1 00:00:00,080 --> 00:00:01,300 This is Scott 2 00:00:01,679 --> 00:00:03,779 with the Becker's Healthcare podcast. 3 00:00:04,639 --> 00:00:06,639 Thrilled today to be joined by a brilliant 4 00:00:06,639 --> 00:00:07,139 physician 5 00:00:07,440 --> 00:00:07,940 leader. 6 00:00:08,320 --> 00:00:11,439 We're joined today by doctor Gregory Mishko. And 7 00:00:11,439 --> 00:00:13,519 doctor Mishko is at in the Endeavor Health 8 00:00:13,519 --> 00:00:15,139 System and heads up the cardiac 9 00:00:15,494 --> 00:00:15,994 cardiology 10 00:00:16,295 --> 00:00:17,675 division, head of cardiology, 11 00:00:18,454 --> 00:00:20,934 and the co director of the Cardiovascular Institute, 12 00:00:20,934 --> 00:00:22,875 which I believe is at Glenbrook Hospital. 13 00:00:23,335 --> 00:00:25,914 He's also a a physician and an MBA, 14 00:00:26,614 --> 00:00:28,954 from the University of Chicago. Great, great school. 15 00:00:29,660 --> 00:00:31,579 Doctor Misko, can you take a moment and 16 00:00:31,579 --> 00:00:33,920 introduce yourself? Then we'll talk to you about 17 00:00:34,060 --> 00:00:36,219 what trends you're watching, what you're most focused 18 00:00:36,219 --> 00:00:37,520 on, and a lot more. 19 00:00:37,899 --> 00:00:38,399 Sure. 20 00:00:38,859 --> 00:00:40,299 Well, first of all, thank you for that, 21 00:00:40,539 --> 00:00:41,520 very kind introduction. 22 00:00:42,045 --> 00:00:45,004 I think I gotta make, two corrections. One 23 00:00:45,004 --> 00:00:47,585 is, I've had a lot of adjectives 24 00:00:48,924 --> 00:00:51,564 ascribed to me. Brilliant has never been one 25 00:00:51,564 --> 00:00:53,405 that has ever been ascribed to me, but 26 00:00:53,405 --> 00:00:56,559 I do appreciate it. And the second, correction 27 00:00:56,559 --> 00:00:57,219 is that, 28 00:00:57,920 --> 00:01:00,079 you you're correct. University of Chicago, very good 29 00:01:00,079 --> 00:01:02,899 school, MBA, but I did it at, Indiana 30 00:01:02,960 --> 00:01:05,040 U Kelley School of Business. And, there may 31 00:01:05,040 --> 00:01:06,799 be somebody listening from the Kelley School. I 32 00:01:06,799 --> 00:01:08,420 gotta make sure that I make that correct. 33 00:01:09,545 --> 00:01:11,384 Right. I see that. I'm so I apologize. 34 00:01:11,384 --> 00:01:13,545 You're an associate professor or taught at University 35 00:01:13,545 --> 00:01:15,784 of Chicago, if I have that right. Yeah. 36 00:01:15,784 --> 00:01:17,164 Clinical professor. Professor. 37 00:01:17,465 --> 00:01:19,625 Right. At University of Chicago and then an 38 00:01:19,625 --> 00:01:20,125 Indiana, 39 00:01:20,905 --> 00:01:22,045 University MBA. 40 00:01:22,664 --> 00:01:25,349 And can you take one moment? It it 41 00:01:25,349 --> 00:01:27,750 seems like Indiana had their very best, 42 00:01:29,030 --> 00:01:30,869 you know, their their their very best football 43 00:01:30,869 --> 00:01:32,170 season of our lifetime. 44 00:01:33,590 --> 00:01:35,030 Take a moment on that. How did that 45 00:01:35,030 --> 00:01:35,530 happen? 46 00:01:37,384 --> 00:01:39,165 This is where I cannot help you. 47 00:01:39,704 --> 00:01:42,685 I am completely divorced from college sport. 48 00:01:44,024 --> 00:01:46,024 So I have no idea what's going on 49 00:01:46,024 --> 00:01:48,510 in Indiana, Notre Dame, any of that. 50 00:01:49,469 --> 00:01:51,069 Well, I what I will do is the 51 00:01:51,069 --> 00:01:52,990 next time now I'm starting to get the 52 00:01:52,990 --> 00:01:54,750 the the frame of this. The next time 53 00:01:54,750 --> 00:01:56,930 I'm gonna ask you about the Argonauts 54 00:01:57,469 --> 00:02:00,510 and the University of Toronto and more. One 55 00:02:00,510 --> 00:02:02,270 of my closest, closest colleagues went to the 56 00:02:02,270 --> 00:02:04,805 University of Toronto and a brilliant, brilliant person. 57 00:02:05,105 --> 00:02:06,864 So next time, we'll dig into that. Let 58 00:02:06,864 --> 00:02:08,224 let me move us back to health care 59 00:02:08,224 --> 00:02:08,724 today. 60 00:02:09,185 --> 00:02:10,805 You have to head up the Cardiovascular 61 00:02:11,185 --> 00:02:13,025 Institute. I know this is one of the 62 00:02:13,025 --> 00:02:15,444 great endeavors at Endeavor Health System. 63 00:02:15,889 --> 00:02:17,489 Take a moment and tell us about the 64 00:02:17,489 --> 00:02:17,989 cardiovascular 65 00:02:18,449 --> 00:02:20,610 institute that's been developed at at the Endeavor 66 00:02:20,610 --> 00:02:21,349 Health System. 