Thursday, December 22, 2016

Ten in 10 ahead


Last month, we highlighted 10 milestones from the last decade as Healthcare Purchasing News marked 40 years of service. This month we fast forward with 10 predictions about the next decade as HPN races toward its 50th year.
  • The group purchasing industry, which surfed a considerable consolidation wave during the last decade, hits some breakwaters in the coming decade, as the largest GPOs foresee greater valuation — in revenue, efficiencies and cost savings — by splintering into key specialties to foster and foment competition. With the market shifting to clinically motivated provider-driven shared services operations, these smaller specialty service organizations cater to data science, labor/workflow and supply/service demands.
  • Armed with legal protection, manufacturers will sign “immediate-use manufacturing” license agreements with providers that allow healthcare facilities to 3-D print a growing array of products on site. Clinicians will be able to produce a variety of implants on demand as a countermeasure to consignment and loaner programs. Bolstered by this progress, manufacturers cautiously expand the 3-D printscape to a variety of commodity items as a strategic solution to disaster-related shortages, and demand-driven backorders.
  • As reports of improperly reprocessed devices multiply, single-use device manufacturing enjoys growth extensions into higher-tech minimally invasive product categories, including single-use-only rigid and flexible endoscopes. Reprocessing SUDs for limited additional use generates heavy debate and discussion.
  • Because a majority of states will require SPD certification over the next decade, a nationwide accreditation and certification requirement surfaces, which is endorsed by a number of clinical and professional organizations. Further, the federal government will require certification of all reprocessing techniques for reusable products as part of granting marketing clearance for all new products and retroactively will phase in the same for previously cleared products over a five-year period.
  • Frustrated (and rightly so) by the slower pace of adoption and implementation of healthcare supply data standards for medical/surgical products versus pharmaceuticals, standards proponents make one last push. Noteworthy organizations succeeding with the federal Unique Device Identification requirements, along with links to electronic health records, push through the operational resistance just ahead of an anticipated CMS penalty for non-compliance. With universal data standards for healthcare products and services in place by the late 2020s, healthcare organizations undercover rafts of data inaccuracies and operational inefficiencies that will reshape education and training in the 2030s.
  • With automation, digital and electronic capabilities woven like fibrous tapestry throughout a number of the largest healthcare trade shows in the U.S., a horizontal integration movement emerges to create a confederated exhibition of clinical and medical science and technologies. This North American Healthcare OmniExhibition for diagnostic imaging, IT, med/surg, laboratory/pathology and oncology includes marketing and sales incentives to encourage cross-attendance and cross-exhibiting/sponsoring growth with an eye on patterning itself after Europe’s ginormous Medica show.
  • Supply Chain finally will be acknowledged and accepted as the largest expense category in a healthcare organization, encompassing both labor and non-labor costs, products and purchased services. Supply & Service Management enjoys departmental and professional title popularity for a while. Consequently, a data science-driven Supply & Service Management department (encompassing collection, analytics, visualization and virtualization) will propel its key executive leaders to C-suite importance, prominence and relevance.
  • Data science gains momentum in Infection Control and Prevention as clinical experts can become certified in surveillance techniques and clinical data analytics. This will motivate epigenetic modeling to reinforce patient and population health-based behavior modification, a controversial but more proactive and less reactive approach to infectious outbreaks.
  • Look for technology advances in air quality to reach new heights as breakthrough developments for filters, scrubbers and pulsed-light stationary and mobile devices emerge that are safe for human exposure even as they render bacteria, dust particles and other microorganisms inert and easy to remove via vacuum suction or blowers.
  • The plethora of personal and remote healthcare devices, including smart phone apps and wearables, hits a fever pitch as manufacturers take a cue from Hollywood’s sensor-bedecked motion/performance capture suits and release healthcare-specific models that can monitor vital signs, chronic conditions and physical therapy progress that can be uploaded to the EHR.

Rick Dana Barlow

Tuesday, November 22, 2016

Ten in 10

Fast  Foreward

Next year marks the 40th anniversary of Healthcare Purchasing News. Technically, HPN reaches the four-decade milestone in April as the bimonthly Purchasing Administration sported a March/April 1977 cover date.

Each successive decade since that auspicious time offered up a wealth of healthcare industry milestones that impacted its growing readership base, spanning supply chain operations, sterile processing, surgical services and infection prevention.

Over the course of 2017, HPN will reminisce about healthcare industry milestones that directly impacted our four key readership segments.

Until then, here are 10 milestones HPN readers have endured during the last decade.

