The Catalyst … accelerating business growth in healthcare

Catalyst Blog August 2017

Posted by Frank Ripullo on Mon, Aug 14, 2017 @05:44 PM

 
Essential Healthcare Management Newsletter
August 2017

 EHM Announces Alliance with CapStack West, Innovation Client Spotlight: Avancen, Partnering with EHM

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"We now have a partner aggregating the right investors to offer funding opportunities to companies of all sizes," said Frank Ripullo, Founder and President of EHM. "Whether our clients seeking cash infusion are pre-revenue startups looking for equity investors, middle-market companies requiring growth or acquisition capital, or market... Read

Client Spotlight: Unknown.png

Our client, Avancen, is going places. Look for us at the October 5-7: HealthTrust Innovation Summit 2017 where Avancen has been invited to participate by HealthTrust's team of Clinical and Operational experts. Read 

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We are honored to get our clients the attention they deserve and glad to be part of an important and innovative solution in the world of medication delivery and security.

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There is a greater focus on new technology now more than ever. And GPOs are paying attention! During first quarter, we scored a big win for Avancen: a New Innovative Technology Contract from Vizient for the World's First Oral PCA Device.Read press release. Is your company ready for this designation?

Your products might be innovative but how do your company operations stack up?

Click now to download!

EHM GPO-IDN  CONTRACTING ASSESSMENT

If you’ve been wondering about outsourcing your national accounts to capture more business in the healthcare sector, but not sure how working with Essential Healthcare Management would look, you can start by downloading our free GPO and IDN Contracting Assessment. Get a preliminary view at collaborating with us to design an outsourcing program for your company’s needs. Truly ingenious!

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Guess which one of these upcoming shows offers the best opportunity to network to drive business through your IDNs?
 
Want to know about networking opportunities?
Yes! Let's have a conversation.

August 28-30, 2017: Fall IDN Summit and Reverse Expo JW Marriott at Desert Ridge Resort and Spa

September 13, 2017: Vizient Clinical Connections Summit. 

March 6-10, 2018: AAOS; American Association of Orthopedic Surgeons www.AAOS.org

March 24-28, 2018: AORN Association of PeriOperative Registered Nurses, Conference and Expo, New Orleans, LA

April 12-15, 2018: AONE www.AONE.org. Baltimore MD

Click here to see more shows. 

 

Essential Healthcare Management, Inc. 

(949) 842-2520

 

 

Tags: EHM, hospitals, healthcare suppliers, medical devices, GPO, IDN, contracting assessment, avancen, healthcare investing, innovation award

GPOs and Medical Device Innovation for Hospitals

Posted by Frank Ripullo on Wed, Mar 01, 2017 @06:23 PM



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There is a greater focus on new technology now more than ever. And GPOs are paying attention! When we think of innovation, we mean products that do something new -- something that doesn’t already exist in the marketplace which is what our client, Avancen, did when they found a practical solution to improving patient care. We recently scored a big win for Avancen: a New Innovative Technology Contract from Vizient for the World's First Oral PCA Device. Check out the press release.

Plenty of companies have innovative products coming through the pipeline but where do they end up?

EHM is fortunate to encounter exceptional companies on the cutting edge of medical industry technology. Innovative medical devices that improve patient safety as well as supplies and devices that advance clinical outcomes is an important part of our business. Anything that makes a hospital run better is game! Whether or not you believe your company’s latest products are innovative because they provide the same, or better than the standard outcomes, and possibly even at a reduced cost to hospitals, is a question that GPOs can examine to determine if their hospital members can benefit. Most GPOs have internal groups focused on finding new technology that meets their current needs. And often, EHM is able to help these medical device companies promote their new technologies through group purchasing organizations and integrated delivery networks to get their products deep into hospitals.

If your company has the latest and greatest in a medical device category, how easy is it to go straight to doctors in order to get product champions? Now, reimbursement, budgets and security are all issues to consider and may not have been before. And, if you get past all of that, do you have enough reps out there to reach your targets? As a medical device supplier, how will you gain the support of any GPO and maintain it as you compete with other vendors on that GPO that are in your space? Here's where we play a pivotal role.

If you are ready to beta test your product, call us. We can launch your product and get end-user feedback for you. An independent study facilitated by a hospital will prepare your product for entry better than any internal studies used for validation.

Check out some of the GPO-sponsored new technology shows below. Your company could be one of the selected new technology firms aksed to attend any one of these annual tradeshows during which facilities meet suppliers and preview their products!

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Today’s group purchasing organizations offer programs that invite cutting-edge devices into the competition. Click the links for more info:

Yes! Let's have a conversation.

 

For more information on medical device innovation in the healthcare supply chain, call (949) 842-2520.

