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Capitalizing on Opportunities in the Non-Hospital Market, Rick Almasy, Nightingale-Alan MES, LLC


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Title: Capitalizing on Opportunities in the Non-Hospital Market, Rick Almasy, Nightingale-Alan MES, LLC

  • Capitalizing on Opportunities in the Non-Hospital
    Market, Rick Almasy, Nightingale-Alan MES, LLC
  • As consumers, we know that patient care has
    shifted from the inpatient, acute-care setting,
    to various non-hospital sites, including clinics,
    surgery centers, imaging centers and physician
    offices. How can the specialty distributor
    penetrate these various sites? Which ones offer
    the most opportunity? Take part in this valuable,
    member-led information exchange.

Hospitals Diversifying?
Medical Professionals Diversifying?
  • Used to be Doctor, Nurse, ancillary personnel.
  • Now Specialist, Doctor, PA, Nurse Practitioner,
    Nurse, Pharm D., PT, RRT, Radiology Tech, etc
  • The past Century has seen the growth and
    transformation of existing professions and the
    introduction of new health care workers. These
    changes are the results of developments in
    technology, education, research evidence, and new
    systems of purchasing, organizing and regulating
    the workforce. Recently disciplinary boundaries
    have come under pressure as a result of staffing
    shortages in medicine, nursing and the allied
    health fields. Unskilled works such as healthcare
    assistants and support workers are taking on
    tasks previously only performed by professionals.
  • Orthopaedic surgeons are a good illustration.
    There are approx 20,000 in the US. Some claim
    this is an oversupply of 20-50. The V.P. of the
    American Academy of Orthopaedic Surgeons stated
    A decade ago when we were fat and sassy, we
    decided to limit our practices to those aspects
    that were fun and well remunerated. We chose not
    to counsel little old ladys about osteoporosis
    we chose not to provide foot care services in our
    offices or put casts on in the E.R.
  • Other providers including podiatrists, internist
    and E.R. docs filled the void.
  • Do we need to look for who is filling the voids,
    or who will fill the voids in the future?

Are GPOs Diversifying?
  • G.P.Os are pursuing customers in the non-acute
    care market, and asking distributors for help.
    Article in repertoire magazine March 2011
  • If you dont receive it get it.

Should we diversify? The Big Box Movers Are.
  • Cardinals Maturing Non-Hospital Strategy
  • Edition December 2009 - Vol 17 Number
    12Article 3330Author RepertoireCardinal
    Healths penetration of the non-hospital market
    has matured over the past 10 years. And it
    continues to do so today, as the company rolls
    out a multi-year transformation of its entire
    medical segment.When Cardinal Health purchased
    Allegiance Healthcare in 1999, it inherited
    Allegiances Care Continuum non-hospital program,
    which relied primarily on telesales and a core
    group of about 25 field reps to penetrate the
    surgery center and physician office markets. Its
    primary targets were non-hospital sites owned
    and/or operated by the distributors big hospital
    and IDN customers. Then, when Cardinal acquired
    Bergen Brunswig Medical Corp. in 2000, the
    strategy shifted. In addition to telesales
    support, the company now had a full contingent of
    field reps to pursue customers who had no
    affiliation with existing hospital and IDN

Top 10 Medical Areas 2011
  • Diagnostic imaging (nuclear imaging,
    interventional radiology, capsule endoscopy and
  • Drug delivery (needle free injections,
    transdermal systems, inhalation system, infusion
  • Molecular diagnostics (biosensors, proteomics,
    nanotechnology, and others)
  • Mobility aid technologies
  • Minimal/non-invasive surgery (stents, bariatric
    surgery, medical robotics and others)
  • Micro-fluids and MEMS (Miniature medical pressure
    sensors, bio chips, protein chips)
  • Non-invasive monitoring (continuous blood glucose
  • Biomaterials (bionic limbs, joint replacement,
    antimicrobial wound dressing and others)
  • Bio-implants (neurostimulation and others)
  • Telemedicines.

