This month's headlines
 

Economy a drag on hospital margins. Providers report putting off acquisition of clinical technology and equipment, according to AHA report. Mean streets. Vendor credentialing where the rubber meets the road – face to face with your customers. Summer help. Kevin Trout has been hiring summer interns for 15 years. They give him a needed hand, while allowing him to test-run potential employees. And it’s a chance for him to mentor others, as he himself was mentored. Profit potential for hard times. Within the past year, a number of major medical manufacturers have requested independent medical distributors to take over the sale of lines that had been sold direct. It’s an opportunity says Mitchell Kramer. Tough times? When the going gets tough, the tough turn it up, says IMDA sales trainer Gerry Layo. And today’s about as tough as it’s going to get. Top 10 medical innovations. Cleveland Clinic’s Top 10 innovations touch on avian influenza, electronic medical records, and various minimally invasive surgeries to treat uterine fibroids, repair heart valves, and remove organs through the body’s natural orifices.

2009 IMDA Annual Conference June 14-16, 2009 Francis Marion Hotel Charleston, SC

Economy a drag on hospital margins Providers report putting off acquisition of clinical technology and equipment

IMDA members have probably been hearing this story from their customers for awhile: Fewer patients are seeking hospital care. A growing proportion of patients need help paying for care. Investment income is drying up. Margins are shrinking.

Well, the numbers seem to bear them out.

According to new report from the American Hospital Association, hospitals -- which employ 5 million people nationwide -- are facing uncertain times as their financial health falters and ability to borrow funds for improving facilities and updating technology is squeezed. The report is based on survey results from 736 hospitals and information from DATABANK, a web-based reporting system used in 30 states to track key hospital trends.

Percent of Hospitals Reporting Various Effects of Credit Crisis November 2008 Increased interest expense for variable rate bonds: 33% Increased collateral requirements: 12% Inability to issue bonds: 11% Difficulty refinancing auction rate debt: 11% Inability to rollover or renew credit: 10% Acceleration of debt: 7% Inability to withdraw funds held by financial institutions: 4% Source: American Hospital Association

Elective procedures and admissions down

Many hospitals are beginning to see the effects of the economic downturn, with more than 30 percent of survey respondents reporting a moderate to significant decline in patients seeking elective procedures, and nearly 40 percent of respondents reporting a drop in admissions overall. The majority of hospitals surveyed also noted an increase in the proportion of patients unable to pay for care. Uncompensated care was up 8 percent from July to September vs. the same period last year.

Total margins fell to negative 1.6 percent in the 3rd quarter of 2008 vs. positive 6.1 percent during the same period last year. Recent turmoil in the stock market has reportedly turned investment gains to losses, further worsening hospitals' financial condition.

Meanwhile, state and federal budget difficulties raise worries about potential cuts to Medicare and Medicaid, which cover half of the patient care provided by the nation's hospitals, according to the hospitals surveyed. Financial stress is forcing hospitals to make or consider making cutbacks, including cutting administrative costs (60 percent of survey respondents), reducing staff (53 percent) and reducing services (27 percent).

The report also shows that the credit crunch is increasing the costs of borrowing money, making it more difficult for hospitals to find the financing for facility and technology improvements. Hospitals saw interest payments on borrowed funds increase by an average of 15 percent from July to September vs. the same period last year. As a result, many are reconsidering or postponing investments in facilities or equipment. Specifically:

• Fifty-six percent of survey respondents said they are considering holding off on renovations or plans to increase capacity.
• Forty-five percent reported delaying purchases of clinical technology or equipment.
• Thirty-nine percent are putting off investments in new information technology.

To view the report, “Report on the Economic Crisis: Initial Impact on Hospital,” go to www.aha.org.

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Editor’s Note: IMDA members are aware of the steps that President Shawn Walker has taken to draw industrywide attention to the vendor credentialing issue. But in an attempt to understand what’s happening in the field, IMDA Update asked members how they were faring with their customers, where the rubber meets the road. Several expressed concern at the potential cost of the process. One member – Jack Burgess of CVC Inc. – called for a national credentialing policy established by the American Medical Association, Joint Commission and others, whereby each rep would have a nationally recognized number and would be credentialed by his or her company. The company would assume liability for its reps, as it does now, suggested Burgess. Meanwhile, Phil Reilly, vice president of finance for KOL Bio-Medical Instruments, offered his take on the issue, as well as some potential solutions. Here’s what he had to say.