67 00:02:22,209 --> 00:02:23,349 Well, this was 68 00:02:24,129 --> 00:02:25,270 a huge undertake 69 00:02:25,729 --> 00:02:26,229 and, 70 00:02:28,014 --> 00:02:30,495 probably the culmination of two or three years 71 00:02:30,495 --> 00:02:30,995 of 72 00:02:31,935 --> 00:02:34,334 rethinking how we wanted this how we want 73 00:02:34,334 --> 00:02:36,275 to, provide cardiovascular 74 00:02:36,735 --> 00:02:37,235 care. 75 00:02:37,854 --> 00:02:39,775 And, if I can just take you through 76 00:02:39,775 --> 00:02:40,275 maybe 77 00:02:40,810 --> 00:02:42,009 two seminal events 78 00:02:42,569 --> 00:02:45,549 three events that led us to ultimately saying, 79 00:02:46,169 --> 00:02:48,349 let's redesign how we provide cardiovascular 80 00:02:48,650 --> 00:02:50,969 care and look at what additional resources need 81 00:02:50,969 --> 00:02:53,150 to go into into that to 82 00:02:54,025 --> 00:02:56,585 provide that reimagined care. And and I would 83 00:02:56,585 --> 00:02:58,844 say it was there were three phases in 84 00:02:59,544 --> 00:03:01,385 that led to the fruition of this project. 85 00:03:01,385 --> 00:03:02,284 The first phase 86 00:03:02,985 --> 00:03:05,724 was the conversion of Skokie Hospital 87 00:03:06,500 --> 00:03:07,959 to an orthopedic hospital, 88 00:03:08,419 --> 00:03:09,080 the only, 89 00:03:09,539 --> 00:03:11,959 dedicated orthopedic hospital, I believe, in Illinois. 90 00:03:12,659 --> 00:03:15,319 And, subsequently, there's a the success 91 00:03:16,340 --> 00:03:19,000 that that hospital has had in delivering 92 00:03:20,105 --> 00:03:21,564 a sole product being 93 00:03:21,865 --> 00:03:24,105 orthopedic care. Now there were bumps in the 94 00:03:24,105 --> 00:03:25,085 road to be sure, 95 00:03:25,544 --> 00:03:27,724 but what we've learned is that, 96 00:03:28,185 --> 00:03:30,905 when you build, if you will, a focused 97 00:03:30,905 --> 00:03:31,405 factory, 98 00:03:32,409 --> 00:03:32,909 providers 99 00:03:33,449 --> 00:03:36,329 are more engaged because there's a greater critical 100 00:03:36,329 --> 00:03:38,989 mass of of orthopods and neurosurgeons 101 00:03:39,769 --> 00:03:42,189 providing that type of care in one place. 102 00:03:43,049 --> 00:03:43,789 The staff 103 00:03:44,625 --> 00:03:46,564 is more engaged because 104 00:03:47,344 --> 00:03:50,884 instead of diluting staff out at multiple sites, 105 00:03:51,985 --> 00:03:54,064 they're all in one place. It's easier to 106 00:03:54,064 --> 00:03:56,805 recruit. It's easier to train, 107 00:03:57,344 --> 00:03:58,805 and it's easier to 108 00:03:59,104 --> 00:03:59,604 retain. 109 00:04:00,439 --> 00:04:01,659 And then most importantly, 110 00:04:02,599 --> 00:04:04,699 actually, patients get jazzed, 111 00:04:05,560 --> 00:04:06,060 because 112 00:04:06,680 --> 00:04:09,800 they're coming into a a hospital where everything 113 00:04:09,800 --> 00:04:11,500 has been greased to provide, 114 00:04:12,854 --> 00:04:15,194 the quickest, the best, the highest quality, 115 00:04:15,735 --> 00:04:18,615 the most efficient care. And what we learned 116 00:04:18,615 --> 00:04:19,355 was that 117 00:04:20,375 --> 00:04:23,415 that hospital has become very, very popular for 118 00:04:23,415 --> 00:04:25,949 orthopedic care. And if you wanna look at 119 00:04:25,949 --> 00:04:28,610 the ZIP codes where patients are coming from, 120 00:04:28,910 --> 00:04:30,990 I think it exceeds our expectations. So there 121 00:04:30,990 --> 00:04:32,689 was lessons learned about 122 00:04:33,310 --> 00:04:36,689 creating a a single site for super specialized 123 00:04:36,829 --> 00:04:37,329 care. 124 00:04:37,964 --> 00:04:38,625 The second 125 00:04:38,925 --> 00:04:40,464 seminal event was 126 00:04:40,925 --> 00:04:44,305 the conversion of Glenbrook Hospital during COVID 127 00:04:45,165 --> 00:04:47,185 to essentially a COVID hospital. 128 00:04:47,884 --> 00:04:48,865 Think about it. 129 00:04:49,245 --> 00:04:49,904 So, again, 130 00:04:50,845 --> 00:04:52,865 a a single hospital committed 131 00:04:54,000 --> 00:04:56,819 to a very complicated disease at the time. 132 00:04:57,519 --> 00:04:59,860 And the third thing that was happening 133 00:05:00,160 --> 00:05:02,000 almost at the same time or the tail 134 00:05:02,000 --> 00:05:02,899 end of COVID 135 00:05:03,439 --> 00:05:05,379 is that we were looking to 136 00:05:06,394 --> 00:05:09,454 renovate Evanston Hospital, which was previously 137 00:05:09,914 --> 00:05:13,055 the hub for all of our specialized cardiovascular 138 00:05:13,274 --> 00:05:13,774 services. 