Top Medical Device Manufacturers
  • 1.
  • Johnson Johnson
  • 23.6 B
  • 2.
  • Siemens Healthcare
  • 17.4B
  • 3.
  • GE
  • 16B
  • 4.
  • Medtronic
  • 14.6B
  • 5.
  • Baxter International
  • 12.6B
  • 6.
  • Philips Healthcare
  • 11.2B

Biggest Medical Device Trends of the Next 10
Years from WHO
  • Medical Device Patents and Obesity
  • According to CBS News, Americans spend about 35
    billion a year on weight loss products.
  • And that number is sure to grow. The following
    chart shows the rate of increase of overweight
    and obese Americans since 1960. If you look
    closely you'll see that obesity has risen from
    about 12 of the population in 1960 to over 30
  • Meanwhile, overweight individuals have hovered at
    about 30.
  • What this means is that more and more people will
    be looking for creative solutions to lose weight.
  • So, where are the opportunities for inventors?
  • Obviously, products that help people lose weight.
    There are thousands of patents for different
    exercise machines and the market is littered with
    trademarked diet schemes and marketing
  • Also, I believe there will be more products that
    promise to keep the weight off in the first
    place. For example, at my local grocery store
    they sell a version of an avocado called a
    "slim-cado". It has about half the fat of a
    regular avocado. I'm not sure how they did this,
    but it sounds like a candidate for a patentable
  • And of course there are the drastic procedures
    like gastric-bypass which uses specialty medical
    device patented tools that could be improved.
  • And the market for medical device patents doesn't
    stop here. The growing obesity epidemic will
    create an even greater need for patents in other
    areas of medicine.

Medical Device Patents and Heart Disease
  • Heart disease accounts for roughly 616,067 per
    year, giving it the dubious distinction of being
    the leading cause of death in the U.S. The
    surprising thing about this number is that it is
    just a fraction of how many lives were predicted
    to be lost to heart disease.
  • Why is this?
  • Maybe its greater awareness of the hazards of
    smoking. Dietary changes. Or more exercise.
  • I think its because of greater funding for
    treatments and cures. A quick web search will
    return thousands of charities and donations that
    host venues to raise money for heart disease.
  • With that in mind, I believe research and
    development into medical devices to treat heart
    disease should be big business for years to come.
    And then of course there are the patents on the
    inventions and improvements to surgery devices
    (think stents for coronary artery blockage).
  • And dont forget about post-surgery needs. The
    average hospital stay after heart surgery is 5-7
    days. During this time there are all sorts of
    tubes, wires and diagnostic equipment involved,
    all of which can be improved (which Im sure some
    smart inventor is working on right now).
  • In part two of this article well see where the
    next wave of new medical devices will come from
    by exploring one of the fastest growing health
    problems in Americaandthe commonly over-abused
    drug that is quickly losing effectiveness (and is
    in dire need or replacement).

Medical Device Patents and Diabetes
  • Coming in as the seventh deadly killer in the
    U.S., Diabetes claims roughly 71,382 lives per
    year. 17.9 million Americans live with diabetes.
    And another 2.5 of the population does not know
    they have the disease.
  • In fact, since 1988 there has been an across the
    board increase of instances of diabetes
    regardless of age, sex or ethnicity.
  • Diabetes is up in Every Category (Click for
    larger view)
  • Diabetes leads to greater incidences of heart
    disease and stroke, high blood pressure,
    blindness, kidney disease, neuropathy (disease of
    the nervous system) and even amputations.
  • And diabetes is a 175 billion per year (and
    growing) industry.
  • Surely, creative new patents and medical devices
    will need to be invented to fight this dreaded
    disease. What are some of the opportunities for
  • There are two types of diabetes. People are
    either born with type-1 diabetes, or they develop
    type-2 diabetes. Both versions result in the
    pancreas producing little or no insulin (a
    hormone needed to allow sugar to enter cells to
    produce energy).
  • Traditionally, diabetics are treated with insulin
    injections to supplement the lower amounts in the
    bloodstream. Perhaps there is some
    invention-in-waiting that is less
    painful/intrusive than injections? Or maybe you
    could invent an "insulin pill" that slowly
    releases insulin over the day? An insulin patch?

