Avoiding reimbursement-based sales

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anonymous said:
100+ views, no replies. Surprised that no one else has given this thought. You all must be ok with your income declining in the future.
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Nice troll, loser. You must be ok with posting a dumb question that gets looked at 100 times and no one cares to answer you.
And to add some color, my income has been steadily going up over the past 9 years despite declining reimbursement because I sell better and I partner with companies that have better products; outcomes, safety, efficiency. Keep selling that "me too" crap you loser.
 




anonymous said:
Nice troll, loser. You must be ok with posting a dumb question that gets looked at 100 times and no one cares to answer you.
And to add some color, my income has been steadily going up over the past 9 years despite declining reimbursement because I sell better and I partner with companies that have better products; outcomes, safety, efficiency. Keep selling that "me too" crap you loser.
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Wow, you're angry. I don't blame you- you're in a segment of the industry that's dying but you just don't see it. Since you're making it personal assuming you know me, let me "add some color" myself. I've been in med sales longer than your stated 9 years (I've actually been with my current company over 9 years). I'm not a device rep (implants, disposables, catheters, etc), which I assume you are based on your response. I'm not in a transactional sales environment, don't sell a "me too" product- I sell highly technical and differentiated capital equipment with a very long sales cycle, a per unit ASP of $750k, and we have 1 competitor in a market creation environment. I don't even sell to individual hospitals- I strictly focus on strategic IDN's. Unlike you, I no longer want my income to be dictated by reimbursement, physician preference, GPO contract status, capital purchasing committees comprised of procurement people who stare at Excel sheets to try to compare us to the competition, etc. I occasionally visit this board to get the pulse on each segment of medical sales and do my best to post thoughtful replies or start new threads to help myself and others. I was hoping that some folks on here are thinking out of the box about ways to actually take control of their career and position themselves into segments of medical sales where decisions are made differently. I'm aware of a couple of segments where income approaches and hits 7 figures, but was genuinely hoping to get other ideas from folks and see if I'm missing anything as I actively explore options.

Instead, I get your response. You're the tough guy on a message board, providing no value and insulting people you don't know by telling them they're "trolling" and a "loser". You'll lie to yourself and everyone on this board and say you're so good at selling that you aren't dealing with purchasing committees, your docs love you and will fight to keep your product, you have all of your accounts locked down. You have no idea what's coming- 85% of hospitals across the country aren't compensated on value-based care yet. Deal with the 15% who are and you'll see your future. Want to see your "loyal" docs get told what to do by procurement? Think the docs will threaten to leave the hospital if they don't use "X" product ( you should read some independent literature on how rarely that has happened in the last 5 years)? Think you can sell a cool niche product without being on contract? Private physician practices are getting purchased weekly by your hospitals. Your docs are employees now, with no power to make decisions. Big data on clinical studies gets fed into intelligent procurement systems that aggregates info on products in the same category and provides an aggregated dashboard of clinical differences between vendors so purchasing people can make a decision on what to buy (not docs). Pricing is now transparent across the entire country with cloud-based procurement systems that sort by vendor name, product name, and SKU. With a single mouse click, purchasing can now see the pricing you offer them and everyone else across the country. Start by googling BroadJump Medical and you'll get a very small example of what I'm talking about. Oh, I forgot to mention they were started within a major GPO and have since spun off to expand their services to let other big GPO's subscribe and access their data. They're growing like crazy and making a fortune. Whoops.

You think the CEO of your company doesn't realize all of this? You think they don't realize you're actually providing absolutely no value in the new world? In the device world (again, not what I do), transactional sales reps can be replaced by a national accounts team to deal with the IDN and GPO and local clinical specialists who can support the cases and deal with nurses and physicians. You're probably the type of device rep who looks down on clinical specialists- mainly because you make so much more money than them and that's how you value yourself. You're unaware that you can be replaced by them and that it makes more financial sense for your company to make that move.

Unlike you, I have taken the last 2 years to join organizations so I can attend conferences (on my own dime) where not a single medical sales rep (other than me) is in the room. These are conferences full of purchasing people, medical consultants, GPO leaders. I wanted to hear what they were saying about the industry, about how they negotiate with reps, how they look at info for making purchasing decisions, and see upcoming trends. It was frightening. Hence, I'm looking to get out of my highly technical, highly differentiated, and (luckily for me) highly lucrative segment of med sales.