139 00:05:14,555 --> 00:05:16,414 And we we were gonna put a substantial 140 00:05:16,474 --> 00:05:18,794 amount of money into that renovation, and we 141 00:05:18,794 --> 00:05:19,535 had some 142 00:05:19,910 --> 00:05:21,050 plans drawn up. 143 00:05:21,430 --> 00:05:23,829 And we we began to present those plans 144 00:05:23,829 --> 00:05:25,990 to all the different stakeholders, and we learned 145 00:05:25,990 --> 00:05:26,490 that 146 00:05:27,110 --> 00:05:29,290 everything that we did at Evanston Hospital, 147 00:05:30,229 --> 00:05:31,449 for several reasons, 148 00:05:32,495 --> 00:05:35,314 nobody was happy. There there was no compromise 149 00:05:35,375 --> 00:05:37,055 that we could make in terms of the 150 00:05:37,055 --> 00:05:38,035 design process 151 00:05:39,214 --> 00:05:40,834 that made people happy. 152 00:05:41,294 --> 00:05:43,634 And in large measure, part of the issues 153 00:05:43,694 --> 00:05:44,194 were, 154 00:05:44,979 --> 00:05:46,659 we were very limited in terms of the 155 00:05:46,659 --> 00:05:48,419 amount of space that we could add on 156 00:05:48,419 --> 00:05:50,519 to the hospital because of the zoning requirements 157 00:05:50,659 --> 00:05:51,399 in Evanston, 158 00:05:52,019 --> 00:05:54,099 and we were acutely aware of the fact 159 00:05:54,099 --> 00:05:55,639 that Evanston Hospital 160 00:05:56,500 --> 00:05:59,000 is a difficult hospital to get to 161 00:05:59,605 --> 00:06:01,305 if we have regional aspirations, 162 00:06:01,685 --> 00:06:04,884 meaning there's no highway associated with it, and 163 00:06:04,884 --> 00:06:07,464 there's no good north, south, east, west, 164 00:06:08,245 --> 00:06:09,305 access roads. 165 00:06:10,004 --> 00:06:13,205 And, similarly, there there's actually no helicopter pad 166 00:06:13,205 --> 00:06:14,504 at Evanston Hospital. 167 00:06:15,620 --> 00:06:16,120 So, 168 00:06:16,579 --> 00:06:19,060 as COVID was ending and we were looking 169 00:06:19,060 --> 00:06:20,199 at repurposing 170 00:06:20,660 --> 00:06:22,439 Glenbrook back to its previous 171 00:06:22,819 --> 00:06:24,439 manifestation, that being, 172 00:06:25,139 --> 00:06:27,079 a med surg hospital for the community, 173 00:06:27,620 --> 00:06:29,959 and then incorporating what we learned 174 00:06:31,324 --> 00:06:33,665 at Skokie Hospital in terms of the orthopedics 175 00:06:34,685 --> 00:06:36,384 administration. And we said, 176 00:06:37,004 --> 00:06:39,745 what if we reimagine cardiovascular care, 177 00:06:40,285 --> 00:06:42,285 put it in a site where there's much 178 00:06:42,285 --> 00:06:43,024 more land, 179 00:06:43,810 --> 00:06:45,569 put it in a site where there's a 180 00:06:45,569 --> 00:06:46,069 helicopter, 181 00:06:47,169 --> 00:06:47,649 and, 182 00:06:48,129 --> 00:06:50,610 put it in a site that has East 183 00:06:50,610 --> 00:06:51,110 West, 184 00:06:51,889 --> 00:06:52,789 access roads 185 00:06:53,089 --> 00:06:55,189 as well as a North South Highway 186 00:06:55,665 --> 00:06:57,125 and, frankly, is adjacent 187 00:06:57,425 --> 00:07:00,225 to an international airport. We're seventeen minutes from 188 00:07:00,225 --> 00:07:00,725 O'Hare 189 00:07:01,345 --> 00:07:02,165 if we, 190 00:07:03,024 --> 00:07:03,524 aspire 191 00:07:04,145 --> 00:07:06,865 to become a regional or national destination of 192 00:07:06,865 --> 00:07:07,365 care. 193 00:07:07,839 --> 00:07:11,459 And so that's how the concept of Lenbrook 194 00:07:12,319 --> 00:07:13,300 came to be. 195 00:07:13,680 --> 00:07:14,979 And literally within, 196 00:07:15,519 --> 00:07:16,899 I would say, a year 197 00:07:17,600 --> 00:07:18,979 of that concept, 198 00:07:19,964 --> 00:07:22,785 plans were drawn up, stakeholders were engaged. 199 00:07:23,564 --> 00:07:24,064 And, 200 00:07:24,845 --> 00:07:27,805 I think within two years, a shovel was 201 00:07:27,805 --> 00:07:29,725 put in the ground. And a year and 202 00:07:29,725 --> 00:07:31,665 a half later, we opened up with 203 00:07:32,350 --> 00:07:33,009 a large, 204 00:07:33,870 --> 00:07:35,389 about a 80,000 205 00:07:35,389 --> 00:07:36,290 square feet 206 00:07:36,830 --> 00:07:37,330 pavilion 207 00:07:38,830 --> 00:07:42,270 built onto the current existing Glenbrook Hospital. So 208 00:07:42,270 --> 00:07:45,889 think of not just the whole hospital being 209 00:07:46,425 --> 00:07:48,285 converted to a heart hospital because 210 00:07:48,665 --> 00:07:51,324 I think heart care is different than orthopedic 211 00:07:51,384 --> 00:07:53,384 care, and we can get into that. But 212 00:07:53,384 --> 00:07:54,524 this is a 213 00:07:55,144 --> 00:07:57,305 a concept is that's well known, I'm sure, 214 00:07:57,305 --> 00:07:59,805 to listeners. It's a hospital within a hospital. 