  • The last decade began with the stock market crash of 2008 and the ensuing “Great Recession” that not only impacted pricing and supply flow but made passage and enactment of the Accountable Care Act within two years more palatable and accepting — even as it served as a prelude to America’s ultimate conversion to a single-payer system, which has yet to reveal itself.
  • President George Bush may have tossed out his moonshot policy item of universal electronic health record availability, access, adoption and implementation, but it didn’t seem to go into overdrive until President Barack Obama’s terms and as a companion to ACA. Unfortunately, adoption and implementation has been outpaced by debates, discussions, doubts and pushbacks about the convenience and reliability of the technology as well as the validity of claimed benefits.
  • As the healthcare industry became more dedicated to and reliant on automation, computers and the internet as well as wireless communication and operations to make processes more efficient, the development also opened the floodgates to hackers as security breaches leapt to all-time highs with millions of patient records exposed.
  • On the bright side, the cause for adoption and implementation of supply data standards for medical/surgical devices and other healthcare products enjoyed a boost of awareness and need recognition with the entrance of GS1 into the mix. Of course, the awareness and excitement far outpaced adoption and implementation for the same reasons cited two paragraphs earlier for EHRs.
  • Futuristic, science-fiction-teeming technology debuted — not just the iPhone and iPad, but also speech-to-speech and speech-to-text translation software, Google Glass (short-lived), smart watches and “wearable” sensors that showed promise for monitoring vital signs as well as managing inventory. Even real-time location systems using radiofrequency identification, infrared, ultraviolet and ultrasound, among other “modalities,” experienced a surge in interest to which adoption and implementation continues to chase and play catch-up. But workable applications in healthcare operations continue in development and far from widespread use, along with 3-D scanning and printing of products, organs and tissue for a variety of legal reasons, and augmented and virtual reality capabilities.
  • Online “portals,” remote monitoring devices, self-service kiosks and telemedicine capabilities experienced a surge in interest and applications as the ACA payer aftershocks forced patient engagement in the care they receive, virtually eliminating the convenience of paying someone else — or having them pay — to make decisions.
  • The medical concept of “never events” saw an unprecedented definition expansion to 29 events grouped into six categories: surgical, product or device, patient protection, care management, environmental, radiologic and criminal. Yet now they also were conjoined to government/public and private reimbursement. “Accountability” quickly grew teeth under “accountable care.”
  • Implants and prosthetic limbs with motorized components or linked to neurological cues brought patients closer to “The Six Million Dollar Man” than your living room analog television set could in the 1970s.
  • Diagnostic imaging capabilities grew by going smaller and faster — from molecular capabilities to holographic and motion-capture 3-D/4-D photographic slices to the measurement of tissue elasticity as a disease marker. We may be a long way off from the magic pill or silver bullet but it seems like that distance is getting shorter. 
  • Finally, the last decade saw the largest consolidation wave in the group purchasing industry since the mid-to-late 1990s under President Bill Clinton’s healthcare reform initiative.

Next month, we’ll highlight some predictions as HPN progresses toward its 50th year.

Rick Dana Barlow

Thursday, November 3, 2016

Getting my goat

by Rick Dana Barlow 

It’s never a good sign when you drive up to your local Dick’s Sporting Goods store early in the morning before traditional business hours and notice a full parking lot with two squad cars near the front entrance. It’s like the Chicago Cubs won the World Series or something. Oh wait…

So I skedaddle into the building hoping to score a few Cubs T-shirts before the pesky crowds arrive (which I expected to happen around lunch hour). Too late. The panoramic scene before me resembled a cross between the Bridal Gown sale at Filene’s Basement in Boston and Billy meandering home through the neighborhood for supper after playing just two houses down in the cartoon “Family Circus.” Underneath the red, white and blue balloon arch commemorating the Cubs’ historic, milestone achievement were two 30-foot-long rows of tables piled high with stacks of different styles of T-shirts, shirts and hats as hordes of suburban fans – obviously taking early lunches from work – nosed, nudged and shouldered their way around each other like locusts. They clawed and pawed for the proper sizes at what had been neatly arranged stacks of linen, leaving rumpled piles in their wake like your teenaged son’s bedroom floor with the empty laundry hamper in the corner.

A police officer, standing stoically off to the side, eyes darting back and forth, his hands gripping his belt of weapons, hardly cracked a smile until I broke him of his beefeater pose with a few innocent comments and questions. It turns out he’d been on duty since 1 a.m. ahead of the store opening at 3 a.m. when the lines started.