Medical Device Patents and Antibiotics
  • Nearly 100,000 people a year die from antibiotic
    resistant infections in the United States alone.
    And doctors are fearing it's only going to become
    more common.
  • The reason? Antibiotics are losing their potency.
  • Heres why, human beings are a vastly complex
    creature. We have multiple systems for pumping
    blood, breathing air and sending electrical
    systems back and forth. Bacteria are so primitive
    they dont even have a nucleus.
  • Our complexity betrays us. The simple antibiotics
    weve used for the last half century have
    prompted bacteria to evolve. To develop
    biological countermeasures that are rendering
    antibiotics harmless. This wouldnt be a problem
    if we were still discovering new antibiotics. But
    the vast majority of antibiotics were developed
    over twenty years ago.
  • What can inventors do?
  • Inventing new antibiotics is NOT the answer.
  • I think the more lucrative area for inventors is
    preventing bacterial infection in the first place
    (if youve seen the explosion in antibacterial
    products over the last twenty years, then you
    know what Im talking about).
  • More and more people will be scared by news
    accounts of these new super-bugs and will look
    for different ways to protect themselves.

(No Transcript)
Medical Device Patents and Cancer
  • Cancer is responsible for roughly 562,875 deaths
    per year, making it the second leading cause of
    death in the U.S.
  • What's worse, the World Health Organization (WHO)
    predicts cancer rates could increase 50 by
    2020. The reasons? Too much smoking, poor diets
    and infection.  
  • Top 10 Cancers According to the CDC
  •  The WHO suggests three ways to curb cancer
    related deaths.
  • "Action now can prevent one third of cancers,
    cure another third, and provide good, palliative
    care to the remaining third who need it, "said
    Dr. Paul Kleihues, Director of the International
    Agency for Research on Cancer (IARC) and
    co-editor of the World Cancer Report."
  • For inventors of medical devices, the third piece
    of advice "good, palliative care" could be a
  • Obviously, there could be advances in
    chemotherapy. And any other sort of drug that
    treats cancer would be welcomed with open arms.
    There are varied forms of radiation therapy used.
    And cryosurgeryor using extreme cold to treat
    tumors sounds like an area ripe for improvements.
  • But those are after the fact.
  • There are opportunities for inventors to improve
    early detection methods. Specifically screenings.
    For example, advances in screenings for cervical
    and breast cancers have increased the odds for
    prevention and successful cure.
  • And the list goes on.

Medical Device Patents and Elder Care
  • Since 1960 the average American lifespan has
    increased by 8.6 years (to 78.4 years up from
    69.8). With this growing elder population comes a
    greater tax on the nation's nursing homes or at
    home care options.
  • The latest census data (from 2007) shows 7.4 of
    Americans aged 75 and older lived in nursing
    homes in 2006, compared with 8.1 in 2000 and
    10.2 in 1990. While the data are trending down,
    I'd bet that the global economic meltdown in 2008
    has dramatically reversed this trend.
  • To make matter worse, most people who enter
    nursing homes can't even afford to be there.
    According to a 2007 USA Today article
  • "The average nursing home patient runs out of
    money within six months and must go on Medicaid,
    Markwood says. That, she adds, "will not only
    bankrupt individuals but also the Medicaid
  • All these statistics add up to a sobering
    reality. The number of people in nursing homes is
    only going to grow and it will cost more money to
    keep them there.
  • So, where are the opportunities for inventors? I
    see two areas.
  • First, new patents for medical devices for people
    who opt for in-home care. At the core of these
    inventions will have to be making life easier for
    the caregivers. Think walk in tubs instead of
    tubs you have to step over. Or handrails for
    bathroom facilities.
  • Second, new patents for medical devices for
    nursing homes. These will have to focus on
    reducing operating costs for the homes. Maybe
    less expensive lift devices.
  • These medical trends are not going anywhere and
    could be an on-going goldmine for any smart

  • In the United States, more than 22 million
    surgeries a year are performed in more than 5,000
    ASCs. ASCs are in all 50 states and can be found
    throughout the world. In the US, most ASCs are
    licensed, certified by Medicare and accredited by
    one of the major health care accrediting
  • The three main accreditors of ASCs are American
    Association for Accreditation of Ambulatory
    Surgery Facilities (AAAASF), Accreditation
    Association for Ambulatory Health Care
    (Accreditation Association or AAAHC) and The
    Joint Commission.
  • Our imaging centers database directory has over
    3200 entries as of June 6, 2011.New York state
    has the most with 384, about 12 of the total.