Tags: medical devices, GPO, new technology, innovation

EHM September 2015 Newsletter

Posted by Jessica Hartman on Wed, Sep 23, 2015 @08:13 AM

Essential Healthcare Management Newsletter
September 2015
EHM Launches eTracer®, the First Sales Data Management Solution to Automate Administration Fee Tracings

SEPTEMBER 22nd, 2015 -- Essential Healthcare Management, Inc., today announced its partnership in a proprietary agreement with, eTracer®, a professional sales data management service to launch software solutions designed to expedite and simplify the tracking of administration fees. eTracer’s® offerings also include: sales data collection, cleaning, processing and reporting; rebate and chargeback processing; sales and commission reporting; and, on-demand web reporting. All software programs are custom-configured to provide real time on-demand web reporting making eTracer®, the perfect solution for creating scalable data for suppliers in the medical device industry.

“EHM is delighted to partner with eTracer®, to offer critical cost-saving sales data management tools to its clients so that they can continue to focus on providing quality products where cutting corners in an ever-changing market has become the trend,” said Frank Ripullo, managing partner of EHM, Inc. “Among one of the many cost-effective ways for suppliers to quickly benefit from eTracer®, is through the GPO fee reporting service which greatly simplifies administration fee tracings resulting in instant savings.”

eTracer®, easily automates data collection and processing leading to customized reports. Every organization wants current and accurate sales reporting. With eTracer®, tracking sales performance through zip codes, is quick and simple. All programs feature on-demand web reporting with continuous access and advanced security settings. The efficient collection of tracings files and reports can instantly validate transactions. Additionally, using a proprietary 13-step system, rebate and chargeback processing is simplified to track claims data for future audits.

"We recently switched from a different service to eTracer and have been extremely pleased. Not only do the reports come earlier in the month than what we were used to, any issues requiring support are handled quickly and efficiently. It is my opinion that this is the strongest and most economically sound solution available in the marketplace as third-party report generation is concerned."

-Brett Hazuka, Vice President, UreSil, LLC

Please click below to find out more information.

Of Course I Want to Know More!

To Schedule a Demo Please Contact: Jessica Hartman, EHM Director of Business Development

jessica@essentialhm.net

Ph: (704) 574 - 2131

www.etracerdata.com


EHM Gains More Experience and Expertise with New Team Members

Eugene Pyatenko - Senior Advisor

Mr. Pyatenko has over thirty years experience in the fields of insolvency and bankruptcy, debtor and creditor rights, commercial transactions, financial structures, litigation, construction and real estate law, international business transactions, and mergers and acquisitions. He has provided corporate strategy and structure advisory services to clients in a wide range of industries including: health, manufacturing, service, transportation, distribution, contracting, automotive and construction, both domestically and internationally. As an attorney, he has worked closely with corporate executive teams, debtors, lenders, and creditor committees in out-of-court as well as formal proceedings and has provided consulting and litigation support services in turnaround, mergers and acquisitions, as well as political endeavors. Mr. Pyatenko is a recognized professional in his field and enjoys many awards and honors from the local business community. Over the years, he has been chosen to lecture on topics ranging from industry specific business strategies to international trade relations and the expansion and development of business connections into foreign trade zones.

Thomas Hickey - Senior Advisor

A Thirty (30+) plus year veteran in the medical sales space and serial entrepreneur. Mr. Hickey was the founder and CEO of a successful, multi-million dollar medical distribution company and developed a technology transfer initiative from Stockholm Sweden. He has held leadership roles in a national GPO, an Orthopedic Power Company and several start-up enterprises. Additionally, Mr. Hickey has served on the Board of American Association of Critical Care Nurses, a 60,000 plus member, not for profit organization, providing him insight into the challenges facing clinical medicine. Mr. Hickey has a varied background of achievement and results. He holds a Master’s Degree in Health Economics and a Bachelors in Business Management. He is an expert in sales and distribution processes and “go to market” strategies for new products and the development of blue water strategies for existing products.

Jon Artz - Advisory Committee Member

Hailing from New York City, Jon Artz has spent the last two decades in Healthcare Sales & Consulting. With his extensive and dynamic background, Mr. Artz has served in various markets within the industry, including: Managed Care, Home Health, Pharma, Product Sales, Service, Finance and Manufacturing. Mr. Artz has developed and grown businesses from Start Up’s to the most well established Healthcare companies. As a Volunteer Advisor to EHM, Mr.Artz offers insight to Business Development strategies to ensure growth in the Healthcare Marketplace. Mr.Artz sits on other advisory committee’s and has acted as 3rd Party Moderator at Business Roundtables and Focus Groups.


About Essential Healthcare Managemnt, Inc.

EHM is the leader in partnering with medical industry suppliers to promote sales by aligning corporate accounts strategies to improve enterprise agility and domestic and global sales. EHM’s lean and fast approach serves a variety of suppliers enjoying market penetration and contract uptake through GPOs, IDNs, RPCs. To facilitate rapid growth, EHM retains an unparalleled network of senior executives. Services include national accounts management, growth planning, contract negotiations, sales, and, marketplace assessment.