With my merchandise in hand, I embarked on a winding tour through all of the nooks and crannies of the store, treading on carpet in spots that probably hadn’t felt shoe soles in a long time and retained that “fresh-floor smell.” (Sadly, I’m referring to the Bears and White Sox merchandise sections, but I digress.) I finally found the back of the line that was growing faster than you could spread the flu virus from coughing with an open mouth. Yes, right next to women’s socks way in the back.

As our queue of about 300 people – and growing by the minute – slowly slithered through the store, my new line-mates and I (who created our own impromptu “live” social network to pass the time) could only chortle as we noticed three or four store “managers” scurrying around the racks of ignored non-Cubs merchandise, trying not to make eye contact with any of the customers winding throughout the building. (We surmised they were managers because their lanyards read “Coach” on them, and they were pointing and talking as if trying to look busy doing nothing while their employees were overheating the few working cash registers at the front of the store.) Most amusing: The FedEx semi-trailer pulled up alongside the other entrance to the store, which was closed off to better manage foot traffic. (By the way, another “Coach” stood by those doors to direct people to the other doors on the other side of the building.)

We joked about storming the truck and offering cash for the Cubs merchandise as there was so little looting, pillaging and rioting in Wrigleyville last night. Some suburb just had to pick up the publicity baton and run with it, you know? We schemed about grabbing all the discarded merchandise along the way by impatient customers, paying for what we could gather and then scalping it on the street outside the store for a 10 percent or 20 percent markup. But alas, we retained our self-control. We already had invested 60 minutes of our morning for a few commemorative T-shirts, so what’s another 30 or so of inching along for another 200 meters to enter the Promised Land of Purchasing? Besides, we were just happy to be ahead of all those people still waiting by women’s socks.

When we finally arrived at the checkout counters – several of which were folding tables sagging at the center – we high-fived one another and stepped up to check out. This is where it turned interesting from a supply chain perspective. None of the merchandise carried a bar code or any kind of radiofrequency identification chip or tag. Instead, the cashier had to visually inspect each item and then thumb through a stapled packet of paper, each sheet sporting an image of a product with a bar code printed next to it. When he matched the item in his hand with the corresponding image in the packet, he scanned the bar code. Time-consuming, indeed. When I asked him why each item didn’t have a bar-code label affixed to it he replied that the merchandise had arrived this morning and was expected to move too quickly to justify marking each item. Of course, had the Cubs lost to the Indians, all this pre-printed merchandise would have been shipped to Africa and remote parts of Asia for distribution anyway, so I partially understood the oversight. I still thought this retail outlet could have configured a better, more efficient system for point-of-sale progress because they had at least a week to plan for it. This wouldn’t happen in hospitals, I reasoned. In most the merch doesn’t move that fast anyway unless you’re hording a treasure trove above the ceiling tiles.

Nonetheless, I exited the store after my 90-plus minute social and retail experiment drenched in euphoria and steeped in history, noticing the long line of people behind stanchions that curved around the building. I briefly entertained a thought to tell them about the wait they faced, but stopped myself. Maybe they were shopping for women’s socks.

Thursday, October 27, 2016




Refugee Aid Sites, Syria & Turkey

Civil war in Syria has led to one of the greatest refugee crises of our time. Current estimates place the number of Syrian refugees at nearly 5 million and that of internally displaced Syrian residents at another 6.6 million. Fully half of these are children. Most of the 5 million fleeing Syria remain in the Middle East, in Turkey, Lebanon, Jordan, Iraq, and Egypt. Of these, Turkey has received the greatest portion of refugees at over 2.6 million.

Refugees are at increased risk of becoming ill, malnourished, abused or exploited. Millions of children have been forced to quit school. Millions more have gone to work for pittance wages. And adults and children alike are suffering from injuries and illnesses caused by the crossfire of war or the crossing of borders. The need for medical supplies to treat the sick and wounded remains high in refugee camps and amongst the urban refugees living in surrounding communities. Medical facilities inside Syria also regularly report urgent and ongoing needs for medicines, supplies and equipment.

In 2016, Globus Relief teamed up with partners Islamic Relief USA and ANSAGIAD, a local Turkish NGO based in Ankara, to help address these ongoing medical needs. Coordination began in February, as ANSAGIAD engaged with relevant medical advisors in Syria and with refugee communities and government agencies in Turkey to determine the extent of the need. In April, Globus Relief shipped 12 containers with over $5 million of medical supplies and equipment. Local Islamic Relief and ANSAGIAD workers coordinated with hospitals, community leaders, governments, camp clinics and other local associations and point-of-use locations to ensure timely and organized delivery of the aid to Turkish refugee camps, private and public hospitals, and Syrian medical facilities and refugee camps. These materials have made a difference in the lives of the refugees; a demonstration human civility in the face of civil unrest.