Humble beginnings

As IMDA presented at the Annual Conference in Chicago, the drivers behind vendor credentialing required by hospitals are multiple, including the Joint Commission, hospital/IDN materials managers and risk managers, providers’ legal departments (mindful of the Stark Amendments, the Health Insurance Portability and Accountability Act of 1996, etc.), infection control professionals, and more. It began as a way to make sure that people – including sales reps – who interfaced with staff and patients met some minimum standards of access.

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The old horror stories of salespeople taking part in surgical procedures were raised. In addition, publicity surrounding Stark/anti-kickback measures and Medicare anti-fraud and abuse provisions was growing. Granted, it was quite a stretch to jump from a salesperson buying coffee and bagels or sending flowers to staff, to a company offering a grant or trip to physicians. But IDNs found it more expeditious to place restrictions on the sales reps, at least initially, and therefore demonstrate that they were attacking the problem.

Re HIPAA, it is true that hospitals needed to take measures to restrict or justify access to and dissemination of patient information Therefore, they had to be on record protecting patient information. From there, it was then an easy stretch to institute new requirements, such as criminal background checks, educational requirements, debarment letters, etc. Add to that insurance certificates demonstrating coverages, as well as knowledge of the provider’s parking restrictions and regulations, location and use of fire extinguishers, check-in procedures, etc. Soon, the spinning top was on the move. Additionally, by imposing such requirements, materials managers could become more involved in the acquisition process. That’s not necessarily a bad thing, but it certainly is an indicator of internal power struggles between clinicians and administrators.

Execution

Soon enough, hospitals saw that they were going to have to find ways to control all this, and many turned to the web-based companies that were springing up and offering to smooth out the process. Selling themselves as intermediaries to facilitate the data flow, these companies both eased the problem and made compliance more complex and expensive. Each of the majors -- Vendormate, REPtrax, Status Blue, VendorClear -- has slightly different models, but all claim only to follow the mandates of the providers, rather than devising new policies or language. This is apparently true, but doesn’t make the compliance any easier.

Further, each of the vendor credentialing company’s approaches is different. For example, Vendormate charges $250 to distributors who need significant access. They can add reps or managers. Status Blue supplies the list of hospitals it deals with in a particular state, and the distributor can then download the various requirements back to them. However, each hospital, regardless of the firm it uses, retains the right to – and often does -- impose its own language, requirements, etc. So, one hospital may make conflict-of-interest a major component, while another may not even have any language or policies applicable to this. As a result, complying with, and being approved by, a particular hospital may take longer with one service rather than another.

Concerns

IMDA members need to be aware of a number of things, particularly:

• The demands your customer are making of your sales reps.
• Shots and inoculations.
• HIPAA, bloodborne pathogens regulations and OR protocol.
• Product training.
• Web-based intermediaries, or vendor credentialing companies.
• Criminal background checks.
• Manufacturers’ relations with your customers.
• The status of reps no longer employed by you.

Staying on top of things. Make sure your people advise you if they are either turned away from, or are issued a temporary pass because they lack the proper credentials. We have found that many hospitals are poor at advising smaller companies of their policies, and the first time someone finds out is when he or she is turned away from a hospital, sometimes even though they have an appointment. Most of the major systems, such as Tenet, HCA, etc., have programs.

In addition, make it clear to your salespeople that they should refrain from agreeing to anything without your approval. Suppose a hospital requires the rep to indemnify/insure them for anything that goes wrong. Usually, that is not something to agree to, as you don’t want to protect anyone for their own mistakes or transgressions. In any event, it is not in the purview of a sales rep to agree to that.

Shots and inoculations. The reality is, more and more institutions require MMR and TB testing as well as Hepatitis B shots. Therefore, you would be well-advised to go ahead and get them done, and have the certificates on file to be used when required.

HIPAA, bloodborne pathogens and OR protocol. These topics come up again and again. You can either certify the training or contract with a service to have your people certified. We have used Medcom for this, and all our people are now certified.

Product training. Oftentimes, hospitals require that the distributor certify that the sales rep has been trained in the products he or she sells. You may be able to meet this requirement by writing a letter demonstrating when, how often and under what circumstances the training was delivered.