Your ego (which is most likely based off of your supposed income level) won't let you take advice from anyone so you'll probably brush off this response.

I wish this board would let people attach a photo because I'd challenge you to post a pic of your 2015 W2 and would gladly post mine. It's a shame but that's probably the only thing that would put you in your place. Good luck.
 




^^^^ This post is right on. Poster # 3 is feeling like a fool, and rightfully so. I agree with 95% of what poster # 4 said but have a couple of things to add:

Poster # 3 thinks he is a progressive rep because he talks about "safety, efficiency, and outcomes." Everyone has been talking about those exact things for the last 4-5 years. Just visit your competitor websites, visit every medical company website selling anything clinical.... everyone's messaging is built around that. Ever since the "triple aim" effort was documented, every company started changing their messaging...therefore reps started changing theirs.

Poster #3 now realizes he is the one who is the "me too" rep now that he has been properly schooled by someone who has a clear view of the entire industry. Poster #4 can drive different conversations with customers because he understands things on a macro level, has attempted to understand things from their viewpoint, and can challenge a customer's thought process.

As someone who spent a lot of time in med sales and then transitioned to medical national accounts, I 100% agree with what poster # 4 says about things like smart procurement systems, transparent pricing, etc. One of the scariest things is hospital consolidation and GPO shifts. When one hospital buys another, they get instant access to the pricing you were offering that hospital on every product. If you were giving the smaller hospital better pricing, the larger (acquiring) hospital will know and question you on it and likely demand retro-pricing for them. It also happens when you see movements in the GPO world- when Tenet ditches MedAssets to go to Healthtrust... the member hospitals report back to Healthtrust when they see price increases on products under HPG pricing compared to Tenet/MedAssets in the past. And that really angers Healthtrust who feels they are the biggest and most-compliant GPO - which makes them feel entitled to the best pricing.

Only thing I disagree with # 4- I'm not sure reps will disappear in exchange for clinical associates. I think this may happen in some companies- but can assure you across the board medical reps comp programs will go down because C-level leadership understands they provide significantly less value moving forward in the new era.

I made the move out of traditional medical sales (radiology imaging) and moved into software. It was very tough to get in but I love not having discussions related to reimbursement, volume declines, physician preference, etc.
 




Wow. Impressive. Two of the biggest blowhards I have ever read about. Apparently you like to hear yourselves talk. And, I wish one of you presented an original thought. Sadly, no. My post was a simple response to the little bitch that was upset that no one responded to his question. Don't fuss like a baby if you post a question and no one cares.
 








anonymous said:
100+ views, no replies. Surprised that no one else has given this thought. You all must be ok with your income declining in the future.
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Original? Who gives a shit. My income is growing, period. Your lame whining is pathetic. "Surprised no one else has given this any thought." Are you really?!
"You all must be ok with your income declining..." Yeah, no. Sounds like you are not cutting it. Good luck out there.
 




anonymous said:
Original? Who gives a shit. My income is growing, period. Your lame whining is pathetic. "Surprised no one else has given this any thought." Are you really?!
"You all must be ok with your income declining..." Yeah, no. Sounds like you are not cutting it. Good luck out there.
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You are such a great sales person. Congrats. You're also delusional and a moron. You keep proving with each post that you have no idea what's coming your way because you only focus on your "growing income" and are so blind you can't see the future. You sound like a typical low-end, transactional med-sales meatball. Not the type of person anyone should take advice from - and luckily you're not attempting to provide any since you're incapable of looking outside of today's world.

Keep patting yourself on the back. You'll be dispensable within 2 years. Count on it.
 




anonymous said:
You are such a great sales person. Congrats. You're also delusional and a moron. You keep proving with each post that you have no idea what's coming your way because you only focus on your "growing income" and are so blind you can't see the future. You sound like a typical low-end, transactional med-sales meatball. Not the type of person anyone should take advice from - and luckily you're not attempting to provide any since you're incapable of looking outside of today's world.

