we can’t provide any medi-cal guidance to our customers,” says Rick Nielsen, president and CEO, Lifeline Pharmaceuticals LLC, Miami, Fla. “We can, how-ever, provide information about market trends or supply interrup-tions, and we can provide resourc-es, such as educational materials on prescribing information.”

Midwinter outbreaksIn about a five-week period, from Jan. 1 through Feb. 6, 121 people from 17 states and Washington, D.C., were reported to have measles, according to the Centers for Disease Con-trol and Prevention. Most of those cases were part of a large, multistate outbreak linked to the Disneyland theme park in Anaheim, Calif., though unlinked outbreaks oc-curred elsewhere as well.

Research conducted by a team at Boston Children’s Hospital and published online by JAMA Pediatrics indicat-ed that vaccine coverage among the exposed populations was far below that necessary to keep the virus in check. By examining case numbers reported by the California De-partment of Public Health and current and historical case

data captured by the Boston Children’s Hospital Health-Map disease surveillance system, the researchers estimated that the measles vaccination rate among the case clusters in California, Arizona and Illinois was between 50 and 86 percent, far below the 96 to 99 percent necessary to create a herd immunity effect.

Using the same data sources, the HealthMap team re-leased a model illustrating how differing rates of vaccine

coverage could affect the growth of a measles outbreak over time. The model suggests that if a popu-lation is fully vaccinated against the virus, one case of measles will give rise to only two additional cases over 70 days. By contrast, if only 60 percent of a population is vac-cinated, more than 2,800 cases will occur over the same time period.

A commentary by Neal Halsey, MD, of Johns Hopkins Bloomberg School of Public Health, published March 9 in the Annals of Internal Medicine, seemed to reinforce the researchers’ findings, suggesting

that more measles outbreaks will occur because vaccine re-fusal has left enough individuals susceptible.

“The relative absence of measles in most areas of the United States for many years has led to an under-appreci-ation of measles-related complications and mortality, and unfounded fears about the association between vaccines and autism have contributed to vaccine hesitancy and the resurgence of measles,” according to the American College of Physicians, which publishes Annals. In his commentary, Halsey called for ramped-up efforts to focus on making sure all eligible U.S. children are vaccinated, and greater col-laboration to increase vaccination internationally.

Monitoring MeaslesSales reps kept an eye on market trends and headlines

during the winter’s measles outbreaks

“Physicians frequently look to

their rep for product information or

supplier information, but they are not

looking for clinical opinions.”

– Darrell Rawlings


“Adult primary care clinicians can assist their pediat-ric colleagues in boosting community protection by rou-tinely reviewing immunization records as they see patients who are transitioning from pediatric care, among other safety measures,” according to the Annals commentary. Physicians may also need to become familiar with clinical presentation of measles, since most practicing clinicians in 2015 will never have seen an actual case.

Just the factsAll the attention paid to the measles vaccine resulted in a spike of activity over the winter, says Rawlings. “To be quite frank, we’re essentially responding to increased ac-tivity more than anything else,” he says. “Much like on the flu side, the news of more outbreaks drives activity.”

In such instances, the rep’s role is to respond to that de-mand, not offer clinical guidance, he says. “They are there to represent the offerings of the company. It wouldn’t be wise to initiate a science discussion with a scientist.”

Says Nielsen, “Due to the recent media attention, we have seen an increase in [measles vaccine] sales in the last few months.” Another factor driving activity is

vaccine manufacturers’ growing usage of social media and the Internet to communicate with physicians, parents of patients and even with patients directly, he adds. “That has changed the way information is flowing.” Though in-tended for physicians, that information is also available to the public who, in turn, are bringing up medical issues – including vaccination – to their doctors.

“From a distributor’s standpoint, we would fulfill the needs of the physician and recommend vaccines that may have a more natural form of introduction to the body, such as a subcutaneous or nasal administration,” he says. The distributor might also recommend vaccines that con-tain the least amount of toxins, resulting in the least amount of side effects.

As for the future? How will the public and the medical community view the outbreak of 2015?

“That really depends on how the states respond,” says Rawlings. “If there is some sort of legal activity that mandates some of this, that could change the game from a demand perspective, and we would respond as such.”


TRENDS

Healthcare providers caring for patients with diabetes

need to tailor their approach to the individual patient, ac-cording to the American Diabetes Association.

Each year, the association provides clinical practice recommendations for diabetes care in its “Standards of Medical Care in Diabetes,” based on the latest evidence supporting such recommendations. “The common motif

of the 2015 Standards is the continued emphasis of indi-vidualizing therapeutic decisions based on factors that in-clude ethnicity, overall risk for [atherosclerotic cardiovas-cular disease], life expectancy, comorbid conditions, the patient’s preferences and goals, and his or her ability to adhere to treatment regimens,” wrote the ADA in a recent commentary in Annals of Internal Medicine, a publica-tion of the American College of Physicians. “Once more, the patient takes the center stage.”

This year’s Standards include 14 sections, but the Annals commentary focused on three:

• Ethnic differences in diabetes risk• Glycemic controls• Blood pressure and cardiovascular risk

Ethnic differencesThe ADA endorsed a new body mass in-dex (BMI) cut point for prediabetes and Type 2 diabetes screening in Asian Ameri-cans, decreasing it from 25 to 23 kg/m2. It has long been recognized that many Asian patients with Type 2 diabetes do not meet “standard” criteria for obesity (BMI >30 kg/m2) or overweight (BMI >25 kg/m2), suggesting that the relationship between BMI and risk for Type 2 diabetes, if any, is shifted toward lower BMI values in this population, according to the association.

“Current BMI criteria for overweight and obesity have been derived from stud-ies in the general population and do not il-lustrate the unique adipose tissue distribu-tion among ethnic groups. In particular, at every BMI level, Asian Americans tend to have a greater percentage of visceral fat, which more closely correlates with insu-lin resistance and risk for Type 2 diabetes when compared with peripheral subcuta-neous fat depots.”

Glycemic controlReflecting updated position statements of the ADA and the European Association for the Study of Diabetes, the Standards emphasize the principle that the definition of any patient’s target hemoglobin A1c level and choice of treatment strategy should be individualized, accounting for such factors as age, comorbid conditions, life expec-tancy, and the patient’s motivation and preferences.

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TRENDS

The lack of head-to-head studies evaluating the efficacy, tolerability, safety (including cardiovascular outcomes) and durability of drugs to treat diabe-tes – including metformin (which ADA calls the preferred initial treatment choice) – have prevented the develop-ment of a “more nuanced, evidence-based algorithm,” according to the ADA. “In the absence of robust comparative effectiveness data, the Standards advocate tailoring combination drug choice based on such factors as risk for hypoglycemia, effects on weight, side effects and cost.”

Blood pressure and cardiovascular riskBoth Type 1 diabetes and Type 2 diabetes markedly in-crease the risk for atherosclerotic cardiovascular disease,

which is significantly reduced by statin treatment, notes the ADA. The 2015 Standards set forth re-vised recommendations for initiat-ing, intensifying, and monitoring adherence to statin treatment and, in effect, adopt the 2013 American College of Cardiology/American

Heart Association cholesterol treatment guidelines.Those guidelines recommended revised systolic

and diastolic blood pressure goals for patients with diabetes to 140 and 90 mm Hg, respectively. “Howev-er, more stringent goals (that is, <130/80 mm Hg) are recommended in patients with other significant cardio-vascular risk factors or for those who can achieve them without ‘undue treatment burden.’”

