HTM COVID-19 Town Hall - Getting Through the Pandemic Together

April 28, 2020

In this April 22 webinar, industry experts shared information about medical equipment supply chain, medical equipment planning for expansions and how to effectively divert equipment and staff in times of need.

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  • Danielle McGeary, vice president of HTM at AAMI (host and moderator)
  • David Brennan, Senior Vice President and Chief Product Officer at PartsSource
  • Michael Ahmad, Vice President, HTM Business Development at ABM
  • Steven Rubino, HTM Project Manager at Scripps Health

ABM (Michael Ahmad, vice president of business development)

Well, first I would like to thank you so much for the opportunity to share our experience with the HTM community. I think this is a great opportunity and we value that and we appreciate it. Since day one of the COVID19 crisis, we have been in the middle of this situation managing the accounts, equipment, and resources in the very hardest spot in the United States. So we absolutely know that we have… to manage more the fixing of the equipment and the maintenance of the equipment. It's always about the patient's safety, the safety of the healthcare givers, as well. Now every day there is more that has been published about the use and the maintenance of the medical equipment including but not limited to compliance, equipment availability, and alternatives to the shortages of the life support equipment.

Examples of that, the shortage of ventilators’ availability, the use of anesthesia equipment as a substitute to ventilators, operating the vents remotely from outside of the isolation rooms, as well as other issues we deal with on a daily basis as HTM programs and examples of that is completion of PMs, parts availability, maintenance resources and maintenance compliance with regulatory standards. Now what we do is we use our own judgment based on our experience, knowledge, and personnel qualities to make decisions and offer consultations related to the medical equipment maintenance and use. Now we have kept ourselves informed with the guidance from the government health organizations like CDC, WHO, OSHA as well as the CMS, The Joint Commission, and FDA. And we found that these are great tools and sources to keep ourselves and others informed, especially when face-to-face communication nowadays is almost impossible.

Uncertainty, learning, coping (5:09)

Now, the big question is how did we position ourselves as a high-quality service provider during this COVID-19 crisis? We found ourselves like everybody else in the middle of this and we must adapt and we must act as quickly as possible to get great results of our service deliveries. Now we looked at the situation and we kind of divided into three different timings. And what we called it is the uncertainty time, the learning time, and the coping time.

Now the uncertainty time is the time when we started this and we found ourselves living with emotions. We're complaining about everything: the shortages of equipment, shortages of resources, what is going to happen? And we were reading the information coming to us and receiving it and just forwarding it. But then we had to take a different approach to this crisis and that's when we pushed ourselves to the learning time.

Now the learning time, it's all about the awareness of the situation. We were raising I huge awareness of this situation. We were looking and digging for information, evaluating the alternatives so we can do the best to deliver quality service. Then, after understanding everything that was going through this learning time, we started to cope and moved ourselves to the coping time.

Now the coping time for us, we believe that we should live this situation. We should offer our talents to whoever needs them. And we need to live the present. We need to act accordingly, but we have to think of futures, alternatives, and solutions. And we have to be innovative and creative, as well.

Now we know that we are all witnessing a very unprecedented time with different responses to the pandemic impact. And we know that healthcare leaders are faced just like us with a very heightened demand demonstrating to their patients, staff, and to the community that they are providing a clean, healthy, safe, and healing environment.

Now because of all that we promoted the “we listen, we act” approach. And what we have done to do that is we were preparing and elevating our employees and our talents based on needs. We have done that by utilizing every expertise and knowledge available to us. And we have done it by finding the right options based on the situations and by maintaining a high-quality and timely service delivery to our clients and to our patients. So to reach the optimum level of success, ABM has created the operational response team, which is made up of multiple subject matter experts from multiple departments and areas of the company to best assess and address the COVID-19 situations for both our team and our clients.

Now the operational response team evaluates the risks and responses regularly to keep up with the changing guidelines and the dynamics of this outbreak. Also, we kept a very constant communication with our employees because we know that... this is the key element for our success and for our response.

Hear, protect, prepare, support, care (8:21)


Now reading and looking for information to elevate our capabilities and deliverables, we practiced an outcome of one of the top healthcare professional’s interviews regarding how they need to be supported during this situation. This interview actually was conducted by the JAMA Network and to summarize what we have taken from that, I will list them as follows, which is … “Hear me, protect me, prepare me, support me, and care for me.”

