Monthly Archives: September 2009

Power Tables

Here’s a look at the demographics for selling power tables:

If it’s true, as some say, that only one out of 10 tables in doctors’ offices are power, you, as a sales rep, have the choice to see the potential in getting the market to change and enhance the patient experience by selling a product that will become industry standard.

Widespread Conversions?

“In five years, I feel confident in saying that we’ll have the market switched from 10 to 1 box to power, to 10 to 1 power to box,” says Dick Moorman, vice president of sales for Versailles, Ohio-based Midmark Corp.

Midmark introduced its 75 power exam table program approximately 15 years ago, and has a full line of power exam and procedure tables on the market today. Its most recent additions are the Ritter Model 222 and 223 and the Midmark Model 622 and 623 high-low tables.

If you think of the dental market, how many have manual moving tables? How many have power tables? You can see the potential for these power tables simply by making this observation.

It’s only a matter of time, says Moorman, citing statistics from the U.S. Census Bureau:

• 31 million people in the United States are over the age of 65.

• A million people reach age 60 every month.

• Most medicine is practiced on people age 60 and over.

• Fifty percent of the federal budget will be consumed by age-related problems by the year 2010.

• In less than a century, this country has added more than 25 years to the average American’s lifespan.

The question is, are reps and their customers there?

Opportunities Everywhere You Look:

When you walk into a clinical setting, stop and look at what you see, says Moorman. “If you see patients with walkers, wheelchairs, people with broken legs, people who are in pain or sick, you should instantly think, ‘I need to help these people.’

Talk to the doctor, ask him how he is going to help the 300 pound man in the wheelchair. How tough is it going to be in a manual chair? You have already fixed a problem the doctor didn’t even realize he had simply by selling the power table.

It’s relatively easy to sell a power table to a physician or clinic that already has one, says Moorman. “Once they have a power table, you don’t have to re-sell them on the benefits.” It’s like selling someone on a color television who already has one, he says. They don’t ever want to go back to black and white.

Even so, some doctors who already own a power table fail to see the possibilities, adds Moorman. They might say, “I already have a power table. Why do I need another one?”

Then you need to ask, “How much do you love it? How many rooms do you have?” That will get the ball rolling.

How can sales reps make the case for the doctor to buy one or more power tables for his or her practice?

Here’s what the manufacturers say:

• First, power tables are good for the patient, many of whom are over 60 or overweight and can’t easily get up onto a manual box table, they say.

• Second, they’re good for the doctor and his or her staff, many of whom are also getting older and shouldn’t be hoisting older or heavyweight patients onto a table.

• Third, power tables are good for the physician’s business, because they show patients that the doctor is high-tech and concerned about their comfort, safety and dignity. And, all things considered, they don’t cost that much money.

Good for the Patient:

The demographics say it all, says Paul Siepmann, vice president for The Brewer Co., based in Menomonee Falls, Wis. Brewer just introduced its first power procedure table, the ASSIST, at HIDA 2003 in Baltimore. The company introduced its ACCESS exam table in July 2001.

“Patients will need more help getting up and onto a table and getting into position for various procedures,” says Siepmann. “Another factor is that obesity is on the rise. With that comes more challenges in positioning the patient.”

Patients can sit in a power procedure table as if it were a chair, adds Vanessa Parrish, director of marketing for Brewer. The doctor can move the patient’s legs up and down. A pelvic tilt mechanism allows the caregiver to position a patient with anaphylactic shock, so that blood goes to the head. Females can be positioned for gynecological examinations and procedures, with better and easier access. The list goes on, she says.

“A power table gives a really positive impression as the patient walks in that [the doctor is] competent, and that the environment is clean, safe and non-threatening. And the power table is a clean, nice, sophisticated looking piece of equipment.”

Good for the Caregiver:

Just as power tables are good for patients, so too are they good for caregivers, say manufacturers. That’s an important point for reps to get across.

“Many injuries in clinical environments occur when maneuvering the patient onto the table,” says Parrish. “Power tables allow for a safer environment for physicians. That’s one of the pitches that reps have to make to the doctor.”

Reps should approach the topic directly, by asking questions about the physician’s practice, continues Parrish. “Power tables sell themselves once you understand the practice and the patients it’s serving,” she says.

“Often, when you’re trying to sell a customer anything – and it doesn’t matter if it’s a power table or not – the first thing they’ll tell you is, ‘I don’t need it,’” says Moorman. “But that’s not true. If you look past what they’re saying, you will see that they’re taking care of patients who are 75 or 80 years old, people in wheelchairs and walkers. They’re dealing with patients who weigh 300 or 400 pounds. They truly need [a power table].

