The key to getting doctors on board is to present them with the evidence, and then put it to a vote.
One of the biggest hurdles in supply chain is gaining physician support for clinical product procurement.
In this interview, Dan Hurry, president of Advantus Health Partners, the Cincinnati based supply chain mangement and group purchasing organization, says the key to getting doctors on board is to present them with the evidence, and then put it to a vote. Hurry spells out the process that he recommends in this, the first of a two-part interview with HealthLeaders. This transcript has been edited for clarity and brevity.
HL: How big of a factor is physician preference in supply chain?
Dan Hurry: From aqualityofcare, fromaneconomic, andfromanefficiencystandpoint,it'sprobably60%ofwhatyoushouldbetalkingaboutandworkingonatanygiventime. Theactivityisrevolvingaround the ORs, the cathlabs,becausethat’s the implantspace,whetherit'scardiac, whether orthopedic, thosearethepredominantspaceswheretheengagementbetweenaphysician and a manufacturingrep andyouroperationalleadersinterconnect.
Would hospitals always belookingforthelowestcost? No.They’re lookingfor what’s thebestoutcomeforthepatientathand. Nowwiththat,it'salwaysdebatableabout whatisthebetterproduct. So, weleanintoclinicalevidenceinallthosescenarios. Thecostofgoods, howmuchwe'rebuyingitforisonlyonepartoftheequation.
HL: Where is the potential for conflict?
DH: In manycases it may berelationshipsthatamanufacturer'srephaswithaphysician. WhatistheirroleintheOR or the cathlab, andhowdoesthatimpactchoice?That spaceisalwaysunderscrutiny with the potential for conflict, butthere'susually asuperficialpointthat'sbroughtforward, so weleanintomostoftheevidenceand thatallcomesfromthephysicians’ sideofthehouse.
We collectandorganizedataonthefront end, andwe puttogether a “factpack.” Using cardiacrhythmdevicesasanexample, we ask what thepatient looks like, howthephysiciansusethe devices, wheredotheyusethesedevices, whatdoesthatlooklikefromeitheraregionaloranationalmarketshareutilizationperspective, whatdo theoutcomeslooklike with anyparticulardevices, etc.
Thefactpack yields datathat allows somecomparablesbetweendifferentscenarios,differentcompanies,differentproducts,whateverthatlookslike.Onceyougetthathomeworkdone,it'stimetoengagethephysicians andseewhat thestate of the unionlookslike.
Typically, there will beaverybriefengagementwith the physicians onthefrontend,beforegatheringthedata,telling them we'regoing to reviewthis.Whenwe'vegotbigger,betteranddeeper data,we'llengageyou onadeeperlevel.
Thenwhenweengagethemonallthefacts,they'rescientists, theywanttoseethedatatheywanttoseewhatthislookslike,andwehavesomedialoguefromthere.Ultimately, we ask wheredowewanttogowiththeproductbasedonitsleadwiththatclinicalevidence?Thenwe'llask howdowenegotiatefor thebestqualityproducts.
HL: How important is volume in price negotiations?
DH: We’ll use the Costcomodelasanexample.Theyusuallydon'tputsub-qualityproductsontheirshelves.Theynegotiateforthebestqualitywithinacategoryorproductmixandmatchwhatdeservesshelfspace.Wedothatat thefrontend.Whataretheproductsthatdeservesomeshelfspace,where weagreethat thisisaqualityproductmadebyaqualitycompany with outstanding outcomes?Howdowenegotiate to comeupwiththeeconomicpackagetosupportcontinuoususe?
Oncethat's done, there is a perpetual review, withcontinuousimprovementexercisesconstantlyengagedwithcategorymanagementteams of cross-functionalplayers in quality,clinical, economicandoperations.
HL: To whatdegreeiscostpartoftheequation?
DH: Wedonotchaselow-costgoods.Wechasethebestqualitygoodsandthendrivethebesteconomicoutcomeforthosequalitygoods. Cost is always a factor, but it is a tertiary concern, behind outcomes and quality.