Please keep Globus Relief in mind for any excess medical supplies, instruments or equipment you may have available.

Thank you for your generous donations that make it possible for Globus Relief to supply Eyes4Zimbabwe with equipment and supplies in this manner. To continue supporting healthcare and humanitarian efforts throughout the world, please contact Globus Relief.

Globus Relief is Your Humanitarian Non-Profit Inventory Solution. Please contact us if you have medical or dental equipment, instruments, and supplies or other resources available for donation.

Tuesday, October 25, 2016

Manage up

Fast  Foreward

By the time you read this we likely will have elected the new “leader of the free world” to occupy The White House.

Short of making any kind of political statement, let’s just say the two primary and two secondary candidates for President of the United States all possess and exhibit distinct styles and their own unique brands of leadership.

What defines leadership? What kind of leader are you?

Lee Eisenstaedt, founder and CEO of Chicago-based consulting firm Value Drivers LLC, wrote a book titled, “Being a Leader with Courage.”

One of the things he posits is four words that every CEO must learn to ask or say.

“What do you think?”

For someone with an over-abundant ego or a softly polished sense of self-worth, those four words can seem like a foreign language. For someone with a servant-hearted and servant-minded style of leadership, those four words signify their standard operating procedure.

“Think about that,” wrote Jim Kendall, head of Kendall Communications Inc. that writes a small business column for the Daily Herald, a suburban Chicago newspaper. “Asking the question almost compels you to at least consider the answer, maybe defend the idea that led to the question, possibly improve it, and likely, take an action.”

Eisenstaedt continued … “Keep asking until the person runs out of things to tell you.”

That can get annoying, for sure, but the idea remains sound. It’s how you manage up instead of down.

Managing down is easy enough — and efficient. After all, a dictatorship is considered by many to be the most efficient form of government. The problem? It also can be deadly. In the workplace, it can be a job-killer — namely the recipient of the whipping and not the one wielding the whip.

But you don’t have to be in the C-suite to be a leader.

Yet leaders may be hard to find as we approach the end of the decade.

During Bellwether League’s Healthcare Supply Chain Leadership Forum last month, presentations and conversations centered on two primary topics: The Accountable Care Act’s impact on various markets as well as on access, cost and quality since inception, and the need to identify and equip the next generation of healthcare supply chain leaders to continue operating in this environment.

Speakers presented results from a nationwide survey of supply chain executives at integrated delivery networks (IDNs) that found that a lot of IDN supply chain leaders are nearing retirement or leaving their positions with mixed results on succession planning.

Further, survey results indicated that leadership skills were the most pressing need for future supply chain executives, due in part to the expanding breadth and depth of responsibility and the criticality of supply chain in a complex healthcare environment. Attendees noted that healthcare can find the necessary talent outside of healthcare because supply chain in other industries seem to have a better handle on the function and its foundational relationship to an organization’s performance and progress. Perhaps that’s why healthcare organizations have seen a growing influx of non-healthcare supply chain executives to its ranks.

It’s unlikely that healthcare-centric and healthcare-specific supply chain experts will see their executive ranks thinned and transfused with non-healthcare industry supply chain experts within the next decade if they start taking action now.

How? They need to encourage their supervisors and managers and directors and vice presidents to ask questions. And then provide answers — or at least suggestions and recommendations. From this leaders and followers will benefit, which will benefit the organizations and the patients they serve.

Management may be a trickle-down concept, but leadership should be a trickle-up enterprise. Just leave gravity — but not gravitas — outside the door.

Rick Dana Barlow

Wednesday, September 28, 2016

EpiPenalty vs. EpiPenance

Fast  Foreward

The brilliant minds at beleaguered Theranos Inc. must have heaved a sigh of relief as Mylan Pharmaceuticals usurped as much negative publicity as word leaked out the company had been price gouging for years its EpiPen product that delivers life-saving epinephrine quickly to those suffering allergic reactions.

Online message boards and social media outlets erupted at the gall, lambasting Mylan’s actions and for the CEO’s reported exorbitant compensation package, she the daughter of a U.S. Senator, which somehow made it even more heinous.

Armchair moralists cried foul, calling for boycotts (unrealistic), government intervention (do we really want federally mandated price controls?) and all sorts of compensatory and punitive punishments for the CEO and her C-suite cronies. One commenter even suggested that the way for the CEO to make amends is to dedicate one full year of her compensation package to a trust fund designed to support those organizations and individuals who cannot or may not afford to pay for access to the desired product. Good luck with that.