215 00:08:01,870 --> 00:08:03,410 Certainly. And and we're certainly 216 00:08:04,029 --> 00:08:04,930 very familiar. 217 00:08:06,110 --> 00:08:07,009 I had the 218 00:08:07,470 --> 00:08:10,209 good fortune or bad fortune of having orthopedic 219 00:08:10,430 --> 00:08:12,689 surgery last year at the Orthopedic Institute. 220 00:08:13,745 --> 00:08:15,985 My mother has also had hip surgery and 221 00:08:15,985 --> 00:08:16,724 knee surgery 222 00:08:17,185 --> 00:08:19,425 replacement at that hospital. So very familiar with 223 00:08:19,425 --> 00:08:20,485 Orthopedic Institute, 224 00:08:21,024 --> 00:08:23,024 and then also very familiar with Glenbrook as 225 00:08:23,024 --> 00:08:24,865 well because we've had eye surgery there. We're 226 00:08:24,865 --> 00:08:26,625 sort of a frequent flyer of the Endeavor 227 00:08:26,625 --> 00:08:28,689 system. Talk to us a little bit about 228 00:08:28,689 --> 00:08:30,470 when you look at this coming year, 229 00:08:30,849 --> 00:08:33,009 doctor Misco, what are you most focused on 230 00:08:33,009 --> 00:08:34,070 and excited about? 231 00:08:35,009 --> 00:08:35,909 Well, gosh. 232 00:08:36,529 --> 00:08:39,649 There's just so many advances in cardiovascular care 233 00:08:39,649 --> 00:08:40,709 that gets you excited. 234 00:08:41,334 --> 00:08:43,014 And and maybe we we start with that 235 00:08:43,014 --> 00:08:45,654 and then talk about the concerns. So some 236 00:08:45,654 --> 00:08:46,955 of the things that 237 00:08:47,975 --> 00:08:49,274 are widely available, 238 00:08:50,695 --> 00:08:52,294 I'll I'll allude to, and then some of 239 00:08:52,294 --> 00:08:54,315 the things that I think are are unique 240 00:08:54,375 --> 00:08:57,420 to to our particular site. There's a revolution 241 00:08:58,279 --> 00:09:00,460 in the drugs that we now have available 242 00:09:00,519 --> 00:09:01,180 to treat 243 00:09:01,560 --> 00:09:02,060 diseases 244 00:09:03,160 --> 00:09:05,960 that have been inadequately treated in the in 245 00:09:05,960 --> 00:09:06,620 the past. 246 00:09:07,399 --> 00:09:07,879 So, 247 00:09:08,279 --> 00:09:09,820 just by way of example, 248 00:09:10,680 --> 00:09:11,740 we now have 249 00:09:12,804 --> 00:09:14,985 exciting or very, very 250 00:09:15,445 --> 00:09:18,644 potent drugs available to treat diseases such as 251 00:09:18,644 --> 00:09:19,865 hypertrophic cardiomyopathy. 252 00:09:20,804 --> 00:09:24,424 There's a drug called mavacamten that's gonna revolutionize 253 00:09:24,804 --> 00:09:25,865 the care of that 254 00:09:26,245 --> 00:09:27,304 not so infrequent, 255 00:09:28,379 --> 00:09:30,160 type of heart muscle disease. 256 00:09:30,540 --> 00:09:32,080 And we also now have drugs 257 00:09:32,460 --> 00:09:34,620 or another type of heart muscle disease called 258 00:09:34,620 --> 00:09:35,120 amyloid, 259 00:09:35,740 --> 00:09:36,960 which is increasingly 260 00:09:37,340 --> 00:09:40,059 recognized in the elderly population and has a 261 00:09:40,059 --> 00:09:41,040 genetic basis. 262 00:09:41,580 --> 00:09:42,879 Drugs such as 263 00:09:43,384 --> 00:09:43,884 Ozempic 264 00:09:44,825 --> 00:09:47,164 and Monjaro or their weight loss equivalent, 265 00:09:47,784 --> 00:09:48,284 Wegovy 266 00:09:48,664 --> 00:09:49,164 or, 267 00:09:49,784 --> 00:09:50,284 ZepBound, 268 00:09:51,304 --> 00:09:53,085 are not only very useful 269 00:09:53,705 --> 00:09:55,085 in managing diabetics 270 00:09:55,465 --> 00:09:56,284 and in, 271 00:09:57,065 --> 00:09:58,125 managing weight, 272 00:09:59,039 --> 00:10:02,019 but have have we've learned has significant 273 00:10:02,399 --> 00:10:02,899 cardiovascular 274 00:10:03,440 --> 00:10:03,940 benefit. 275 00:10:04,480 --> 00:10:06,579 So we now use these drugs 276 00:10:07,039 --> 00:10:07,539 routinely 277 00:10:08,559 --> 00:10:10,820 to manage patients who may not be diabetic 278 00:10:11,440 --> 00:10:13,539 but have some form of kidney disease, 279 00:10:14,274 --> 00:10:16,934 heart failure, or coronary artery disease. 280 00:10:17,394 --> 00:10:19,714 And over time, these drugs will become more 281 00:10:19,714 --> 00:10:20,214 accessible, 282 00:10:20,595 --> 00:10:22,054 read more affordable, 283 00:10:23,154 --> 00:10:25,154 and I think will be more applicable to 284 00:10:25,154 --> 00:10:26,134 larger populations. 