Now “hear me,” we practice that by doing daily huddles which has given us an opportunity to share all the updates to hear from the frontline and to understand and address any concerns that may come up.

The “protect me,” what we have done is we equipped our client with the latest safety information as we have it, and by altering schedules of our employees to keep the team healthy and by creating enhanced cleaning SOP or processes and the checklist for our employees to make sure that we are minimizing the infections.

Now “prepare me” is we prepared ourselves with everything that we need from pre-ordering the parts, locating items that are difficult to find, and by prearranging temp labor. Because we know that with the shortages of staff, we needed to act quickly and be very well prepared for it.

 “Support me,” it was very clear that we have to share the best practice on our daily calls and we make sure that this is going to help them to stay informed and to stay safe, as well. In addition to the safety moments that we do on every call, every day, with every meeting and every huddle, we make sure that intentionally we are taking care of our employees, their very well-being, and making sure that they are all safe and sound to take care of their business.

Now with all of the well-thought processes created for this event by our professionals within our HTM and ABM, we are acting very leveland we are preparing for every event at this very critical time. We have developed two work shifts for our employees because we wanted to minimize and limit the close contacts. We separated technicians, especially in the areas ... and probably you know as HTM communities we may have shops that are small. We make sure that the employees are not clustering in their small shops. We identified some positions such as the field service imaging engineers, sterilizer engineers, and others if they can work from home or if they can work from a remote site to minimize the close contacts. We created a very specific outside vendor policy because this is very important to make sure that the traffic going in and out from our hospital through our department is very well taken care of and it's a very well thought-out process in there.

Now also what we have done is we identified the forecast for our HTM resource requirements and we have done that by focusing on the search planning information that we received from the hospitals or from certain areas that we receive information, such as the number of beds and medical equipment required or requested, the dates of the predicted peak time and bed shortages. And also we continuously kept monitoring the input from the hospital activities and practices, the hospital activities, their schedules, and the human resource needs and needed to manage the HTM department and HTM program.

Now probably every facility has gone through procured or donated medical devices. These medical devices are why we understand the importance of the vents and other equipment during the COVID-19 time. We also understand that there are some minimum requirements that these medical devices must comply with to ensure quality, safety, and effectiveness when used for the management of COVID-19. Our policy is in this regard is all this equipment should be provided with accessories, consumables, and spare parts that are required to operate for a minimum duration of three months.

Also, we maintain the cybersecurity compliance when installing new equipment to the hospital’s network and we have to make sure that when we are plugging in equipment, because of the kind of “hurry up and wait” situations that we are in, that we take care of our network and we make sure that this is not a gateway for hackers or any other attempts to get into our network and start doing whatever they are not supposed to be doing on our network.

Now, there are other examples that we worked on, especially in this event, is the negative pressure rooms … the creativity of making sure that these negative pressure rooms are not going through construction and going through the process of rebuilding rooms. There are other alternatives that we found and we shared all of this information with our clients, with our partners, to make sure that we minimize the time frame to build those pressure rooms. And they can do it at the very cost-effective way.

Now to conclude this presentation with all of you guys. I would just go with just some closing remarks that I would say our clients are trusting us to keep them safe and protected in this very unprecedented time. Where ourselves actually, we are having to face multiple challenges like equipment shortages and availability. That's a problem. Access to necessary equipment and parts. And this is another challenge that we have to go through—maintaining regulatory compliance. Still, we have to take care of our patients, make sure our employees are all safe, but at the same time we have to remain in compliance because at some time, one of those regulatory agencies have to come back and ask us questions about why we're not in compliance at certain times.

The human resource shortages is another issue that we have to deal with. The surge and the clinical unit's reconfiguration needs. And that takes a lot of effort and a lot of time of our employees to take care of. And then making sure that we assist with providing information that the clinical staff can use to remain safe and focused when taking care of their patients every day. Now at the very end guys, I would like just to thank you all and thank AAMI and special thanks for all our frontline employees that they are taking care of every patient, every caregiver, every day and making sure that we are all safe, our patients are taken care of in a timely manner, and making sure that we are as an HTM community, we are very productive and very efficient.

Scripps Health (Steven Rubino, HTM project manager) (15:57)

Scripps Health is a multifacility organization that is throughout the San Diego County area, and the Biomedical Engineering Department is a department that is a shared department all the way across, in-house program. So when we initially got our requirements to start planning for COVID, you can imagine that we were getting requests for information from different sources, supply chain, from the different hospitals and different clinics, the command center. All kinds of questions were coming across.

