Where have all the reps gone during COVID? |

Where have all the reps gone during COVID?

COVID-19 WILL CAUSE A PARADIGM SHIFT IN HOW MEDTECH COMPANIES INTERACT WITH PROVIDERS (MedGadget)

Survey Results from Medtech Executives

By:  Liv Williamsen & Jennifer Fried, CEO, ExplORer Surgical


Uncertainty begets innovation, and we are living in the most uncertain times in healthcare.

During the COVID-19 crisis hospitals stopped elective procedures causing significant financial strain on the healthcare ecosystem.  As the pandemic spreads, the human cost grows.  The healthcare industry is racing to respond and manage critical business issues caused by the crisis.  Even as restrictions are loosening, hospitals are finding that patients aren’t necessarily banging on the door to get surgery or see a care provider.  “A recent Needham survey showed about a third of respondents said they would be fine with having an elective procedure this quarter, but 26% would not until next year at the earliest.” One thing is certain, the healthcare ecosystem will never be the same.  However, what it will look like no one yet knows. 

(U.S. Navy photo by Mass Communication Specialist 2nd Class Sara Eshleman)

Bottom line: Healthcare providers and patients have been forced to accept new ways of connecting, thanks to this pandemic.  Many providers have turned to telehealth as a solution.  Amazingly, Cleveland Clinic, has been working to integrate telehealth into their care delivery model for over 7 years.  Now, they report over 80% of their patient visits are done via remote visits.  Even Medicare and Medicaid tore down barriers that once blocked use of telehealth to open the door for physicians to see patients virtually.  The rest of the Medtech industry is trying to catch up – with a race to upgrade their support infrastructure and support customers remotely.  Medtech innovation, from companies like ExplORer Surgical or rMarkBio, are addressing these challenges.  The ship has sailed; “business as usual” will be anything but usual.

In an effort to understand the challenges Medtech executives face in a “new” COVID-19 world, we posed a series of questions to them.  Interestingly, 82% of all executives felt customer interaction will look different in our “new world.” Consequently, in AvaMed’s recent roadmap to reopening elective procedures they recommend that medical device reps offer remote support whenever possible.  With these considerations it is causing executives to think about how to pivot and evolve.  Our survey uncovered these three primary concerns:

  • Access to hospitals for their clinical and sales teams
  • Physician and sales rep training
  • High case demand and not enough support

Everyone has something at stake as we try to determine a successful business model now and in the future. 

Respondent’s Demographics

Of those who responded to our survey the demographic was comprised of sales leadership (48%), marketing executives (28%), and clinical and training leadership (24%).  Those who responded to the survey covered a wide array of the specialties in the Medtech sector, as seen on the right.  By having a strong cross-section of surgical specialties it helped us understand how organizations are thinking about their business operations in a COVID-19 world.   

Where have all the reps gone?

While many elective procedures have been cancelled, there are patients with high acuity that necessitate immediate action and surgery.  For these cases, medical device manufacturers have faced a major dilemma – limited access to hospitals due to the high level of risk, and the inability to support their customers and products.  The survey showed that less than 20% of reps are able to cover cases in person.  This is either due to hospital restrictions, personal concern about exposure to the novel Coronavirus, or companies wanting to mitigate risk for their employees.  Moreover, a little more than 70% of lifescience reps are remotely supporting their customers through video, phone or some combination of the two.   Unfortunately, there are other instances of med tech companies seeing a complete halt to procedures.  In Med Tech Dive they published that “knee replacements, for example, all but stopped last month. Zimmer Biomet and Stryker were among the medtechs that flagged that impact.” How can things turn around?  This aligns with interviews I have had with orthopedic surgeons and physical therapists.  They fear job layoffs are imminent.  Fear is keeping patients away even as restrictions are easing. 