If you would like to learn more about EHM, please contact us:

Yes! Let's have a conversation.

www.essentialhm.net

 

Tags: EHM, healthcare suppliers, medical devices, GPO, Frank Ripullo, Management, Fee reporting, tracings, etracer, Stan Schroeder

EHM and Intego

Posted by Jessica Hartman DeVore on Thu, Oct 04, 2012 @01:42 PM

ESSENTIAL HEALTHCARE MANAGEMENT LEADS INTEGO, A CRITICAL ALERT SYSTEMS COMPANY, IN EXPANDING NATIONAL ACCOUNTS STRATEGY

DALLAS – September 26th, 2012 – (EHM) a healthcare business consulting firm, was chosen by Intēgo® to help secure contracts with integrated delivery networks and group purchasing organizations across the United States.

EHM is a healthcare business development firm, creating demand for the products and services of leading medical suppliers.  Since 2007, the group has served the needs of clients, combining corporate accounts strategy and operational infrastructure.  EHM guides clients through the procurement process and helps companies present their offerings to key decision makers and target audiences.

Intēgo® has been the leading manufacturer and installer for healthcare communication products and services for the healthcare industry since 1985. Intēgo® provides Nurse Call products to hospitals and skilled nursing facilities nationwide.  The Intego Software’s CommonPath™system is the most comprehensive nurse call solution on the market. It is designed to accommodate today’s three principal nurse call modes of operation; Direct to Caregiver, traditional to nurse station, and the CommonPath Centralized™ approach.

Tags: Essential Healthcare Management, EHM, medical, healthcare suppliers, medical devices, brand management, business development

EHM and eDocs4MDs

Posted by Jessica Hartman DeVore on Thu, Aug 30, 2012 @01:34 PM

ESSENTIAL HEALTHCARE MANAGEMENT SELECTED BY eDOCUMENT SOLUTIONS, LLC. TO PROPEL GPO, IDN, AND RPC PENETRATION STRATEG

DALLAS – August 29, 2012 – (EHM) a healthcare business consulting firm, was chosen by eDocs4MDs to help secure contracts with group purchasing organizations, integrated delivery networks, and regional purchasing coalitions across the United States.

EHM is a healthcare business development firm, creating demand for the products and services of leading medical suppliers.   The group combines corporate accounts strategy and operational infrastructure to meet the needs of their clients.  The EHM Team brings over 100 years of healthcare experience to the table and is fully dedicated to changing healthcare for the better.

eDocument Solutions, LLC (eDocs4MDs) is a leader in information management services, assisting organizations across the country with storing, protecting and managing their information. Derived from the request of partnerships and practices across the country, eDocs4MDs created a Solution that is encompassing on document management without having to put the onus on the office staff.

Tags: Essential Healthcare Management, medical, healthcare suppliers, medical devices, business growth

ACA’s 2013 medical device tax has already killed jobs & expansion plans

Posted by Jessica Hartman DeVore on Thu, Apr 19, 2012 @10:02 AM

The Patient Protection and Affordable Care Act (ACA) includes a new 2.3% tax on the U.S. sale of medical devices beginning in 2013. The tax was included to raise $20 billion in revenue to partially offset the cost of the new, $1 trillion health program. The 2.3 percent tax is imposed on revenue, not profits, so that the tax applies to devices regardless if they are sold at a loss.
This particular financing measure is now the target for repeal by a growing number of Members in Congress because of its impact on patient access to life-saving therapies, American jobs, and medical innovation in the United States.

Regardless of how the Supreme Court rules on the ACA, there are many claims about the tax that are inaccurate and do not reflect existing realities about its impact.

Jobs and investment will suffer
 
Claim: The new tax will not shift employment offshore because the tax does not create an incentive to move production overseas.
Reality: Even without going into effect until 2013, the device excise tax has already caused companies to lay-off workers, grow device manufacturing jobs outside the U.S., reduce investment in research and development, and eliminate capital investment in new U.S. facilities. The device excise tax applies to the sale of medical devices in the U.S.

This is on top of our federal tax rate at 35 percent and state and local taxes. Combining these U.S. taxes with a slow and cumbersome approval process, the excise tax adds tremendous disincentive to companies wanting to stay in the U.S. and compete in the global marketplace. Compare Ireland’s tax of 12.5 percent of profit and Canada’s national tax of about 15 percent of profit for most companies to the existing U.S. tax rate of 35 percent that many companies face.
 
Tack on the new federal tax of 2.3 percent of sales, which equals about a tax of 15 percent on profit for most companies, and U.S. manufacturers in 2013 will pay a tax of about 50 percent for every dollar earned. Companies operating outside the United States will be at a distinct competitive advantage as those taxes start from a significantly lower base.
 