285 00:10:28,480 --> 00:10:29,620 We have now 286 00:10:30,240 --> 00:10:32,820 new methods for treating atrial fibrillation, 287 00:10:33,279 --> 00:10:35,539 a procedure called pulse field ablation, 288 00:10:36,799 --> 00:10:37,299 which, 289 00:10:38,079 --> 00:10:39,059 if its promise 290 00:10:39,839 --> 00:10:40,339 bears 291 00:10:40,639 --> 00:10:42,659 bears out with greater usage, 292 00:10:43,325 --> 00:10:46,125 we'll see it being a safer and quicker 293 00:10:46,125 --> 00:10:47,664 procedure for atrial fibrillation, 294 00:10:48,764 --> 00:10:50,625 with the need for less resources, 295 00:10:51,644 --> 00:10:54,524 and, the ability to get patients out quicker 296 00:10:54,524 --> 00:10:56,784 and, again, as I said, safe more safely. 297 00:10:57,509 --> 00:10:58,490 We are seeing 298 00:10:59,350 --> 00:11:02,170 movement now to have nonsurgical 299 00:11:02,550 --> 00:11:03,690 means to essentially 300 00:11:05,110 --> 00:11:08,389 replace or repair every cardiac valve within the 301 00:11:08,389 --> 00:11:11,050 heart. So this revolution, which 302 00:11:11,504 --> 00:11:13,665 began in and around 02/2012, 303 00:11:13,665 --> 00:11:14,485 put transcatheter 304 00:11:14,865 --> 00:11:15,924 aortic valve replacement, 305 00:11:16,384 --> 00:11:16,884 however, 306 00:11:17,985 --> 00:11:20,965 the ability to replace the aortic valve nonsurgically, 307 00:11:22,144 --> 00:11:24,144 and and what we've learned with that type 308 00:11:24,144 --> 00:11:24,965 of technology 309 00:11:25,929 --> 00:11:28,809 now is available for the mitral valve and 310 00:11:28,809 --> 00:11:32,170 the tricuspid valve and the pulmonic valve. There 311 00:11:32,170 --> 00:11:34,350 are only four valves in the heart. 312 00:11:35,450 --> 00:11:38,190 And whether the valve is stuck or leaking, 313 00:11:39,044 --> 00:11:41,445 there is now or very soon to be 314 00:11:41,445 --> 00:11:42,904 a the ability 315 00:11:43,524 --> 00:11:43,924 to, 316 00:11:44,325 --> 00:11:46,184 replace or repair that valve 317 00:11:46,884 --> 00:11:47,384 nonsurgically. 318 00:11:49,044 --> 00:11:50,105 That's an enormous, 319 00:11:50,804 --> 00:11:51,464 an enormous, 320 00:11:51,845 --> 00:11:52,345 undertaking 321 00:11:53,199 --> 00:11:54,500 and and a real accomplishment. 322 00:11:55,199 --> 00:11:57,679 One of the frustrations of these types of 323 00:11:57,679 --> 00:11:58,820 advances, though, 324 00:11:59,360 --> 00:12:02,079 is that there is always the assumption that 325 00:12:02,079 --> 00:12:04,019 once the FDA approves 326 00:12:04,879 --> 00:12:07,459 these types of technology, you can automatically 327 00:12:08,159 --> 00:12:09,014 institute it. 328 00:12:09,495 --> 00:12:10,154 But often, 329 00:12:10,695 --> 00:12:11,754 insurance coverage 330 00:12:12,375 --> 00:12:15,835 is delayed from the time of FDA approval. 331 00:12:16,535 --> 00:12:19,335 So you're left with this clinical conundrum where 332 00:12:19,335 --> 00:12:20,475 you have access 333 00:12:21,335 --> 00:12:22,554 to a new procedure, 334 00:12:23,470 --> 00:12:26,129 but you have no mechanisms of reimbursing 335 00:12:27,149 --> 00:12:27,889 the hospital 336 00:12:28,750 --> 00:12:30,850 for the cost of the procedure. 337 00:12:31,710 --> 00:12:32,450 I wish 338 00:12:32,990 --> 00:12:35,409 that more attention was paid to this, 339 00:12:36,415 --> 00:12:38,115 and that the federal payments 340 00:12:39,695 --> 00:12:40,195 agencies, 341 00:12:40,815 --> 00:12:41,634 try to, 342 00:12:42,174 --> 00:12:42,674 determine 343 00:12:43,375 --> 00:12:46,274 or come more into alignment with the federal 344 00:12:46,335 --> 00:12:49,340 approval processes. But this has been something that's 345 00:12:49,340 --> 00:12:52,000 been very vexing to us where we participate 346 00:12:52,059 --> 00:12:53,919 in the research trials 347 00:12:54,539 --> 00:12:56,080 that lead to the approval 348 00:12:56,539 --> 00:12:57,840 of these devices. 349 00:12:58,379 --> 00:13:01,580 And during the research phase, these devices and 350 00:13:01,580 --> 00:13:02,080 payment 351 00:13:02,574 --> 00:13:04,914 is is guaranteed by the federal government, 352 00:13:05,934 --> 00:13:06,674 by fiat. 353 00:13:07,214 --> 00:13:09,294 And so you get paid to participate in 354 00:13:09,294 --> 00:13:11,554 the research trial, meaning you cover your costs. 355 00:13:12,254 --> 00:13:14,514 The device is now approved, 356 00:13:15,690 --> 00:13:18,889 but you can't continue to use the device 357 00:13:18,889 --> 00:13:19,710 or the technology 358 00:13:20,330 --> 00:13:22,429 because now there's no payment mechanism 359 00:13:22,730 --> 00:13:24,750 because the research trial has ended. 