Keep patting yourself on the back. You'll be dispensable within 2 years. Count on it.
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Yawn. You continue to assume things about me proving your lack of general insight. Your second post (when you were whining that no one answered) claimed we all had declining income. Whose focus?! Tell me more about what I can't see in the future. You are some blow hard, know it all wanna be. You're right, why would anyone want to take advice from someone with a long history of professional success and is growing their business and income - despite your claim. Keep guessing loser. Dispensable within 2 years? Yeah, we've heard it before a long time ago. Still here, and growing. Tell the board more about these stupid med-sales meatballs that you are superior to. We want to hear all about it. How do you make yourself so great?
 




anonymous said:
Your second post (when you were whining that no one answered) claimed we all had declining income. Tell me more about what I can't see in the future. You are some blow hard, know it all wanna be.
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Maybe the 3rd time of me saying the same thing is the charm. I have never said that you "all HAD declining income." My 2nd post, if you actually scroll up and read it says, "...you all must be ok with your income declining IN THE FUTURE." Key words: in the future. You keep trying to convince me that you're successful and things are great because you are only focusing on today/this year compared to the past. I can't really help you if that is your thought process because I'm looking forward 2-3 years.

My income, like yours, has grown steadily and sharply since things stabilized in 2012. I am in expensive capital equipment, so the shock waves of the '08 crash were felt for about 4 full years in my segment, hence the sharp increase since. I'll make quite a bit more money this year than in 2015 and this will be my best year out of my 14 years in med sales. The difference between you and I is I see the train stopping (and want to jump off now) because I have taken a lot of time to investigate what I think the future holds. As I have described in prior posts, it's not looking pretty in virtually any segment of medical sales where reimbursement is concerned for a lot of reasons.

If you care to keep the banter going, if you tell me what segment of medical sales you're in, I'd be happy to continue being a "blowhard" and tell you exactly what you aren't seeing in your future based on the dozens of conferences I've attended of medical thought leaders, consultants, etc. I'm not sure it will do any good because you aren't showing any signs of proving that you are capable of looking past today. Today is not a predictor of next year or certainly 2018 in med sales.
 




This is quickly becoming one of my favorite threads on CP. While there are few guarantees in life, here are some solid guarantees:
1) Poster # 3 is a current or past Stryker rep
2) Poster # 3 likely talks about himself in 3rd person, wears/wore scrubs in an airport, flexes in the mirror and smells of hair gel, Axe body spray and tanning beds.
3) Poster #4 will single-handedly crash the CP server with his lengthy responses

Please keep this thread going. We want more!
 




anonymous said:
Maybe the 3rd time of me saying the same thing is the charm. I have never said that you "all HAD declining income." My 2nd post, if you actually scroll up and read it says, "...you all must be ok with your income declining IN THE FUTURE." Key words: in the future. You keep trying to convince me that you're successful and things are great because you are only focusing on today/this year compared to the past. I can't really help you if that is your thought process because I'm looking forward 2-3 years.

My income, like yours, has grown steadily and sharply since things stabilized in 2012. I am in expensive capital equipment, so the shock waves of the '08 crash were felt for about 4 full years in my segment, hence the sharp increase since. I'll make quite a bit more money this year than in 2015 and this will be my best year out of my 14 years in med sales. The difference between you and I is I see the train stopping (and want to jump off now) because I have taken a lot of time to investigate what I think the future holds. As I have described in prior posts, it's not looking pretty in virtually any segment of medical sales where reimbursement is concerned for a lot of reasons.

If you care to keep the banter going, if you tell me what segment of medical sales you're in, I'd be happy to continue being a "blowhard" and tell you exactly what you aren't seeing in your future based on the dozens of conferences I've attended of medical thought leaders, consultants, etc. I'm not sure it will do any good because you aren't showing any signs of proving that you are capable of looking past today. Today is not a predictor of next year or certainly 2018 in med sales.
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Reimbursements are generally being squeezed and have been for years, I agree. But that is not new, and neither is this common worry of when will this end. I don't think it will. While reimbursement appear to move down, total healthcare spending is rising...like crazy. Fastest growing market over the last 15 years. You have been earning more; Me and my colleagues are doing well, and have been for years. What's the problem? Clearly innovating companies find value in reps who bring tech to market, and are willing to pay us for it. Is it easy, no. Are our customers influenced by this rhetoric, a bit? I know, when central purchasing gets taken over by the fed we are all out of jobs. I don't buy in to that. Probably a risk factor of 5% today or less. Certainly, I think that risk incr in time. In all seriousness, I need to skate for another 10 yrs or so before I ring out. I think this market has that and then some. Yes, we might have to shift, change specialties, but that's not that difficult. Painful for the first 12-18 months.