Stop diabetes before it startsWith more than 86 million Americans living with pre-

diabetes and nearly 90 percent of them unaware of it, the American Medical Association and the Centers for Disease Control and Prevention announced that they have joined forces to take urgent action to prevent diabetes.

Prevent Diabetes STAT: Screen, Test, Act - Today™ is a multi-year initiative that expands on the work each organization has already begun to reach more Ameri-cans with prediabetes and stop the progression to type 2 diabetes.

“It’s time that the nation comes together to take im-mediate action to help prevent diabetes before it starts,” AMA President Robert M. Wah, M.D., was quoted as say-ing. “Type 2 diabetes is one of our nation’s leading causes of suffering and death – with one out of three people at risk of developing the disease in their lifetime. To address and reverse this alarming national trend, America needs frontline physicians and other healthcare professionals as well as key stakeholders, such as employers, insurers, and community organizations, to mobilize and create stronger

linkages between the care delivery system, our communi-ties, and the patients we serve.”

People with prediabetes have higher-than-normal blood glucose levels but not high enough yet to be con-sidered type 2 diabetes, according to AMA and CDC. Re-search shows that 15 percent to 30 percent of overweight people with prediabetes will develop Type 2 diabetes within five years unless they lose weight through healthy eating and increased physical activity.

As an immediate result of their partnership, the AMA and CDC have co-developed a toolkit to serve as a guide for physicians and other healthcare providers on the best meth-ods to screen and refer high-risk patients to diabetes pre-vention programs in their communities. The toolkit, along with additional information on how physicians and other key stakeholders can Prevent Diabetes STAT, is available online at www.ama-assn.org/sub/prevent-diabetes-stat/for-health-care-professionals.html?utm_source=Press_Release&utm_medium=media&utm_term=031215&utm_content=prediabetes_stat&utm_campaign=partnership.

Editor’s note: The commentary referred to in this article was published online first at www.annals.org on March 24, 2015.

“Once more, the patient takes the

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TRENDS

EHR IsolationAccording to one study, some doctors have

been slow to implement EHR

A substantial proportion of physicians are unsure

about or are not planning to participate in a government program that provides economic incentives to implement and use electronic health records. Those physicians tend to be older than others, and in smaller, independent practices.

If and when they do implement EHR, they may require extensive support in selecting and using electronic systems.

Writing in the March 2015 issue of the Annals of Internal Medicine, Catherine DesRoches, PhD., Mathematica Policy Re-search, Cambridge, Mass., reported results of surveys in 2011, 2012 and 2013 of 3,400 primary care and specialist physicians. The researchers’ primary goal was to measure associations between the stage of EHR adoption and practice characteristics.

Among the findings:• In 2011, 44 percent of physicians had an EHR that

met basic criteria. (These were considered “early adopters,” according to DesRoches)

• Between 2011 and 2013, an additional 19 percent adopted a basic EHR (“new adopters”).

• In 2013, 20 percent were in the process of imple-menting an EHR or had implemented one without some functions required for a basic EHR (“partial implementers”). Eight percent were planning to adopt an EHR in the next two years (“planners”), and 9 percent were not planning to adopt an EHR (“persistent non-adopters”).

Additionally:• Persistent non-adopters were, on average, older

than other physicians.• The mean number of physicians employed in the

main practice location of persistent non-adopters

was 2.3, compared with 33.4 among early adopters and 15.1 among new adopters.

• Persistent non-adopters were significantly more likely to be employed in independent solo or two-physician practices than early and new adopters, who were significantly more likely to be employed by a hospital or medical school, group or staff-model HMO, or network owned by a hospital or other type of healthcare organization.

• Most persistent non-adopters reported fee-for-ser-vice as their primary compensation, whereas early and new adopters were more likely to report salary adjusted for performance.

• Persistent non-adopters seemed less likely to par-ticipate in incentive programs focused on improv-ing the quality and continuity of care and were significantly less likely than early and new adopters to receive or have the potential to receive addition-al payments for managing patients with chronic conditions or complex needs.

“Persistent non-adopters in small, isolated practices may be facing a unique set of challenges that limit their ability to adopt an EHR,” writes DesRoches. “Failure to address the needs of these physicians has implications be-yond adoption, because new models of healthcare deliv-ery require the use of an EHR.

“Physicians who choose not to make the change to EHRs may find themselves further isolated if these new models be-come widespread, but they may move toward adoption as the penalty phase of the meaningful use program draws closer. If so, they are likely to require extensive support in selecting, implementing, and using these systems.”


The federal government’s proposals for Stage 3 of the

“meaningful use” criteria for electronic health records are intended to improve information-sharing by promoting in-teroperability among EHRs.

“[The] proposed rule will be an integral component in the shared nationwide effort to achieve an interoperable health system,” Karen DeSalvo, MD, MPH, MSc, national coordinator for health IT, was quoted as saying. “The cer-tification criteria we have proposed in the 2015 Edition will help achieve that vision through provisions that con-sider the range of health IT users and uses across the care continuum, including those focused on interoperable stan-dards, data portability, improved transparency, privacy and security capabilities, and increased oversight through [the Office of the National Coordinator for Health Informa-tion Technology’s] Health IT Certification Program.”

Under the Health Information Technology for Eco-nomic and Clinical Health (HITECH) Act, doctors, health-care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt and

“meaningfully use” health IT technology certified by the Office of the National Coordinator for Health Informa-tion Technology, or ONC. Since the programs began in

2011, more than 433,000 eligi-ble professionals and eligible hospitals have received an in-centive payment, representing about 60 percent of eligible professionals in either the Medicare or Medicaid pro-grams and about 95 percent of eligible hospitals, accord-ing to the U.S. Department of Health and Human Services.

The Stage 3 proposed rule’s scope is generally lim-ited to the requirements and

criteria for meaningful use in 2017 and subsequent years. CMS is considering additional changes to meaningful use beginning in 2015 through separate rulemaking.

“ The proposed rule will be an integral component in the shared nationwide effort to achieve an interoperable health system.”

– Karen DeSalvo

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Interoperability is focus of ‘Meaningful Use’ Stage 3 proposals


TRENDS

Physician practices are engaging in new healthcare

payment models intended to improve quality and reduce costs, but are finding that they need help managing increasing amounts of data and figuring out how to respond to the di-versity of programs and quality metrics from different payers. Even so, most are faring well with the new models. These are among the findings of a joint study by the non-profit RAND Corporation and the American Medical Association.

Researchers studied 34 physician practices in six geographic markets to determine the effects of alternative healthcare pay-ment models on physi-cians and medical practices in the United States. The payment models included episode-based and bundled payments, shared savings, pay-for-performance, capi-tation and retainer-based practices. Accountable care organizations and medical homes also were examined.

Among the practices surveyed, none had experienced financial hardship as a result of the new payment models. The overall financial impact – including practice stability – of the alternative payment mod-els ranged from neutral to positive.