Adoption of technology for communication is becoming the new norm.  Salemi writes, in Medical Device and Outsourcing, that the pressures to reduce risk of exposure for their employees puts immense pressure on medical device companies to broadly institute practices that have been adopted during COVID-19 – remote calls during surgery.  Medical societies are collaborating on the best way to resume elective surgery as COVID-19 curve flattens.  On April 17, 2020,  ACS issued a statement in conjunction with AORN, ASA, and AHA to consider the following: testing availability for staff and patients, formation of a committee to determine case priority, and have a social distancing policy for staff, visitors, and non-essential team members.  Certainly, reps jobs will become increasingly more difficult as the ability to hunt and farm within a hospital changes due to new restrictions.  They will be forced to negotiate the quagmire of new hospital policies implemented to protect hospital staff and patients.  It will require medtech reps to approach customers differently, and companies will need to upskill their sales team in order to accomodate a virtual world.  Becker Hospital IT notes, “the COVID-19 pandemic will have a long-lasting effect on the healthcare industry, with new potential for digital health initiatives and data-sharing.” 

Anticipated Challenges

Challenge #1: High Case Demand Due to a Backlog of Cancelled/Postponed Cases

Elective procedure cancellation started in early March as a directive from CMS trying to preserve PPE and hospital beds for those in greatest need.  Consequently, the backlog of elective procedures has medical device executives scrambling to find solutions – large territories with many hospitals make reps’ ability to cover cases very difficult.  In conversations with medical device leadership, they have concerns about the sheer volume of cases that have been postponed, and reps’ vulnerability to COVID-19 as they start to re-enter hospitals. 

Slowly the procedure restrictions are being lifted and “shelter in place” mandates are easing, with these changes we are seeing surgery centers and hospitals slowly resuming elective procedures.  However, this does not mean all Medtech companies are ready to send their reps back into the OR.  For example, it has been reported that one neuromodulation company has decided to reduce the cost of their stimulators and not provide site of service stimulator programming.  It is unknown if this will be done remotely by a rep through a trained RN or office assistant or through some other means.  Similarly, AvaMed released a statement recommending reps cover cases remotely as much as possible to protect themselves and others.  As evidenced by ongoing recommendations from hospitals, AORN, ACS, AvaMed, and other groups, Medtech companies are faced with a changing business model and they are seriously starting to consider how they should adapt to the challenges their old model poses. 

There is no doubt the pandemic has caused a disruption to healthcare’s ecosystem.  Like Glorikian said in Forbes recent article that disruption is messy, and there’s a lot of uncertainty in figuring out how technology can impact healthcare.   Disruption is good.  It causes us to stop and evaluate what and how we can do things better and differently.  This is exactly what it is causing Medtech leaders to do.   

Challenge #2: Physician and Sales/Clinical Representative Training

Training is the cornerstone for any biotech and medical device company.  A significant portion of business operations are traditionally planned around hands-on activities. From training and mobilizing sales forces to engaging with providers and patients, medical device and biotech companies have relied on face-to-face communication to develop, train, and sell their products.   Consequently, more than a third of respondents felt training needed to be rethought.  Moreover,  live case proctoring and in field training causes great concern for med tech executives with 92% of them worried about what this will look like post-COVID 19. 

With continued travel restrictions and government recommendations to maintain 6 feet apart, face-to-face interaction with hands on learning is nearly impossible.  Medtech leadership is critically thinking about how to virtualize these key, high-touch training events and help their organizations develop their new virtual muscles. Thankfully, innovative healthcare technology companies are seizing the opportunity to offer remote training and education, from enhanced 3D modeling and VR to digitized procedure workflows and remote face-to-face training, it is making it easier for Medtech companies to pivot and adapt.   

Challenge #3: Hospital Access

Limited access to hospitals for Medtech companies means less product support, inability to troubleshoot, and provide high quality customer service.  Moreover, it limits new reps from observing cases and learning procedure technique and best practices.  Additionally, providing peer-to-peer training from experts becomes nearly impossible.  Many device companies rely on proctorships to ensure “stickiness” of their product.  Physicians, like all of us, feel more comfortable when taught by a peer.  It becomes increasingly more important when considering a physician learning a new procedure or using a new device for the first time. 