Ambulatory Surgical Centers
  • Top 20 Surgical Procedures by Volume, CY 2009 ASC
    Claims Rank Volume
  • Procedure Short Descriptor
    Volume of
  • 1 Cataract removal with IOL lens insert, 1 stage
    1,150,342 20.6
  • 2 Upper Gastrointestinal (GI) endoscopy with
    biopsy 441,591 7.9
  • 3 Colonoscopy with biopsy 341,161 6.1
  • 4 Colonoscopy, diagnostic 290,385 5.2
  • 5 Laser surgery (lens) 272,248 4.9
  • 6 Colonoscopy with lesion ablation or removal
    232,258 4.2
  • 7 Injection spine lumbar, sacral (caudal)
    229,137 4.1
  • 8 Injection foramen epidural lumbar, sacral
    207,053 3.7
  • 9 Inject paravertebral f jnt l/s, 1 lev 125,918
  • 10 Colorectal cancer screening high-risk
    individual 92,715 1.7
  • 11 Cataract removal, IOL lens insert prosthesis,
    complex 76,136 1.4
  • 12 Colorectal cancer screening low-risk
    individual 76,093 1.4
  • 13 Colonoscopy with lesion ablation or removal
    74,091 1.3
  • 14 Upper GI endoscopy, diagnostic 73,003 1.3
  • 15 Cystoscopy 72,286 1.3

Depending on FEMA Money?
  • The House Appropriations Committee approved an
    additional 1 billion for the Federal Emergency
    Management Agency on Tuesday to ensure the agency
    has enough resources to cover disaster response
    efforts in Missouri and in other states recently
    hit by natural disasters.
  • Alabama Republican Robert Aderholt, who chairs
    the spending committee's panel that oversees
    FEMA's budget, pressed for the additional money
    to be added to the bill funding the department
    for the upcoming fiscal year.
  • "FEMA is projecting that under the best-case
    scenario, the disaster relief fund will
    essentially run dry before the end of the fiscal
    year," Aderholt said in a statement after his
    committee approved the bill.
  • Under House rules, any increases for one agency's
    budget must be offset with cuts to another
    program. To pay for the boost to FEMA's budget,
    the committee cut money from a Department of
    Energy program that promotes the development of
    energy-efficient vehicles.

  • What are Community Health Centers?
  • Community, Migrant, and Homeless Health Centers
    are non-profit, community-directed providers that
    remove common barriers to care by serving
    communities who otherwise confront financial,
    geographic, language, cultural and other
    barriers. Also known as Federally-Qualified
    Health Centers (FQHCs), they
  • ? are located in high-need areas identified as
    having elevated poverty, higher than average
    infant mortality, and where few physicians
  • ? are open to all residents, regardless of
    insurance status or ability to pay
  • ? tailor services to fit the special needs and
    priorities of their communities, and provide
    services in a linguistically and culturally
    appropriate manner
  • ? provide comprehensive primary and other health
    care services, including services that help their
    patients access care, such as transportation,
    translation, and case management
  • ? provide high quality care, reducing health
    disparities and improving patient outcomes1 and
  • ? are cost effective, reducing costly emergency,
    hospital, and specialty care, and saving the U.S.
    health care system 24 billion a year.2

  • In the U.S. and Territories, there are
  • ? Approximately 1200 Health Center Organizations
  • ? Over 8000 Delivery Sites
  • ? Serving 20 Million Patients, including
  • o 941,000 Migrant/Seasonal Farmworker Patients
  • o 1 million Homeless Patients

  • The new business person must see his or herself
    not as someone who is out to count chips, but as
    someone who is passionate about making the world
    better through the products they sell. It may be
    to make someone laugh, to save their lives, or
    even to provide more freedom. The point is that
    the new business person must take on the
    responsibility of creating a better world. It is
    the new business person that seeks glory in the
    name of honor, instead of the mountain they

  • Are there any products that you currently have
    that can be marketed outside of Hospitals?
  • Stand Alone Surgical Centers, EMS/Fire
    Departments, Government Facilities ( Schools/
  • Are their similar products to market outside of
    Hospitals that would not be such a steep learning
    curve for your sales group?
  • Do you need to hire other sales persons?