It’s disingenuous to say that that level of taxation will not lead companies to locate new factories and research and development arms outside of the U.S. Foreign manufactures have a clear price advantage by paying a tax bill that can be half what a comparable U.S. firm will pay. Academic claims that the tax will not have an impact on U.S. jobs is naive and does not match reality. Medical device companies have signaled a warning for several months now.
 
Here are just a few examples:
-Stryker Corporation announced a layoff of 1,000 workers due to the tax
-Boston Scientific built a $35+ million research and development center in Ireland instead of North America
-Boston-Scientific is also girding for a $100+ million charge to earnings in 2013
-Zimmer plans to lay off 450 and take a $50 million charge against earnings
-Cook Medical has shelved plans to build a medical device factory annually in the U.S.
 
No windfall for the device industry
 
Claim: The ACA will insure millions of people and therefore device companies will benefit from new business through the sale of more devices.
Reality: Reducing the number of uninsured will not increase the number of patients seeking medical devices. Most of our medical technologies are either used today by patients in emergency situations or by elderly patients who are already insured by Medicare. There will be no windfall for our industry just because more, non-elderly patients have access to insurance.

 
Here’s why: In the emergency room today, patients receive our technologies regardless of whether they have health insurance or not. These devices that are used in this setting include drainage catheters, tracheostomy tubes, intubation devices and myriad of other devices to maintain life. Federal law requires that all patients in need of emergency services be treated regardless of their ability to pay or whether they have health coverage. The ACA does not change this paradigm.
 
Further, the administration has stated that the demographic group that will most benefit under the ACA are the non-elderly. Young people tend not to be in need of stenting or other vascular or organ repairs for aging related conditions. Most of the patients that use our products are elderly and today they are either treated in the emergency room without regard to health insurance or covered by Medicare that already reimburses hospitals for medical devices.
 
This analysis is borne out in Massachusetts, which has a similar universal health care approach. Internal analysis shows that medical device sales did not increase beyond the increase expected prior to enactment of the Massachusetts new health law.
 
Devastating impact on medical innovation

Claim: Tax will have little effect on medical innovation.
Reality: The device excise tax will have a real and serious impact on medical innovation in the United States as research, development and manufacturing move overseas as a result of the existing tax and regulatory systems in this country. While the medical technology industry has helped to fuel the U.S. economy in recent years, its position as a global leader may erode over the next decade.
 
This will no doubt affect: 1) the ability of Americans to access future break-through medical advancements; and, 2) the growth of U.S. jobs. In the future, China, India and Brazil will experience the strongest gains in developing next-generation products. Without changes to U.S. policies, gains may lead to an exodus of capital, jobs and research away from the U.S. toward these growing markets. (Source: ’Medical Technology Innovation Scorecard: The Race for Global Leadership,’ PwC, January 2011.)
 
The economics of this highly competitive sector are not static and several policies have driven American medical device companies to seek clinical data and launch new products outside of the United States. The new, 2.3 percent excise tax on the selling price of a device will leave companies no choice but to reduce research and development and capital investment in the U.S. It will lead companies to migrate to lower cost tax jurisdictions and tax start-up companies, whether those firms have profits or not.
 
The new tax will force companies to limit research budgets to test new products and ideas – the lifeblood of growing device companies. When these resources are curtailed, patients pay the price with more limited medical treatment and a reduced chance of survival.
 
In addition, the tax will limit capital investment in new facilities. Boston-Scientific projects a $100+ million annual hit to earnings from the tax. Cook estimates it will cost $20 million a year ’ about what we had planned to invest annually in new factories across the Midwest, factories such as the plant that opened 1n 2010 in Canton, Ill., or the expanded plants opened in 2009 in Spencer, IN.
 
Wages from those jobs ripple through and strengthen the local community. This new device excise tax will deny patients access to life-saving medical technologies because companies will be forced to move jobs and research facilities overseas. It is fool-hardy to believe that U.S. companies will be able to compete globally when their competitors do not face the tax and regulatory burdens here in the United States. We are already seeing the impact of the medical device tax and this is just the beginning if this tax is not repealed. Americans deserve access to these break-through technologies.

MEDCITY – Devices
April 16, 2012
By Kem Hawkins (President and CEO of Cook, Inc.)

Tags: hospitals, healthcare suppliers, IDNs, integrated delivery networks, medical devices, market research, Center for Medicare and Medicaid Services, Affordable Care Act, ACA, market forecasting, sales

Follow Up Calls

Posted by Stan Schroeder on Thu, Feb 16, 2012 @03:45 PM

In my 20 years of medical sales experience, one of the most common mistakes I see sales professionals make is having follow-up calls that are not what they should be. If you are calling someone who has done business with your organization in the past but you don't know them well - or it is your first time personally calling them, make sure you are well prepared.
 