That said, I am interested in your take on a few markets; interventional cardiology/radiology, gastroenterology, thoracic surg. Sorry to disappoint...no I don't work for Stryker or any ortho company. I will play nice...although I do think your concerns are generally unfounded.
 




anonymous said:
Reimbursements are generally being squeezed and have been for years, I agree. But that is not new, and neither is this common worry of when will this end. I don't think it will. While reimbursement appear to move down, total healthcare spending is rising...like crazy. Fastest growing market over the last 15 years. You have been earning more; Me and my colleagues are doing well, and have been for years. What's the problem? Clearly innovating companies find value in reps who bring tech to market, and are willing to pay us for it. Is it easy, no. Are our customers influenced by this rhetoric, a bit? I know, when central purchasing gets taken over by the fed we are all out of jobs. I don't buy in to that. Probably a risk factor of 5% today or less. Certainly, I think that risk incr in time. In all seriousness, I need to skate for another 10 yrs or so before I ring out. I think this market has that and then some. Yes, we might have to shift, change specialties, but that's not that difficult. Painful for the first 12-18 months.

That said, I am interested in your take on a few markets; interventional cardiology/radiology, gastroenterology, thoracic surg. Sorry to disappoint...no I don't work for Stryker or any ortho company. I will play nice...although I do think your concerns are generally unfounded.
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I agree with some of what you are saying. Especially getting paid to "bring tech to market." As I mentioned, I have been in market creation for several years now and have been handsomely rewarded for landing customers in my region. A few points:
- "When central purchasing gets taken over by the fed" - I don't think this is happening. For many reasons I am hopeful that we won't become a single payer system like Canada. This has nothing to do with my fears.
- "Me and my colleagues are doing well, have been for years. What's the problem?" To me the problem is this market is changing more now than it has in the last 20 years so it's dangerous to think of things in today's terms or yester-year terms. In 2018 roughly 90% of hospitals will be shifted away from fee-for-service and will be paid on quality and outcomes. I don't think half of them are ready. I personally believe in the next 15-24 months you are going to see the biggest change in purchasing behavior that you have ever seen in this industry. There is already a huge move to consolidate vendors within a health system in an effort to reduce costs and streamline processes but it's about to get worse. It's one of many reasons Medtronic is spending billions of dollars on acquisitions- they are preparing for a scenario where the biggest company wins (to leverage contracts, multi product discounts, etc).
- "While reimbursement appear to move down, total healthcare spending is rising...like crazy". Spending is rising due to the volume associated with baby boomer care (pig in the python). There is an obvious problem looming. Revenue coming in (reimbursement) is declining and costs are climbing. Hospitals are already on razor thin margins and they're going to beat the crap out of vendors on price in order to survive. Do some math on your business to see what happens if you have to drop price by 10% and your quota goes up by 5%-7%. Not a good scenario.


Feedback on markets:
- Interventional cardiology/radiology- the squeeze is just now starting in disposable items. This is classified as mid-tier volume for hospitals (on a procedure basis) so your friends in purchasing are just now getting to these categories after beating the crap out of vendors in orthopedics and pacemakers (highest volume procedures). Speaking broadly, the consensus is there is little differentiation in clinical outcomes. Look for large health systems to consolidate vendors (most likely to 2 vendors), push-down their decision to docs and force docs to get pre-approval to use certain devices that fall out of the scope of the 2 contracted vendors. If I were in this space I would want to be with one of the big players (BSX, Bard, MDT) but even then you have some risk that a contract won't go your way.
- For capital equipment in that space, radiology is predicted to decline in every modality except ultrasound for the next 5-7 years. You will also see shifting of assets to be placed strategically between non-acute and acute settings. You'll also see consolidation of services offered (meaning a site that used to have a modality at all 10 of their locations may now only put it at 6 or 7). There are some interesting capital opportunities within interventional cardiology.
- Gastro: can't comment, not familiar with the space and haven't heard it discussed at conferences.
- Thoracic: will be somewhat similar to the interventional cardiology space. Likely hasn't seen the squeeze start yet due to it being lower- to mid- procedure volume.