360 00:13:25,290 --> 00:13:26,350 That's a real conundrum. 361 00:13:28,294 --> 00:13:29,914 Some of the newer things that, 362 00:13:30,375 --> 00:13:32,855 are coming that we are beginning to use 363 00:13:32,855 --> 00:13:36,475 more frequently are more effective screening tests, 364 00:13:37,575 --> 00:13:39,995 for the detection of cardiac disease. 365 00:13:40,670 --> 00:13:42,430 One of them in particular I'd like to 366 00:13:42,430 --> 00:13:42,930 highlight 367 00:13:43,470 --> 00:13:43,970 because 368 00:13:44,430 --> 00:13:46,110 I think we have been on the leading 369 00:13:46,110 --> 00:13:47,809 edge of providing genetic 370 00:13:48,350 --> 00:13:48,850 care 371 00:13:49,710 --> 00:13:50,529 or genomics 372 00:13:51,070 --> 00:13:53,170 to our patient population. So 373 00:13:54,355 --> 00:13:56,934 probably about ten years ago, the system embarked 374 00:13:56,995 --> 00:13:58,535 on a a commitment, 375 00:13:59,555 --> 00:14:01,815 both in time, personnel, and treasure 376 00:14:03,315 --> 00:14:03,815 to, 377 00:14:04,835 --> 00:14:07,095 develop a a genomics program 378 00:14:07,569 --> 00:14:09,169 that can be applied to both, 379 00:14:09,649 --> 00:14:12,529 primary care populations as well as specialty care 380 00:14:12,529 --> 00:14:13,029 population. 381 00:14:13,889 --> 00:14:17,169 And within our own division, working with our, 382 00:14:17,649 --> 00:14:19,990 partners in genomics and industry, 383 00:14:20,825 --> 00:14:22,924 we've developed a commercially available 384 00:14:23,784 --> 00:14:24,684 risk panel, 385 00:14:25,784 --> 00:14:27,485 a polygenic risk score. 386 00:14:28,424 --> 00:14:30,985 So patients can get a test tube just 387 00:14:30,985 --> 00:14:33,304 like they get with 23 andMe. They put 388 00:14:33,304 --> 00:14:34,924 some saliva into it, 389 00:14:35,330 --> 00:14:36,710 and we can develop 390 00:14:37,330 --> 00:14:38,629 predictive scores 391 00:14:39,330 --> 00:14:39,830 using, 392 00:14:41,250 --> 00:14:42,389 multiple genes 393 00:14:43,009 --> 00:14:45,809 to your lifetime risk of developing coronary artery 394 00:14:45,809 --> 00:14:49,669 disease, aortic aneurysm, diabetes, and kidney disease, 395 00:14:50,825 --> 00:14:53,004 and atrial fibrillation for that matter. 396 00:14:53,384 --> 00:14:56,345 So, obviously, this is not something that you 397 00:14:56,345 --> 00:14:58,745 would necessarily apply to somebody in their eighties 398 00:14:58,745 --> 00:14:59,485 or nineties, 399 00:15:00,024 --> 00:15:02,105 but this is something that we are beginning 400 00:15:02,105 --> 00:15:02,605 to, 401 00:15:03,065 --> 00:15:05,644 distribute to our patients, offers to our patients, 402 00:15:06,480 --> 00:15:08,799 particularly younger patients who are interested. Hey. I 403 00:15:08,799 --> 00:15:10,659 have a family history of heart disease 404 00:15:11,679 --> 00:15:13,759 or, am I at risk for heart disease? 405 00:15:13,759 --> 00:15:15,459 And sometimes we even see 406 00:15:15,839 --> 00:15:18,240 patients who have established heart disease saying, I'd 407 00:15:18,240 --> 00:15:20,384 I'd like to know what what what were 408 00:15:20,384 --> 00:15:22,464 the genetic risks that were associated with me 409 00:15:22,464 --> 00:15:25,264 getting this disease. Because the majority of cardiac 410 00:15:25,264 --> 00:15:27,924 disease are not caused by one gene. 411 00:15:28,464 --> 00:15:30,544 They're caused by dozens or, 412 00:15:30,945 --> 00:15:31,684 more genes 413 00:15:32,269 --> 00:15:35,389 that interact with our environment to subsequently produce 414 00:15:35,389 --> 00:15:36,049 the disease. 415 00:15:36,750 --> 00:15:38,190 So the idea is that, 416 00:15:38,990 --> 00:15:41,090 although genes are very, very influential, 417 00:15:41,470 --> 00:15:43,009 it's it's not necessarily 418 00:15:43,790 --> 00:15:45,169 a % destiny. 419 00:15:45,764 --> 00:15:46,825 And that if you identify 420 00:15:47,205 --> 00:15:48,504 the genetic predilection 421 00:15:49,205 --> 00:15:50,024 early enough, 422 00:15:51,045 --> 00:15:52,665 you can make the most appropriate, 423 00:15:53,764 --> 00:15:57,125 medical decisions and environmental decisions to either put 424 00:15:57,125 --> 00:15:58,965 off the disease or avoid it in its 425 00:15:58,965 --> 00:15:59,465 entirety. 426 00:16:00,004 --> 00:16:01,125 And we're looking at, 427 00:16:01,799 --> 00:16:03,419 widely distributing this 428 00:16:04,200 --> 00:16:06,460 in, a diverse population. 