But changing the payment system probably isn’t enough to ensure that patient care will improve, said Dr. Mark W. Friedberg, the study’s lead author and a senior natural scientist at RAND, a nonprofit research organi-zation. “For alternative payment methods to work best, medical practices also need support and guidance. It’s the

support that accompanies a new payment model, plus how well the model aligns with all of a practice’s other incentives, that could determine whether it succeeds.”

Key findings:• Physicians agree that the transition to alternative

payment models has encouraged the develop-ment of team-based care. Additional benefits for patients include increased access to care and physi-cians through telehealth or community-based care.

• Most physician leaders are optimistic about alter-native payment models, while physicians not in leadership roles have some apprehension, particu-larly with regard to new documentation require-ments. For example, physicians are supportive of new patient registries that list patients with certain health conditions as a way to improve care. But they are skeptical about documentation whose link to better care is less clear.

• Practices are investing significantly in information systems to analyze large amounts of data about practice patterns. But when crucial data (such as quality performance feedback and drug prices) are missing or inaccurate, they have difficulty using data analysis to improve care and reduce spending.

• As physician practices make substantial investments in data collection, payers also should consider help-ing physician practices manage the information. Such investments could enhance the effectiveness of new payment models, and help medical practices make the best use of computerized health records and other health information technology.

Physicians grapple with new payment models

Even so, most practices are doing OK with pay-for-performance and other models

“ Despite the pressure to contain costs, practice leaders are trying to avoid creating situations where doctors are paid more when patients do not get the services they need.”

– Mark Friedberg, MD


• Payers should consider ways to harmonize key components of alternative payment mod-els, especially performance measures. Medical practices usually contract with many payers, each of whom may have different performance measures tied to payment rewards. So medi-cal practices must cope with how to address hundreds of performance measures and create a coherent response.

• Most medical practices have shielded in-dividual physicians from direct exposure to the new financial incentives created by payers. While practices are paid more for improved performance, practices generally use nonmonetary incentives to encourage physicians to change their decision-making. Those methods often are intended to ap-peal to physicians’ sense of professional-ism. “Despite the pressure to contain costs, practice leaders are trying to avoid creating situations where doctors are paid more when patients do not get the services they need,” said Friedberg.

• Alternative payment models generally have not changed the core content of physicians’ clinical work. Efforts to improve efficiency by delegat-ing some tasks to non-physicians have had the unintended consequence of increasing the intensity of physicians’ work, raising concerns about burnout.

The project conducted interviews between April and November 2014, speaking with 81 people from 34 physician practices in the following markets: Lit-tle Rock, Ark.; Orange County, Calif.; Miami, Fla.; Boston, Mass.; Lansing, Mich.; and Greenville, S.C. Researchers also spoke to leaders of 10 payers, nine hospitals or hospital systems, seven local medical societies, and five Medical Group Management Association chapters.

The report, “Effects of Health Care Payment Models on Physician Practice in the United States,” is available at www.rand.org.

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TRENDS

Demand for physicians continues to grow faster than

supply, leading to a projected shortfall of between 46,100 and 90,400 physicians by 2025, according to a report from the Association of American Medical Colleges.

It is true that growth in the supply of APRNs (e.g., clinical nurse specialists, certified registered nurse anesthe-tists, certified nurse-midwives, advanced nurse executives or nurse practitioners) and other health occupations may help to alleviate projected shortfalls to an extent. But even taking into consideration potential changes in staffing, the nation will likely face a growing shortage in many physician specialties, especially surgery-related specialties, according to AAMC. A multipronged strategy will be needed to help ensure that pa-tients have access to high-quality care.

“The trends from these data are clear – the physician shortage will grow over the next 10 years under every likely scenario,” AAMC President and CEO Darrell G. Kirch, MD, was quoted as saying. “Because training a doctor takes between five and 10 years, we must act now, in 2015, if we are going to avoid serious physician shortages in 2025.

“The solution requires a multi-pronged approach – continuing to innovate and be more efficient in the way care is delivered as well as increased federal support for graduate medical education to train at least 3,000 more doctors a year to meet the healthcare needs of our na-tion’s growing and aging population.”

The most current report updates previous reports published by the AAMC Center for Workforce Studies in 2008 and 2010, and was intended to incorporate the latest modeling methods and available data on trends and fac-tors affecting the physician workforce.

Total physician demand is projected to grow by 86,700 to 133,200 (11 percent to 17 percent), with population

growth and aging accounting for 112,100 (14 percent) in growth. By comparison, physician supply will likely in-crease by 66,700 (9 percent) if labor force participation pat-terns remain unchanged, with a range of 33,700 to 94,600 (4 percent to 12 percent), reflecting uncertainty regarding future retirement and hours-worked patterns.

Projected shortfalls in primary care will range be-tween 12,500 and 31,100 physicians by 2025, while de-mand for non-primary care physicians will exceed supply by 28,200 to 63,700 physicians.

Affordable Care ActExpanded medical coverage achieved under the Affordable Care Act, once fully implemented, will likely increase demand by about 16,000 to 17,000 physicians (2 percent) over the in-creased demand resulting from changing demographics, according to the AAMC report. The Congres-sional Budget Office estimates that 26 million people who otherwise

would be uninsured in the absence of ACA eventually will have medical insurance.

The anticipated increase is highest (in percentage terms) for surgical specialties (3.2 percent), followed by primary care (2 percent), medical specialties (1.7 percent), and “all other” specialties (1.5 percent). Within these broad categories there are differences in the impact of the Affordable Care Act for individual specialties.

Advanced practice cliniciansThe lower ranges of the projected shortfalls reflect the rapid growth in the supply of advanced practice clinicians and the increased role these clinicians are playing in pa-tient care delivery, reports AAMC. But even in these sce-narios, physician shortages are projected to persist.

Not Enough NumbersAccording to one report, the demand for physicians exceeds supply

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TRENDS

New payment methodologies – including bundled pay-ments and risk-sharing arrangements – and innovations in technology suggest that the work of health professionals may be restructured in the coming years. Given the number of nurse practitioners, certified nurse midwives, and certi-fied registered nurse anesthetists graduating each year, if labor force participation patterns remain unchanged, then the supply of advanced practice nurses (APRNs) will grow more rapidly than is needed to keep pace with growth in demand for services at current APRN staffing levels. These trends suggest that an additional 114,900 APRNs could be available to both expand the level of care currently pro-vided to patients and help offset shortages of physicians.

Similarly, the supply of physician assistants (PAs) is projected to increase sub-stantially between 2013 and 2025, though addi-tional research is needed to quantify the expected impact, reports AAMC. While this rapid growth in supply of APRNs and PAs could help reduce the pro-jected magnitude of the physician shortage, the extent to which some specialties (e.g., surgery specialties) can continue to absorb more APRNs and PAs given limited physician supply growth is unclear.

One bright spotIf there is a bright spot in these projections, it is that the projected shortfalls of physicians in 2025 are smaller than those cited in the earlier study. AAMC says this is due to new data and the dynamic nature of projected assumptions,

AAMC’s prediction that demand for physicians in 2025 will exceed supply by 46,100 to 90,400 compares with a 130,600 shortfall projected in the 2010 study. Current pro-jections suggest primary care physician demand in 2025 will exceed supply by 12,500 to 31,100 physicians (the 2010 study projected a 65,800 shortfall, about half the overall shortage). The projected shortfall for non-primary care is 28,200 to 63,700 (vs. a projected shortfall of 64,800 in the 2010 study).