So our initial instruction was to simply plan for patient surges, but there's no guidance on the care level requirement, or if the surge patients would be placed in existing or converted or net new locations. We were also asked about how much would it cost per bed to create a med-surg area or a critical care area. And I thought that was kind of an interesting request. As we went forward and looked at some of those costs, we were able to identify a cost per bed in the range of around, med-surg would be around forty-two, forty-three thousand dollars. That's a pretty bare bones with the gurney. And if you're in an ICU bed, you'd be around $72,000. I can tell you from equipment planning, those numbers are really pretty thin. I can tell you that an ICU would usually run well over a $100,000 a bed, and probably fifty or sixty thousand for a regular med-surg bed.

So we had to look at what equipment we had and how we could take and bring different items in. And so we decided to put together a list based upon our experience and knowledge of the areas. We created a spreadsheet, and this spreadsheet is available if you're interested. It's pretty in depth if you reach out to Danielle, but it lists all the equipment types by the facility, like gurneys, vital signs machines, patient monitors, infusion pumps, and a host of other equipment, and how many were in the inventory at the different sites. We did that so that we could begin to understand what was available in the different sites.

The list was based on our experience, as I said before, and this gave us a framework to build out our equipment plans. And we wanted it to be confirmed by patient care leaders, but unfortunately, I'm sure you all have experienced it, everybody has been pretty busy, and it's pretty hard to get any kind of buy in. Everybody has their own ideas. So we did our best to refine the list to indicate bare minimums that were needed in each area.

We eventually received some guidance from our command through the state, through FEMA, and they asked us to begin to look at phase one, phase two, phase three, and phase four, which is phase one's at a 100% capacity. Phase two at 115% and on from the other two phases. That kind of actually helped us out. Phase one, 100% capacity, for any of the HTM biomedical engineering programs, you experience that every year where you have the peak flu seasons that go on, where you're slammed with patients. You've got a code ABC, where they're trying to get patients out of the hospital, because they've got patients that are in the emergency room trying to get in.

And so you've experienced that. And for the most part, our equipment requirements are already existing. So that helped us to begin to establish a baseline from where we wanted to go. The 115% capacity, the 125%, all became percentages to us. And later this would become kind of important, because through these percentages, we were able to take and determine the level of equipment that would need to support those kind of surges. So if you're talking to a different hospital, talking to a hospital and a specific department, they're going to want to have 150 infusion pumps all stacked in their department ready to go. The reality is they don't need that many pumps. And so what they want and what they need became our “drive to,” and we use this phasing to help drive with what they should be actually having.

And this proved to be very beneficial. Also, while we're very conscientious of patient care and providing the highest level of care, we don't want to leave anything out. Without having appointments and elective surgeries and stuff, Scripps Health, like I'm sure every hospital in the nation, was confronted with lost revenue. And so we had to be conscientious and aware of our resources. So again, this helped to drive people to get what they needed, but not necessarily what they wanted. And this was a good way for us to help drive that that point down.

As guidance improved, surge plans were circulated, and we did our best to begin to look at using existing equipment. Specifically for us, we have 30+ outside clinics, and there's a lot of equipment inside there that can be brought into the hospital area in support of the surge. So we identified those areas, and we were very careful to make sure that we had those areas identified. And wherever we could, we would make sure that people knew what we were doing. We set up a process for tracking equipment and making sure that we were able to take and return that equipment back to its proper owner.

The actual surge patient population ratios, they're all unknown to us. We just know they're going to come on us. So again, all the more reason why we use these percentages to help drive what we did. And we monitor it every day, and we still do. Every morning, we look at our ops supervisors' reports to see how many patients we received that are COVID, how many are on vents, and how many patients are actually in the med-surg areas. And as census rises, we were able to direct resources to them with the use of this.