We contract with afewoutsidecompaniesthatarerunbyphysicianswho doindependentassessmentsofoutcomes, quality,theattributesassociatedwithanygivenproduct. We’ll ask if theseassessmentsalignwithourphysicians’ experience. Theymayormaynotagreewithan analysis andthat'swherewewanttogaintheir input.
HL: Who has the ultimate say in what product is purchased?
DH: We have a cross-function of folks, physicians, C-suiteexecutives, quality,economics, finance.Supplychainis runbyacertaingroupoffolks that gothroughthisprocess. There’s a vote andaproxyandwhat welandonandwhat'sapproved.It'snoindependentgroup inandofitself.
Once we'velandedon therightproduct or productmix,like anyotherconsumer,wenegotiatebasedonattributes,ourcommitmenttotheproducts, theoptimallogisticssolution,whatdo ourpaymenttermslooklike, everythingthatkindofsupportstheeconomicequationfortheproductsthatwe'veselected. There’s no rocketscienceout there.
The FDA is providing a one-year soft launch for the Drug Supply Chain Security Act mandates, effective November 27.
Pharmaceuticals suppliers, manufacturers and other stakeholders are being urged to use the looming "stabilization period" for the Drug Supply Chain Security Act (DSCSA) to reach compliance with federal interoperability regulations, and "not take your foot off the gas."
The Food and Drug Administration on August 30 said it would exercise enforcement discretion during the one-year period, effective Nov. 27, 2023, "to accommodate additional time that trading partners in the pharmaceutical supply chain may need" to validate DSCSA mandates.
At a Healthcare Distribution Alliance seminar in late August, stakeholders were cautioned that the stabilization period is not an opportunity to slack off on compliance.
"The point of the stabilization period isn't to take your foot off the gas," Gregg Gorniak, vice president of the Manufacturer Operations and Data Services and Secure Supply Chain Lead, Cencora, told attendees at the seminar, while urging them to prioritize meeting the interoperability requirements laid down in DCSCA.
"This whole thing is around the safety of the patient," Gorniak says. "We need to make sure we get it right."
That advice was seconded by FDA officials who attended the seminar.
"This [stabilization period] should not be viewed as justification to stop implementation," Leigh Verbois, FDA director of Drug Security, Integrity and Response, told the gathering. "We want this implementation to be done by 2024."
Connie T. Jung, FDA senior advisor for policy, told the gathering that the agency's actions is "only intending for the stabilization period to apply to [FDA's final guidance for Enhanced Drug Distribution Security Requirements Under Section] 582(g)(1)," and emphasized."
"This does not mean to stop anything," she says.
Stakeholder Concerns
The HDA and other drug supply chain stakeholders have raised concerns with the FDA about DSCSA's requirements and the "uneven state of industry readiness for November 2023, underscoring that the progress of implementation and the law's single compliance date for all trading partners could lead to supply chain disruptions and interruptions to patient care."
HDA CEO / President Chip Davis praised the FDA's decision to ease into the mandate, saying "the agency heard the concerns of distributors, manufacturers and pharmacists and provided guidance that will ultimately minimize the potential for disruptions in the short term."
The FDA says it will use the stabilization period to fine-tune DSCSA guidance, with a focus on wholesaler/3PL provider licensing. Additionally, the agency is planning to survey small dispensary readiness and hold additional public hearings.
Help for Independent Pharmacists
In particluar, independent pharmacies have raised concerns about the special compliance challenges facing smaller dispensaries.
"If you look at most of the larger chains, they're ready, or they [would have been ready] to flip this on in November, but not necessarily be getting data because their trading partners may not be ready to send data," Ilisa Bernstein, chief lobbyist for the American Pharmacists Association, told seminar attendees.
"But for the small dispensers, the independent pharmacies ... they were just not ready."
However, the ATA urges tighter privacy provisions for physicians.
TheAmerican Telemedicine Association and affiliate ATA Action are voicing support for the Centers for Medicare & Medicaid Services' proposed rule for the 2024 Physician Fee Schedule, which the advocates note extends into the new year the telehealth flexibilities put forward during the COVID-19 public health emergency.
