All together now

Provider and supplier organizations hammer out a consensus statement on vendor credentialing of clinical reps

A number of provider and supplier organizations, including the Association for Healthcare Resource & Materials Management, were, at press time, close to hammering out a consensus statement on vendor credentialing, at least as it affects so-called “clinical” sales reps. When completed, the statement was to be presented to the Joint Commission, which has been working on vendor-credentialing standards for the industry for some time.

Suppliers’ concerns about vendor credentialing have been well-publicized. Those concerns include the potential high cost of credentialing, particularly for clinical reps; the lack of standards; fear about how data will be used; and fear that vendor credentialing will morph into vendor management and, ultimately, denial of vendors’ access into healthcare facilities.

But providers have their concerns as well. “Vendor credentialing was top of mind at last year’s AORN Congress, not only among industry members – manufacturers and distributors – but also our members and their facilities,” says Fred Perner, vice president of business development for the Association of periOperative Registered Nurses in Denver, Colo. AORN executives learned that the issue was also a high-profile concern for at least two other provider organizations, who approached AORN about exploring some joint activity on the issue. Those organizations were the American Association of Critical-Care Nurses (AACN) and AHRMM.

While investigating the issue, Perner discovered that AdvaMed – a Washington, D.C.-based association representing medical products manufacturers – had already begun work on proposed standards of its own. “We saw that their criteria closely mirrored AORN’s views, and we said, ‘Why re-invent the wheel?’” says Perner. AORN contacted AdvaMed to see whether multiple organizations could collaborate on a joint statement.

But the vendor-credentialing issue had heated up for other organizations as well, including IMDA, the Downers Grove, Ill.-based association for medical specialty distributors and reps. IMDA President Shawn Walker of North Andover, Mass.-based Bay State Anesthesia, and Bill Vitez of Sylmar, Calif.-based Tri-anim (an IMDA member) spoke with leaders of several other organizations to explore the possibility of coordinating their positions on vendor credentialing of clinical reps. “We realized that we could accomplish more if we had more bandwidth, as opposed to fighting the good fight on a stand-alone basis,” says Walker. The other organizations were the Health Industry Representatives Association, Health Industry Distributors Association, Healthcare Manufacturers Management Council and the Medical Device Manufacturers Association. Together, they created the Innovative Healthcare Access Coalition, or IHAC.

Suppliers’ concerns
IMDA and its fellow IHAC members have long been concerned about the potential costs of vendor credentialing, particularly those imposed by vendor credentialing companies that charge suppliers on a per-hospital or per-IDN basis. But IHAC members’ concerns run deeper than that.

“One problem is vendor credentialing’s ugly stepsister, vendor management,” says Walker. “The terms are being used interchangeably, but they’re really not the same thing. It’s not just ‘Did you have your [vaccination] shots?’ It’s turning into a management tool. Providers are monitoring who the sales reps saw, where they went and what they’re talking about. And our concern is that this evolution promises to stifle innovation.”

Closely related is concern about how information is being collected, how it is being stored, and what will be done with it, continues Walker. “We’re concerned about the bigger issue of privacy and the safety of our information, and making sure that any standard is do-able on a national basis from a legal perspective.”

Left unchecked, acute-care customers’ demands could lead to untenable situations for vendors, she adds. For example, in a number of states, employers are legally prohibited from demanding that their employees get drug tests without probable cause. Yet some customers are demanding that vendors show proof of such testing. While it appeared likely the final document would call for drug testing, it also appeared likely that it would reference the difficulty of obtaining such tests in certain states. “While we would have preferred to have the whole thing removed from the document, at least now, we’ll be able to provide some perspective as to why the drug testing issue isn’t so cut and dried,” says Walker.

Mission-driven approach
Meanwhile, AORN has always viewed vendor credentialing in the context of the organization’s mission, which emphasizes safety, optimal outcomes and professional support and collaboration, says Perner. “So our reason to get involved was mission-driven.”

“AORN strongly believes that the industry representative plays an incredibly important role in the clinical setting, in terms of training, support and guidance with new technology,” he says. At the same time, the organization and its members need to make sure that sales reps are appropriately trained in OR protocol, aseptic technique, how to respond to emergencies, etc., he adds. Whatever standards for vendor credentialing are arrived at, AORN hopes they will balance the needs of the rep with those of the hospitals on whom they call.

One issue the organizations had to resolve was how to define a “clinical” rep. Defining a rep as “clinical” or “non-clinical” makes a big difference, not only in the fee the rep has to pay the vendor credentialing company (or hospital), but in the criteria the rep must meet in order to qualify as “credentialed.” At press time, the organizations had agreed that a clinical rep should be defined as one who is in the “immediate vicinity” of patient care.

Says Walker, “A clinical rep is not someone who’s visiting the OR in the middle of the night, or someone visiting the ICU but staying at the desk, or someone who goes into the OR but only to talk to the manager in her office.” Adds Perner, “AORN is pretty much saying, clearly, if patients are present, then these criteria should apply to [the clinical rep].”

Another issue to be addressed was the type of insurance sales reps should carry. The two most-oft-mentioned choices are product liability and professional liability. The former covers the product itself, while the latter insures the rep who sells it. IHAC lobbied against mandating product liability insurance, arguing that some reps – particularly manufacturers’ reps – might not have access to such insurance. At press time, it appeared that all the organizations had agreed that clinical reps should carry either product liability or professional liability insurance.

The materials managers’ role
While AHRMM is a participant in the industry effort to arrive at some consensus surrounding vendor credentialing, at least one member questioned how involved materials managers should be in the vendor credentialing process. That person, Jay Kirkpatrick, CEO of HCA Nashville Supply Chain Services in Nashville, Tenn., is also AHRMM’s current president.

“AHRMM felt a responsibility [to get involved in the preparation of the statement to Joint Commission] because a significant portion of our membership is part of the process in their facilities,” he says. But, he adds, perhaps materials managers should allow their facilities’ credentialing committees to take ownership of the process, as they do with physicians. The reason? Credentialing committees do credentialing, materials managers don’t. The primary reason many materials managers get involved in vendor credentialing is simply because of the word “vendor,” Kirkpatrick continues. When handed the opportunity by administration, most materials managers grab it. “They’re take-the-ball-and-run type of people,” he says.

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