Contracting News February 2011

Letter to the Editor

To the editor:

I have been in medical sales for 21 years – ten years with Titus/General Medical/McKesson (1990-2000), and the last eleven years as an independent manufacturer’s rep. Half of my manufacturers have products that are directly sold into the acute market, and I have been impacted by the credentialing efforts (both in time and monetarily). It is a burden that most of my independent peers have purposely avoided. I acknowledge that the financial cost for the two programs in which I am enrolled (Vendormate and Reptrax), cost me about $1,000 per year, plus an average of 2-3 hours each week responding to the numerous e-mails and advisories for updated policy and guideline changes.

I read the last two articles in your December 2010 magazine (“The Unfinished Book” and “Vendor Credentialing Costs How Much?”) and would like to share my perspective on a few thoughts.

First, I believe a comment was made in one of the articles to the effect that “everyone acknowledges the need for credentialing.” That may be true of hospitals, but not of all parties involved. And the real question is WHY do hospitals universally agree on the need for credentialing? What is their motivation? The true motivations behind credentialing will also reveal many of the solutions.

Second, I do believe that those reps entering into hospitals MUST be sensitive to being a guest in someone else’s house, and must agree to abide by their rules of decorum for reasons of safety and security. For too long, reps have abused their anonymity, and snuck into departments, hoping to plant seeds of change in the hearts of hospital staff. Hospitals have been frustrated in losing control to these instruments of change – in their own system. I believe that this is the true cause of credentialing. It is a valid concern for hospitals, and they are trying to better manage affairs in their own houses. But, in this broad stroke of the pendulum, they close the door to knowledge and innovation that can help them use technological advancements to solve many of the challenges they face in providing valuable patient care.

Third, Kevin Connor stated that their member facilities need to know that the reps have their PPDs, that they are insured, and that they are not criminals. While these may be valid external concerns, to what specific instances or trends can he or any other hospital point, for causes that these rules are necessary? Have there been any instances in which patient safety or security has been compromised due to sales reps visiting their facilities? I personally know dozens of acute care reps, and I must say, I have never met a single one who “appeared” threatening for reasons of infectious diseases, or having criminal backgrounds that might pose a threat. They have all been courteous and polite people, some of whom I count as good and trusted friends. They are good and honest people who anyone would count a benefit to have as a friend or neighbor. And, in the limited tenure of credentialing and its heavy costs on both vendors and hospitals, what measurements of safety and security have shown improvement? Not that they have to justify any implementation of rules and guidelines, but again, what is their true motivation?

Every visit I make to any of my hospitals gives me the opportunity to watch the public visitors who wander into sometimes very critical areas, without any qualifications or screening. Here are people who evidently (by coughing and other external sanitary indicators) pose a threat, who may carry infectious illness and disease, who may be evading the law, and who definitely know nothing of being compliant with the many policies and procedures the hospital places on visiting reps. These people are placing patients and staff in far more risk than sales reps. If hospitals were truly motivated by patient safety, then they would install security guards at every entrance, who would be qualified to screen visitors for health and safety issues. But of course that would be unacceptable to visitors of their clients, and outrageously expensive and logistically impossible. Thus, I believe the intentions in point two are clearly the hospital’s motivations for such credentialing programs, and the credentialing programs have taken advantage of, and perpetuated the program’s opportunities for financial gains.

The credentialing companies’ reticence to collectively formulate national guidelines, and “push back” against the hospitals to adjust their policies to such standards, simply serves their best financial interests.

Fourth, I have also had demands made – in terms of credentialing policies – that are not placed on hospital staff. There have also been no open means of recourse for objective resolutions. In one case, a hospital demanded that I have a chickenpox vaccination. They would not accept my disease history or vaccination documentation stating that I had had chickenpox when seven years old. They would also not accept my painful secondary witness – a case of shingles at the age of 44, showing compliance with this requirement (shingles being an indicator of having had chickenpox). Before I could enter the hospital, they demanded I go across the street and pay $240 to the county clinic, for my first of two chickenpox shots. I warned them, that if this initiated a reoccurrence of shingles, there would be serious consequences to the hospital. The standards program manager pulled me aside after the discussion, and admitted that the hospital’s employees were not asked to comply with such a chickenpox requirement. This is the kind of inequity and abuse that occurs when a lack of consistent national standards are in place.

Couldn’t the Journal of Healthcare Contracting provide more than a report of industry perspectives, and become a collective vehicle for change? You could become an ally and a productive tool in the hands of medical sales reps. You might bring together the various parties in a third party forum, that could honestly and openly address these matters that so heavily impact our market. Until such honest forums occur, with the intent on really meeting hospitals’ needs for product control and patient safety, the financial motivations for the existence of numerous credentialing companies will grow unabated.

Tim Lorenz
Lorenz Medical
Peoria, Ariz.

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