And do yourself a favor - put as much pre-call planning into your phone calls as you do your personal visits for the best results. There really should be no such thing as a "cold call" any more with key people in an organization since you can do so much research before you call. If they have any authority - they expect that you have done your homework.
 
Here is an outline I might use to call on someone I don't know well....
 
Good morning _____, this is Rob Bahna with Resuscitation International.
 
I have been working with other ________ departments (or title you are talking to), discussing some ideas that have helped them deal with some of the unique challenges they are facing today with SCA victims. We have seen some outstanding customer satisfaction and positively affected patient outcomes.
 
I would like to ask you a few questions to see if some of our solutions might make sense for your department.
I would like verify some of the information I have been able to learn about your facility and
make sure I understand them from your perspective as the ____________(title)?
 
Ask about them…..

 
I understand you have been a _________ for 5 years. What are the biggest changes you have seen in that time as it relates to how your responsibilities have evolved? Where do you find yourself spending a lot of time where you didn’t use to?
 
Besides yourself, who else do you involve in the important process of purchasing medical supplies and equipment?
 
Sell Your Company
 
Jane, we know it is important for you to know who you are doing business with. Resuscitation International has been servicing the emergency medical supply and equipment needs of pre-hospital professionals for 10 years. We have a proven track record of being an industry leader. We are proud to have more than 100,000 agencies and professionals rely on RI.
 
OR

 ______, as you are well aware, over the last 10 years we have seen a shift in acuity levels. You are being asked to do higher levels of care in many situations with less resources, especially in today’s economy. RI has been in business for over 10 years – and we can help you deal with these challenging times.
 
Determine Your Customer’s Objectives
 
Make them stop and think – ask high gain questions that differentiate you and are not only situational.
 
 
1) What Criteria do you use to evaluate your potential suppliers (business partners)?

2) How do you prefer to place your orders?
 
3) Which company do you currently order your supplies from today?

Do you order from more than one company?
 
4) Could you please share with me what your experience has been with Resuscitation International?
 
If they do not volunteer it – ask them
 
5) It looks like you have not ordered from us in the last ______, could you share with me some of the reasons?
 
 
Engineer Agreement to Demonstrate Product-Program
 
 
________, I appreciate you taking the time to share this information with me. Based on your feedback, and some recent changes we have made it (whatever areas kept them from ordering from us – or things they like about others) we believe we can make your job of ordering easier and be very competitive from a price perspective.

When do you normally place your supply orders? What do we need to do to earn a shot at your next order?
 
If my pricing is competitive, would there be any other reason that would prevent us from doing business together?
 
Best of Luck. Be proud to put your signature on everything you do. Or don't do it.
 
Rob Bahna
Vice President of Sales
Resuscitation International

Tags: selling, Essential Healthcare Management, hospitals, healthcare suppliers, teamwork, medical devices, brand management, market research, priorities, sales, business growth, Management, strategic thinking, business development

Emerging Trends in Gastroenterology Reimbursement Lower Payments, Larger Health Care Organizations Likely To Come

Posted by Jessica Hartman DeVore on Tue, Nov 08, 2011 @10:24 AM

Chicago—As the effects of the Affordable Care Act begin to take shape, it’s clear that physicians will experience a different future regarding reimbursement. In particular, gastroenterologists can expect shared savings programs, bundled payments and re-valued gastrointestinal (GI) procedural codes to directly impact their pay in the years to come, according to economic and policy experts.

The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) are responsible for implementing the new rules and programs. For example, in April, CMS proposed to create accountable care organizations (ACOs), which are groups of coordinated health care providers that agree to be accountable for the overall cost and care of a Medicare patient population and that are willing to tie their reimbursement to quality improvements that reduce overall costs.

Likewise in May, CMS announced its final rule on implementing the Hospital Inpatient Value-Based Purchasing program, which will use a “mix of standards, process, outcomes, and patient experience measures” to score hospitals “on their overall achievement relative to national or other appropriate benchmarks.” The agency said it “will make value-based incentive payments to acute care hospitals, based either on how well the hospitals perform on certain quality measures” or on how much the hospitals’ performance improves after a baseline period. Eventually, the program will likely extend to the level of the individual physician. The HHS stated that the scoring program may be used by “consumers … to make meaningful distinctions among providers’ performance.”

Health Care Market Realignment

By tying reimbursement to quality metrics, the new programs will create newer, larger health care entities and a shift from fee-for-service to flat payments to physicians.

“The Affordable Care Act is trying to bring back risk for what we do and for whom we are accountable to,” said Lawrence Kosinski, MD, MBA, a managing partner of the Illinois Gastroenterology Group, in Elgin, and chair of the American Gastroenterological Association Institute’s Practice Management and Economics Committee.

One response to these developing changes has been to pool the new risk. “From a macro point of view, the provider side is aggregating. You see hospitals aggregating, you see physician groups aggregating, and you see hospital and physician groups [integrating]. Why are they doing this? To get large enough to handle the risk of a population of people,” said Dr. Kosinski.