Good for the Doctor’s Business:

Economics can help sell the power table as well. Naturally, selling a more expensive power table instead of a manual box table is good business for the distributor and the rep, whose commission check will be higher. The doctors who purchase power tables also enjoy economic benefits, say manufacturers.

Consider that power procedure tables allow family practitioners to do more in-office procedures than ever, hence improving their cash flow.

“Fifteen or 20 years ago, you had to go to hospital for many procedures, but now these are being done in the physician’s office,” says Parrish. That helps keep the revenue in the physician’s office. And the reality is, doctors can’t do these procedures efficiently on a box table, she says.

Naturally, doctors might get the shivers when they see the price tag of a power table. But if the rep can help them understand life cycle cost, tax implications and financing options, he or she can minimize that initial negative reaction.

“A lot of times, when you try to sell physicians any piece of capital equipment, they’ll say, ‘I want something cheap. I don’t need all that,’” says Moorman. In too many cases, the rep will immediately fall back to a less expensive product, in this case, a manual box table.

“But here’s a question I like to ask,” he adds. “‘Doctor, I have inexpensive tables that I can sell to you.

But before you decide, let me ask you, how long do you plan on keeping your table?’ Usually the answer is ‘Forever’ or ‘Till I die or go out of practice.’

“They’re thinking, ‘I’m spending this money here and now.’ But salespeople have to wake them up to the fact that this is not a purchase for today. It’s a lifetime investment.

“‘If you’re going to have this for the rest of your life, let me show you what you should buy or at least consider. Think about it, Doctor. You have patients who are 75 years old already. What are they going to be like five years from now? What are you going to be like five years from now?’

In fact, the feds offer a 50 percent tax credit for those buying equipment that improves access for the disabled. (Even so, this is something that the physician might want to discuss with his or her tax advisor.) What’s more, Section 179 of the tax code allows businesses to accelerate depreciation on new capital equipment. Finally, the trade-in value of a power table will almost surely exceed that of a manual table.

An Overview of Pulse Oximeters

Pulse oximetry is based on the principle that oxygen is carried in the bloodstream, bound primarily to hemoglobin, according to E. Hill and Stoneham, M.D.  One molecule of hemoglobin can carry up to four molecules of oxygen – a 100 percent saturation level. Light is absorbed at two different wavelengths by the hemoglobin. The absorption rate differs, depending on the degree of oxygenation. As the light passes through tissues, it has a pulsatile component. The oximeter measures:

  • The oxygen saturation of hemoglobin in arterial blood.
  • The pulse rate in beats per minute.

Why Is a Pulse Oximeter Used?

Pulse oximeters provide a rapid indication of a patient’s changing level of oxygenation. Since the level of oxygenation is continuously being monitored, pulse oximeters allow for clinical intervention before significant hypoxia, or low levels of blood oxygen, occurs. This is very important in situations where general anesthesia is being administered, since an anesthetic can deprive the body of the oxygen it needs. That is why many states require the use of a pulse oximeter while administering anesthesia.
A pulse oximeter can also be used to make sure Medicare patients, before beginning home oxygen therapy, meet certain clinical criteria. In addition, they are often used to monitor patients with chronic obstructive pulmonary disease (COPD) and asthma.

How it Works:

A pulse oximeter employs a peripheral probe and a microprocessor unit, which displays a waveform, the oxygen saturation and the pulse rate. Most units have an audible pulse tone. The pitch of the tone is proportional to the oxygen saturation level. The clinician or doctor places the probe on the patient’s finger, ear lobe or nose.

The probes have two light-emitting diodes – one in the visible red spectrum (660 nm) and the other in the infrared spectrum (940 nm) – that pass through the body tissues to a photodetector. As the light beams pass through the tissues, light is absorbed by blood and soft tissue. The amount of light absorbed depends on the degree of oxygenation and hemoglobin within the tissues. Hill and Stoneham offer the following tips for optimal use of pulse oximetry:

  • Plug the oximeter into an electrical socket to recharge the batteries.
  • Turn on the unit and wait for it to go through calibration and check tests.
  • Select the correct probe with regard to size and use.
  • Avoid excess force when positioning the probe.
  • Allow several seconds for the pulse oximeter to detect the pulse and calculate the oxygen saturation.
  • Read off the displayed oxygen saturation and pulse rate.

Advances in Technology:
In the past four years, manufacturers have made strides in oximetry technology, according to a recent report by Anesthesi-ology News. For instance, Nellcor Puritan Bennett of Pleasanton, Calif., now makes a unit reported to provide accurate readings for adults and neonates during motion. Other models are designed to determine signals that could be mistaken for a pulse.

Another example is a model by Masimo Corp. of Irvine, Calif., which is designed to process the red and infrared signals. The company’s Signal Extraction Technology (SET) employs digital signal processing, low-noise hardware and sensor technology designed to decrease the impact of ambient noise and non-arterial physiologic noise produced during motion.