"The proposed rule is, overall, positive for the telehealth community and patients, and looks beyond the now-expired COVID-19 public health emergency to continue the expansion of telehealth services, providing much needed clarity for physicians and other stakeholders across the country," Kyle Zebley, ATA senior vice president, public policy, and executive director, ATA Action says in an 11-page letter sent this week to CMS Administrator Chiquita Brooks-LaSure.
However, Zebley says the proposed rule raises privacy concerns for physicians.
"During the PHE, CMS did not require providers to list their home address when most care was provided virtually," he says. "We urge CMS to permanently allow providers to bill their practice address in order to maintain the confidentiality and security of the provider’s home address, especially for those providing mental health services. It is imperative that this flexibility not be allowed to expire at the end of 2023."
The death toll from the wild fires hit 99 on Tuesday, with dozens more fatalities expected.
Teledoc Health is offeringfree 24/7 virtual primary healthcare services for survivors, first responders and other Hawaii residents affected by Maui's devastating and deadly wildfires.
The offering by the Purchase, NY-based telehealth provider will give affected residents access to healthcare professionals for nonemergency services including nonnarcotic prescription drug refills by calling Teledoc Health at 855-225-5032. Emergency cases are referred to 911.
"When medical resources are already strained during natural disasters, virtual care can help patients manage wildfire-induced flare ups of chronic illnesses, such as asthma," Teladoc Health CMO Vidya Raman-Tangella, MD, says in a media release. "Virtual care is a proven solution that supports community health during these times, and we are grateful to provide access to care as Hawaii rebuilds and recovers from the fires."
At least 99 people have been confirmed dead from the wildfires, and the number could double over the next 10 days, Hawaii Gov. Josh Green told CNN.
"It is a tragedy beyond tragedies," the governor said about the fires that started sweeping parts of the island last week.
Teladoc has routinely offered free virtual care to people living in areas that have devastated by natural disasters, including hurricanes, wildfires, tornadoes, floods, power outages and blizzards for non-emergency illnesses including respiratory infections, urinary tract infections, and prescription drug renewals.
The collaborative focuses on neurosurgery, rheumatology and drug-resistant epilepsy.
Cincinnati Children's Hosptial and Indiana's Parkview Health have expanded their decade-long collaborative to include remote pediatric specialty care consultations for patients in their service areas, the nonprofit providers announced jointly.
Cincinnati Children's pediatric experts will be available to consult with outpatients at Fort Wayne's Parkview Regional Medical Center as part of a larger plan to eventually connect other medical specialties through virtual care.
"This new collaboration leverages Cincinnati Children's excellence in pediatric neurosurgery, rheumatology and drug-resistant epilepsy with the pediatric expertise and knowledge of Parkview Health medical providers," Ken Tegtmeyer, MD, medical director of the Center for Telehealth at Cincinnati Children's, says in a media release.
"We remain committed to working with Parkview Health and families in the Fort Wayne region to ensure that their children get the specialized care they deserve in a convenient setting and at the most appropriate level."
The health systems, 180 miles apart, began collaborating on trauma services consultations over the past decade. In 2018, they started a telehealth collaboration for cardiology, gastroenterology and general surgery. This latest collaborative broadens the consultations to include pediatric neurosurgery, rheumatology and drug-resistant epilepsy for children living in northeast Indiana and northwest Ohio.
Parkview Health, formed in 1995, operates 10 hospitals, including Parkview Women's & Children's Hospital and a network of primary care and specialty physicians.
"The goal of our new, enhanced collaboration with Cincinnati Children's is to better meet the needs of our community," says Tom Miller, MD, physician executive, Women and Children's service line, Parkview Health.
"Our collaboration is patient-centered and will increase access to Cincinnati Children's specialty care for Fort Wayne area families. This could reduce or even eliminate the need for travel to receive specialized pediatric care," he says.
"For patients who require care at Cincinnati Children's, a coordinated approach for referrals and local follow-up appointments will streamline the experiences of these families."
The estimate included $125.5 million for states and $515.7 million for the federal government.
