All Together Now

Edition: March 2009 - Vol 17 Number 03
Article#: 3148
Author: Repertoire

On the surface, it's an unlikely coalition. But then again, this is the era of bipartisanship.

A number of provider organizations and supplier organizations were, at press time, close to hammering out a consensus statement on vendor credentialing, at least as it affects so-called "clinical" sales reps. When it is completed, they will sign their names to it and present it to the Joint Commission, which has been working on vendor-credentialing standards for the industry for some time.

Suppliers' concerns about vendor credentialing have been well-publicized. Those concerns include the potentially high cost of credentialing, particularly for clinical reps; the lack of standards; fear about how data will be used; and fear that vendor credentialing will morph into vendor management and, ultimately, denial of vendors' access into healthcare facilities.

Providers seek standards too

It turns out providers have some concerns about the issue as well. "Vendor credentialing was top of mind at last year's AORN Congress, not only among industry members - manufacturers and distributors - but also our members and their facilities," says Fred Perner, vice president of business development for the Association of periOperative Registered Nurses in Denver, Colo. AORN executives learned that the issue was also a high-profile concern for at least two other provider organizations, who approached AORN about exploring some joint activity on the issue. Those organizations were the American Association of Critical-Care Nurses (AACN) and the Association for Healthcare Resource & Materials Management, or AHRMM.

While investigating the issue, Perner discovered that AdvaMed - a Washington, D.C.-based association representing medical products manufacturers - had already begun work on proposed standards of its own. "We saw that their criteria closely mirrored AORN's views, and we said, 'Why re-invent the wheel?'" says Perner. AORN reached out to AdvaMed to see whether multiple organizations could collaborate on a joint statement.

But the vendor-credentialing issue had heated up for other organizations as well, including IMDA, the Downers Grove, Ill.-based association for medical specialty distributors and reps. (See "A Plea for Common Sense," August 2008 Repertoire.) IMDA President Shawn Walker of North Andover, Mass.-based Bay State Anesthesia, and Bill Vitez of Sylmar, Calif.-based Tri-anim (an IMDA member) spoke with leaders of several other organizations to explore the possibility of coordinating their positions on vendor credentialing of clinical reps. "We realized that we could accomplish more if we had more bandwidth, as opposed to fighting the good fight on a stand-alone basis," says Walker. The other organizations were the Health Industry Representatives Association, Health Industry Distributors Association, Healthcare Manufacturers Management Council and the Medical Device Manufacturers Association. Together, they created the Innovative Healthcare Access Coalition, or IHAC.

Suppliers' concerns

IMDA and its fellow IHAC members have long been concerned about the potential costs of vendor credentialing, particularly those imposed by vendor credentialing companies that charge suppliers on a per-hospital or per-IDN basis. But IHAC members' concerns run deeper than that. "One problem is vendor credentialing's ugly stepsister, vendor management," says Walker. "The terms are being used interchangeably, but they're really not the same thing. It's not just 'Did you have your [vaccination] shots?' It's turning into a management tool. Providers are monitoring who the sales reps saw, where they went and what they're talking about. And our concern is that this evolution promises to stifle innovation."

Closely related is concern about how information is being collected, how it is being stored, and what will be done with it, continues Walker. "We're concerned about the bigger issue of privacy and the safety of our information, and making sure that any standard is do-able on a national basis from a legal perspective."

Left unchecked, acute-care customers' demands could lead to untenable situations for vendors, she adds. For example, in a number of states, employers are legally prohibited from demanding that their employees get drug tests without probable cause. Yet some customers are demanding that vendors show proof of such testing. "We felt it was problematic to have a standard that reps in companies headquartered in seven states would not be able to adhere to," she says. While it's likely the final document will call for drug testing, it will probably reference the difficulty of obtaining such tests in certain states. "While we would have preferred to have the whole thing removed from the document, at least now, we'll be able to provide some perspective as to why the drug testing issue isn't so cut and dried," says Walker.

Mission-driven approach

Meanwhile, AORN has always viewed vendor credentialing in the context of the organization's mission, which emphasizes safety, optimal outcomes and professional support and collaboration, says Perner. "So our reason to get involved was mission-driven."

"AORN strongly believes that the industry representative plays an incredibly important role in the clinical setting, in terms of training, support and guidance with new technology," he says. At the same time, the organization and its members need to make sure that sales reps are appropriately trained in OR protocol, aseptic technique, how to respond to emergencies, etc., he adds. Whatever standards for vendor credentialing are arrived at, AORN hopes they will balance the needs of the rep with those of the hospitals on whom they call.

What exactly is a 'clinical' rep?

Integrating the thoughts of multiple organizations can be daunting, but AORN, AdvaMed, AACN, AHRMM and IHAC were at press time close to putting the final touches on a document to submit to the Joint Commission. That's not to say some thorny issues - such as drug testing - didn't arise.

For example, the organizations had to agree on how to define a "clinical" rep. Defining a rep as "clinical" or "non-clinical" makes a big difference, not only in the fee each has to pay the vendor credentialing company (or hospital), but in the criteria the rep must meet in order to qualify as "credentialed." At press time, the organizations appear to have agreed that a clinical rep is one who is in the "immediate vicinity" of patient care.

Says Walker, "A clinical rep is not someone who's visiting the OR in the middle of the night, or someone visiting the ICU but staying at the desk, or someone who goes into the OR but only to talk to the manager in her office." Adds Perner, "AORN is pretty much saying, clearly, if patients are present, then these criteria should apply to you."

Another issue that had to be addressed was, "What kind of insurance should the sales rep be required to carry?" The two most-oft-mentioned choices are product liability and professional liability. The former covers the product itself, while the latter insures the rep who sells it. IHAC lobbied against mandating product liability insurance, arguing that some reps - particularly manufacturers' reps - might not have access to such insurance. In the end, all the organizations had appeared to agree that clinical reps should carry either product liability or professional liability insurance.