Factors explaining differences between the 2015 and 2010 projections include:

• The U.S. Census Bureau revised downward its 2025 population projections by about 10.2 million people

(from 357.5 million to 347.3 million). This down-ward revision equates to approximately 24,000 lower FTE demand for physicians.

• The number of physicians completing their gradu-ate medical education has risen from about 27,000 to about 29,000 annually.

• The new projections more closely reflect imple-mentation of the Affordable Care Act, growth in supply of advanced practice clinicians, and trends in use of healthcare services.

• The 2010 study assumed that supply and demand were in equilibrium in 2008 for all specialties except primary care, whereas this update assumes supply and demand were in equilibrium in 2013 for all specialties except primary care and psychiatry. Hence, the new demand projections extrapolate a “2013” level of care delivery compared with the “2008” level of care deliv-ery extrapolated by the earlier 2010 projections.

‘Moving target’Predicting supply-and-demand for physician services is a moving target, says AAMC. “Uncertainties regarding how emerging care delivery models and changing care prac-tices might affect physician supply and demand, together with uncertainties regarding how clinicians and care set-tings will respond to economic and other trends, under-score the importance of ongoing research on potential implications of the evolving healthcare system for the na-tion’s physicians,” according to the report.

“The large range for the shortage projections reflects un-certainty about key supply and demand determinants, re-flecting important areas for future research. These include:

• How physician retirement patterns might change over time based on economic factors, work satisfaction, trends in health and mortality, and cultural norms regarding retirement.

• Whether younger physicians will continue to have similar work-life balance expectations as older cohorts. How clinician staffing patterns are likely to evolve over time.

• The effects of different payment models.

Repertoire readers can view the AAMC report, The Com-plexities of Physician Supply and Demand: Projections from 2013 to 2025, at www.aamc.org/download/426242/data/ihsreportdownload.pdf.

“ Because training a doctor takes between five and 10 years, we must act now, in 2015, if we are going to avoid serious physician shortages in 2025.”

– Darrell G. Kirch, MD

HMMC Fall 2015 Executive Conference Omni Hotel Chicago

November 3 - 5, 2015

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HMMC’s Conference in Chicago promises to be another exciting event where leaders from our manufacturing community come together to gain insight in industry, become better leaders and to network with peers. An exciting and talented group of speakers and panel discussions will address

timely and pertinent issues that every manufacturer of medical devices must deal with today.

HMMC Fall 2015 Executive Conference Omni Hotel Chicago

November 3 - 5, 2015

SAVE THE DATE

HMMC’s Conference in Chicago promises to be another exciting event where leaders from our manufacturing community come together to gain insight in industry, become better leaders and to network with peers. An exciting and talented group of speakers and panel discussions will address

timely and pertinent issues that every manufacturer of medical devices must deal with today.


TRENDS

“ACP remains concerned that

the financial burden on medical students from the

cost of medical education, along with problematic payment models

and administrative hassles for physicians, are barriers to general internal medicine and primary care careers.”

– Patrick Alguire, MD

Upward trend for internal medicine residencies

“The American College of Physicians is pleased to see that the number of internal medi-cine positions offered in 2015 in-creased to 6,770, or about one in four of the available residencies,” Patrick Alguire, MD, FACP, senior vice president for medical educa-tion, American College of Physi-cians, was quoted as saying. “ACP remains concerned, however, that the financial burden on medical students from the cost of medical education, along with problematic payment models and administra-tive hassles for physicians, are bar-riers to general internal medicine and primary care careers, which are the heart of a high perform-ing, accessible, and high quality health care system.”

Internal medicine enrollment numbers have increased every year since 2010:

• 2,772 in 2010• 2,940 in 2011• 2,941 in 2012• 3,135 in 2013• 3,167 in 2014• 3,317 in 2015

The percentage of U.S. seniors matched to postgraduate year one (PGY-1) positions increased from 18.9 percent in 2011 to 19.8 percent in 2015. The percentage of internal med-icine positions filled by U.S. seniors has remained steady at approximately 49 percent over the last four years.

The 2015 match for internal medicine is still below the 3,884 U.S. medical school graduates who chose internal medicine residency programs in 1985, according to ACP. The great majority of current internal medicine residents will ultimately enter a sub-specialty of internal medicine, such as cardiology or gastroenterology. Only about 22 percent of internal medicine residents eventually choose to special-ize in general internal medicine, com-pared with 54 percent in 1998.

The 2015 match also showed an increase of U.S. medical graduates who matched in Internal Medicine-Primary Care (156 in 2010, 166 in 2011, 186 in 2012, 200 in 2013, 202 in 2014, and 206 in 2015,) and in Med-icine-Pediatrics (299 in 2010, 309 in 2011, 276 in 2012, 312 in 2013, 284 in 2014, and 319 in 2015).

The number of U.S. senior medical students choosing internal medicine residen-cies increased by about 5 percent in 2015, according to the American College of Physi-cians. During this time, the number of new internal medicine positions increased by about 4 percent. According to the 2015 National Resident Matching Program, 3,317 U.S. medical school seniors matched for residency training in internal medicine.

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TRENDS

Physicians should refrain from screening for cardiac

disease in adults at low risk for coronary heart disease with resting or stress electrocardiography, stress echocardiogra-phy, or stress myocardial perfusion imaging, the American College of Physicians (ACP) advises in a paper published in the March 17, 2015, issue of Annals of Internal Medicine.

“Cardiac screening in adults at low risk for coro-nary heart disease is low value care because it does not improve patient outcomes and it can lead to potential

harms,” said ACP President David Fleming, MD, MA, MACP. “Physicians should instead focus on strategies for improving cardiovascular health by treating modi-fiable risk factors such as smoking, diabetes, hyperten-sion, high cholesterol, obesity, and encouraging healthy levels of exercise.”

Authored for ACP’s High Value Care Task Force by Roger Chou, M.D., “Cardiac Screening with Electrocar-diogram, Stress Echocardiography, or Myocardial Perfu-

sion Imaging” is intended to provide phy-sicians with practical advice based on the best available evidence, according to ACP.

Rather than screening low risk adults for coronary heart disease, physicians should start a cardiovascular risk assess-ment with a global risk score that com-bines individual risk factor measurements into a single quantitative estimate of risk. Patients in the low risk category should not be screened with resting or stress elec-trocardiography, stress echocardiography, or stress myocardial perfusion imaging.

The American College of Physi-cians’ advice does not pertain to pa-tients with symptoms or to athletes for pre-participation screening.

The ACP’s High Value Care initia-tive is designed to help doctors and pa-tients understand the benefits, harms, and costs of tests and treatment op-tions for common clinical issues so they can pursue care together that im-proves health, avoids harm, and elimi-nates wasteful practices. ACP defines High Value Care as the delivery of ser-vices providing benefits that make their harms and costs worthwhile.

Don’t Overdo ItAmerican College of Physicians advises that some cardiac screening may be excessive

“ Physicians should focus on strategies for improving cardiovascular health by treating modifiable risk factors such as smoking, diabetes, hypertension, high cholesterol, obesity, and encouraging healthy levels of exercise.”