Today, clinicians have more choices when it comes to pulse oximetry. An informed sales rep who understands the different technologies available can help his or her customers get the most accurate results, stay in compliance and increase the quality of care for the patient.

Scales

Patient weighing has been a critical part of the medical assessment process since its beginning. Weight is used to determine how much medication to prescribe, whether a baby is growing at a proper rate, to assess cardiac patients for fluid retention and to determine if a patient is gaining weight to offset a wasting disease.

Today, patient weighing is more important than ever, as obesity has become a national problem. An estimated 65 percent of Americans are overweight and the rate of childhood obesity has doubled in the last decade. Obesity is now the second most common preventable cause of death, with over 300,000 deaths a year attributed to it. The trend shows no sign of abating and continues to be fueled by “super-sized” meals and more sedentary lifestyles.

The Scale Market:

The professional medical scale market is estimated to be in the $40- to $60-million dollar range on an annual basis.  When combined with the retail and the fitness market, the number becomes much larger.  The medical market number includes scales sold into the acute care market, as well as physician offices and clinics, nursing homes, rehabilitation and home health care.

Every medical facility has a scale, usually more than one. With obesity on the rise, many of these facilities are looking to upgrade their current equipment to better accommodate their patient population.  Simply put, as the rate of obesity increases so does the need for better scales.

Scales are also very much like exam tables – they are very visible to the patient, and really help define a facility or a practice from a marketing perspective.  As a sales representative with access to new technology and more aesthetically pleasing scales, it pays to identify outdated products that need to be replaced.  After identifying those products, a solid working knowledge of scales will prepare you to make sales presentations that can significantly increase your business in this segment.

Different Types of Scales:

Balance Beam Scales
This remains the most used scale in the United States, but sales are declining as sales of digital scales grow.  Most beam, or mechanical, scales can weigh up to 350 to 400 pounds, and offer a height-rod option and a handrail option.  The most important features are usually the scale’s overall design and construction.

Digital Scales
The sales and use of digital scales continue to grow.  There are a number of different configurations, from floor models to column models.  They work by determining the force on a load cell, which is usually in the base, and converting that pressure to weight.  They also make it possible to communicate with a computer and transmit electronic medical records.

Infant Scales
These are available in both mechanical and digital models, although digital infant scales far outsell mechanical infant scales. While digital scales are quieter and less likely to disturb an infant, the most compelling selling feature is that they are able to compensate for the infant’s movement.

Specialty Scales
These are offered in a wide range of categories, in both digital and mechanical versions. They include:
– wheelchair scales
– handrail scales
– chair scales
– bed and under-bed scales
– sling scales

These scales tend to be more expensive and a demonstration is usually necessary. From a distributor sales representative’s perspective, it’s important to be able to identify opportunities to sell these scales and bring in the manufacturer to help demonstrate, close the sale and in-service the product.  On higher-end scales, the manufacturer also brings the in-depth knowledge that is necessary to compete with direct selling companies.  In the hospital market, where Scale-Tronix is selling on a direct basis, it is absolutely necessary for distributors and manufacturers to work together.

Digital vs. Mechanical:

The use of mechanical scales is still more widespread than digital scales. When the first electronic scales were introduced in the 1980s, they were unreliable and prone to breakdowns. Not only did physicians distrust them, distributor sales representatives opted not to sell them, fearing they would just be picking them up later to return them for repair or replacement.

The good news is, this is changing.  Today, the majority of hospitals have converted to digital scales, and the rest of the market is following.  The sales of digital scales are climbing quickly and that’s certainly no surprise with digital technology being so pervasive in our society, where everything but human beings are weighed by digital products.

In fact, today digital scales are outselling mechanical scales for the first time, according to HPIS data on distributor sales. HPIS reports that sales of digital scales have increased 61 percent since 2001, while sales of mechanical scales have decreased 12 percent.

That’s because most of today’s digital scales have significantly improved their performance over the first digital scales that were introduced in the 1980s. In addition, they can streamline a practitioner’s workload by providing a reliable weight in less time and with less hassle.

Technological advances also allow for more innovative features like larger platform sizes, improved performance and the ability to connect with an office’s electronic medical records or download to a PC.

For a distributor sales representative, many are choosing to sell digital scales for different reasons.  Today all of the leading scale manufacturers offer reliable digital scales, so that is no longer an issue.  Perhaps more important, digital scales have a higher average sales price than mechanical scales, meaning more sales volume and margin.

Stress Testing

Here is a look about the importance of preventing any type of cardiovascular disease:

• 64,400,000 Americans have one or more forms of cardiovascular disease (CVD).

• CVD claimed 931,108 lives in 2001 (38.5 percent of all deaths).