The level of complexity of medical devices cannot be overstated.  In the world of robotic surgery, it takes OR teams 30+ cases to feel comfortable with setting up the robot, moving it, and using it.  This however does not account for any troubleshooting in robotics.  Often medical device companies have a clinical and a field engineer supporting most cases.  Their primary role is to support the staff and physician wherever possible.  

Because robotics carries another layer of complexity UPMC’s Surgical Oncology for Hepatobiliary Disease developed a highly specialized robotic surgery certification process called, CART (Center for Advanced Robotic Training).  They learned that in order to become highly proficient at robotic surgery, it required ongoing mentorship and training.  It is an expensive program, but highly effective and therefore valued by many.  Imagine if this face-to-face training were virtual, and the support could be instantaneous.  That is the way of the future.  Being able to train faster, and be more nimble is more important than ever.  The ability to integrate technology that facilitates virtual training and learning will make Medtech companies more competitive now and in the future. 

It is unlikely that virtual interaction will ever take the place of face-to-face support and training, but it will likely be a marriage of virtual and in-person case support.  According to our survey,  93% of the respondent’s said hospital access will not be the same in a post-COVID-19 world for the near and long-term.


Remote Access: The Way Forward

Narrowing of hospital access for Medtech companies is familiar ground, but COVID-19 pandemic has taken it to an extreme.  Vendors have had to comply with credentialing companies that charge a premium for access to hospitals, and even after jumping through all those hurdles reps still find it difficult to get access to providers.  Now medtech leadership is scrambling to find tools to give their reps virtual access to provide case support and connectivity to care teams.  

Many of the short-term issues have been mitigated and the next stage of strategic planning is underway as Medtech executives anticipate the long-term business implications from this pandemic.  What will that new normal look like, and what role will technology play in the road ahead? 

Virtual access and the ability to provide excellent patient outcomes through cloud technology is the direction medtech companies and hospitals are headed.  We are seeing great enthusiasm around ExplORer’s cloud-based platform that brings together the rep and the OR team creating seamless communication and collaboration through digitized procedure workflows to include images, video and live video interaction.  

All around us our the environment is changing, office spaces are being reconstructed, plane seating is being reconfigured, telehealth is being adopted faster than ever before, and so will virtual case support.  The responses from our survey are a testament to the future of digital connectivity and the need to adapt to our current times.  ExplORer Surgical’s experience in building cloud-based procedure workflows and leveraging their platform to support cases virtually, or live, is more important than ever before.  As Steve Collens observed, “the platform provides detailed content live in a simulation environment for physician training and, during procedures, can display images and videos on mobile tablets for providers in the room, while reps monitor progress and provide live feedback remotely.”  What are you waiting for?  Technology is here to stay!

Find out how ExplORer Surgical will help your team maintain excellent surgical outcomes.

Watch how ExplORer Surgical’s platform can support your team in delivering excellent case outcomes by connecting your reps virtually or in person to each and every case.  Never miss a case again!
To learn more, schedule a demo today.


[1] Muchmore, S.  (2020, May 19).  Knee replacements nearly halted as hospitals braced for COVID-19, new data show.  Retrieved on May, 19, 2020 from https://www.medtechdive.com/news/knee-replacements-nearly-halted-as-hospitals-braced-for-covid-19-new-data/578219/.