– David Fleming, MD

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TRENDS

Approximately $4 billion was invested in digital health

in 2014. That is 125 percent more than in 2013 and four times the amount of 2011. With figures like that, it’s no wonder digital health has the attention of venture capital-ists and entrepreneurs.

Naomi Fried, PhD, vice president, medical informa-tion and innovation, Biogen Idec, cited these statistics at the MidAmerica Healthcare Venture Forum, held recently in Chicago. Biogen Idec is a Cambridge, Mass.-based bio-technology firm focused on therapies for the treatment of neurodegenerative diseases, hematologic conditions and autoimmune disorders.

The Forum, presented by MedCity News and Mid-America Healthcare Investors Network, brought together investors and healthcare start-ups to discuss technology as well as the best approaches to commercialization and new business models.

Fried used her presentation to answer five questions:• What is digital health?• Why are digital tools needed?• What is the future of digital health?• What are the barriers to digital health?• What advice would she offer innovators

and entrepreneurs?

What is digital health?Digital health used to mean electronic medical records, said Fried. It still does, but it encompasses much more today. Telehealth – that is, the remote delivery of care – is one aspect. Using computers, cellphones, videoconfer-encing and other technologies, patients and doctors can confer remotely in “virtual clinical visits.”

Home health monitoring – another aspect of digital health – is catching on for chronic disease management. For example, patients with congestive heart failure moni-tor their weight daily, giving doctors a heads-up when un-wanted fluid buildup is occurring.

Wearable devices that track our activities – running, eating, etc. – are also a grow-ing part of the digital health landscape, Fried added.

Why are digital tools needed?Today, people use their cellphones to check the weather, monitor their stocks, stay current with friends through social me-dia, do their banking, and more, said Fried. But very little healthcare is deliv-ered digitally. “I think that needs to change,” she said.

The reason is, digital solutions offer mobility

and portability. “Doctors and nurses are busy and on the go,” she said. “It would be great for them to get informa-tion as they move throughout the day.” Digital data frees caregivers from their clinics and workstations. “Patients are also becoming untethered. This means they can get care where they are – at work, home, school.”

By migrating from paper-based data to digital data, providers can combine and analyze information in a way

Digital health ‘More than a gleam in

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Using computers, cellphones,

videoconferencing and other

technologies, patients and

doctors can confer remotely in “virtual

clinical visits.”


they never were able to before, she added. “The future of healthcare will be all about data mining and analysis, to help us prevent diseases and create new therapies.”

Digital health can lead to lower healthcare costs, said Fried. For example, providers can monitor pa-tients with chronic conditions, heading off emergen-cies, which are traumatic for the patient – and expen-sive. What’s more, telehealth can spare patients and doctors the time and expense of personal visits, which often end up with referrals.

“Patient convenience is a huge piece, and a won-derful opportunity for cost-savings,” she added. For example, sick children can be cared for at home rather than being driven by their mom or dad to a tertiary care children’s facility. Home-based video robots can moni-tor patients in the days following surgery, sparing them the inconvenience of getting in the car and going to the doctor. “Em-ployers are excited too,” because telehealth means fewer days off for employees.

What is the future of digital health?“We will see clinically important infor-mation coming from wearables,” and not merely those found at the sporting goods store, said Fried. Google’s “smart” contact lens, which can measure glucose levels in tears, is an example of a promising tech-nology under development. Fried foresees more usage of “smart,” sensored clothing and utensils. “Even our cars will be digitally enabled,” she said, with the capability of measuring blood pres-sure and other biometrics. These “invisibles” will be embedded in the environment, to help consumers track their health and stay healthy.

What are the barriers to digital health?Technology hurdles aside, one question is the degree to which digital health will be regulated by the Food and Drug Administration and other agencies, said Fried. Heavy-handed regulation could hamstring the industry. But there are other barriers, including privacy concerns. “It’s imperative that any solution guard patient data; it can’t fall into the wrong hands.” Another barrier is the lack of interoperability among digital systems. Existing IT systems are complex, opaque and hard to access; more-over, a lack of standards hampers interoperability.

Words of advice for innovators and entrepreneurs?Fried offered these suggestions to innovators:

• When developing a product or service, start with real healthcare problems. Patients are looking for convenience, and providers have to respond. Doc-tors’ most valuable asset is their time, and any tech-nology that can save them time can be easily mon-etized. On-line access to new medical information is one example. Meanwhile, payers are demanding better outcomes, and technology can help. And who isn’t looking for ways to reduce healthcare costs?

• Build a team to work on these solutions. “Don’t innovate in isolation,” Fried advised. A variety of opinions and people strengthen innovation.

• Focus on human-centered design. “If you’re work-ing on a solution for clinicians, think of their work-flow and how the tool will work for them,” she said. “If you’re working on something for the patient or consumer, make it easy or even fun to use.”

• Start with an MVP – that is, a minimum viable product. Start with a basic solution to help you test your hypothesis. Keep it simple.

• Don’t be afraid of failure. “Failure is inevitable when innovating,” she said. “Very rarely do you get it right the first time.”

• Have fun. “Innovation can be hard and frustrat-ing.” It’s important to introduce some levity into the process.

“ Patients are becoming untethered. This means they can get care where they are – at work, home, school.”

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HEALTHY REPS

Unplug and unwindWho wouldn’t jump at the chance to take advantage

of paid vacation time? Apparently, about 40 percent of the work force. According to research from Ala-mo Rent A Car conducted January, 2015, about 40 percent of American workers who receive paid va-cation as a job benefit do not use all of it. And, of those who do use at least part of their vacation time, only half unplug – or turn off their devices – while on break.

When asked why they didn’t use all their vacation days, 47 percent of participants responded that they

were too busy at work. In fact, 19 percent reported five days or more of paid vacation went unused in 2014. That said, those who claimed to have used all of their paid vacation were more likely to unplug while on their trips (54 percent vs. 37 percent of respondents).

The study also found that parents are more likely to get paid vacation than non-parents (59 percent vs. 47 percent). At the same time, parents tend to take shorter vacations than non-parents. About 37 percent of parents reported their family vacation lasted five days or less versus 26 percent of non-parents.

Alamo’s research suggests that younger Ameri-can workers are finding it increasingly difficult to leave work behind. About 35 percent of millennial respondents report they are likely to work every day while on vacation. In addition, about 29 per-cent of this group says that completing work prior to taking vacation is an additional stressor.

Vacation trendsAlamo’s research identified several vacation pat-terns among respondents, including the following:

Frequency, length and timing.• Thirty-eight percent of respondents prefer

taking two vacations per year, and they are six times more likely to vacation during the summer.

• Thirty-six percent report taking family vacations lasting, on average, six to seven days.

Electronics.• Fifty-three percent of respondents use

screen time on vacation to keep everyone entertained during the flight or drive.

• Dads report being more likely than moms to approve the use of electronic devices for their children on vacation (98 percent vs. 93 percent).

• Six percent of parents do not let their children use any electronic devices on vacation.

Stressors.• The greatest source of vacation stress ap-

pears to be over-spending. Forty-six percent of respondents report feeling apprehensive about this.

• About 26 percent of respondents say they find packing to be stressful as well.