We get into ventilators. Wow. What a mess. First of all, command and a lot of the executive leadership, they all said, "Well we got, we've got CPAPs, so that'll take care of it." No, it won't. "Well, we've got BiPAPs. We'll get used BiPAPs." Well, they've got to be converted to an invasive if you're going to be supporting a COVID or critically ill patient, but for the most part, you don't want them up with a mask blowing everything out, aerosolizing the virus and all that. We pushed for and drove home the need to have critical care beds. Working with the county was a challenge, because the county didn't understand medical equipment, even though they had somebody overseeing the needs. So we had to educate them as well as our own executive staff. And I used the pulmonologists and the respiratory department to help educate everyone for our needs and what needed to be done. We put together the list of all the ventilators that we had by the model numbers, and we identified their priority of use. So obviously for critical care and COVID patients, they demand some pretty specific modes of ventilation. And we wanted to be very careful of using those until they were actually needed. And wherever possible we wanted to use converted BiPAPs or ventilators that had lesser capability, but still could help ventilate, on a very basic level, patients.

How do we figure out our need or our quantity for ventilators? Well, first of all, we went into each of the hospitals, and we looked hanging on the wall, and I think everybody's hospital has got the same thing, is your hospital license. And on your hospital license, it outlines the number of beds that you're authorized to have, you're licensed to have. And specifically, it'll address your ICU beds that you have. So we took those beds for each of the hospitals. We've got a total of them. And then using information from the county and from FEMA, they said about 85% of the patients that go into critical care will be on vents. And those patients will probably be COVID. But that's not always the rule, but most of them will be. But if they're in the ICU, they're going to need, most likely, the critical care beds. So we did the 85% rule. You have 159 ICU beds, you're going to need probably 136 vents to support that in those areas.

So we used that, and then we were able to apply that to the 115% capacity, the 125% capacity, and the 140%, and we identified very quickly the shortage of critical care vents that we did. So that helped to drive prioritization of vents for use and reach out to the county with our requirements for critical vents to support our anticipated deficits. Those rose pretty quickly.

Anesthesia machines. So you hear everybody talking about, "And we can use anesthesia machines." Well, yes you can. Anesthesia machine generally requires an anesthesiologist to manage that machine, and they’ve got to stay with that machine. Yes, they could teach a respiratory therapist, but it is a bit of a challenge to do that. And also we want to put on filters to protect that. In one case we did actually use, not for ventilation, but we did use an anesthesia machine for COVID surgery, and they ended up putting in a machine in the OR and a machine in recovery, and when they were completed, we had to clean both machines, sterilize, replace flow sensors, and that became costly, and it took two machines down at one time. So we had a lot of discussion about what we could and can't do. But for the most part, anesthesia machines will only be a last resort. They're really not a great idea to be using.

I also looked at what did we miss? And we've got a hospital that's surging right now. And I went to the ICU. It was interesting. They didn't realize they needed to reach out to the command center and tell them they had some shortages of equipment. We talked about and planned for infusion pumps, but we missed PCA, patient-controlled analgesia. We missed that. We also missed BIS monitoring. We kind of knew it, but didn't think it'd be necessary. If you have a paralyzed patient, you're going to have to have some level of brain monitoring going on to see where they're at.

And nerve stimulators proved to be real important too. And obviously those are extremely hard to come by, because they seem to get in people's briefcases and stuff like that. But at any rate, we had to get that to them. And then NG tube placement devices, some of you may know that as CORTRAK. If you've got a tube in your nose, and you're trying to feed a patient, you need to place it correctly. So those became really important for us to do that.

So we have done fairly well. At this time, we are surging, we found out that Mexico is a problem, and patients are now coming, or family members are coming across the border. And so our southern part of San Diego is surging at this point in time, but we're hoping it will stabilize, and hopefully see a drop here shortly. That kind of covers it. As I said before, if you're interested, what I've said right now is only a tip of the iceberg of what I have on a spreadsheet. If that's of any interest to you, I did make it available to Danielle, and if you'll reach out to her by email, I think she said we would be happy to share that with you.

Oh, by the way, I would tell you this. When we completed our spreadsheet, it was interesting. We had a couple of vendors say, "Are you done with your planning?" And we said, "Yeah." "Would you mind sharing it with us?" And I said, "What's going on?" And they said, "We've got a couple of hospitals, and they just don't know what to do." And I was kind of shocked by that. And I said, "Yeah, absolutely. I'll do whatever I can to help people out." The point being to everybody here, maybe as a community, we've got to reach out. If people are not sure what they need to do, please reach out to me. Please reach out to other hospitals and see what they're doing. Please don't sit there with, as I say, “paralysis from analysis.” Please ask and be more than happy to help you out.