[2] Cleveland Clinic (2020, April 22). COVID-19 Is Igniting a Redesign of Healthcare Communication.  Retrieved on May 15, 2020 from https://consultqd.clevelandclinic.org/covid-19-is-igniting-a-redesign-of-healthcare-communication/

[3] Salemi, T.  (2020, May 1).  COVID-19 is here: Medtech may never be the same.  Medical Device and Outsourcing.   Retrieved on May 11, 2020 from https://www.medicaldesignandoutsourcing.com/covid-19-is-here-medtech-may-never-be-the-same/5/

[4] AORN and AvaMed Guidelines.  Re-entry Guidance for Health Care Facilities and Medical Device Representatives.  Retrieved on May 20, 2020 from https://medtechresponds.com/wp-content/uploads/Re-entry-Guidance-for-Health-Care-Facilities-and-Medical-Device-Representatives.pdf

[5]  Muchmore, S.  (2020, May 19).  Knee replacements nearly halted as hospitals braced for COVID-19, new data show.  Retrieved on May, 19, 2020 from https://www.medtechdive.com/news/knee-replacements-nearly-halted-as-hospitals-braced-for-covid-19-new-data/578219/.

[6]  Salemi, T.  (2020, May 1).  COVID-19 is here: Medtech may never be the same.  Medical Device and Outsourcing.   Retrieved on May 11, 2020 from https://www.medicaldesignandoutsourcing.com/covid-19-is-here-medtech-may-never-be-the-same/5/

[7] American College of Surgeons. Safely resuming elective surgery as COVID-19 curve flattens: ACS, ASA, AORN and AHA develop roadmap for readiness.  Retrieved on May 11, 2020 from https://www.facs.org/media/press-releases/2020/joint-resuming-surgery-041720.

[8] Drees, J.  (2020, April 23).  Becker Hospital IT.  Judy Faulkner on COVID-19’s financial impact & how digital health advancements will help patients.  Retrieved on May 15, 2020 from https://www.beckershospitalreview.com/ehrs/judy-faulkner-on-covid-19-s-financial-impact-how-digital-health-advancements-will-help-patients.html.

[9]  https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations.pdf

[10] Kelly, S.  (2020, May 20).  Medtech Dive.  AdvaMed, health systems set ground rules for return of sales reps.  Retrieved on May, 26, 2020 from https://www.medtechdive.com/news/advamed-hospitals-covid-19-ground-rules-for-sales-reps-return/578287/?

[11] Bean, R. (2020, April 26).  Forbes.  Moneyball Medicine: Data-Driven Healthcare Transformation.  Retrieved on May 15, 2020 from https://www.forbes.com/sites/ciocentral/2020/04/26/moneyball-medicine-data-driven-healthcare-transformation/#44e2786258ab.

[12] Collens, S.  (2020, May 1).  Four ways Medtechs companies are adapting to a COVID-19 world.  Retrieved on May 5, 2020 from https://matter.health/posts/four-ways-life-sciences-companies-are-adapting-to-a-covid-19-world/#utm_source=featured-share&utm_medium=humans&utm_campaign=blog-covid-pharma.

[13] Collens, S.  (2020, May 1).  Four ways Medtechs companies are adapting to a COVID-19 world.  Retrieved on May 5, 2020 from https://matter.health/posts/four-ways-life-sciences-companies-are-adapting-to-a-covid-19-world/#utm_source=featured-share&utm_medium=humans&utm_campaign=blog-covid-pharma.

[14] https://www.upmc.com/healthcare-professionals/education/advanced-robotic-surgery-training

[15] Collens, S.  (2020, May 1).  Four ways life science companies are adapting to a COVID-19 world.  Retrieved on May 5, 2020 from https://matter.health/posts/four-ways-life-sciences-companies-are-adapting-to-a-covid-19-world/#utm_source=featured-share&utm_medium=humans&utm_campaign=blog-covid-pharma.

One response to Where have all the reps gone during COVID?

  1. COVID-19 is Forcing Medical Supply Chains to Change… And that’s a Good Thing: Part I – Working Title September 14th, 2020 at 5:24 pm

    […] elective surgeries for implantable devices like knee replacements have dropped by 99%. Moreover, nearly 50% of orthopedic sales reps have been forced to use exclusively digital means to support physicians or […]