It may surprise some to learn that, depending on where one lives, he or she is more likely – or less – to receive paid vacation time. Midwesterners re-portedly are the most likely to get paid vacation time (62 percent of respondents). Of these respondents, 43 percent seek a warm and sunny destination. (Per-haps the Midwest weather is a factor?) About 13 percent of respondents from the West say they pre-fer outdoor vacations, while respondents from the South are more likely to schedule weekend getaways or cruise vacations. Northeasterners, on the other hand, appear to prefer vacations to theme or water parks (about 14 percent of respondents).

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Apple Watch: Does it deliver?Those who haven’t already purchased the new Apple Watch are missing out on something big: the expense. At a cost of $349 for an Apple Watch Sport to $17,000 for a high-end Apple Watch Edition, consumers likely expect a whole lot of bang for their buck. Here’s what they get:

• Access to such apps as Instagram, MLB.com, At Bat, Nike+ Running, Open Table, Shazam, Twitter and WeChat.

• Bands available in leather, rubber and stainless steel.• Aluminum, stainless steel or gold case.• Touch screen with scratch-resistant sapphire crystal

Retina display and integrated antenna.• Up to 18 hours of battery life.• Snap-in-place charger.• Easy-access chatting, calling and Apple Pay.• Customizable watch face.• Alarms, stopwatch, ability to monitor physical activity.• Screen swipes that permit user to check on meet-

ings, sports scores, stocks, weather and more.• Remote camera feature that allows user to line up

the shot, set the timer or take the photo on his or her iPhone.

There’s more. As with Apple phones, users can see thumbnails of their BCFs (best contacts forever). Better yet, they can send customized vibration patterns, which the receiver can feel on his or her wrist. They can draw a sketch to send to a friend that will animate on the receiv-er’s Apple Watch. And, they can even send their heartbeat to a friend. Indeed, for $17,000 ($549 for the average Joe looking to buy a low-end Apple Watch) what’s there not to love? Source: Chicago Tribune.

Chew on thisLooking for a fresh take on sales? Think cookies – Girl Scout cookies, that is. For the past three years, Girl Scouts has focused on technology as a central mission of the organization, recently implementing a Customer Engage-ment Initiative to transform how to use technology to

communicate with girls, adults, and councils, and to more effectively deliver the Girl Scout experience. It has paid off and the organization recently received honors from Fast Company in its annual ranking of the world’s 50 Most Innovative Companies issue. Earning recognition as one of the World’s Top 10 Most Innovative Companies of 2015 in not-for-profit, the publication called out GSUSA for creating Digital Cookie, an educational digital sales program run entirely by the girls. The new addition to the Girl Scout Cookie Program introduces girls to new lessons about online marketing, app usage and ecom-merce, while creating a safe and interactive space for sell-ing cookies. Digital Cookie marks the first national digital platform in the history of the iconic cookie program.

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.

QUICK BYTES

Technology news

Quality and price may be two of the most universal languages spoken

by sales reps and their customers. And, as many experts point out,

where a product is made should not supersede how well it is made.

That said, American-made products are generally known to follow

specifications that meet the needs of healthcare providers.

The special section will be a pull out in the magazine featuring

manufacturers that produce products in the USA.

Repertoire is excited to announce

a special section coming in July.

“Made in America”

If you want your organization featured in this special section please contact

Scott [email protected]

770.263.5256

vol.24 no.7 • July 2015

repertoiremag.com

Made In The USA


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 newsStay put!Attention California drivers: You need to remain in your vehicle when driving on the freeway, or any other roads for that matter. Consumer Watchdog recently warned the California Department of Motor Vehicles that it must not allow Google and others with a vested interest in develop-ing driverless vehicles to push the DMV into issuing rules regulating the public use of robot cars on highways that are inadequate to protect public safety.

Consumer Watchdog’s letter listed a number of short-comings of Google’s driverless car technology, including its ability to respond to:

• Weather. Heavy precipitation interferes with the vehicle’s sensors and they don’t work in the snow or heavy rain.

• Human hand signals. The robot cars can’t inter-act reliably with hand signals given by the human driver of another vehicle, or a policeman using only hand signals to direct traffic.

• Sunshine. If the sun is behind a traffic light, it can interfere with the driverless car’s ability to determine the traffic light’s color.

• Changing road conditions. The sensors don’t recognize large potholes or open manholes. Also, if a traffic light were installed overnight, as in the case of a road construction site, the car’s driverless navigation system would not expect it.

• Pre-mapped roads. Google’s robot cars rely on detailed sensor mapping of routes before the robot car hits the road. If a Google driverless car tried a route that had not been specially mapped, possibly including a large parking lot, it wouldn’t know what to do.

• Pedestrians. The driverless cars’ video sensors can’t reliably distinguish between a tree branch blowing in the wind and a pedestrian.

The decision regarding whether to allow a particu-lar manufacturer’s driverless cars to be offered to the public should be informed by the results of safety test-ing that is being done under the DMV testing regula-tions now in effect, according to Consumer Watchdog. DMV regulations governing the testing of driverless cars on California highways took effect on Sept. 16, 2014. A key safety provision of the testing regulations is the requirement that there must be a test driver in

the driver’s seat who is capable of assuming control of the car. Safety issues have not been the only concern about driverless cars. The DMV’s autonomous vehicle regulations should provide that driverless cars gather only the data necessary to operate the vehicle and re-tain that data only as long as necessary for the vehicle’s operation, Consumer Watchdog said. The regulations should provide that the data must not be used for any additional purpose, such as marketing or advertising, without the consumer’s explicit opt-in consent.

A key safety provision of the testing

regulations is the requirement that there must be a test driver in the driver’s seat who is capable of assuming

control of the car.

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Sometimes the pieces fit together just right. For David

Kohlstedt, since his school days, there’s been little question that healthcare was the right field for him to pursue. “I have always been passionate about helping others and joined the healthcare industry in 1983,” says Kohlstedt, an account manager for Tri-anim. Not to sound corny, he adds, “but when I was a kid it was the lights, the sirens and the shiny stuff ” that attracted him to the industry. By the time he en-tered high school and began to consider a profession that would interest him, “it just seemed natural that I would go into the fire service as a firefighter/paramedic.

“My senior year of high school, I enrolled in a vo-cational program that gave me the opportunity to work [weekday afternoons] as a student aid/orderly at Palos Community Hospital (Palos Heights, Ill.),” Kohlstedt continues. He also joined the Orland Fire Protection Dis-trict (Orland Park, Ill.) as a cadet. Once he graduated, the hospital hired him full time in the emergency room, and the fire department took him on as a paid-on-call em-ployee until 1987, when he was promoted to a full-time firefighter paramedic. In 1993, he was promoted to the rank of lieutenant.

“There is an indescribable feeling and satisfaction that you get when you are able to help somebody who is in need,” says Kohlstedt. “This feeling is multiplied exponen-tially when you can help someone during a crisis [he or she] may be having. [Not only that], the excitement that goes along with the job, and the camaraderie you have with the men and women you work with, is something you can’t find anywhere else

Prepared for Each Moment

For David Kohlstedt, following his passion has paid off in the form of a rewarding career.

