Why reps need to stay close to customers to clearly understand how they manage the seasonal events in their practice, not just respiratory season.
By Jim Poggi, Principal, Tested Insights
Those of us who are passionate about selling lab products seek to find new, interesting and engaging ways to introduce lab testing in our conversations with our key customers nearly every day. Information about new tests, improvements to current tests and other interesting facts provided by our key manufacturing partners is a great source of “what’s new” information. In addition, many distributor home offices publish information you can use to share useful lab information with your customers.
But, if you are like me, sooner or later the well of interesting new information tends to run dry. In this column I will present some information about seasonal disease incidence we can count on to actively engage with our customers. At the same time, I plan to present information as a reminder that customer visit spikes for our customers based upon the season of the year. I will also look at the leading causes of death and present some facts and information about which are seasonal and which are not.
Look for a few surprises as some of the information on seasonality for the leading causes of death is not intuitive and challenges the conventional wisdom. As an added bonus, I have done some additional research on urinalysis to learn why this easy, non-invasive and highly informative assay seems to be used less frequently today than in past years.
Let’s take a look at the leading causes of morbidity and mortality to uncover which disease states can provide a seasonal message to deliver. I think you will find a surprise or two in the data and information shared.
The table on the following page summarizes which of the leading causes of death are seasonal, and which are not. Why provide this information? Two reasons. First, these diseases are the ones our customers see day in and day out and are top of mind for them as they work to improve the health of the patients under their care. The second reason is that, as I conducted my research, I found a few surprises, and as we review the data together, you may experience a surprise or two also.
The seasonal causes of death
We have all sold upper respiratory disease tests for several years and flu, RSV, pneumonia and COVID are all widely acknowledged to be seasonal. But, did you know that strep is not seasonal and incidence is pretty consistent year-around? Look at your customer data, check with trusted colleagues, and I am pretty sure you will find what I did. Strep may well peak in the late fall and winter months, but my data showed substantial strep activity all year long.
Are you asking your customers what their experience is? Are you reminding your customers of the strep options you offer? Keeping this data in view and sharing it may well identify you as a consultant with a little more insight and information than others.
The data also shows “unintentional injuries” as seasonal, but if you look closely at the data, it is more a case that issues related to risk (frequent outdoor activity in cold any icy conditions, frequent social gatherings in the warner months, and other factors influence the sorts of unintentional injuries our customers, especially in urgent care centers, see). While we do not presently have specific lab tests to diagnose patients susceptible to unintentional injuries, our customers see them frequently and the precursors that lead up to them, including overindulgence in alcohol and drugs, driving in dangerous conditions, water sports accidents and heat stroke.
While we cannot diagnose unintentional injuries, lab products play a part in follow up and recovery from them. CBCs, metabolic and organ panels are common tests used for follow up to unintentional injuries. It’s worth your time to ask your customers what their follow-up plan includes for the most frequently encountered unintentional injuries their patients present with. Don’t be surprised if lab tests you offer make the list. Make sure your customers are ordering them from you.
The balance of the leading causes of death
There are so many conversation starters here, and you are probably using many of them. A few come to mind.
For respiratory season, have you seen a rise in incidence of flu yet? Do you feel you are prepared with the number and types of respiratory tests you will need? Be sure to have last year’s data with you to share and help them plan. Are you looking to change any of these tests? They may be looking to move to reader based or molecular systems. Do not assume they will stay with the status quo and be sure to be well informed of the range of solutions your key lab manufacturers are offering, as well as any promotions that may be available.
For diabetes there is an equally large number of ways to thoughtfully engage. What impact are you seeing from the new GLP-1 medications on your patients? How is it impacting your diagnostic and follow-up activities? To what extent is it influencing your testing for diabetes and lipids? To what extent are you prescribing continuous glucose monitoring systems?
Heart disease is now recognized as a year-round disease. We used to think of a surge in cases in winter months, particularly in parts of the country with harsher winters. But recent data shows significant summer incidence in heart disease. Not at the level of winter, but clearly a year-round issue. It’s worth discussing BNP, lipids and other diagnostic tools all year and making sure you consult with your trusted lab manufacturers to bring the full portfolio of cardiac tests, including diabetic tests, to the table in your customer meetings.
Are the Leading Causes of Death Seasonal?
| Data from CDC 2022 | ||||
| Rank | Cause of Death | Incidence Trend | Seasonal? | Comments |
| 1 | Heart Disease | Increasing | No | Summer and winter both show upward trends |
| 2 | Cancer | Decreasing | No | |
| 3 | COVID-19 | Seasonal; dropped out of top 10 | Yes | Yes, as with other upper respiratory pathogens |
| 4 | Unintentional injury | Increasing | Yes | Surprisingly, yes. Suicides peak in late spring and summer |
| 5 | Stroke | Increasing | No | |
| 6 | Chronic lower respiratory disease | Decreasing | No | |
| 7 | Alzheimer Disease | Increasing | No | |
| 8 | Diabetes | Increasing | No | |
| 9 | Influenza and Pneumonia | Increasing | Yes | Yes, as with other upper respiratory pathogens |
| 10 | Kidney Disease | Unchanged | No | |
Seasonal activities your customers experience
Some of these seasonal activities will involve us directly and involve lab testing opportunities, and others are simply part of the rhythm of their practice and may or may not involve lab testing. But, the better informed you are, the more likely you are to be able to engage thoughtfully and earn the respect and trust of your key customers.