I want out for all of the reasons I have mentioned above. No denying there are pockets of opportunity, but I'm not comfortable with the number of factors that can dictate my income and are 100% out of my control.
 




Id like to thank the OP for the insight and post, probably one of the better informative and legitimate posts Ive ever seen here on CP!
All this rings true in my experience. For me in my area of Med Sales it started 15 years ago with MD Buyline and went on from there. The point of my post is simply that it has severely affected the trajectory of my career. In my area I had to switch 10 years ago and sell based on a (P4P) pay for performance concept as fee for service disappeared. Subsequently in my region all the hospitals consolidated into two health systems, even smaller community based hospitals sold out in order to stay open. All the physician practices were bought up and all the doc's are employees now. I've watched the consolidation jettison multiple manufacturers out of the area/market. If your company didn't get the contract in one of the two systems your business was gone. I've watched multiple reps I'd known for ten to twenty years loose their jobs and replaced by regional clinical spec. Several manufactures have regional reps and don't cover some markets anymore, there's no need for a transactional rep. All the deals are now done at the GPO/IDN level with strategic and nat account people.
In addition you can go into one of the two systems in my region and find that 80% of the products are provided by five manufacturers.
Given the outcome of the election I really don't see much change. CMS will continue on the path they're on and manufactures are running leaner than ever a trend they'll continue on to maximize revenue. The ACA only accelerated everything and put an end to the traditional Med Sales career field.
 




Id like to thank the OP for the insight and post, probably one of the better informative and legitimate posts Ive ever seen here on CP!
All this rings true in my experience. For me in my area of Med Sales it started 15 years ago with MD Buyline and went on from there. The point of my post is simply that it has severely affected the trajectory of my career. In my area I had to switch 10 years ago and sell based on a (P4P) pay for performance concept as fee for service disappeared. Subsequently in my region all the hospitals consolidated into two health systems, even smaller community based hospitals sold out in order to stay open. All the physician practices were bought up and all the doc's are employees now. I've watched the consolidation jettison multiple manufacturers out of the area/market. If your company didn't get the contract in one of the two systems your business was gone. I've watched multiple reps I'd known for ten to twenty years loose their jobs and replaced by regional clinical spec. Several manufactures have regional reps and don't cover some markets anymore, there's no need for a transactional rep. All the deals are now done at the GPO/IDN level with strategic and nat account people.
In addition you can go into one of the two systems in my region and find that 80% of the products are provided by five manufacturers.
Given the outcome of the election I really don't see much change. CMS will continue on the path they're on and manufactures are running leaner than ever a trend they'll continue on to maximize revenue. The ACA only accelerated everything and put an end to the traditional Med Sales career field.
 




anonymous said:
Id like to thank the OP for the insight and post, probably one of the better informative and legitimate posts Ive ever seen here on CP!
All this rings true in my experience. For me in my area of Med Sales it started 15 years ago with MD Buyline and went on from there. The point of my post is simply that it has severely affected the trajectory of my career. In my area I had to switch 10 years ago and sell based on a (P4P) pay for performance concept as fee for service disappeared. Subsequently in my region all the hospitals consolidated into two health systems, even smaller community based hospitals sold out in order to stay open. All the physician practices were bought up and all the doc's are employees now. I've watched the consolidation jettison multiple manufacturers out of the area/market. If your company didn't get the contract in one of the two systems your business was gone. I've watched multiple reps I'd known for ten to twenty years loose their jobs and replaced by regional clinical spec. Several manufactures have regional reps and don't cover some markets anymore, there's no need for a transactional rep. All the deals are now done at the GPO/IDN level with strategic and nat account people.
In addition you can go into one of the two systems in my region and find that 80% of the products are provided by five manufacturers.
Given the outcome of the election I really don't see much change. CMS will continue on the path they're on and manufactures are running leaner than ever a trend they'll continue on to maximize revenue. The ACA only accelerated everything and put an end to the traditional Med Sales career field.
Click to expand...