By Laura Thill

David Kohlstedt


“At the Orland fire protection District we were cross-trained as Firefighters/Paramedics,” Kohlstedt continues. “At each station we would have an ambulance, as well as a variety of fire suppression vehicles (e.g., engines, trucks, and or a squad). I worked a shift schedule of 24/48 and lived at the firehouse every third day – meaning I was on duty for 24 hours, and off for 48.” Al-though his shift was scheduled to end at 7:00 a.m., there were days when an early-morning call came in, detaining him and his colleagues well beyond quitting time. “On many occasions we would be dispatched around 6:00 a.m. and, depending on [the nature of the call], might not get off till noon.” A typical day’s work also involved vehicle inspections and housework, as well as a training exercise or two, he adds.

In 1999, after 16 years, Kohlstedt made the decision to transition into a sales role. It was a good fit, he recalls of the first job he took in automotive aftermarket sales. But an even better

opportunity arose when a recruiter called him about a po-sition that became available in Tri-anim’s EMS division – currently called Bound Tree Medical.

“Sales is about taking care of the customers’ needs,” says Kohlstedt. “I learned how to do that from my experi-ence in automotive aftermarket sales. But, when the op-

portunity at Tri-anim opened up, this was fantastic!” Emergency medical equipment was something he knew and loved, and it was clear that this would be a perfect fit, he points out.

A helping handNot being able to take care of an-other person’s needs can be frustrat-ing, particularly for one who devotes his days to providing his custom-ers with the best possible solutions. Such was the case for Kohlstedt on a recent flight with his manufacturer rep partner, Brian Kroes, a territory manager at Flexicare. “Brian and I were sitting in the second-to-last row

“Sales is about taking care of the customers’ needs.

I learned how to do that from my experience in automotive

aftermarket sales.”– David Kohlstedt


corner

of the airplane,” he recalls. “A flight attendant asked the gentleman sitting next to us in the aisle seat if he could move, as they had a passenger who was not feeling well and needed to be near the lavatory.

“Looking over my shoulder, I could see there were three flight attendants standing around the open lavatory door,” he continues. “When I asked the first flight atten-dant what was wrong with the passenger, she told me he was nauseous and sweaty. I informed her that I am a retired paramedic and asked if there was anything I could do to help. She immediately said there was, and asked if I could take a look at him.”

The passenger, who appeared to be in his late 70s, ex-hibited symptoms of a possible heart attack, he explains.

“I stayed with him for the remaining 30 minutes or so of the flight. During that time I monitored his vitals and made sure we had everything ready in the event that things got worse.” As it turned out, Kroes had a Flexicare dual-can-nula in his bag. Hesitant to place an airline oxygen mask on the ill man in case he vomited, Kohlstedt believed the Flexicare cannula would provide a perfect solution. Unfor-tunately he couldn’t use it, because the oxygen bottle on board was not a fit.

“Medical emergencies occur on flights quite a bit,” Kohlstedt says. “It would have been great if I could have connected the cannula. Instead, I held an orange airline oxygen mask in front of the patient’s face, while I applied a cold compress to the back of his head.” A tense situation, yes. But, once a paramedic, always a paramedic. “Even as a

retired paramedic, it all comes back to you,” he says. Upon landing in Chicago, the patient was taken by ambulance to a nearby hospital. Although he never learned how the ill passenger fared, Kohlstedt has made a point to follow up with the airline and recommend they prepare better for emergencies such as this one.

Flying highAs grounded as Kohlstedt is on the job, when it comes to relaxing, he takes off – literally. “I have a commercial multi-engine aircraft license, so I can fly both single and twin engine aircraft under 12,500 pounds,” he says. Al-though it’s becoming increasingly challenging to find the time to fly, he is committed to flying at least every 90 days

in order to keep his license current. It appears that staying current with the

new aircraft technology can be equally as chal-lenging as staying current with new medical technology. “Most of the newer aircraft have glass cockpits, and it’s truly amazing what they can do,” says Kohlstedt. In addition to keeping up with new electronics, pilots must take constant steps to avoid mishaps, such as allowing external pressures to influence criti-cal decisions they make while airborne. “[It’s important for pilots to conduct] a thorough preflight inspection and follow checklists through every phase of the flight,” he says.

“The farthest I have flown is to Key West in a twin Cessna 310,” he says. “There are so many things that I enjoy when I am flying. The complexity of the whole process takes my

mind off of everything else that’s going on. I really love it.”

Training and prepPerhaps one of the biggest lessons Kohlstedt has learned over the years is that training and preparation are critical to a successful outcome. “Whether you are in the back of an ambulance, in the cockpit of an airplane or in the office of a customer, you need to be prepared for [each] moment and anything that may arise during that time,” he says. “You must have a clearly defined destination before you start, and do the preparation necessary to get you there.

“I have always enjoyed keeping busy, and I have always enjoyed the work I’ve done,” he says. “And, I continue to do so at Tri-anim, calling on respiratory and anesthesia de-partments for our acute care division.”

“ Whether you are in the back of an ambulance, in the cockpit of an airplane or in the office of a customer, you need to be prepared for [each] moment and anything that may arise during that time.”

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PEOPLE

Born in 1960, Barnaba was raised in Baltimore County, Md. His father, Vince Barnaba, be-gan his career in 1955 at Murray-Baumgartner Surgical Instrument Co., Baltimore, as that company’s first physician salesman, says Davis. When Murray-Baumgartner was acquired by Healthco, Vince Barna-ba was named branch sales manag-er until the company was acquired by Foster Medical (now McKesson Medical-Surgical), at which point he was promoted to president of Fos-ter/Murray-Baumgartner. Vince Barnaba retired in 1993, and he and wife, Pat, live in Towson, Md.

Customers came firstMike Barnaba began his medical sales career at Foster/Murray-Baumgartner, where he worked in customer service from 1980 to 1984, says Davis. “My first impres-sions of Mike were very positive. I was amazed at how he accepted responsibility and always put his customers’ needs first, especially at his young age. He also had his own unique way of calming down even the most irate customer. I could tell by his passion to succeed

that he was there to learn as much as possible, so he could start his career in medical sales.”

Barnaba left to take a position with Clay Adams (now Becton Dick-inson). “He was instrumental in the success of Clay Adams’ new product launch of their QBC blood analyzer, and was among the company’s top salespeople,” says Davis.

In 1988, he and his older brother, Rick Barnaba, created Barnaba Asso-ciates, an independent rep firm. (Rick continues to work for GE Healthcare today.) In 1993, Mike and Rick joined Southern Sales Associates, an inde-pendent rep firm founded by Chris Kelly and Brian Taylor, who later founded Repertoire magazine.

“I first met Mike Barnaba when he was a high school kid working in the warehouse at Murray-Baumgart-ner,” says Taylor.

“Mike was such a personable young guy – always with a big smile on his face,” he continues. “He was the type of guy who made you want to be around him. It was years later that we added the ‘Barnaba Boys,’ as we called them, to our team at Southern Sales Associates. They covered the mid-At-lantic states for our rep group.

“Mike was very knowledgeable about the products, having grown up in the business and being ground-ed via his warehouse work, picking orders and such. He worked hard, and was a real professional in his approach to selling. He was a very good salesman.”

Mike Barnaba: Passionate about sales

“He was a bright light that left us

way too soon.”