Web-based vendor credentialing company. You can usually work through the applicable contracted website, though the process is often cumbersome. However, sometimes you may have an experience like ours, in which two companies surfaced as representing the same hospital system. When we asked the customer to which one we should reply, we received no answer at first. Then we were advised that they were evaluating both companies and to wait until we were notified as to next steps. That was disconcerting. Realize too, that each intermediary has a different model.

Criminal background checks. We consulted our counsel before doing these. A number of companies run these computer-based searches. SentryLink is one. The process only takes a minute or so. However, there are a couple of caveats. First, the employee must approve the check. Consult your counsel. Second, after we have run a check, we do not send the actual report to the hospital, as it may contain a social security number, for example. Instead, we send a standard form letter to the hospital/intermediary that states that we have conducted the background check and there is nothing “…that would prohibit…..” etc., etc. In other words, you have to be as careful as possible before releasing anything.

Vendor/supplier/manufacturer relations. You may run into situations where your rep has credentials, but the manufacturer rep does not. Just because your rep can get into a hospital doesn’t mean that the vendor rep can as well. Also, you, as an owner or executive, may find it difficult to get into a hospital with one of your reps. Some hospitals have temporary badges and may have the ability to not only let you in, but to keep a record of how many times you have used the temporary access.

Status of former reps. This is something that may not be on the IDN’s or intermediary’s radar screen. But the reality is that a sales rep who leaves your employ may still have credentials or remain in the database of a hospital. Although the reason for that rep’s departure may be benign, it may also be a situation where he/she was terminated for cause, in which case you don’t want a customer under the impression that the rep still represents you. Therefore, it is best to keep a master file with all accounts in which your company is registered, and the names of credentialed reps. When a change occurs, notify the website or hospital of the fact.

Going forward

IMDA has done a great job with this issue. President Shawn Walker and the leadership have not just complained, but they have gone ahead and accessed people while trying to educate the members. They continue to work to not only standardize but also keep the communication lines open. Some other groups are either just paying lip service or are putting out position papers restating the problem.

The reality is that this will not go away any time soon, though we can hope that it will reach standardization and reality sooner rather than later. But the pressures on hospitals are real, and they have to react as best they can.

It would be good to know how larger manufacturers and distributors are reacting. Are hospitals treating everyone alike, or are some folks getting passes? There is also some lack of geographic symmetry here. KOL Bio-Medical encountered the pressures early last year and they have continued. In other parts of the country, the concept has been slower to take form.

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Kristy Szpara

In the spring of 1999, marketing major Kristy Szpara was finishing up her junior year at Indiana University of Pennsylvania in Indiana, Pa. She interviewed for some summertime internship positions and received two offers. The first was from a local Pittsburgh radio station. The second was from a young, tiny medical products distributor named Grandview Medical Resources. The company, which at the time was focused on the long-term-care market, only had five employees. But the owner, Kevin Trout, convinced Szpara that her summer would be well spent at Grandview. “He indicated to me that he wanted me to truly get an introduction to the healthcare industry, and my internship experience provided me just that,” she says.

Small staff, small office

Back in 1999, Grandview had a small staff to match its small office, and owned no delivery vehicles. What’s more, e-mail had yet to become a primary means of communicating with one’s customers. Marketing campaigns via fax were popular, says Szpara. The young intern helped create marketing campaigns for some of the company’s primary product lines, and was placed in charge of transmitting ads to nursing homes throughout western Pennsylvania, West Virginia and parts of Ohio and Kentucky.

In addition, she rode along with Trout as he visited a number of Grandview’s facility customers. “This was a wonderful experience, because it was on these trips that Kevin passed along to me his valuable sales and marketing lessons,” Szpara recalls. “And it was during this time spent in facilities that I decided to pursue a career in healthcare.”

Two weeks after she finished her internship, she received a call from Trout, who told her that when she graduated, she had a job as the company’s marketing director. She accepted it, and remains in that post today.

“I would definitely say that my internship was valuable,” she says. “Prior to Grandview, I did not have any idea what field I wanted to pursue following graduation. It was my time with the company and with Kevin that opened my eyes to healthcare.”

A 15-year tradition

Trout has been hiring interns from his alma mater, Indiana University of Pennsylvania, for 15 years or so. Not every summer, but close to it. The internships at Grandview tend to be marketing-and-sales-oriented, since that’s the part of the business that Trout most closely controls.