PartsSource (David Brennan, senior vice president and chief product officer) (31:18)

So I would just start with a similar message to Danielle's. This is an unprecedented situation. It is absolutely crazy. And I just want to thank everybody out there in the HTM community who is protecting our families collectively, our businesses, our communities, and salute you for being on the front lines, for the heroics that we see every day. And we just couldn't be more appreciative, and it just renews our commitment every day to support you the best way that we can.

PartsSource is a technology-based service company. For those of you that don't know us, we service over 3,500 hospitals in the United States, and we have sort of a unique perspective on the buying patterns for parts and equipment and services across the U.S. From our perspective, we have seen an incredible shift in the marketplace in the last week or so. We have seen a move from the early phases of this disease and this crisis, and what some people have called sort of the “resolve phase.” I like Michael's “uncertainty, learning, and coping phases,” as well, but I think this “resolve” label is an interesting one. It sort of connotes a feeling of, "We are resolved collectively as a country to beat this thing. We're resolved to find solutions collectively. We're resolved to help each other and go through that uncertainty and learning step," the coping phases that that Michael mentioned earlier. We've seen incredible behaviors in the HTM community over the last six weeks—very, very thoughtful preparation—I think what Steve just walked through is a great example of some of that. We've also witnessed in a real way in our warehouses and on our teams the panic and the surge-buying around vents and infusion pumps, patient monitoring in particular, and gotten sort of a front-row seat to the incredible creativity that is coming out of the HTM community and teams like Steve's. This change that we've seen though, that we're seeing a new sort of duality emerging marked by two very different kinds of fights going on, if you will, in the U.S. right now. The first is on the coasts, right? Like our friends like Steve who are seeing surges or those in New York City that are still fighting the disease, that are literally renting out hotels, they're leveraging every square inch of space still, they're partnering with FEMA, they are consistently consuming large quantities of parts, accessories, equipment, repair services, PMs, etc. They don't have paying customers per se, and that is part of the problem, but they have more work than they can handle.

As you can imagine, that contrasts very much with other parts of the country, in the South, in the Central U.S., and out West in certain places. These are hospitals that have prepared for the worst, but thankfully the worst never came. They are marked by sort of all-time-low patient census counts, no elective procedures going on, no revenue, and therefore extensive layoffs, furloughed employees, and in HTM teams, that are no longer at full-fighting strength. While they're no longer at full-fighting strength, their leadership is still thinking about the next phase. We're sort of calling this, and I've heard it referred to as the “resilience phase” of where we are with this pandemic, resilience in the sense that we need to make this work. HTM teams are classically known for their creativity and just getting it done.

This is less certainty about the future than we've ever seen. It's about sort of resiliency to make plans to restart hospitals, to reboot departments, to reopen certain procedures, to activate their marketing departments and convince the public that their space is clean and virus free, and most importantly, to get patients through the front door for normal procedures. This is what's sort of dominating the non-surge, non-hotspot conversation, and it's only made worse by the macroeconomics. Seventy-five percent of hospitals are reporting negative margins for 2020. I think most people saw that Moody's rating service downgraded the financial outlook for all U.S. nonprofit hospitals last week. It is going to be a cashflow nightmare. It's going to be very, very difficult for the U.S. healthcare scene. And it's unclear how long it will last, it's unclear if there'll be a resurgence.

But what is clear is that outside the hot zones, it's a different battle than inside the hot zones. HTM communities, depending on where they are regionally, are going to need to pivot their strategy at one point or another here. We know that that it's not going to go back to the way it was. It's not going to be the old normal. Eventually we'll find a new normal, but it's going to be chaotic for a while. We know that elective surgeries need to be restarted where they can be restarted in a safe and effective way that matches where they are on the curve. We know that these will reemerge, and they have to reemerge to recover from the revenue losses that we're seeing. We know that teams, as they're coming out of a surge, are rebalancing their beds, reallocating space, rethinking their capacity, planning for this next phase of uncertainty.

We know that cath-angio rooms and procedures to alleviate pain and traditional imaging will increase, and we're seeing leaders who are actively readying their fleets for that phase. Most importantly, we know that it won't be even in recovery. We know that some places will surge back and come back faster than others. Others will be very, very slow. All of that is going to affect the supply chain. All of that duality, the hot spots, the cold spots, back orders, that's what's driving our conversations with our customers. At PartsSource, we manage probably more data about more customers and more suppliers than anybody else. Our conversations are about smart procurement solutions, about historical work order analysis to get to some of those numbers and ratios that Steve mentioned, to start planning ahead for, "What does the next phase look like? What should I be doing with my precious few dollars to make those dollars stretch as far as you can?"