– Brian Taylor

Mike Barnaba was a passionate medical salesperson and, later, a successful entrepreneur in the roofing business. “[H]e lived each and every day to its fullest,” says Kevin Davis, a medical products sales-person most recently with Propper Manufacturing – and Barnaba’s brother-in-law. “He never made excuses for yesterday or thought about tomorrow.” Barnaba died unexpectedly in November.

Mike Barnaba


In 1995, after 15 years in medi-cal sales, Barnaba went to work for a friend of his from high school in the roofing business, explains Davis. Be-fore long, he was named president of National Roofing Co. in Baltimore. He played a major role in rehabbing structures following damaging Atlan-tic and Gulf State hurricanes in 2004 and 2005. “He was also proud to have replaced the roof on the Vehicle As-sembly Building at NASA Kennedy Space Center,” says Davis. In 2010, he left National Roofing and part-nered with business contacts to form Roofing and Sustainable Systems in Baltimore. He served as the compa-ny’s president until his death.

“Mike used his experience in medical sales to make a successful transition into the roofing busi-ness,” says Davis. “He had an un-canny ability to think outside the box and go after contracts most roofing companies would ignore. His true specialty was estimating and negotiating government roof-ing maintenance contracts. He was old school when it came to contract negotiations, and believed a hand-shake truly meant something.”

Called from Sunday dinnerDavis recalls two incidents that reflect Barnaba’s commitment to serving his customers, even at a very young age.

In 1978, when Barnaba was a high-school senior, working part-time

in the warehouse at Murray-Baumgart-ner, a blizzard struck the Baltimore region, making travel next to impos-sible, Davis says. “One of the cus-tomer service reps had a Jeep, and he picked up Mike and me and we got to work. Our main concern was to ensure that the hospitals that pur-chased IV solutions from us had enough inventory to get through the storm. We called our accounts, filled their orders and contacted the Maryland National Guard, who vol-unteered to deliver the products to the respective hospitals.”

Nine years later, “we were hav-ing a usual Sunday dinner at Vince’s house when Vince got a call from the purchasing manager at Franklin Square Hospital,” Davis continues. An Amtrak train had collided with a CSX freight train in Chase, Md., and the injured were being routed to Franklin Square. “Vince, Michael and I drove to the warehouse, loaded our cars with any products we deemed necessary for the possible variety of injuries they would be treating, and delivered them to the hospital before the first victim even arrived.”

Barnaba leaves behind his wife, Jane; and daughters Lauren, Lindsey and Lisa. His younger brother, Tom, works for biotechnology firm Nano-EnTek Inc.

“Mike will be missed by his fam-ily and his many friends,” says Taylor. “He was a bright light that left us way too soon.”

“He was old school when it came to contract negotiations, and believed a handshake

truly meant something.” – Kevin Davis

“ He also had his own unique way of calming down even the most irate customer.”

– Kevin Davis


NEWSMidmark announces addition of new case-work project managers to medical divisionMidmark Corporation announced the addition of Jona-than Coombs to the medical division salesforce as project manager. Coombs will report to Dave Cantwell, national sales manager, casework products and services, and will be responsible for continuing the growth of Midmark Clini-cal Solutions and the new Synthesis Casework Collection. Coombs will be responsible for casework products and services in Arkansas, Indiana, Kentucky, Mississippi and Tennessee. He brings more than 14 years of experience in the sales and healthcare project management field. Most recently he held the position of implementation manager for Balfour Resource Group(BRG) in Nashville, Tenn. Coombs holds a Bachelor of Science degree in civil engi-neering from Western Kentucky University.

Welch Allyn names second winner of Ripple Effect ContestWelch Allyn and Heart to Heart International announced Kathleen Iles, a first-year medical student at SUNY Upstate Medical University, as the second winner of the 2014 Ripple Effect Contest. This summer, Iles and the other 2014 and 2013 Ripple Effect student winners will work alongside physicians and aid workers in impoverished and medically underserved communities in Haiti. The Ripple Effect Contest encourages medical students to use social media to share how they will create their own “ripple effect” of good in their community or globally. Entrants were asked to “like” the Ripple Effect program page on Facebook and share a picture with a short essay or a short video showcasing their “ripple effect” – a brief narrative about how they would “change the world” by using their training to help those in greatest need.

»» CorrectionIn the March 2015 Rep Corner, “A Gift of Life” Melissa Deitz, special account service rep, Henry Schein, and Wendy Klein, medical sales support team rep, Henry Schein, were incorrectly identified in the image captions. Repertoire regrets the error.

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LEADERSHIP

A young freshman cadet hurried down the

hallway, running late for his next class at the military academy. Turning a corner, he suddenly collided with another student. Sprawled on the ground, he looked up and winced when he saw the derisive smirk on the face of the upperclass-man he had just run into. As expected, the older cadet didn’t pass up the opportunity to haze the younger man; choosing his words carefully, the upperclass-man said mockingly, “You look like a barber!”

The freshman’s ears reddened and he ducked his head as he quietly responded, “I was a barber, sir.” Startled

by the coincidence, the senior cadet abruptly turned on his heel and strode off, hurrying toward his dorm room. Upon arriving in his room, obviously shaken, the upper-classman announced to his roommate that he would never haze another plebe again, explaining, “I’ve just done some-thing stupid and unforgiveable. I managed to make a man ashamed of the work he did to earn a living.”

After that incident, West Point cadet Dwight D. Eisen-hower strove to never humiliate, embarrass, or demean another person, no matter how annoyed he became. This personal resolution developed into a keen sense of diplo-macy that served him exceedingly well as he slowly rose

in military rank and ultimately became the 34th President of the United States.

The mark of a leaderDiplomacy is a mark of a leader who demon-strates strong strategic and pragmatic leader-ship. Leaders who are strategic and pragmatic are very perceptive, with a knack for pinpointing

needs and striking compromise. Skillful at mediating con-flict and diplomatically handling individual perspectives and attitudes, these leaders work well with people and tend to make discerning personnel decisions.

Planning for long-term results, strategic and pragmatic leaders make well-thought-out decisions based on facts and simple logic. These leaders are results-oriented and understand the value and im-portance of working together to reach the most desirable outcome.

Which of your leadership strengths – like the diplomacy of Dwight Eisen-hower – can you improve and better

leverage to become a more effective strategic and prag-matic leader? By focusing on improving and applying your leadership strengths, you can become a leader who:

• Is perceptive to needs and individual perspectives• Is skilled at striking compromise• Is extremely results-oriented• Plans for long-term results

Properly answering this question, and taking fo-cused, purposeful action based on your answer, not only can, but will improve your personal, professional and organizational leadership!

Focus on Your Leadership Strengths

Dan Nielsen is the author of the books Presidential Leadership (2013) and Be An Inspirational Leader (summer 2015). He regularly writes and speaks on the topics of Leadership Excellence and Achieving Greater Success, and is available to deliver keynote presentations or facilitate discussions for your organization. For more info, please visit www.dannielsen.com. To watch Nielsen’s videos on Presidential Leadership, visit the Repertoire YouTube channel.

By Dan Nielsen

Leaders who are strategic and pragmatic are very perceptive, with a knack for pinpointing needs and striking compromise.

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