Indiana students need to work six weeks to earn credit for the internship, but almost all of them stay throughout the summer. When Trout started bringing in interns, the positions were unpaid. Now they are paid. His 2008 interns were fraternity brothers. “I’m active on the alumni board of directors of my college fraternity,” he says.

The screening process for summer interns is simple, says Trout. “I ask them, ‘What do you want to do when you graduate? If you want to go into something related to healthcare sales and marketing, this is an appropriate internship for you. If you have no desire to get into healthcare, then this is not for you.’” He encourages students who are interested in other industries to do volunteer work for a company or organization in that industry.

From Day 1, Trout focuses on teaching the interns about the healthcare industry. Most often, he assigns them to some special project, of which there are always plenty at Grandview. They also go on sales calls, demos, and even spend time in the truck and in the warehouse.

This past summer, Trout assigned his two interns to two projects. The first was developing a website for the company. “It hasn’t been high on our priority list,” he says. But the interns spent their summer compiling information to present on the website, which should be up and running soon.

The second project found the interns calling up people from IMDA’s database of prospective members to find out if they were still in business, and if they were still qualified and interested in IMDA membership. The interns then did a little selling. “They would explain, ‘IMDA has a lot of benefits you may not be aware of,’” says Trout. “We had them focus on product liability insurance, sales training and the opportunity to pick up product lines. ‘And it’s only a hundred bucks a month to belong.’ They ended up passing several names on to me. We may actually get a couple of members out of it.”

Focus on ‘real’ projects

Trout makes sure his interns are engaged in real projects that will help them learn about healthcare. “You don’t want to bring them on and make them a clerk. You want to challenge them, let them be creative. They’re marketing majors. They need to be creative. So I say to them, ‘Tell me what you can come up with based on what you know about our business.’”

The payoffs for Trout are several. First, he gets inexpensive labor. Second, he gets a first-hand look at people he might want to hire for his company. “Fitting into a company’s culture is such an important part of professional hiring,” he says. By hiring interns, “You’re putting people to the test. What would they be like if they were an employee here? They might be good, good people, but they might not fit in your company.”

Of his interns, he has hired two: Szpara and one other. “He was a dynamo,” says Trout of the second one. He spent a year doing order intake, learning the business. Then he went into the field as a sales rep, a position he held for four years before joining Cardinal Health recently. “He wanted exposure to corporate America,” says Trout.

“These are two examples where our interns were so good, they became part of our organization and were huge contributors to our success.”

To Trout, bringing in interns has additional meaning. It’s called payback. “I had a mentor who got me into this industry. If you’ve been mentored, you owe it to mentor someone else behind you. I’ve been doing that for students from my alma mater for almost 15 years. I tell them, ‘If I knew when I was your age what I know now, this is what I would have done differently.’ Things nobody told me.”

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Within the past year, a number of major medical manufacturers have requested independent medical distributors to take over the sale of product lines that had been sold by the manufacturers’ direct sales forces. Manufacturers see this as a way to cut expenses and to convert their fixed costs to variable expenses, greatly improving cash flow.

Tough economic times present IMDA members with opportunity. Rather than wait for such offers, they should consider seeking out national sales managers of major manufacturers with proposals that could allow them to reduce costs while upgrading their sales efforts. After all, IMDA members can provide long-standing relationships with both physicians and material managers.

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Financial issues to consider

Before making a conversion, manufacturer and IMDA member alike must consider personnel and financial matters. If the IMDA member purchases product from the manufacturer, the manufacturer’s gross sales would be diminished, because the distributor’s margin would be subtracted from the manufacturer’s gross sales in financial reports. This generally would not be acceptable to the manufacturer. Therefore, the distribution company must agree to be compensated by commissions, while the manufacturer continues to bill customers. In order to determine a commission rate that works, the IMDA member should do a careful cost analysis of such things as billing, bad debts, inventory, value of money tied up in inventory, and the like. The distributor will probably have to hold consigned inventory and, if necessary, take responsibility for the handling and repair of consigned instruments.

Manufacturers used to require distributors to purchase instruments, but that practice seems to have faded in recent years, freeing up distributors’ cash and adding to the manufacturer’s assets on its balance sheet. Even so, in a conversion to an independent sales force, the manufacturer and distributor must make sure that the issue of who owns and who pays for the instruments is dealt with.