These seismic shifts are integrating physician groups on a smaller scale, and health care organizations and ACOs on a larger scale. Dr. Kosinski recently merged his practice with two other Chicago-area gastroenterology practices, and now has added a fourth to compete on a regional level and control costs.

On the grander scale, hospital systems are purchasing physician practices.

“Gastroenterology is becoming an employed specialty,” said Joel Brill, MD, the chief medical officer of Predictive Health, in Phoenix, and former chair of the AGA’s Practice Management and Economics Committee. “With one in five gastroenterologists already in employed settings, the number will continue to grow.”

Dr. Kosinski added, “Physicians will not be on fee-for-service; rather, they will have fixed incomes with performance bonuses based on balanced scorecards.”

A recent survey by the Medical Group Management Association shows a nearly 75% increase in the number of physicians employed by hospitals since 2000. Hospital-owned physician practices now outnumber those owned by physicians themselves.

In May, Robert Kocher, MD, former special assistant to President Obama for health care, laid out the reason in an editorial in The New England Journal of Medicine. In addition to primary care physicians, hospitals are now aggressively targeting specialists in order to create “what could effectively become closed, integrated health care delivery systems.” These larger systems not only control pricing power—a Virginia hospital system reportedly charged four to 10 times as much for a colonoscopy as providers in similar, separate markets—but they can also “reduce excess costs associated with unnecessary practice variation.”

Or as Dr. Brill puts it: “He who writes your check will decide what you do.” The big question in this scenario is not whether screening colonoscopy is reimbursed at $1,200 or $2,500, but whether the procedure needs to be done at all, he said. If hospitals employ both primary care and specialist physicians, hospitals effectively control primary care referral patterns for all GI services, which could impact gastroenterologists regardless of whether they spend their time performing office consultations or procedures.

Bundled Payments

In addition to encouraging salaried employment from hospitals and promoting joint ventures between a gastroenterologist and a local hospital, the health reform act will alter GI physicians’ reimbursement by establishing a bundled payment program through Medicare. The program will set a flat fee for “an episode of care,” only for those events requiring hospitalization.

Because screening colonoscopy, for example, is primarily a diagnostic procedure, the bundled payment system will likely not be as complicated for gastroenterologists as it could be for physicians managing chronic conditions in a fixed-fee system. However, physicians with ambulatory surgery centers will have to scrutinize their practice to see where they can increase savings.

“A lot of what gastroenterologists do today are services that are diagnostic and therapeutic as opposed to [those that manage] chronic conditions,” said Dr. Brill. “Where bundled payments could possibly impact us is that if you perform a colonoscopy and have a complication, such as a bleed or the patient has to be brought back because of a poor prep, this could affect what you and the facility get paid for the second procedure. Then you’ve got to figure out how you’re going to spend your money.”

“Right now, if we do a screening colonoscopy and find a polyp, there is no control over when the patient returns for a surveillance colonoscopy,” said Dr. Kosinski. “We may bring them back in three years even if it is not appropriate according to guidelines. What’s coming and what I’ve seen is that the payers are going to give physicians something like a gift card—you’ve got $1,500 for your screening colonoscopy—and the GIs are going to say, ‘Maybe I can use conscious sedation, maybe I don’t want that anesthesia expense,’ and hold on to as much of that dollar as they can. When we get down to the nitty gritty, you will have screening and surveillance done at a fixed cost for the package of the procedure.”

Procedure Reimbursement

By far the most significant effect of health care reform will be on procedure reimbursement, both facility and professional fees. Four years ago, CMS began to phase in a new ASC fee schedule as the result of a Congressional mandate that the schedules should align with payments to hospital outpatient departments. However, the mandate stipulated that the changes in spending across ASCs remain budget-neutral, with the result that ASC fees for GI services fell approximately 25%, said Glenn Littenberg, MD, the managing partner of Gastroenterology Associates, in Pasadena, Calif., and chair of the American Society for Gastrointestinal Endoscopy’s (ASGE) Practice Management Committee.

“One of the big issues is the trend in [ASC] reimbursement for GI endoscopy, which is really a continuation of the trend that began a few years ago,” said Dr. Littenberg, who is also currently the ASGE’s adviser to the American Medical Association (AMA) Current Procedural Terminology editorial panel. “Reimbursement for the facility side from Medicare for screening colonoscopy has now fallen to about or below the level at which the services can be provided. While CMS wants to have effective care delivered in quality facilities and to improve rates of screening for colorectal cancer, its payment policy undermines this [goal].”

The effect on professional fees reflects a change in how CMS is dealing with the recommendations of the AMA’s Relative Value Scale Update Committee (RUC), which makes annual recommendations to CMS on reimbursement rates for physician services. Every five years, the RUC also performs a broader review of the entire Resource-Based Relative Value Scale. Until this year, CMS accepted the vast majority of the RUC’s recommendations and largely left the RUC to determine which physician services to re-value. However, the Affordable Care Act specifically calls for the CMS to have greater scrutiny over reimbursement rates.