Forty states and the federal government lost out on $641 million in 2020 because the states' separate Children's Health Insurance Programs were not required to seek rebates from drug makers, a federal data brief shows.
Federal law requires states to use the Medicaid Drug Rebate Program (MDRP) to get rebates for Medicaid-covered outpatient prescription drugs provided through Medicaid or Medicaid expansion. However, that rebate mandate does not apply for separate Children's Health Insurance Program (CHIP) drugs.
Using estimates by state agencies, the data brief by the Department of Health and Human Services' Office of the Inspector General sought to identify drug rebates that states could have collected if their separate CHIPs had been mandated to get MDRP rebates.
"If federal law were to require states to obtain rebates under the MDRP for separate CHIP drugs, the 40 states that operated separate CHIPs could, according to our estimates, have invoiced, collected, and directly received $641.2 million from the drug manufacturers for calendar year 2020," OIG reports.
The estimate includes $125.5 million for states and $515.7 million for the federal government.
The data brief contains no recommendations. CMS was not obligated to respond, and did not.
Nearly half of respondents ages 50-64 with mounting medical expenses report taking on credit card debt to pay bills.
Relentless annual increases in health insurance premiums and deductibles are outpacing wage growth for many working older Americans with employer-sponsored health plans, a new Commonwealth Fund study shows.
The study finds that more than half (54%) of low-income adults and nearly one-third of adults with moderate incomes are underinsured, and face higher out-of-pocket costs which nearly half of respondents say led them to skip or delay care.
Among the findings:
Nearly half (47%) of low-income older adults, and more than one-third (35%) of those with moderate income, said it was very or somewhat difficult to afford their premiums.
54% of those with low income and nearly one-third with moderate income were underinsured, meaning that they had high out-of-pocket costs and/or deductibles relative to their income.
Nearly half of those with low income reported skipping or delaying needed care because of cost.
Difficulties paying medical bills and paying off medical debt loads affected 44% of older adults with low income and two of five of those with moderate income.
Nearly two-thirds (63%) of those struggling with medical bills and debt were not confident they have enough money to retire — more than double the rate for older adults without problems paying their medical bills.
Nearly half (46%) of respondents with medical bill problems reported taking on credit card debt to pay off their bills, one-third received a lower credit rating because of their bills, and more than a quarter exhausted their savings to pay their bills.
The data was taken from the Commonwealth Fund’s 2022 Biennial Health Insurance Survey of more than 8,000 adults ages 19 or older and conducted by the research firm SSRS.
The analysis focused on 1,978 respondents ages 50-64 with low and moderate incomes. Low income is defined as less that 200% of the federal poverty level or $27,180 for an individual and $55,500 for a family of four in 2022. Moderate income is between 200% and 400% of poverty, or $54,360 for an individual and $111,000 for a family of four.
The partnership gives Amazon employees and their partners free access to Maven's clinicians.
Women's and family telehealth provider Maven Clinic announced Tuesday that it is partnering with Amazon to bolster the on-line retail giant's healthcare offerings for its full- and part-time employees in 50 countries beyond the U.S. and Canada.
"We're delighted to support Amazonians around the world as they plan and grow their families," Kate Ryder, founder / CEO of New York-based Maven Clinic, says in a media release.
"There are too many barriers to care in healthcare systems that were not built around the needs of women and families, and Amazon is cutting through that complexity by making it exceptionally easy for their employees to access high-quality, personalized care in their own language at any hour of the day or night."
The partnership will give Amazon employees and their partners free access to Maven's board-certified reproductive endocrinologists (fertility doctors), obstetricians, gynecologists, nutritionists, mental health providers, adoption coaches, and other care providers.
Amazon employees can access free local support through a “care advocate” who will help them navigate fertility services, provide referrals, and advise them on local family-building guidelines.
The virtual care is available in 35 languages, using video or message chat with doctors, nurses, coaches, and other experts.
Lian Neeman, global director of benefits at Amazon, says the new offering “takes the guesswork out of the family-building process, which can often be confusing and overwhelming."