• Other 2001 mortality: total cancer 553,768; accidents 101,537; HIV 14,175.

• Almost 149,000 Americans killed by CVD are under age 65.

• From 1991 to 2001, death rates from CVD declined 9.2 percent.

• Despite this decline in the death rate, in the same 10-year period the actual number of deaths increased 0.9 percent.

• This year an estimated 1.2 million Americans will have a new or recurrent coronary attack.

• About 340,000 people a year die of coronary attack in an Emergency Department or without being hospitalized.
It is very important to have a physical done at least once a year to help prevent cardiovascular disease.  It is the number one killer of Americans every year, and it continues to grow as diseases such as obesity continue to rise.  With Stress Testing physicians and patients can work together to help prevent cardiovascular disease.
What Is Exercise Stress Testing?

Stress testing is an evaluation of the patient’s cardiovascular system using an ECG, treadmill and blood pressure unit. The purpose is to screen patients for heart disease and help predict, or unmask, potential coronary problems. The exercise stress test is used to check for problems that show up only when the heart is working hard, and normally wouldn’t be seen during a routine ECG.

How Is Exercise Stress Testing Done?

• The patient is prepped and stress electrodes, which are more robust than regular ECG electrodes and are designed to stay on during the test, are applied to the patient’s chest.

• A baseline ECG and blood pressure are taken.

• The exercise protocol is started. There are numerous protocols that gradually increase the speed and elevation of the treadmill.

• During exercise the physician will monitor the patient’s ECG, heart rate, blood pressure and physical symptoms.

• When the test ends, an ECG and blood pressure measurement should be done for documentation of the heart at maximum effort or sub-maximum effort.

• It is important to continue monitoring the patient’s ECG, heart rate and blood pressure during recovery because some problems are uncovered in that phase.

• It is important during testing and recovery to have a defibrillator and emergency cardiac drugs available.

 

Indications for Stress Testing:

• Screen for latent coronary disease

• Exercise prescription

• Symptomatic individual

• Evaluate arrhythmias

• Evaluate therapy patients

• Follow up on patients with known coronary artery disease for progression

• Patients with multiple risk factors

Vital Sign Monitors

Vital signs are measurements of the body’s most basic functions. The four main vital signs routinely monitored by medical professionals and healthcare providers include:

• Body temperature

• Pulse rate

• Respiration rate (rate of breathing)

• Blood pressure (Blood pressure is not considered a vital sign, but is often measured along with the vital signs.)

Vital signs monitors provide continuous monitoring of multiple critical parameters, including temperature, noninvasive blood pressure, pulse rate, ECG and oxygen saturation (SpO2), making them suitable for conscious sedation procedures as well as simple monitoring. They are found in the acute care setting as well as clinical and private office settings.

Key Selling Points:

• Ease of transport and portability
• Versatility and flexibility
• The clarity with which readings are displayed
• Their ability to be networked with central workstations
•  Their ability to be incorporated into electronic medical records systems.

Ease of transport of vital signs monitors is a strong selling point in both inpatient and outpatient settings. Some models weighing less than 10 pounds can be easily carried with convenient carrying handles. Many monitors can be stand- and roller-mounted for easy transport. For example, GE Medical Systems touts that its DINAMAP PRO Series Monitor sports roller blade-style wheels for effortless gliding.

Accessories for vital signs monitors can include reusable or disposable cuffs, cuff hoses and power cords. Some units have built-in printers or recorders, so that waveforms and graphic trends can be captured for later review or the record. (Built-in printers and recorders can be especially useful to track apnea events by recording the patient’s respiration, heart rate and oxygen saturation level.) Other models can be connected wirelessly to printers.
Connectivity:

Like many technologies, vital signs monitors are becoming smaller and smaller. The Welch Allyn Micropaq wireless ambulatory monitor, for example, features waveform display, multi-parameter monitoring and patient alarm capabilities in a patient-wearable device. This 1-pound unit provides measurement of ECG, heart rate and pulse oximetry. It’s said to be well-suited for use in cardiac care with ambulatory patients connected wirelessly to a network and central nursing workstation.

Data from vital signs monitors could become an integral part of electronic medical records very soon. In fact, as many as 64 GE DINAMAP PRO monitors can be connected to its CHANT Server software for automatic uploading into the electronic medical record.

At least one company – QRS Diagnostics in Plymouth, Minn. – uses PC Card technology to convert off-the-shelf PC, laptop or handheld computers into medical devices, including monitors. The company’s VitalCards product has yet to be cleared by the FDA. However, it’s already marketing cards for spirometry, electrocardiography and spirometry/pulse oximetry. Combined with personal digital assistants (PDAs) that support wireless networking, these cards can be used for mobile wireless health monitoring.