429 00:16:07,159 --> 00:16:09,179 So that would include patients 430 00:16:09,559 --> 00:16:10,539 within the 431 00:16:10,840 --> 00:16:13,820 suburban environment within, Endeavor Health, 432 00:16:14,165 --> 00:16:16,965 but also patients in the city environment with 433 00:16:16,965 --> 00:16:20,105 Endeavor Health and in pay in patients 434 00:16:20,485 --> 00:16:22,985 who both can afford and can't afford, 435 00:16:23,845 --> 00:16:25,545 this type of genetic testing, 436 00:16:26,004 --> 00:16:28,404 which costs in the range of about 250, 437 00:16:28,404 --> 00:16:30,024 2 hundred and 70 5 dollars. 438 00:16:31,419 --> 00:16:33,679 In fact, we are going to, I believe, 439 00:16:33,740 --> 00:16:36,480 fund a project within the North City 440 00:16:36,860 --> 00:16:39,919 where we will provide this type of, technology, 441 00:16:40,700 --> 00:16:43,600 this type of testing to populations that otherwise 442 00:16:43,740 --> 00:16:44,879 couldn't afford it 443 00:16:45,414 --> 00:16:48,315 and then, look at how we can modify 444 00:16:48,455 --> 00:16:49,355 their risks, 445 00:16:50,134 --> 00:16:51,914 and and follow these patients, 446 00:16:52,615 --> 00:16:53,754 over the long term. 447 00:16:54,695 --> 00:16:57,115 Thank you. Doctor Misko, you've had this fantastic 448 00:16:57,815 --> 00:16:58,315 career, 449 00:16:59,059 --> 00:17:01,159 Clinical professor at the University of Chicago, 450 00:17:01,620 --> 00:17:04,680 head of cardiology at Endeavor at North Shore, 451 00:17:05,059 --> 00:17:07,960 helped to found and drive this cardiovascular institute. 452 00:17:08,819 --> 00:17:10,359 You know, from Toronto, 453 00:17:10,819 --> 00:17:11,319 Ottawa, 454 00:17:11,619 --> 00:17:13,000 Kelley School Of Business, 455 00:17:14,095 --> 00:17:17,054 a lifelong learner, of course. It sure seems 456 00:17:17,054 --> 00:17:17,714 like it. 457 00:17:18,174 --> 00:17:20,595 Doctor Misko, take a moment on what advice 458 00:17:20,654 --> 00:17:22,974 you would give to other emerging leaders wanting 459 00:17:22,974 --> 00:17:24,994 to have impactful and satisfying careers. 460 00:17:25,769 --> 00:17:28,570 That's a great question. And and and, I 461 00:17:28,570 --> 00:17:31,210 I get called probably every three or four 462 00:17:31,210 --> 00:17:33,529 months out of the blue from somebody who 463 00:17:33,529 --> 00:17:35,210 says, can I, you know, bend your ear 464 00:17:35,210 --> 00:17:36,349 for half an hour 465 00:17:37,609 --> 00:17:39,609 and, you know, tell me, is it worthwhile, 466 00:17:39,609 --> 00:17:41,470 for instance, to go and get an MBA? 467 00:17:42,625 --> 00:17:45,045 So as I think about my own career, 468 00:17:45,904 --> 00:17:47,845 I sort of fell into leadership. 469 00:17:48,625 --> 00:17:49,365 I didn't 470 00:17:49,825 --> 00:17:51,285 pursue it in 471 00:17:52,545 --> 00:17:55,345 a programmatic or preplanned way. So I think 472 00:17:55,345 --> 00:17:57,204 the first thing I would say is 473 00:17:58,359 --> 00:17:59,179 be more 474 00:17:59,960 --> 00:18:00,460 conscious 475 00:18:02,039 --> 00:18:04,299 or goal directed than I was 476 00:18:05,079 --> 00:18:05,579 and 477 00:18:06,119 --> 00:18:07,660 begin to look at 478 00:18:08,119 --> 00:18:09,419 developing that administrative 479 00:18:09,720 --> 00:18:12,140 career earlier on than I did. 480 00:18:12,454 --> 00:18:13,835 So that would be the first, 481 00:18:14,375 --> 00:18:16,315 the first thing I would do is is 482 00:18:16,694 --> 00:18:17,674 really examine 483 00:18:19,174 --> 00:18:21,095 what do you want your career path to 484 00:18:21,095 --> 00:18:21,595 be 485 00:18:21,974 --> 00:18:23,974 and then begin to pursue it at at 486 00:18:23,974 --> 00:18:26,454 a younger age. Now, obviously, at a younger 487 00:18:26,454 --> 00:18:26,954 age, 488 00:18:28,220 --> 00:18:31,119 there are gonna be considerations about pursuing leadership 489 00:18:31,900 --> 00:18:32,400 different 490 00:18:32,700 --> 00:18:34,539 than than, say, when I began to pursue 491 00:18:34,539 --> 00:18:35,920 leadership in my fifties. 492 00:18:36,380 --> 00:18:38,240 And one of those, importantly, 493 00:18:38,700 --> 00:18:40,480 is, you know, family obligations. 