What about the sales force?

Another extremely important issue must be addressed: What happens to the manufacturer’s sales force? The IMDA member taking on a major line will need additional salespeople, while the manufacturer will have to take care of its displaced sales force. In most cases, the manufacturer will require the distributor to absorb all or most of its sales force. This requires intense due diligence on the part of the distributor. In fact, the IMDA member must:

• Receive and analyze each employee’s employment agreement as well as the manufacturer’s employee handbook to determine what obligations -- both financial and operational -- the distributor is assuming.

• Analyze the effect of the proposed new employees’ compensation and benefits packages on the distributor’s existing sales force.

• Examine performance data on each salesperson to see if there are employees whose performance does not warrant their being hired or retained over the long term. At the very least, such an examination will indicate which salespeople require more instruction and management.

• Study all employment contracts, as well as the portions of the distributor’s agreement with the manufacturer dealing with absorption of its sales force. These contracts can help the distributor determine its financial obligations as well as its obligation to retain employees.

• Study what bonuses the employees might be entitled to, making sure that the manufacturer pays bonuses already earned.

In addition to absorption of employees, the distributor may be required to absorb leases on office space and equipment. All such leases must be analyzed to determine their cost and duration.

Long-term commitment

The distribution agreement with the outsourcing manufacturer must be carefully negotiated. While the distributor may be greatly expanding sales, it is also greatly expanding overhead. For that reason, the distributor must have a long-term commitment from the manufacturer, and should attempt to negotiate a substantial buyout if the manufacturer terminates the relationship or fails to renew the contract.

Going back one step, the distributor must analyze whether the deal will even be profitable. IMDA members are salespeople, and salespeople are naturally optimistic. You may think that representation of a major manufacturer will both enhance your reputation and increase your ability to sell other products. This may be true, but that’s no reason to take on an unprofitable line. The distributor must analyze the downside risk as well as the upside potential.

Early in the process, the distributor should bring its accountant and attorney into the analysis and the negotiations. I do not suggest that you add the cost of professionals at the outset of such discussions, since the discussions may lead nowhere. I do suggest that you bring in professionals as soon as it is reasonably certain that a deal will be made, but before serious negotiations begin as to what the deal may be.

Difficult economic times can create great opportunities for those willing to seek them out. Absorption of a major product line from a manufacturer looking for ways to cut overhead and maximize sales may well be one of these opportunities.

Mitchell Kramer is IMDA’s legal counsel. He may be reached at (800) 451-7466 or by e-mail.

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Editor’s Note: In this month’s issue, Gerry Layo covers the first three letters of the acronym “REFUSE.” In next month’s issue, he’ll pick up with “U,” “S” and “E.”

When times get a little tough in selling, we often hear of some people (myself included) stating that they “refuse to participate in a recession.” As a matter of fact, this has been said so often that it is becoming a bit of a cliché.

We do, however, need to REFUSE some of the things that hold us back during tougher economic times. We do need to REFUSE to suffer mediocrity from ourselves or our people. We do need to REFUSE to drop our prices but instead raise the bar on our value. We need to REFUSE to let our customers get a better experience buying from a competitor. We need to REFUSE to lose! It is in this vein that I thought I would lay it out, as I often do, in an acronym that I designed for a recent keynote address in Phoenix.

‘R’ stands for “Re-engage”

When economic times get tough, it is often easier for salespeople and sales leaders to pull back from relationships. They instead focus on the various tasks and activities of the day that seem important to drive revenue. Salespeople chase more leads, send more proposals, push harder and run faster. The result is a lack of connection with their existing customers. Leaders and managers focus more on the sales numbers and pricing than they do on the PROCESSS and the PEOPLE involved. As a result, they lose connection with their salespeople.

When things are slower, we need to re-engage! Oftentimes we like to say that we have to “Dance with the one that brought you!" In every sales organization, the true value of the organization lies in the relationships that exist between the leaders and the sales reps and between the reps and the customers. Turn your focus back to the people and the processes necessary to further those relationships—especially when economic times are more challenging. Remember, you get have a tendency to get out of the relationship what you put into it!

‘E’ stands for “Excitement!

Pay attention to the conversations going on around you today. How many are about business being down? How many center on the current economic state of affairs? How many focus on the stock market’s roller-coaster ride? How many are just plain negative?