“The key thing is Section 3134, which requires the secretary [of HHS] to review and identify potentially misvalued codes,” said Dr. Brill, who is the AGA’s RUC adviser. “For years, CMS pretty much accepted what the RUC recommended—but that’s no more.”

For example, in the 2011 Physician Fee Schedule Proposed Rule, CMS specifically pointed to several GI codes that it believes are misvalued and need to be surveyed for 2011, including upper GI endoscopy diagnosis and biopsy, colonoscopy and biopsy, and colonoscopy and polypectomy.

“Medicare has challenged the GI societies to defend their reimbursement for our bread-and-butter procedures,” Dr. Brill said.

Clearly, CMS wants to be much more aggressive in how they evaluate the physician workload behind a service, said Dr. Littenberg. “We are going to be challenged to defend the values that we believe are pertinent to our services. The outcome may well be that reimbursement for services will fall, because it’s almost impossible to increase the value within a budget-neutral system that is not keeping up with inflation.”

In the future, the Affordable Care Act also calls for the creation of the Independent Payment Advisory Board (IPAB), an executive-branch agency charged specifically with reducing the Medicare growth rate. Importantly, HHS must implement the board’s proposals unless Congress adopts equally effective alternatives; the only way to avoid this would be if both houses of Congress, including a three-fifths super majority in the Senate, vote to waive the requirement. Importantly, however, the IPAB is strictly limited in what it can do to slow Medicare costs: The board cannot ration health care, raise revenues or increase Medicare beneficiary premiums, meaning that physician fees become a likely target for curbing costs.

“The way that the legislation is written, it puts physician fees very much up front in the efforts of the IPAB because they have so many restrictions on what else they can do,” said Dr. Littenberg. “It doesn’t leave much [to cut] besides durable medical equipment, pharmaceutical costs and physician services.”

Adapting to Health Care Reform

Physicians who hope to adapt to these myriad changes need to be able to prove their value and then position their practice to work with others to find savings.

In terms of collecting data, physicians have to ask, “How is this going to result in a benefit or recognition for me,” said Dr. Brill. “As a physician, you should be asking that question very critically—how are the data going to translate into an incentive? Will my fees go up? Will I get paid in a more timely manner? Will co-pays to me get reduced or disappear? Will I be freed from having to submit requests for pre-authorization?”

Whether gastroenterologists are collecting data through an electronic medical record system, an endoscopy reporting program or a registry, the data should align with the outcome measures that Medicare and payers want to see, Dr. Brill said.

Gastroenterologists also need to recognize the power structure within their community and make an effort to find partners.

“More than the government, our biggest threat is the local hospitals, who have the ability to change everyday practice a lot more than the government does,” said Dr. Kosinski. “They are forming very, very large, powerful networks and they are buying the primary care base and employing the people that send us business. So my best advice is ‘do not declare war on your hospital.’ And, do not feel like you have to sell your practice to your hospital. Look to pursue ways of being engaged with your local hospital and your local medical community. Don’t spend your entire day in your ASC. You can’t survive if you spend your life just cranking the colons. You’ve got to work with your hospital, joint-venture with them, and stay engaged with your primary care base.”


Dr. Kosinski reported no relevant financial or other commercial relationship with any manufacturer or provider of products or services relevant to this article. Dr. Littenberg reported financial or other commercial relationships with Abbott Laboratories. Dr. Brill reported financial or other commercial relationships with Avantis Medical Systems, BARRX Medical, Inc., Boston Scientific Corporation, Centocor, Inc., Early Bird Alert, Inc., EndoChoice, Inc., Given Imaging, Novartis Pharmaceuticals, Salix Pharmaceuticals, Inc., SciDose, SmartPill, Spectra Science and USGI.

 


Written By: Gabriel Miller

Tags: healthcare, ACO, healthcare suppliers, ACO Regulations, ACOs and suppliers, medical devices, Healthcare Service Provider, ACA, Afforable Care Act

Referrals

Posted by Stan Schroeder on Tue, Sep 20, 2011 @12:48 PM

We all know how important and valuable referrals are to our business, both short and long term. Several industries survive on referrals, and they almost always help separate average performers from those at the top of the list in selling success. They will help you get over that quota and earn more.

Like many aspects in selling, the length and depth of your relationships with your customers will likely have an impact on the number of referrals you are getting. If they trust you and believe in your credibility – the risk is minimized in their mind.
 
However, in today’s fast paced selling environment, the most successful sales people are the ones who are actively asking for referrals from as many of their customers as they can. We have all run into situations where we get contact information and give them a call and they say “We just went with a competitor. If only you would have called us last week.”
 