494 00:18:41,424 --> 00:18:42,724 Because I do think 495 00:18:43,265 --> 00:18:43,765 that 496 00:18:44,224 --> 00:18:44,724 assuming 497 00:18:45,105 --> 00:18:46,325 a large leadership 498 00:18:46,945 --> 00:18:47,445 position 499 00:18:49,105 --> 00:18:51,904 and trying to maintain a clinical practice at 500 00:18:51,904 --> 00:18:52,805 the same time, 501 00:18:53,184 --> 00:18:53,684 something 502 00:18:54,259 --> 00:18:55,799 has to give. And, usually, 503 00:18:56,419 --> 00:18:59,460 it's understanding that you might have less time 504 00:18:59,460 --> 00:19:02,039 for family obligations. So this is something that 505 00:19:02,500 --> 00:19:04,419 each individual has to say, how young is 506 00:19:04,419 --> 00:19:05,159 my family, 507 00:19:06,099 --> 00:19:07,159 if I have one, 508 00:19:07,534 --> 00:19:09,394 and and how much flexibility 509 00:19:09,694 --> 00:19:11,694 do I have to take away from or 510 00:19:11,694 --> 00:19:12,994 how much time can I 511 00:19:13,615 --> 00:19:14,914 take away from my family 512 00:19:15,375 --> 00:19:16,914 and still maintain a family? 513 00:19:17,214 --> 00:19:18,734 So that would be the second thing would 514 00:19:18,734 --> 00:19:20,115 be to look at your own 515 00:19:20,609 --> 00:19:21,349 personal circumstances 516 00:19:22,049 --> 00:19:22,549 before 517 00:19:23,089 --> 00:19:23,589 overcommitting. 518 00:19:25,170 --> 00:19:27,029 The third thing that I would say 519 00:19:27,569 --> 00:19:28,470 is that 520 00:19:29,569 --> 00:19:30,950 medical school alone 521 00:19:32,289 --> 00:19:35,029 certainly selects out bright people, 522 00:19:36,184 --> 00:19:37,884 and there's nothing to say that 523 00:19:38,505 --> 00:19:39,805 anything that I do 524 00:19:40,265 --> 00:19:42,204 hour to hour or day to day, 525 00:19:42,744 --> 00:19:45,085 I couldn't do just by virtue of being 526 00:19:45,224 --> 00:19:46,525 a relatively intelligent 527 00:19:47,224 --> 00:19:48,525 individual or physician. 528 00:19:49,250 --> 00:19:51,410 But I do think that it helps to 529 00:19:51,410 --> 00:19:52,390 get additional 530 00:19:52,850 --> 00:19:54,789 education under your belt that 531 00:19:55,250 --> 00:19:56,150 revolves around 532 00:19:57,170 --> 00:19:57,670 leadership 533 00:19:58,450 --> 00:19:58,950 development 534 00:19:59,890 --> 00:20:03,029 and the skill set that's required to 535 00:20:03,575 --> 00:20:05,674 be an effective administrator. So 536 00:20:06,134 --> 00:20:07,994 in my case, I chose an MBA, 537 00:20:08,454 --> 00:20:10,855 and I think that's an extraordinarily good vehicle. 538 00:20:10,855 --> 00:20:12,315 It's not the only vehicle. 539 00:20:12,775 --> 00:20:15,575 It does require a significant commitment of time, 540 00:20:15,575 --> 00:20:16,375 particularly if you, 541 00:20:17,015 --> 00:20:19,679 importantly, if you go to a good program, 542 00:20:19,679 --> 00:20:21,039 and I did go to a very good 543 00:20:21,039 --> 00:20:21,539 program. 544 00:20:22,159 --> 00:20:24,000 But I do think you need to start 545 00:20:24,000 --> 00:20:26,720 getting educated about things that you might not 546 00:20:26,720 --> 00:20:28,579 have ever thought about, like 547 00:20:29,359 --> 00:20:29,859 accounting, 548 00:20:31,565 --> 00:20:32,065 finance, 549 00:20:32,444 --> 00:20:33,505 capital management, 550 00:20:34,285 --> 00:20:35,265 micro, macroeconomic, 551 00:20:36,845 --> 00:20:37,984 leadership development. 552 00:20:39,244 --> 00:20:41,484 And then I think the final thing that 553 00:20:41,484 --> 00:20:44,065 I would encourage young people to do, 554 00:20:44,960 --> 00:20:46,019 or younger people, 555 00:20:46,880 --> 00:20:48,259 would be to find a mentor. 556 00:20:49,359 --> 00:20:52,640 Find somebody who's done it and maybe say, 557 00:20:52,640 --> 00:20:53,299 hey. Listen. 558 00:20:53,920 --> 00:20:54,820 Would you mind 559 00:20:56,160 --> 00:20:58,339 that we touch bases every quarter 560 00:20:58,894 --> 00:21:00,894 and I just bounce some ideas off of 561 00:21:00,894 --> 00:21:01,394 you. 562 00:21:02,335 --> 00:21:04,014 So off the top of my head, I 563 00:21:04,014 --> 00:21:05,794 would say it would be those four things. 564 00:21:06,894 --> 00:21:10,034 Thank you, doctor Mishko. What a remarkable career, 565 00:21:10,414 --> 00:21:11,794 and and I've seen firsthand 566 00:21:12,169 --> 00:21:13,470 the work at the Cardiovascular 567 00:21:14,009 --> 00:21:14,509 Institute. 568 00:21:14,970 --> 00:21:16,829 Just fantastic what you're doing. 569 00:21:17,289 --> 00:21:17,789 Congratulations 570 00:21:18,089 --> 00:21:20,650 to yourself and the Endeavor Health System, and 571 00:21:20,650 --> 00:21:22,409 thank you so much for joining us today 572 00:21:22,409 --> 00:21:24,829 on the Becker's Healthcare podcast. Just outstanding. 573 00:21:25,454 --> 00:21:27,534 I I really appreciate the opportunity to highlight 574 00:21:27,534 --> 00:21:29,294 what we've done here at Endeavor. Very proud 575 00:21:29,294 --> 00:21:29,954 of it.