"Our benefits are designed to care for all our employees' needs, and that means ensuring they have the resources they need to live their best lives, regardless of their personal circumstances,” Neeman says. “Maven's approach to fertility and family building supports our employees around the world and is tailored to each person."
Countries where Maven is now offered as a free benefit to Amazon employees and their partners:
Asia / Pacific: Australia, India, Indonesia, Japan, South Korea, Malaysia, New Zealand, Philippines, Singapore, Thailand, Vietnam
Latin America: Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru
Middle East and Africa: Bahrain, Egypt, Israel, Jordan, Kenya, Kuwait, Mauritius, Morocco, Nigeria, Saudi Arabia, South Africa, Turkey, United Arab Emirates
However, OIG wants more details on what telecommunications platforms are used.
A federal watchdog is offering mixed reviews in its audit of telehealth for end-stage renal disease (ESRD) during the public health emergency.
The Department of Health and Human Services' Office of the Inspector General found that most of the claims for telehealth ESRD care "generally met certain Medicare requirements."
That finding comes with a caveat.
"Most medical records for sampled claim lines included documentation identifying that the service was provided via telehealth but did not include documentation that would allow us to determine whether the services were provided using 1) audiovisual interactive technology and 2) technology that was non-public-facing," the audit states.
The audit covered a stratified random sampling of $38 million in Medicare Part B payments for 179,952 ESRD-related telehealth services provided between March and December 2020, volume that OIG says represents a 10,000% increase over pre-pandemic 2019.
One stratum included 75 claim lines for telehealth services provided to in-center dialysis patients, and the other included 25 claim lines for telehealth services provided to at-home dialysis patients.
OIG says it conducted the audit to "verify whether providers complied with Medicare requirements, determine what telehealth-related information was documented in the medical records, and further inform policymakers and other stakeholders as they consider permanent changes to telehealth policies."
"Providers documented limited information related to telehealth services in the medical records, but the ESRD-related telehealth service claim lines generally met certain Medicare requirements," the audit states.
OIG made no recommendations in the report but says "it would be beneficial for the medical records to document the type of telecommunications system used to perform the telehealth visit. This information may be beneficial to CMS and OCR when considering future oversight mechanisms or changes regarding remote communication products."
The award recognizes providers for excellence in their supply chain processes.
Patient safety watchdog ECRI this week named the 12 winners of its 2023 Healthcare Supply Chain Excellence Award.
The Healthcare Supply Chain Excellence Award, now in its twelfth year, recognizes members of ECRI's portfolio of supply chain services who "demonstrate exemplary utilization of services across the procurement lifecycle, including budgeting, benchmarking, technology assessment, and strategic development."
ECRI evaluated candidates' 2022 spend management and market analytics for capital medical devices, supplies, physician preference items, service contracts, and reagents.
"We're proud to award twelve healthcare systems with our prestigious award this year. These top-performing organizations have successfully navigated ongoing disruptions in the global supply chain market using ECRI's data-driven, evidence-based services," says Marcus Schabacker, MD, PhD, president / CEO, ECRI. "We are honored to partner with them in delivering high-quality, cost-effective patient care."
The winners, listed in alphabetical order, are:
Adventist Health System/West | Roseville, CA
Broward Health | Fort Lauderdale, FL
Children's Health | Irving, TX
Hawai'i Pacific Health | Honolulu, HI
Jackson Health System | Miami, FL
MaineHealth | Portland, ME
MultiCare Health System | Tacoma, WA
Northeast Georgia Health System | Gainesville, GA
Northwell Health | New Hyde Park, NY
RWJBarnabas Health | West Orange, NJ
University of Miami Health System | Miami, FL
Wellstar Health System | Marietta, GA
More than 3,000 U.S. hospitals and health systems are members of ECRI's strategic sourcing and supply chain programs. ECRI has analyzed nearly $60 billion in supply and capital spend over the past year.
Tim Browne, vice president, supply chain solutions, ECRI, noted that this year's winners "have faced post-COVID supply chain challenges, but their adherence to using data analytics, best practices, and leadership engagement has enabled them to overcome obstacles and make strategic, evidence-based decisions without sacrificing quality or patient care."