Hospital Experts Predict Ten Emerging
Technologies That Will Shape Health Care Next
  • From pill-sized cameras to radioactive compounds
    that let doctors see inside a patients brain,
    Cleveland Clinics Top 10 Medical Innovations for
    2011 showcases new techniques, therapies and
    approaches to treating a host of diseases.
  • The list of breakthrough devices and therapies
    was selected by a panel of Cleveland Clinic
    physicians and scientists and unveiled during
    Cleveland Clinics 2010 Medical Innovation

The Top 10 Medical Innovations for 2011 are
  • 10. Capsule endoscopy for diagnosis of pediatric
    GI disorders
  • A pill-sized camera captures 50,000
    high-resolution images during its painless six-
    to eight-hour journey through the digestive
    tract, proving better than x-ray at detecting
    small bowel ulcerations, polyps and areas of

  • 9. Oral disease-modifying treatment for multiple
  • Before fingolimod was approved by the FDA this
    year, MS drugs had to be injected or infused on a
    regular basis. This oral medication effectively
    stops T-cells from attacking the myelin sheaths
    that cover nerve fibers.

  • 8. Exhaled nitric oxide (NO) breath analysis for
    diagnosing asthma
  • A new hand-held diagnostic testing device
    measures a patients level of exhaled NO, which
    is a biomarker for asthma. Monitoring NO levels
    allows doctors to more accurately tailor
    treatment strategies.

Not What I thought a Toga was?
  • 7. Transoral gastroplasty, or TOGA
  • A new experimental weight-loss option for obese
    patients who want to lose weight and improve
    their health without undergoing major surgery.
    This scar-less procedure represents a
    significant improvement in minimally-invasive
    bariatric surgery and losses approaching 40
    percent of excess body weight can be expected
    within a year.

  • 6. Telehealth monitoring for heart failure
  • Miniature implantable monitors to measure
    pulmonary artery pressure daily and at-home
    devices to monitor weight, heart rate and blood
    pressure of heart failure patients allow doctors
    to adjust medication quickly, improving patient
    outcomes and quality of life, while reducing

  • 5. Hepatitis C protease-inhibiting drugs
  • Two drugs awaiting FDA approval treat hepatitis C
    using protease inhibitors, which work by blocking
    a key enzyme that viruses need to copy themselves
    and proliferate. In clinical trials, cure rates
    for the protease inhibitors are higher than
    current hepatitis C treatments, with fewer side

  • 4. JUPITER study and statins for healthy
  • The JUPITER (Justification for the Use of Statins
    in Primary Prevention an Intervention Trial
    Evaluating Rosuvastatin) trial pointed out for
    the first time that many seemingly healthy people
    are at higher risk for heart disease than
    previously thought, suggesting that statins
    should be prescribed even to people with low LDL
    (bad cholesterol), if they have high C-reactive
    protein levels.

  • 3. First therapeutic cancer vaccine approved by
    the FDA
  • While not a cure for prostate cancer,
    sipuleucel-T is the first cancer vaccine to
    receive FDA approval. Prescribed to men with
    advanced prostate cancer, the drug coaxes their
    own immune systems into attacking and removing
    the cancer, reducing the risk of death by 24
    percent compared to placebo.

  • 2. Anti-CTLA-4 drug (ipilimumab), a targeted
    T-cell antibody for metastatic melanoma
  • The effectiveness of ipilimumab in treating
    melanoma confirms the role of immunotherapy as an
    effective treatment. In patients with advanced
    stage III or IV melanoma, 23 percent were still
    alive after two years compared to 14 percent of
    patients who received standard treatment.

  • 1. New molecular imaging biomarker for early
    detection of Alzheimers disease
  • Currently, positive diagnosis of Alzheimers is
    only possible upon autopsy. But a radioactive
    molecular imaging compound called AV-45 and a PET
    scan can allow doctors to see inside patients
    brains to detect beta-amyloid plaques, the
    tell-tale signature of Alzheimers.