In tough economic times, the culture that exists in your organization and the attitude of your sales team is of utmost importance. Is your sales team culture a place that is exciting and supportive, or overbearing and taxing? Do your people get to come to work or have to go to work? There needs to be a solution-based, EXCITING element to your team today! The conversations and meetings need to be about WHAT TO DO today to change things instead of WHAT HAPPENED yesterday to cause problems.

So today -- right now -- come up with no less than 10 ways to inject some EXCITEMENT back into your sales team environment. Design and run a series of exciting, fun, growth-oriented sales meetings and leave the numbers OUT of the meeting. Invite in some outside resources to work with or address your team, such as customers, partners, or vendors—and make the purpose of the meeting to re-connect, re-engage, and have fun! Have a red-shirt Wednesday with prizes for the best red shirt! Design a new contest to drive action and activity. Spend more time creating excitement and less wallowing in misery and uncertainty. Your customers will “smell the excitement” on you!

‘F’ stands for ‘FOCUS’

Too often during tougher selling environments, we have a tendency to lose our focus. We confuse activity with productivity, and busy-ness with business! Below is a list of five areas in which you need to remain FOCUSED to continue to grow regardless of what the marketplace throws at you:

Your goals. What are you aiming for and why are you “in the game?” When you are focused on WHY as you “enter the battle” every day, you will find that you can put up with almost any of the WHAT you have to do.

The customer. Make sure that your customer and their needs are not lost in your need to continue to drive revenues. Reconnect with your customers and their needs of today! Their needs today may be different than their needs of yesterday.

Pre-call preparation. Make a conscious effort to spend more dedicated time prior to every sales call in preparation for the call. Understand the purpose of the call and the things that need to be uncovered, discovered, and communicated. Every minute you spend in preparation can increase your opportunity for success on each call substantially.

Contact. Make sure that, in your effort to keep driving revenue, you don’t lose contact with your customers and clients. Remember that selling is a contact sport, and continue to develop and roll out new ways to add value and stay at the top of their consciousness. If you’re not visible, you are in-visible!

Training and growth -- If you’re not training, you’re not gaining. Stay focused on sharpening the axe and continually developing ways to add to your personal and professional growth. Read, listen to audio programs, and attend workshops. Turn off the TV and turn on the brain!

Gerry Layo is CEO of Sales Coach International, Granite Bay, Calif., which – through speaking engagements, workshops and extended coaching/consulting engagements – is dedicated to helping companies in the areas of sales, sales leadership and customer service. He conducted two IMDA training seminars in 2008. He may be reached at www.gerrylayo.com.

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As IMDA members know, today’s innovation is tomorrow’s standard of care. Cleveland Clinic physicians and scientists unveiled their Top 10 Medical Innovations for 2009 during the health system’s recent 6th annual Medical Innovation Summit in October. The innovations touch on avian influenza, electronic medical records, and various minimally invasive surgeries to treat uterine fibroids, repair heart valves, and remove organs through the body’s natural orifices.

Four major criteria served as the basis for qualifying and selecting the Top 10:

• Does the technology have significant potential for short-term clinical impact (either a major improvement in patient benefit or an improved function that enhances healthcare delivery)?
• Does it have a high probability of success?
• Is it on the market or close to being introduced?
• Does sufficient data exist to support its nomination?

IMDA Announcement Stay in touch. . . with IMDA's listserv. Now it's easier than ever to electronically communicate with your fellow IMDA members. It's called a listserv, and it's up and running now. It replaces the electronic bulletin board. Simply write your message, address it to the IMDA listserv address (found in the "Members Only" section of www.imda.org)  and click "send." All your colleagues will receive the message. Plug into the power of IMDA through IMDA's listserv.

10. Private-sector national health information exchange. A comprehensive system of electronic health records that link consumers, general practitioners, specialists, hospitals, pharmacies, nursing homes, and insurance companies is in the process of being established.

9. Doppler-guided uterine artery occlusion. Fibroid tumors occur in close to 40 percent of women older than 35, triggering pelvic pain, pregnancy complications, and heavy bleeding, according to the health system. Doppler-guided uterine artery occlusion is a new, non-invasive approach to treat such tumors.

