A lot of you asked to hear this story, so here goes.
First, my disclaimer: all that I will tell you, I have learned from observation, from colleagues and especially from the Ross rep who visits the office where I work.  I believe all of this to be accurate, but some parts might not be.  I do not believe that I am presenting any information which is not available to anyone willing to search.
Premier Contracting is a method by which companies bid for the right to supply a certain family of products to a group of hospitals.  Hospitals form buyer groups to negotiate for good prices; companies bid at lower-than-normal prices in exchange for long and *exclusive* contracts.  It is my understanding that this is widespread - for example a group of hospitals may use only Brand Q intravenous supplies because of their Premier Contact.  Not very controversial - no one is gonna go home and buy Brand Q IV tubing because he had it in the hospital (well, *almost* no one!).  Same thing happens with pharmaceuticals, and that might raise a few more eyebrows, but never the less it is common in the managed care age.
Premier Contracts apparently run for a 5 year period, and the whole point (for the supplier) is that they are exclusive.  You can't have two such contracts with two competing companies.
Some background on my situation: I work for a large pediatric private practice; we see newborns at 2 area hospitals.  In all local hospitals, "choice" of ABM is dictated by the physician, and of course is made to seem based on some health principles, but in reality is usually a rotation: currently, we use a schedule of 6 months each of the 2 available brands.  (Naturally no one orders the brands which are direct-advertised to consumers...)  All ABM manufacturers would like us to use their product exclusively (known for some reason as a single rotation), and they compete to offer the practice perks to do so.  In our case the perk is printing.  Much as I abhor it, the ABM companies handle the printing of our various patient ed and chart materials.  This makes it possible, ironically, to avoid using *their* patient ed materials.  To their credit, they have not attempted to influence content.  A few years back, we agreed to a single rotation for a year; the most notable effect was that our printing often "couldn't be done" because "the budget ran out".  Some thanks.  As one might have anticipated, the rep also got more pushy, as though he "owned" us - which, in a sense, he did.  (Yes, I argue against this relationship whenever possible, and indeed I may eventually win my "cut the cord" campaign...)
Several weeks ago, the MJ rep came to us evidently distraught because, she said, some sort of underhanded dealings by the Ross rep had "tricked" the purchasing dept (with no input from the mother-baby or peds units) at the larger hospital to agree to carry Ross ABM exclusively in exchange for a better deal on bottles and nipples.  The memo from purchasing that I saw talked about annual savings of some tiny amount; maybe $10,000? (Evidently the facts are a *little* different, but the outcome was the same.)  She wanted the doctors to petition the hospital to give them back the right to make a choice for their patients, which they did, with some success.  When I mentioned this at a MALC (local LC org) meeting, someone told me that it sounded like a Premier Contracting thing.  She told me the general stuff you read above.
My first question when I head of this was, "why would the hospital contract for something they don't even *pay* for?"  The other day, thanks to out Ross rep, I found out.  He came in moaning about how they'd been made to look like bad guys by MJ for Premier Contracting with the hospital, and when I expressed interest he went out and got his sales materials to "prove" to me how innocent the whole thing really was.
He told me that Ross has negotiated Premier Contracts with between 200-300 hospitals nationwide, 30 in Michigan.  The benefit from the hospital's point of view is that they get a 30-50% discount - not on bottles and nipples, but on nutritional supplements ("adult formulas" like Ensure, and all of the equipment that goes with them - feeding tubes, pumps and so forth).  Ah Hah!  Now I get it!  So much of this kind of stuff is used on so many units (special formulas for oncology patients, etc.etc.) that the amount of money involved is quite significant - well into the $millions each year.
In exchange for this price break, the hospital must agree to "execute the Ross Nutritionals Division Document"  (quoted from the contract materials).  I could not see this document - indeed the rep professed to not know what it was.  He told me he "thought" it "just meant" using at least 80% Ross ABM for formula-fed babies.  (Apparently the 80% figure is the one newly negotiated after the doctors raised a stink about the complete elimination of MJ products; the original intent was presumably 100%.)  However, in the papers I did get to see, I saw no verification that the babies whose mothers choose BF would be excluded from the count, nor any explanation of how.  What I *did* see was a paragraph reminding sales reps that it was their responsibility to make sure that the hospital was clear that Ross product was to be used *exclusively* in that designated 80% -- and that this includes in prenatal visits, childbirth classes and so forth.  No MJ literature or samples to be tolerated at any point.
What the rep told me was that his company will lose billions of dollars a year on the sale of adult nutritional products, and that they "hope" to make it up of the sale of infant formula products to parents after discharge.  He stressed that he "isn't interested in" BF moms, "unless they supplement, or stop BF".
Naturally, I have several concerns.  It seems certain that Ross is confident that it can make up the loss of income from adult products by capturing a greater part of the ABM market - there's no way this is a billion dollar gamble.  I want to know specifically *what* is in that contract: how are BF babies excluded from the percentages?  How will exclusive product use be measured?  Will staff now be forbidden to remove items from gift packs, or to refuse to allow certain types of items in the packs, as many places do now?  Will every hospital in the contract groups have to supply patients with the new Ross pump?  Will there be quotas of gift packs to be distributed?  Will rising breastfeeding rates be prohibited because they lower the numbers of "Ross babies"?  My own experience in the office is that once a rep feels that he has all of your business, he (or she) becomes more rather than less manipulative, and less rather than more responsive.  At the office level this hospital move is likely to crystallize doctors' support for or rejection of the various ABM reps - in my case I hope that the blatancy of marketing practices will actually help strengthen my case against relationships with the ABM companies period.
I believe that purchasing department haven't a clue that the ABM thing is as twisted and controversial as it is.  As I said above, no one is basing individual at-home purchases of thousands of dollars on the brand used in the hospital in the case of these other supplies.  And it seems quite clear that the input of unit managers, physicians and staff members (let alone LCs) is not being sought as the Premier decisions are made.  Can we be confident that patient interests are being safeguarded in the negotiation of these contracts?
I would be very much interested in hearing what the rest of you know, whether it confirms or contradicts my story.  In particular, I would *love* to see an actual contract.
One last thing.  In addition to a primer on Premier Contracts, the rep gave me a spiel on the "new improved" Ross ABM product.  I was especially struck by the citations regarding comparisons of various measures of progress in "BF" vs ABM-fed babies.  Reading the small print, I noted that the "BF" babies were "exclusively breastfed for 3 months" (no definition of exclusive) and then fed with a "regular" ABM.  Not only is this not BF to my way of thinking, it also seems to me that most studies regarding the proven benefits of BF show a significant relationship to 4 months of BF - so even if one accepted that they were not going to compare *truly* BF babies, at the very least it seems that they should have allowed for a full 4 months of "exclusive" BF.  And just *one more* comment, for those who haven't heard: the "new" Ross ABM is expected to produce frequent, runny stools ("just like breastmilk").  It comes out next month, I understand, and I know that I for one will get a lot of calls from mothers who are alarmed at the "diarrhea" (remember, I care for formula-feeding families, too).  Bet we see a lot of switching to soy or other products at first, due to "allergy" sx.  Just thought I'd warn you.
Well, sorry this is so long.  I am not known for brevity, but I did my best.  I await your comments.
Willow          [log in to unmask]