I would encourage all of you out there to seek out partners for the next phase of this journey that are rich in data. If you yourself don't have good data—I think Steve sort of referenced this—if you can't lean on peers in the industry or find it, then I think you're going to need to find supply chain partners that can help you through it and really sort out misconceptions, sort out wants versus needs. We hear questions all day, every day that aren't really based in fact or data. We hear that, "Prices are rising everywhere. This is a China problem. I'm stuck, and I can't win," but the reality is that price gouging, while in some areas like PPE, has been real, it's not really happening on O2 sensors or batteries or filters.

Goods from China are flowing very steadily, and I actually see more issues on the OEM side where well-managed, thoughtfully run OEMs were running just-in-time inventory operations and have been caught behind the curve and are now scrambling to catch up. I see evidence that that they are catching up, actually. Good news, I see evidence of HTM teams that are actually driving savings every day. I think as Steve said, there are actions you can take, and top HTM programs around the country are taking stock of their assets. They're mining their work order data. They're sharing it with their trusted advisors. They're separating needs versus wants. They're working together to build out par levels that make sense. I would encourage everyone out there to seek out partners that have active supplier management, that are constantly monitoring the supply and demand situation for you.

We, like Steve, have shared a lot of information. We have modality guides and part guides for particular modalities that been affected by COVID-19. We've shared those with thousands of folks, and I'll work with Danielle to make sure that we can get those guides out to you as well. These guides contain key SKUs per model and suggested quantities for those key SKUs based on the size of your fleet. Now, as we think about and work with systems across the country that are making attempts to reopen and planning what procedures they will open, we'll shift our focus to helping them plan for their imaging, for their surgery, for ultrasound and other key modalities that are poised to come back.

Again, I would encourage you to find partners that have active quality vetting programs, that have surveillance systems that help you get the best mix of high, high-quality parts, high-reliability deliverability, and at the best price. It's these sort of building blocks that make up the contingency plans. Contingency plans are built on flexibility. You have to look for partners and solutions that give you optionality, that don't just offer one kind of part from one person, that they can look for OEM parts, OEM equivalents, refurbished parts, tested parts, and they have the teams and resources to search out creatively for alternatives. Thermometers are a great example. Welch Allyn temp probes were quick to go out of stock, and thermometers were something that everybody got creative and found solutions for very quickly. It's about doing your homework. It's about pulling in trusted partners. It's about leveraging the data that you do have. If you don't have it, there are peers that have it. There are companies like us that have it, and good partners out there will know SKU by SKU, model by model what's on back order and configure custom contingency plans for you.

To do this, it is sort of a different behavior and different mindset that I think people need to embrace, which is the top leaders in the HTM community are not protective of their data. They're actively sharing it, like Steve mentioned. They are looking for analytics or using their own to find cost-out solutions. People call us every day and say, "Okay, I've got this kind of problem. This is my install base. This is my historical work order volume. Help me build a plan, whether it's using who I've used in the past, or show me alternatives to my current methodology. I need to save money. I need to be safe. I need to be secure in the coming months." Whether it's parts or service contracts or equipment, there are almost always more holistic solutions out there than just having your team sort of dialing for parts.

There are solutions out there that give you better control, better visibility to what you're doing, better savings overall, and again, if you don't have great data, and I know a lot of systems out there don't have great data, then there are peers you can benchmark. There are companies like us that manage all that data, and we can help as well.

Contingency Plans—The Big Picture (44:00)

If we shift away from parts for a second to look at the bigger, larger picture, top HTM leaders know that they need to build these contingency plans. They understand that they are coming out of a constrained supply chain situation with the first surge. There could be another. There could be certain problems as imaging and elective procedures begin to reopen. They understand that they are already… behind the curve. They're looking at their staffing. They're looking for scalable solutions across their staffing landscape.

They are looking for things that they can order now for the coming months, where they can find the best talent and make sure that talent is going to show up on their doorstep at the appropriate time to provide the appropriate relief for their teams. PartsSource is one of the solutions in this space. We have over 500 service technicians, and we're fielding calls for preventative maintenance jobs that are six or eight or 10 weeks out because it's the easiest, cost-effective way to scale their internal teams with high-quality resources. Other partners of ours have decided to outsource entire modalities because that's what matched their staffing profile, that's what matched their needs, that's what matched their contingency plan.