Annual school physicals
Annual school physicals typically include vital signs measurements and an assessment of the child’s physical and mental development, as well. Updating vaccination records has been a part of the annual physical but some areas of the country no longer require them. Be sure to know the practice in your territory. With childhood obesity at a high level, there are good reasons to discuss lipid and hemoglobin A1C assessments of children whose BMI indicates obesity. In combination with advice on diet and exercise, these wellness activities provide a proactive means of maintaining the good health of our children.
Medicare annual wellness visits
These patient visits are not a replacement for an annual physical. They comprise a wide-ranging visit that includes vital signs, personalized health advice, review of prescriptions and a cognitive assessment. For many patients, tests for lipids and hemoglobin A1C are appropriate. Patients with other chronic conditions will have additional testing needs which may include CBC, PSA, BNP and other tests. A great conversation starter would be to consider asking your key customers abut how they conduct annual Medicare wellness visits and to what extent they include testing as a part of these visits.
End-of-year patient visits
Many private pay and Medicare patients schedule visits toward the end of the year to maximize their insurance benefits, especially if they have already exceeded their annual deductible amount. As with the Medicare annual wellness visit, make sure to thoughtfully ask about your key customers’ end-of-year patient experiences. Do they usually see a substantial increase in visits toward year end? How do they plan for medical and surgical supply needs as well as additional testing requirements? How can you help them plan ahead? What do they believe the coming year end patient visit trend will be like? Are they considering any changes in patient management during peak seasonal visit times?
Respiratory season
Respiratory season is always top of mind for the experienced account manager. As we approach fall and help our customers prepare, it is important to assess their satisfaction with last season’s testing platform and the tests they used. Are they satisfied and willing to use the same platform and products again this season? Are they looking to add new tests? Is it time to “go molecular” or upgrade to a higher throughput and capacity platform?
There is a lot to know here and thoughtful conversations with both the clinical practitioners AND the lab personnel will round out the picture. You need to make sure to check in with both teams to assure you understand the respiratory seasonal dynamics thoroughly. As long as both groups have the same impression and understanding, you are in an excellent position to move forward with this year’s continuation of last year’s plan.
But if there is a disconnect, it’s time for a business review to get everyone on the same page. I would schedule it formally and ask your customer, depending on their review of last year’s lab testing experience, whether they want to include the manufacturer of the tests they used last year or whether they want to consider interviewing a select few manufacturers to consider options for the coming season.
Urinalysis update: why has urinalysis testing seemed to have declined?
I have been puzzled over this observation for a few years now. I go back to the days when urinalysis test strips and readers were prominently visible in just about every physician practice I called upon. Inevitably, there were also a few urine cups surrounding the lab sink waiting to be tested. In the last few years, it is clear that routine urinalysis testing has become less common. I have wondered why and even wrote a column a while ago portraying urinalysis testing as the “forgotten test.”
I believe I have finally found out what has happened. Many advocacy groups, including the United States Preventive Services Task Force and several IDNs no longer consider wide scale routine urinalysis screening as imperative. USPSTF recommends urinalysis screening for pregnant women between 12 and 16 weeks of gestation. They do not recommend screening for asymptomatic men and nonpregnant women. In my literature research, I have encountered similar recommendations from prestigious university health organizations and healthcare networks.
One of the more common objections has been that findings of trace amounts of blood in the urine are relatively common with no serious etiology and frequently expensive follow up fails to determine a cause that needs medical attention or intervention. Note that for symptomatic patients, this is not the case and urinalysis can help diagnose diabetes, urinary tract infection and other conditions that require treatment. It is also important to note that UTI is one of the more common causes of sepsis so there is clearly a balancing act between general screening of the asymptomatic population and assuring urinalysis for the symptomatic patients.
So, what can we conclude as we consider lab testing and seasonality? My personal conclusion is that we need to stay close to our customers to clearly understand how they manage the seasonal events in their practice, not just respiratory season. We have all been attuned to anticipate respiratory season and work hard to protect our current business from competition.
But how many of us go on and ask the follow-up questions to understand the other seasonal activities that our key customers face? It is my experience that this deeper dive often gets overlooked as we manage supply issues, backorders, questions about new products and the inevitable challenges of proving that we are knowledgeable consultants and that we add value far beyond the products we offer and the pricing we provide to our customers.
Considering the bigger picture and understanding the dynamics of the seasonality your customers encounter is an important element of adding value for them and increasing their spend and satisfaction with you and your company. Be sure to keep this thinking in mind as you hold routine meetings and business reviews with your key customers. It will pay dividends for you and them.