This is Scott
with the Becker's Healthcare podcast.
Thrilled today to be joined by a brilliant
physician
leader.
We're joined today by doctor Gregory Mishko. And
doctor Mishko is at in the Endeavor Health
System and heads up the cardiac
cardiology
division, head of cardiology,
and the co director of the Cardiovascular Institute,
which I believe is at Glenbrook Hospital.
He's also a a physician and an MBA,
from the University of Chicago. Great, great school.
Doctor Misko, can you take a moment and
introduce yourself? Then we'll talk to you about
what trends you're watching, what you're most focused
on, and a lot more.
Sure.
Well, first of all, thank you for that,
very kind introduction.
I think I gotta make, two corrections. One
is, I've had a lot of adjectives
ascribed to me. Brilliant has never been one
that has ever been ascribed to me, but
I do appreciate it. And the second, correction
is that,
you you're correct. University of Chicago, very good
school, MBA, but I did it at, Indiana
U Kelley School of Business. And, there may
be somebody listening from the Kelley School. I
gotta make sure that I make that correct.
Right. I see that. I'm so I apologize.
You're an associate professor or taught at University
of Chicago, if I have that right. Yeah.
Clinical professor. Professor.
Right. At University of Chicago and then an
Indiana,
University MBA.
And can you take one moment? It it
seems like Indiana had their very best,
you know, their their their very best football
season of our lifetime.
Take a moment on that. How did that
happen?
This is where I cannot help you.
I am completely divorced from college sport.
So I have no idea what's going on
in Indiana, Notre Dame, any of that.
Well, I what I will do is the
next time now I'm starting to get the
the the frame of this. The next time
I'm gonna ask you about the Argonauts
and the University of Toronto and more. One
of my closest, closest colleagues went to the
University of Toronto and a brilliant, brilliant person.
So next time, we'll dig into that. Let
let me move us back to health care
today.
You have to head up the Cardiovascular
Institute. I know this is one of the
great endeavors at Endeavor Health System.
Take a moment and tell us about the
cardiovascular
institute that's been developed at at the Endeavor
Health System.
Well, this was
a huge undertake
and,
probably the culmination of two or three years
of
rethinking how we wanted this how we want
to, provide cardiovascular
care.
And, if I can just take you through
maybe
two seminal events
three events that led us to ultimately saying,
let's redesign how we provide cardiovascular
care and look at what additional resources need
to go into into that to
provide that reimagined care. And and I would
say it was there were three phases in
that led to the fruition of this project.
The first phase
was the conversion of Skokie Hospital
to an orthopedic hospital,
the only,
dedicated orthopedic hospital, I believe, in Illinois.
And, subsequently, there's a the success
that that hospital has had in delivering
a sole product being
orthopedic care. Now there were bumps in the
road to be sure,
but what we've learned is that,
when you build, if you will, a focused
factory,
providers
are more engaged because there's a greater critical
mass of of orthopods and neurosurgeons
providing that type of care in one place.
The staff
is more engaged because
instead of diluting staff out at multiple sites,
they're all in one place. It's easier to
recruit. It's easier to train,
and it's easier to
retain.
And then most importantly,
actually, patients get jazzed,
because
they're coming into a a hospital where everything
has been greased to provide,
the quickest, the best, the highest quality,
the most efficient care. And what we learned
was that
that hospital has become very, very popular for
orthopedic care. And if you wanna look at
the ZIP codes where patients are coming from,
I think it exceeds our expectations. So there
was lessons learned about
creating a a single site for super specialized
care.
The second
seminal event was
the conversion of Glenbrook Hospital during COVID
to essentially a COVID hospital.
Think about it.
So, again,
a a single hospital committed
to a very complicated disease at the time.
And the third thing that was happening
almost at the same time or the tail
end of COVID
is that we were looking to
renovate Evanston Hospital, which was previously
the hub for all of our specialized cardiovascular
services.
And we we were gonna put a substantial
amount of money into that renovation, and we
had some
plans drawn up.
And we we began to present those plans
to all the different stakeholders, and we learned
that
everything that we did at Evanston Hospital,
for several reasons,
nobody was happy. There there was no compromise
that we could make in terms of the
design process
that made people happy.
And in large measure, part of the issues
were,
we were very limited in terms of the
amount of space that we could add on
to the hospital because of the zoning requirements
in Evanston,
and we were acutely aware of the fact
that Evanston Hospital
is a difficult hospital to get to
if we have regional aspirations,
meaning there's no highway associated with it, and
there's no good north, south, east, west,
access roads.
And, similarly, there there's actually no helicopter pad
at Evanston Hospital.