The idea here is that now is the time to act if you're... Depending on where you are in the curve, whether you're preparing to reopen or you're ramping down, there will be other phases. There will be other surges. There will be other backlogs. Certain skill sets, certain parts, certain equipment will certainly become scarce again. I would encourage you all to find a partner that's passionate about your success and ask yourself sort of the key question, which is, "Okay. This is the state of my HTM team. I'm either going through layoffs. I'm going through furloughs. Some of my staff is available. Some is not available. I have different staffing models. We have different hours. It's been all turned upside-down."

It's not a matter anymore of whether you know how to do something, whether you can repair your own defibs or your own infusion pumps. The question is, "Should you? Is that the best use of your time? Is that the best use of your scarce resources?" I find that depot repair is a classic example of that. We repair thousands and thousands of small portable devices every week. But what's interesting is that a sizable chunk of that comes from systems that absolutely can repair. They have that technology, they have that skillset in-house, and they have chosen to control their destiny. They've chosen to use those scarce resources elsewhere.

That's the thought process change that I would have you focus on, proactive capacity planning that allows you to choose your own battles, finding the partners who can leverage data to help you plan for your consumption, eliminate overbuying, separate, as Steve said, the difference between needing it and wanting it, and making sure you're taking actions on your fleet before the mad rush that will happen certainly again. Know your consumption ahead of time. If you have inventory, work with a partner that can determine the right safety stock levels for you. Leverage either your benchmark data or their benchmark data. If you don't carry inventory, work with a supplier who can analyze your assets, proactively engage on your behalf, and make sure you have continuity of supply. We run global analytics. I'm looking at some dashboards right now on my screen for consumption patterns across the U.S. by modality and we place daily replenishment orders for our warehouse and for our customers.

And the third point would be to assess your staffing. Make sure you're looking at your capacity, make sure you're leveraging outside resources to strengthen your team. This is what I see the best of the best doing right now. Tracking the data very closely and knowing that they can work to generate additional capacity on that team even during these crazy, crazy times. They can generate savings and they can bend that cost curve ultimately for their department and for their hospital when cashflow is at the worst point in modern history. So anyway, thanks for your time today. I look forward to taking your questions.



What is the latest on the PM, planned maintenance requirements? 


Danielle McGeary (answering for AAMI): So as many of you know, AAMI has been working closely with The Joint Commission and the DNV and also with CMS directly. And just to be absolutely clear, CMS sets the rules, The Joint Commission and accrediting bodies, such as The Joint Commission or the DNV and others are like the police officers, they enforce the rules set by CMS. So until CMS issues a waiver, The Joint Commission, the DNV, and other accrediting agencies’ hands are tied. So CMS has been made aware of the issue by the DNV and The Joint Commission and AAMI—we have reached out directly as well. We are still waiting to hear back at this time. I know that's probably not the answer that everyone wants to hear, but that is the current status of that, and we will be sure to update everyone as soon as we hear more. But know we are doing everything in our power and communicating everything to CMS as we get information from the field.


Where did HTM fit into the hospital incident command structure? Were you in the traditional logistics branch or did you change the command structure to include an HTM planning branch?


Steven Rubino: So the HTM was at times was kind of like an offshoot, a stepchild, hate to use that term. But we have become pretty vital in their requests. I truly wish we sat at the table, along with supply chain, with the executive leadership, as they're looking at things. They have people that, some of you know me, I'm from the military. So I believe in a chain of command and I believe there's certain roles that people play, and sometimes in the civilian market there are people in a role that really shouldn't be in that role.

So I say that because initially we weren't included in it, but after the information we started providing, we came into a very critical role. So now most anything regarding equipment goes to command, and command reaches out to us and we help to redistribute the assets. Hope that answers your question.


What is your involvement with donated equipment from governments or colleges? Do you just perform an electrical safety?


Steven Rubino: I just had a doctor's office donate an anesthesia machine to us. I got a picture of it and I had a senior director, no it was a vice president told me that "We're going to get it because we need anesthesia machines." And I said "No, we have plenty of anesthesia machines, and this doesn't look very good." Some of the pictures showed the last time PM was done was June, 2017 and so me, personally, and I would think most biomeds, we're not going to let a piece of equipment come into our facility without going through and checking out to make sure it's right. And if the PM hasn't been done since 2017, I've got some very serious questions about it.

