Boiling Point

Edition: January 2008 - Vol 16 Number 01
Article#: 2847
Author: Repertoire

CHICAGO—Vendor credentialing — an issue that has been bubbling for some time under the surface for medical products salespeople — appears to be on the verge of boiling over. But manufacturers and distributors have reason to be optimistic that some order may be brought to the process before it spins out of control. Vendor credentialing was the topic of a panel discussion at the Fall Conference of the healthcare Manufacturers Management Council (formerly the Healthcare Manufacturers Marketing Council).

In the past year or two, distributors, manufacturers and manufacturers’ reps have grown increasingly concerned about the proliferation of requirements that providers are demanding vendors meet in order to call on them — criminal background checks, proof of immunizations, proof of training on the products they sell, proof of training on codes of ethics, etc. What’s particularly worrisome for suppliers is that providers haven’t agreed on a common set of requirements suppliers must meet. Suppliers are concerned about the time and cost involved in complying with providers’ requests, many of which duplicate suppliers’ own background checks of new employees.

One organization – Strategic Marketplace Initiative (www.smisupplychain.com) – already has tried to address the issue by issuing a recommended protocol for vendor credentialing, called “Management Guidelines for Vendor Access.” (See “Guidelines for Vendor Access Issued,” November 2006 Repertoire.) More recently, the Joint Commission signaled its intention to get involved, and has pledged to conduct a “field review” of the subject in the first quarter of 2008, during which it will solicit public comments on the issue.

Cause for concern

“I’ve seen these vendor access programs really accelerate in the past 18 months,” said John Tara, director of corporate strategic marketing for Boston Scientific, speaking at the HMMC Conference. Tara estimated that 75 percent of U.S. hospitals have some type of formal credentialing process in place. “It’s hard to see it not going to 100 percent,” he added. That’s a problem for the company, which has about 2,500 field reps in the United States alone.

“There are 5,000 hospitals, and 5,000 different vendor credentialing requirements,” said Tara, who worked on the Strategic Marketplace Initiative guidelines as well as on a committee for AdvaMed, the Washington, D.C.-based association of manufacturers, which has been exploring the issue. “You can be looking at tens of thousands of credentialing requests processed each year. Then you have renewals. So there’s redundancy, risk management, compliance issues, and the cost of the system.”

The issue is scary for small sales companies as well,according to Frank Krimowski, president of the Health Industry Representatives Association, another panel member at the HMMC Conference. “It becomes a nightmare for a small company,” he said. “You have to create a mini-department in your company just to handle documentation. There isn’t a day that goes by without somebody calling or e-mailing me and saying, ‘I just got asked for this,’” said Krimowski.

“The big concern on our members’ part is overcredentialing,” added panel member Matt Rowan, president of the Health Industry Distributors Association. An example would be demanding blood-test results for reps who call only on the materials management department, he said.

The panelists conceded the need for some kind of vendor credentialing. Beginning last year, the Joint Commission began quizzing hospital administrators about the extent to which they knew who was walking the floors of their facilities, according to Tara. “Most hospitals realized they didn’t know who was gaining access to the institution,” he said. Unfortunately for suppliers, many providers simply modified their medical-staff-credentialing processes to accommodate vendor-credentialing. The result is a myriad of requirements, few of which take into account the nature of the sales rep and his business in the providers’ facility.

Seeking a win-win

What’s needed, the panel members agreed, is a process that will ensure patient safety, patient confidentiality and quality of care, while also ensuring that providers gain access to innovative medical technology and skilled sales professionals to demonstrate proper use of those technologies.

AdvaMed has already submitted comments to the Joint Commission. In a letter, the association supported the goal of establishing “minimum HCIR standards that protect the interests of patient care.” (“HCIR” stands for “health care industry representative.”) That said, the organization decried the current state of affairs. “Currently, the HCIR is experiencing an expanding range of burdensome and inconsistent vendor access policies which are applied to both clinical/sales and, on some occasions, to non-clinical/administrative medical technology personnel, as well as vendors such as delivery personnel and non-healthcare product vendors,” the association wrote. “In other instances, hospitals and health systems are applying professional credentialing standards (such as standards applicable to physicians) to all third parties who enter the facility.” Such standards often duplicate the suppliers’ own screening and training procedures, and even violate the privacy of field sales reps (if the provider demands their social security number, home address, etc.), according to AdvaMed.

Are passports the answer?

Some suppliers are lobbying for the creation of a universally accepted “passport,” which would certify that the sales rep had met certain basic requirements, such as criminal background checks, vaccinations, knowledge of patient confidentiality laws, etc., according to the panel members at the HMMC Conference. In addition, AdvaMed and others have proposed that the industry recognize that reps calling on the OR and other patient care areas should meet different standards than those who call on the purchasing department only. (This approach was advocated by the Strategic Marketplace Initiative in its recommended guidelines.)

As it prepares to conduct its field review, the Joint Commission has consulted existing industry documents for guidance, according to the organization. Specifically, it cited the “Statement on Health Care Industry Representatives in the Operating Room,” issued by the American College of Surgeons, which was revised in September 2005 (see http://www.facs.org/fellows_info/statements/st-33.html); and “The Role of the Health Care Industry Representative in the Perioperative/Invasive Procedure Setting” by the Association of periOperative Registered Nurses, which was most recently ratified in March 2006 (see http://www.aorn.org/ PracticeResources/AORNPositionStatements/Position_HealthCareRepresentative).

Both the ACS and AORN concede the vital role that sales reps play in providing quality patient care. For example, the American College of Surgeons says that “[h]ealth care industry representatives…, by virtue of their training, knowledge, and expertise, can provide technical assistance to the surgical team, which expedites the procedure and facilitates the safe and effective application of surgical products and technologies.” That said, ACS calls for providers to verify documentation that certifies the sales rep has had education and training in:

• HIPAA compliance and all matters related to patient rights and confidentiality

• Appropriate conduct and attire in the OR environment

• Aseptic principles and sterile techniques

• Infectious disease and bloodborne pathogens

• Occupational safety (biohazardous waste, fire, electrical, radiation and other safety protocols).

• Other applicable practices that may be related to the operation of the hospital.

HMMC is an association of senior-level sales and marketing executives from small, medium and large companies whose primary business is the manufacture and supply of products and services for sale to the entire spectrum of healthcare. The organization has scheduled its Spring 2008 Conference for West Palm Beach, Fla., April 15-17.