So,
as COVID was ending and we were looking
at repurposing
Glenbrook back to its previous
manifestation, that being,
a med surg hospital for the community,
and then incorporating what we learned
at Skokie Hospital in terms of the orthopedics
administration. And we said,
what if we reimagine cardiovascular care,
put it in a site where there's much
more land,
put it in a site where there's a
helicopter,
and,
put it in a site that has East
West,
access roads
as well as a North South Highway
and, frankly, is adjacent
to an international airport. We're seventeen minutes from
O'Hare
if we,
aspire
to become a regional or national destination of
care.
And so that's how the concept of Lenbrook
came to be.
And literally within,
I would say, a year
of that concept,
plans were drawn up, stakeholders were engaged.
And,
I think within two years, a shovel was
put in the ground. And a year and
a half later, we opened up with
a large,
about a 80,000
square feet
pavilion
built onto the current existing Glenbrook Hospital. So
think of not just the whole hospital being
converted to a heart hospital because
I think heart care is different than orthopedic
care, and we can get into that. But
this is a
a concept is that's well known, I'm sure,
to listeners. It's a hospital within a hospital.
Certainly. And and we're certainly
very familiar.
I had the
good fortune or bad fortune of having orthopedic
surgery last year at the Orthopedic Institute.
My mother has also had hip surgery and
knee surgery
replacement at that hospital. So very familiar with
Orthopedic Institute,
and then also very familiar with Glenbrook as
well because we've had eye surgery there. We're
sort of a frequent flyer of the Endeavor
system. Talk to us a little bit about
when you look at this coming year,
doctor Misco, what are you most focused on
and excited about?
Well, gosh.
There's just so many advances in cardiovascular care
that gets you excited.
And and maybe we we start with that
and then talk about the concerns. So some
of the things that
are widely available,
I'll I'll allude to, and then some of
the things that I think are are unique
to to our particular site. There's a revolution
in the drugs that we now have available
to treat
diseases
that have been inadequately treated in the in
the past.
So,
just by way of example,
we now have
exciting or very, very
potent drugs available to treat diseases such as
hypertrophic cardiomyopathy.
There's a drug called mavacamten that's gonna revolutionize
the care of that
not so infrequent,
type of heart muscle disease.
And we also now have drugs
or another type of heart muscle disease called
amyloid,
which is increasingly
recognized in the elderly population and has a
genetic basis.
Drugs such as
Ozempic
and Monjaro or their weight loss equivalent,
Wegovy
or,
ZepBound,
are not only very useful
in managing diabetics
and in,
managing weight,
but have have we've learned has significant
cardiovascular
benefit.
So we now use these drugs
routinely
to manage patients who may not be diabetic
but have some form of kidney disease,
heart failure, or coronary artery disease.
And over time, these drugs will become more
accessible,
read more affordable,
and I think will be more applicable to
larger populations.
We have now
new methods for treating atrial fibrillation,
a procedure called pulse field ablation,
which,
if its promise
bears
bears out with greater usage,
we'll see it being a safer and quicker
procedure for atrial fibrillation,
with the need for less resources,
and, the ability to get patients out quicker
and, again, as I said, safe more safely.
We are seeing
movement now to have nonsurgical
means to essentially
replace or repair every cardiac valve within the
heart. So this revolution, which
began in and around 02/2012,
put transcatheter
aortic valve replacement,
however,
the ability to replace the aortic valve nonsurgically,
and and what we've learned with that type
of technology
now is available for the mitral valve and
the tricuspid valve and the pulmonic valve. There
are only four valves in the heart.
And whether the valve is stuck or leaking,
there is now or very soon to be
a the ability
to,
replace or repair that valve
nonsurgically.
That's an enormous,
an enormous,
undertaking
and and a real accomplishment.
One of the frustrations of these types of
advances, though,
is that there is always the assumption that
once the FDA approves
these types of technology, you can automatically
institute it.
But often,
insurance coverage
is delayed from the time of FDA approval.
So you're left with this clinical conundrum where
you have access
to a new procedure,
but you have no mechanisms of reimbursing
the hospital
for the cost of the procedure.
I wish
that more attention was paid to this,
and that the federal payments
agencies,
try to,
determine
or come more into alignment with the federal
approval processes. But this has been something that's
been very vexing to us where we participate
in the research trials
that lead to the approval
of these devices.
And during the research phase, these devices and
payment
is is guaranteed by the federal government,
by fiat.
And so you get paid to participate in
the research trial, meaning you cover your costs.
The device is now approved,
but you can't continue to use the device
or the technology
because now there's no payment mechanism
because the research trial has ended.
That's a real conundrum.
Some of the newer things that,
are coming that we are beginning to use
more frequently are more effective screening tests,
for the detection of cardiac disease.
One of them in particular I'd like to
highlight
because
I think we have been on the leading
edge of providing genetic
care
or genomics
to our patient population. So
probably about ten years ago, the system embarked
on a a commitment,
both in time, personnel, and treasure
to,
develop a a genomics program
that can be applied to both,
primary care populations as well as specialty care
population.