In further developing your own sense of urgency, you need to put asking for referrals on your TO ACCOMPLISH list as an activity that you routinely engage in with your customers. But you will find more success if you sell them on giving your referrals versus simply asking.
 
Answer the question for them of WHY should they give you a referral? Remind them of the positive results and experiences that they have had and get them emotionally involved. I believe people buy on emotion and justify it logically – which is why it is always critical to recreate a portion of that emotion before you ask for something.
 
Kathy, from our conversations it appears that you have been happy with the service that Resuscitation International has provided, and you have told me that our pricing has been very competitive. Is that a fair statement? Great - I am glad to hear that. Do you know of any other departments/services in your area that could benefit from our outstanding prices and service - I am sure they will thank you for it....
 
John, I am glad to hear about the great results you have seen from using the Weil Mini Chest Compressor. You mentioned that the ease of implementation, and consistently providing compressions at the adequate rate and depth, without interruption have resulted in some very positive outcomes. Do you have any colleagues at other departments in the area that you feel might benefit from this device to help them experience similar results in their communities?
 
Sandy, thank you for sharing your experience with the Weil Mini Chest Compressor and how it has helped you streamline your protocols and your training. Obviously, quality CPR sustained over time is a critical link in trying to save these patients, and I am glad you have found the MCC a valuable tool to help accomplish this. Can you think of any other departments or colleagues who you feel would benefit from this great new device?

You may never know exactly why they will give you a referral (maybe they are interviewing at that facility and they want to show how up to date they are on industry trends…). But you won’t get very many if you don’t sell them on it. We all know we should ask for referrals. Like everything in sales – it is not what YOU KNOW, it is WHAT YOU DO that matters.

 
Rob Bahna 
Vice President of Sales
Resuscitation International

Tags: Essential Healthcare Management, Schroeder, hard work, EHM, healthcare, medical devices, brand management, referrals, sales, business growth, strategic thinking, business development

Committee Meetings

Posted by Stan Schroeder on Mon, Sep 19, 2011 @04:29 PM

If you are fortunate enough to sell in the medical field, particularly in the acute care setting, one of the things you deal with are committee meetings.
 
Whether it is a new products committee, value analysis committee, code committee - sometimes they seem endless. However, you know you need to deal with them and attempt to stack the deck in your favor so the outcome is what you want it to be.
 
Having been in the medical field for over 20 years (I remember when HMO and PPO and GPO were just letters.....) I have seen many successful sales people handle committee meetings well.
 
As you know, the key is to have a strong internal champion who is sold and on your side. And of course you need to understand why they are going to be your champion (they do things for their reasons – not ours).

It might be that they are true patient advocates that are always looking for the best sources to elevate standards of care. But, there is probably a secondary reason as well – like they are trying to impress their boss, or they are looking to be promoted in the future, or they know that improving patient satisfaction is a key initiative for the quarter. The most successful sales people will understand those reasons most of the time.
 
The first rule is to be in the meeting whenever possible. You will most likely hear that they don’t allow sales people in the meeting. Have they ever? And if you can’t be there – then you need to turn your champion into the best sales person you can in your place.
 
Here are some questions to make sure you ask your champion:

 
I understand this is an important decision. How can I help?
What can we do to convince the rest of the committee?
What will you do if your supervisor or someone else on the committee objects to our proposal?
How do you think the product will benefit your specific environment?
I have helped bring this in at other facilities. Would you like to know what they did to ensure success?
Has there ever been a situation in which a sales consultant was allowed into the meeting?
Have you ever had a chance to drive a new solution like this through the committee?
 
A few other thoughts:
 
1) Find out who is on the committee and attempt to see them before the official meeting. It is always better to stack the deck in your favor and know the votes going in (like a political vote). People always act differently if they have ownership in the idea.
 
2) If it is a big enough decision to warrant it, let them know that you will be in the area if they have any questions during the meeting. Hang out in the cafeteria or clear your schedule and be available by phone. Many of you have been brought in when a technical question comes up if they know you are available (and you have set it up correctly).

3) Make sure you know the next steps after the meeting and have that set up assuming a positive outcome. Get the next steps going as quickly as possible.

 
4) Think of the committees as a way to keep other salespeople out. Most won’t do the work necessary or put in the time appropriately to do all these things. They rely on a champion and go from there.
 
I had an infection control nurse champion tell me one time that I needed to find someone else to bring the product through committee because she had sponsored my last 2 products successfully and they would “vote it down” just because it was her again. I wish I could tell you I was good enough to have figured that out myself – but I certainly learned to look at each account as an individual puzzle.
 
"Do not let what you cannot do interfere with what you can do."
John Wooden

Rob Bahna 
Vice President of Sales
Resuscitation International

Tags: Schroeder, EHM, hospitals, IDNs, medical devices, GPO, sales, business growth, Management, strategic thinking, business development