But such a magnanimous gesture may not be part and parcel of her personality. Maybe it wouldn’t even be in ours were we faced with such opportunity. After all, we live in a capitalistic, free-market economy. Prices are set based on supply and demand, as well as what the market allows and will bear, but especially what the general public will accept.

To counter the vitriol aimed at its pricing structure, Mylan introduced a generic alternative at half the price. Critics remained unimpressed. Was the product as potent as the brand-named version? Would you need to buy more to achieve the same outcomes as the original? Was this a way for Mylan to retain its profit quotas and expectations?

Mylan may have “cut” the price via generic alternative as a “magnanimous” gesture, but the real issue is that our system enables all of this behavior. This really doesn’t represent a capitalistic free-market economy. After all, if it did, people would protest and stop buying the product once competitors emerged or were forced by government edict/executive order, shifting to lower-priced competitors (if they existed), which would drive Mylan to reduce their prices.

The issue here is that Mylan raised prices to an egregiously obnoxious level over a 10-year period, justifying it partly on the high quantities of free product they have to give to schools. To some, that redefines the concept of “free” markets. To others, it’s merely the Sheriff of Nottingham canceling Christmas while Robin Hood rallies the educational system around unfunded charity mandates.

This doesn’t mean schools and other organizations should not have access to EpiPen inventory. It just means that everyone should realize the fundamentals of economic inertia: For every action/decision, there is an equal but opposite reaction/decision. You poke a balloon on one end and if it doesn’t pop you’ll find a protrusion on the other end.

Gravity, physics and good sense. Sigh. 

Perhaps the better — or at least less sticky and stinky solution — is to allow the feds a little regulatory latitude, albeit heavily checked, for them to require that any product brought to market has a generic alternative readily available to guarantee competition right from the start. The caveat? The generic version would have to be owned by a completely separate company with no shared stockholders or venture capital investment houses. This way, the market can be allowed to dictate pricing. This also means that Mylan would have to divest its generic version either as a spin-off or outright sale to another company. Sound draconian and intrusive? Maybe. Maybe not.

There’s something of a precedent in the telecommunications industry. Back in the go-go 1980s, the perceived hegemonic monopoly AT&T (colloquially known as “Ma Bell”) had to divest a variety of assets (a “voluntary” settlement as a hedge against federal fiat). AT&T spun off its research and development conceits and its local calling operations, but retaining the long-distance calling market. The local calling operations broke into smaller regional corporations to enable competition. Furthermore, as communication technology started migrating to fiber-optic cable from copper wire, these regional companies and their “Baby Bell” subsidiaries (I worked at Illinois Bell Communications, for example) were “encouraged” to lease “available” lines to smaller companies to engender competition.

Can Big Pharma or any other healthcare corporate entity learn from the telecommunications industry? You bet. Whether on Wall Street or via private equity venture capitalists, it’s a “just call,” because “we’re all connected.”

Rick Dana Barlow

Wednesday, September 21, 2016




Salt Lake City, UTAH

Two companies. One war.
Hundreds of victors.

A war was brought to truce through service at the Globus Relief headquarters in Salt Lake City, Utah in August. Companies NFP/FirstWest Bene t Solutions, a Utah-based insurance broker and health and retirement bene ts consultancy, and Hospice for Utah, an in-home hospice service company, waged a wellness war over the summer months, each challenging the other to better living through a system of points won for healthy habits and positive life changes made. And the prize to the victor? The losing team had to convert the winning team’s points into donation dollars at a rate of 5 cents per point.

The teams tallied the nal results at the end of summer and NFP/FirstWest was dubbed champion. The resulting donated funds were used to help resupply a local Utah dental o ce that had been devastated by re earlier in the year, su ering a quarter of a million dollars’ worth of damage. Because of Globus Relief’s unique acquisition and distribution methods, the funds produced a humanitarian impact multiple times greater than the original donation.

The companies celebrated the victory on August 15 at Globus Relief’s warehouse in Salt Lake City. Representatives from each company joined Globus Relief sta in re-packaging medication administration packets to be sent to humanitarian e orts worldwide through Globus Relief’s many charity partners. The true victors of this story turned out to actually be the victims of other wars waged – hundreds of poverty-stricken people in need.

Please keep Globus Relief in mind for any excess medical supplies, instruments or equipment you may have available.

Thank you for your generous donations that make it possible for Globus Relief to supply Eyes4Zimbabwe with equipment and supplies in this manner. To continue supporting healthcare and humanitarian efforts throughout the world, please contact Globus Relief.

Globus Relief is Your Humanitarian Non-Profit Inventory Solution. Please contact us if you have medical or dental equipment, instruments, and supplies or other resources available for donation.