So electrical safety, no, it's got to go through a full-blown checkout, and probably might even need to have a PM. And it's a difficult time in COVID right now because everybody wants everything right now, but you have to stand your ground. You got to remember there's a patient tied to this, and I wouldn't want my family member on that machine until I was 100% sure that it would function correctly. So I'm not happy about donated equipment. I sincerely appreciate it, the offer. But I think sometimes you can get into a real bind that people start trying to dump junk on you.


Did you experience staff shortages because of this pandemic and how did you handle it?


Michael Ahmad: The way we handle the search and human resources, if I did hear your question right, actually we are working with our HR department very closely. We are talking to our network in the market and making sure that we have communication with especially the veterans of the biomed departments in the past, like retirees or people that they decided to do something different, and they are willing to come back and help, we are in very, very good contact with them. Temp agencies, we've been in contact with them too as well, to make sure that they are very well prepared for our requests, and we've been very successful in fulfilling all our positions and making sure that we don't have any open positions, and so far on all our accounts that we manage across the country, we've been doing extremely well.


Is PartsSource performing training on PMs and repairs for ventilators? I know so far these trainings are usually done by the OEM, but due to these circumstances can PartsSource do it?


David Brennan: I think the answer is I don't know that we have dispatched people in recent weeks to do training on ventilator PMs, but certainly we work with our network to dispatch people to take care of ventilators and do those PMs onsite. We do quite a bit of work in the patient monitoring and infusion space as well. So I'll have to look into the training question.


Were rental agencies factored into the expanded capacity projections? Were they able to commit equipment to your sites including for contingencies, and were you competing with other providers for rental resources?


Steven Rubino: Yes! I think David made a very excellent statement in that you need to partner with companies that can support you. So there are about five healthcare organizations in our area and we were drawing all the rental equipment we could, and trying to reach out and get whatever we could, especially towards ventilators, but also for PCA pumps, and other things like that. Yes, we were in competition with other healthcare organizations, and I think when it comes to ventilators and stuff, I know we're going to be replacing our entire fleet the next two to three years, and my plan is to take the existing fleet that we have—it's in good shape, keep it in good shape—and mothball it for other surges. So some of the things that I'm looking at trying to do to manage the shortages. I think people hoard equipment and I wish there was a way we could manage that a little bit better so that we had equipment available to meet patient needs.


How did you minimize the COVID-19 exposure to your employees?


Michael Ahmad: Oh, that's a good question, and I think I did mention some of that in the presentation. What we have done is we created the two to three shifts schedule to minimize the kind of close contact between our employees, and we made sure that we separate our employees from each other as much as we can. Areas where we've had shops are small, and we are hosting more than one or two or three employees in a small shop, we make sure that we separate those from each other as much as we can. And for those technicians or engineers that can work remotely, whether it's from another site or whether it's from their own homes, we encourage them to do so. This will minimize the presence of the cluster in our shops and make sure that the contacts between employees is minimized.

Also we've been educating our employees a lot on how to take care of themselves and how to practice certain safety precautions. We do that action in every huddle, every meeting, every call that we have, we call it the “safety moment.” And we share all the information with our employees from sanitization to hygiene, cleaning, cleaning, cleaning, social distancing. A lot of other information that's been provided to us, whether by CDC or other organizations, or by our own safety department within ABM.

So all this information has been constantly shared with our employees. And we've seen the effectiveness of this information being provided to them with the results that we see. I mean all of our employees are healthy, all of them are taking care of the business on a daily basis. And I think we just had one case across the entire country from our HTM department, especially for the front-line employees. And that's a great success rate. And so far everybody's healthy. Everybody's doing great.


Has PartsSource seen an unanticipated shortage? or instance, there are reports that dialysis may be in short supply in New York City.


Steven Rubino: I think everything is in short supply in New York City. I would say that yes, there is an increased back order, week over week, here. If I look at my data, it looks to be about 10% worse this week over last week. And so I couldn't tell you that we've reached bottom on that from a surge perspective. Whereas in other modalities such as infusion or patient monitoring, we're seeing demand levels come off of highs more than seven days ago, and returning to sort of pre-COVID levels now. So I'm happy to, if whoever asked the question wants to reach out to me, happy to share more data and get deeper into the dialysis world more directly.

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