I'm the OP. Glad you enjoyed the post and I enjoyed reading your response. You have clearly experienced what I am trying to avoid...and what I see coming for the rest of the entire healthcare market. The hospitals are being forced to merge/acquire so they can keep jockeying for position and leverage against the insurance companies (who are getting larger and more powerful). Buying the physician practices allows the health systems full control over patient flow/care management and better control over expenses and vendor consolidation. As someone who believes true innovation is driven by start-ups and not from the giant companies, this is sad to watch because it will be so hard for the small companies with great products to get into a health system. Their fate will lie in their ability to get purchased by a large player (Medtronic, Boston Sci, Stryker, GE, etc) who can get their products in the door.

I'm extremely close to making my transition into a different niche of healthcare sales. Out of curiosity, how big is your market (size of your city/town)? You mention there are effectively 2 health systems now so I am assuming you're in a smaller/mid-size market as opposed to a major city. It would be interesting to hear more specifics about your market to draw parallels along other parts of the country. Thanks for taking the time to post an insightful reply.
 




anonymous said:
I'm the OP. Glad you enjoyed the post and I enjoyed reading your response. You have clearly experienced what I am trying to avoid...and what I see coming for the rest of the entire healthcare market. The hospitals are being forced to merge/acquire so they can keep jockeying for position and leverage against the insurance companies (who are getting larger and more powerful). Buying the physician practices allows the health systems full control over patient flow/care management and better control over expenses and vendor consolidation. As someone who believes true innovation is driven by start-ups and not from the giant companies, this is sad to watch because it will be so hard for the small companies with great products to get into a health system. Their fate will lie in their ability to get purchased by a large player (Medtronic, Boston Sci, Stryker, GE, etc) who can get their products in the door.

I'm extremely close to making my transition into a different niche of healthcare sales. Out of curiosity, how big is your market (size of your city/town)? You mention there are effectively 2 health systems now so I am assuming you're in a smaller/mid-size market as opposed to a major city. It would be interesting to hear more specifics about your market to draw parallels along other parts of the country. Thanks for taking the time to post an insightful reply.
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Yes OP my area/region is mid market in the Midwest and the population is just about 1.9M and regionally about 3.0M. As the pressures on healthcare (mainly costs/spending) began to increase and the provider consolidation took place in my region I had several counterparts in larger metropolitan areas that weren't experiencing it the same as I was. They weren't feeling the "Squeeze" as they had more hospitals and doc's who weren't bought up yet and weren't completely seeing the consolidation. I've been in large player companies and then made the move over to smaller innovation and technology based companies. Yes, its very true some of the smaller companies I've been at had the end game of bringing product to market and getting enough share/penetration to sell out and get acquired. In terms of innovation to market, I can tell you it's very difficult now to bring that to providers. When hospitals are running on negative to 1-3% margins its probably harder now than ever before. The ACA has some good points that were going to be instituted regardless in one form or another, but it really added to the burden of the provider. Even before the ACA more burden should have been focused on the payer! The insurance companies are running the show with unprecedented leverage over every aspect of healthcare. The keys to the kingdom were dropped in their lap under the ACA and hopefully the new administration can recognize it and start to turn things around.
 




anonymous said:
Yes OP my area/region is mid market in the Midwest and the population is just about 1.9M and regionally about 3.0M. As the pressures on healthcare (mainly costs/spending) began to increase and the provider consolidation took place in my region I had several counterparts in larger metropolitan areas that weren't experiencing it the same as I was. They weren't feeling the "Squeeze" as they had more hospitals and doc's who weren't bought up yet and weren't completely seeing the consolidation. I've been in large player companies and then made the move over to smaller innovation and technology based companies. Yes, its very true some of the smaller companies I've been at had the end game of bringing product to market and getting enough share/penetration to sell out and get acquired. In terms of innovation to market, I can tell you it's very difficult now to bring that to providers. When hospitals are running on negative to 1-3% margins its probably harder now than ever before. The ACA has some good points that were going to be instituted regardless in one form or another, but it really added to the burden of the provider. Even before the ACA more burden should have been focused on the payer! The insurance companies are running the show with unprecedented leverage over every aspect of healthcare. The keys to the kingdom were dropped in their lap under the ACA and hopefully the new administration can recognize it and start to turn things around.
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OP again. Great post and feedback. Thanks for contributing. I agree with what you're saying here. Appreciate the response.
 




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