8. Integration of diffusion tensor imaging (tractography). Diffusion tensor imaging, or DTI, allows neuroscientists to non-invasively probe the long-neglected half of the brain called white matter, with its densely packed collection of intertwining insulated projections of neurons that join all four of the brain’s lobes, allowing them to communicate with each other.

7. LESS and NOTES. Laparoendoscopic single-site surgery (LESS) reduces laparoscopic surgery to a small cut in the belly button. Natural orifice transluminal endoscopic surgery (NOTES) bypasses normal laparoscopic incisions altogether. Instead, the surgeon gets to an appendix, prostate, kidney, or gallbladder through one of the body’s natural cavities, such as the mouth, vagina, or colon.

6. New strategies for creating vaccines for avian flu. A newer vaccine approach that uses a mock version of the bird virus called a virus-like particle (VLP) may offer a better solution to protect people against infection from the deadly avian virus, according to Cleveland Clinic clinicians.

5. Percutaneous mitral valve regurgitation repair. Using a tiny barbed, wishbone-shaped device, the heart is fixed non-surgically from the inside out. A catheter is guided through the femoral vein in the groin, up to the heart’s mitral valves. The clip on the tip of a catheter is then clamped on the center of the valve leaflets, which holds them together and quickly helps restore normal blood flow out through the leaflets.

4. Multi-spectral imaging systems. The imaging system is attached to a standard microscope, where researchers can stain up to four proteins using different colors and look at tissue samples with 10 to 30 different wavelengths, allowing for the accumulation of more information than is currently available, according to Cleveland Clinic. This helps researchers to better understand the signaling pathways in cancer cells, and to develop more targeted therapies, which might allow physicians to better personalize treatment for individual patients.

3. Diaphragm pacing system. Four electrodes are connected to the phrenic nerves on the diaphragm. Wires from the electrodes run to and from a control box about the size of two decks of playing cards worn outside the body. When the electrodes are stimulated by current, the diaphragm contracts and air is sucked into the lungs. When not stimulated, the diaphragm relaxes and air moves out of the lungs.

2. Warm organ perfusion device. Once a heart becomes available for transplant, surgeons have just four hours before the organ begins to decay. This device, though, reportedly recreates conditions within the body to keep the heart pumping for up to 12 hours.

1. Use of circulating tumor cell technology. A blood test that measures circulating tumor cells – cancer cells that have broken away from an existing tumor and entered the bloodstream – has the ability to detect recurrent cancer sooner, while also predicting how well treatment is working and the patient’s probable outcome, according to Cleveland Clinic. The test results will allow physicians to better monitor a patient’s progress, adjusting treatment if necessary.

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IMDA Update Published by IMDA 5204 Fairmount Ave., Downers Grove, IL 60515 Phone:  (630) 655-9280 (866) IMDA-YES (866-463-2937) Fax: (630) 493-0798 Website:  www.imda.org E-mail:  imda@imda.org   Staff Katie Swartz: Executive Director Judy Keel: Executive Vice President Patti Perillo:  Senior Administrator Mary Moran:  Chief Financial Officer Mark Thill, Editor & Communications Director (847) 255-0716 Mitchell Kramer, Legal Counsel (800) 451-7466 Barbara Kramer, Legal Counsel (734) 930-5452 George Ayd, Jr., Insurance Administrator (703) 652-1309         2009-2010 Directors President Kevin Trout, Grandview Medical Resources, Inc. (412) 914-0950 President-Elect Anthony Marmo, Martab Medical (201) 512-1100 Secretary/Treasurer Hal Freehling, Jr., O.E. Meyer Company (419) 609-1633 Chairman of the Board Dave Campbell, PhD, Vital/Med Systems Corporation (303) 660-0888 Directors-at-Large Tom Birmingham, Bay State Anesthesia, Inc. (978) 682-6321 George Howe, Mercury Medical (727) 573-0088 Philip M. Reilly, KOL Bio-Medical Instruments, Inc. (703) 378-8600 Don Reiter, Specialty Respiratory Care, Inc. (818) 717-8807 x19 Bill Schultz, IPV Medical, LLC (760) 212-2769 Past-President Shawn Walker, Bay State Anesthesia, Inc. (978) 682-6321 Manufacturer Representative to Board Tim Beevers, Beevers Manufacturing & Supply (503) 472-9055 The ideas presented in this newsletter may or may not be applicable to your particular situation.  Always consult your tax advisor, attorney or CPA before putting them into effect.