And within our own division, working with our,
partners in genomics and industry,
we've developed a commercially available
risk panel,
a polygenic risk score.
So patients can get a test tube just
like they get with 23 andMe. They put
some saliva into it,
and we can develop
predictive scores
using,
multiple genes
to your lifetime risk of developing coronary artery
disease, aortic aneurysm, diabetes, and kidney disease,
and atrial fibrillation for that matter.
So, obviously, this is not something that you
would necessarily apply to somebody in their eighties
or nineties,
but this is something that we are beginning
to,
distribute to our patients, offers to our patients,
particularly younger patients who are interested. Hey. I
have a family history of heart disease
or, am I at risk for heart disease?
And sometimes we even see
patients who have established heart disease saying, I'd
I'd like to know what what what were
the genetic risks that were associated with me
getting this disease. Because the majority of cardiac
disease are not caused by one gene.
They're caused by dozens or,
more genes
that interact with our environment to subsequently produce
the disease.
So the idea is that,
although genes are very, very influential,
it's it's not necessarily
a % destiny.
And that if you identify
the genetic predilection
early enough,
you can make the most appropriate,
medical decisions and environmental decisions to either put
off the disease or avoid it in its
entirety.
And we're looking at,
widely distributing this
in, a diverse population.
So that would include patients
within the
suburban environment within, Endeavor Health,
but also patients in the city environment with
Endeavor Health and in pay in patients
who both can afford and can't afford,
this type of genetic testing,
which costs in the range of about 250,
2 hundred and 70 5 dollars.
In fact, we are going to, I believe,
fund a project within the North City
where we will provide this type of, technology,
this type of testing to populations that otherwise
couldn't afford it
and then, look at how we can modify
their risks,
and and follow these patients,
over the long term.
Thank you. Doctor Misko, you've had this fantastic
career,
Clinical professor at the University of Chicago,
head of cardiology at Endeavor at North Shore,
helped to found and drive this cardiovascular institute.
You know, from Toronto,
Ottawa,
Kelley School Of Business,
a lifelong learner, of course. It sure seems
like it.
Doctor Misko, take a moment on what advice
you would give to other emerging leaders wanting
to have impactful and satisfying careers.
That's a great question. And and and, I
I get called probably every three or four
months out of the blue from somebody who
says, can I, you know, bend your ear
for half an hour
and, you know, tell me, is it worthwhile,
for instance, to go and get an MBA?
So as I think about my own career,
I sort of fell into leadership.
I didn't
pursue it in
a programmatic or preplanned way. So I think
the first thing I would say is
be more
conscious
or goal directed than I was
and
begin to look at
developing that administrative
career earlier on than I did.
So that would be the first,
the first thing I would do is is
really examine
what do you want your career path to
be
and then begin to pursue it at at
a younger age. Now, obviously, at a younger
age,
there are gonna be considerations about pursuing leadership
different
than than, say, when I began to pursue
leadership in my fifties.
And one of those, importantly,
is, you know, family obligations.
Because I do think
that
assuming
a large leadership
position
and trying to maintain a clinical practice at
the same time,
something
has to give. And, usually,
it's understanding that you might have less time
for family obligations. So this is something that
each individual has to say, how young is
my family,
if I have one,
and and how much flexibility
do I have to take away from or
how much time can I
take away from my family
and still maintain a family?
So that would be the second thing would
be to look at your own
personal circumstances
before
overcommitting.
The third thing that I would say
is that
medical school alone
certainly selects out bright people,
and there's nothing to say that
anything that I do
hour to hour or day to day,
I couldn't do just by virtue of being
a relatively intelligent
individual or physician.
But I do think that it helps to
get additional
education under your belt that
revolves around
leadership
development
and the skill set that's required to
be an effective administrator. So
in my case, I chose an MBA,
and I think that's an extraordinarily good vehicle.
It's not the only vehicle.
It does require a significant commitment of time,
particularly if you,
importantly, if you go to a good program,
and I did go to a very good
program.
But I do think you need to start
getting educated about things that you might not
have ever thought about, like
accounting,
finance,
capital management,
micro, macroeconomic,
leadership development.
And then I think the final thing that
I would encourage young people to do,
or younger people,
would be to find a mentor.
Find somebody who's done it and maybe say,
hey. Listen.
Would you mind
that we touch bases every quarter
and I just bounce some ideas off of
you.
So off the top of my head, I
would say it would be those four things.
Thank you, doctor Mishko. What a remarkable career,
and and I've seen firsthand
the work at the Cardiovascular
Institute.
Just fantastic what you're doing.
Congratulations
to yourself and the Endeavor Health System, and
thank you so much for joining us today
on the Becker's Healthcare podcast. Just outstanding.
I I really appreciate the opportunity to highlight
what we've done here at Endeavor. Very proud
of it.