Times They are a Changin’

As a few of you may have noticed (probably very few), I have not posted a blog for about 2-3 months. This absence reflected another of my functions; that of assistant to my Nat’l Sales Manager, Mr. Gary Haugen.

Apparently, hospital administrators, in their search for value-based services and products, have started to notice evidence-based claims for product performance in contrast to acceptance of marketing “spin” and product discounts. For us, this has meant requests for clinical trials of our miniSQUAIR® smoke and bioaerosol capture device from large healthcare systems on both the East and West coasts. At such times, it is best for me to be in the operating room and not at a desk.

Although I have taught clinicians during the past few months, I have also learned a lot from them and gained an education that I would like to share with you so let’s begin…

Product Purchases

Buying decisions are in the process of moving upstairs to the executive level and bypassing lower echelon managers and often, clinicians.

What does this mean?

It means that individual hospital value assessment committees are simply barriers to acceptance whereas corporate buying committees now determine which company’s products will be purchased. They decide which devices receive clinical trials and/or acceptance bypassing the lower level hospital committees. This new system favors established medical material distributors that have contracts and relationships already in place. Early stage innovators now have greater delays and expenses before the value of their products is recognized. Also, going forward, contracts will more commonly be needed initially instead of purchase orders from individual hospitals. Further, teaching efforts by independent reps will be diminished and will continue to be replaced by the direct reps and technicians employed by the large distributor companies that have multiproduct contracts.

The Current Environment

This change in the sales process can lead to distortions in the marketplace that can defeat what the health system declares that it wants to achieve, that is, value-based healthcare. I believe that the miniSQUAIR device serves as a perfect example of this distortion as seen in our own community.

While health system purchasing managers want financial advantage from the distributors, they often have minimal knowledge of the clinical implications of their purchasing decisions. Instead of evaluating products on evidence-based documentation of functional value to patients and/or staff, they “bean count” without assessing the short and long-term effects of their decisions. In other words, functionally similar products that have totally different value propositions are not adequately compared.

For example, the miniSQUAIR has been tested at independent laboratories for smoke capture efficiency and for aerosol capture capability at the site of smoke release. Products to which it has been compared have not. Data from these laboratories has shown the miniSquair™ to have a 99.5% smoke capture efficiency and complete capture of the known viable bacteria that are within the smoke aerosol. No other company that sells the competitive ESU (electrosurgical) “pencil” has published any such functional data, instead relying on market “spin.”

Thus, in a large Minnesota health system, our product’s acceptance for use has been discouraged and our request for access to a retrospective patient review of SSI rates (related to the miniSQUAIR’s ability to capture bioaerosols) has been priced out of our reach.

How can we or should we interpret such decisions? The obvious conclusion is that we are being displaced by the demands of a large distributor that sells a competitive product that is included in a multiproduct contract. Such an agreement takes priority over the short and long-term health effects of chronic smoke inhalation on members of the perioperative team and perhaps even the surgical outcomes of their patients that they claim publicly to want to improve….or

We can conclude that purchasing decisions are being made with a silo mentality without adequate input from others with facts to share that pertain to the product(s) in question.

The solution to this conundrum is that education, based on evidence presented by those most familiar with the topic must precede purchasing decisions. Others who are expert at risk analysis, financial modeling, etc. need to be part of the final analysis.