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Hello. This is Francesca Matthews with the Becker's

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ASC review podcast.

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I'm thrilled to be joined today by doctor

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Anthony Tortellani, a cardiac and thoracic surgeon and

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professor emeritus,

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in in clinical cardiothoracic

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surgery

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at Weill Cornell Medical

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College. Doctor Tortellani, thank you so much for

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being here today.

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My pleasure. Hopefully, it will be assisting you.

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Well, great. To start us off, could you

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please introduce yourself and tell us a little

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bit about your background?

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I am

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Emeritus professor. I

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spent

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almost all my career either as chief of

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cardiothoracic surgery or as chairman at different hospitals,

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almost all within the Cornell network. And

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I was involved with building

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the first ambulatory surgery center at Northwell. I

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was involved with

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building

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the ambulatory when we converted a floor at

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New York Presbyterian Hospital to ambulatory surgery

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and in the building of

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the ambulatory

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surgery center, which included cardiology

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at Methodist Hospital, which was a hospital that

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joined our network.

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And

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ultimately, at a safety net hospital,

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I was part of

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a strategic planning that decided

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committee, which decided not to build

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a, ambulatory surgery center because they didn't have

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the funds nor the patient population to support

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it. So I have a lot of experience

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in

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developing and running of ambulatory surgery centers.

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Gotcha. So quite a a wealth of experience

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there.

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What are the top three trends that you're

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following in health care today?

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Well, I I and this was discussed in

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some detail at the annual meeting.

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The great concern about not having enough caregivers,

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primarily anesthesiologists,

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nurses,

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and nurse anesthesia,

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assistants,

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that is a real problem that's gonna get

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worse

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over the next seven or eight ten years

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unless,

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we increase the number of anesthesiologists

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we're training.

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This year, there are 1,400,

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medical students interested in going into anesthesia in

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this country,

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and we had no positions for them.

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And they expect within the next ten years,

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we're gonna be short about

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thirty

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six

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thirty six,

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I'm sorry,

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no, about 5,000 or 6,000 anesthesiologists

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across this whole country.

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So we're looking at a major problem. I

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think the important thing is much of the

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anesthesia

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that's provided in ambulatory surgery can be provided

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for by

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Nurse Nestys

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at the head of the bed with anesthesia

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anesthesiologists

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in close proximity.

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I think so that will be

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the short term solution.

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But I think that's

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a trend that we have to fix. I

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think the second trend is a decrease

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in profit margin at hospitals. I don't mean

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that hospitals are making money to put money

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in people's pockets. I mean

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that

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to grow

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hospitals, you need to have a profit margin

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to build buildings and develop programs.

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And what's happening today in medicine,

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with

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limitations in Medicare and Medicaid

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and the introduction of AI into medicine, which

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I'll talk about in a few minutes, is

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going to increase

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the cost.

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And I don't know how we can increase

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cost unless we increase profit margins, which at

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least in the major medical centers

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in New York is not happening.

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So that's a trend I'm concerned about.

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And the third trend is

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the invasion

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of for profit

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organizations

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into medicine,

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whose primary

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concern is not patient care, but its primary

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concern is making profit for

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the equity

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holders

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in that company.

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So, I think those are the

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overall major concerns

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that I have with the three trends I

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see

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about medicine, but not actually within the practice

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of it. Those are the outside concerns that

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I see.

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Mhmm. Absolutely. And that all definitely resonates with,

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you know, the folks I speak to over

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here at Becker's every day and just some

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of the conversations that I've been having.

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What are you most excited about right now

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in health care overall or in the ASC

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space specifically either? Well, I think

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if you keep in mind my concerns,

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I think what's really exciting

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is the involvement

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in artificial intelligence in medicine.

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And I think it can be

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very important

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and I think it's obvious that it's going

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to be important

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in

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the

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administrative,

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the supply chain

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and the administrative

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hierarchy and organization within

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medicine.

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But I think what's exciting to me is

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not the business side of it, but the

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tremendous, tremendous

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influence they're having in basic science research.

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It's unbelievably

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important,

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their role in basic science research at the

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cellular and subcellular

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levels,

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which is being directly applied

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into

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clinical care.

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They're import in there, and they can do

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help us do massive research,

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and it's ongoing at the present time. I'm

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not talking about six months or ten years

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ago. I'm talking about

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now, today, yesterday. If you look at the

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Journal of

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Nature,

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which is the foremost journal in the world,

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or Nature Medicine,

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what AI is doing to help us do

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research is unbelievable.

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But I think it also

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is really important

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in the application in clinical medicine.

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And there, it's helping us it's helping radiologists

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to read,

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X rays and PET scans and MRIs more

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accurately

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and at the

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cellular level, which we've never been able to

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do before.

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So I think that's happening, which makes

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us able to diagnose the diseases

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much earlier

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at a time when it's curative

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with minimal invasive therapy with less surgery, meaning

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more cases being done in ambulatory surgery by

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coincidence.

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So I I think

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it's been great, and it's also been assisting

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us in clinical decision making.

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So it was written recently that we're gonna

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go from generative

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care, which is what we're doing now. Somebody's

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at the bedside looking at the patient, looking

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at the x rays, looking at the blood

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work and making decisions

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to precision medicine,

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which is diagnosis made at the cellular and

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subcellular level,

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which makes it much earlier in the disease

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process,

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which increases the chances of cure, especially in

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cancer or heart disease.

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And

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finally,

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it will help

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in applying

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to a degree

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surgery

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to

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the care and decision making. So we're going

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to go from generative

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to precision

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to personal care where the care will be

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for the individual,

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not for the people who have, let's say,

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lung cancer, but for that particular individual and

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that individual's

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particular cancer problem. So I'm very excited about

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that. Really excited about it.

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Yeah. Absolutely. The advancements

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that AI is is bringing to to research

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and

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to diagnosis are incredible. I feel like I

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read a new stunning headline every day.

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Let me just add to that for a

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sec because I said it, but I did

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maybe didn't say it clearly.

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AI is allowing us to make the diagnosis

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that much

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earlier, which means we don't need to do

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so much invasive surgery. The surgery would be

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less and less invasive.

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Mhmm. Yeah. No. And I know that that's

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that's you know, just there's huge implications there

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for

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the overall, like, efficiencies and cost and experience

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of of everything we know about health care.

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So,

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yeah, and

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kind of moving to a different different area

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here. But how are you thinking about growth

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over the next twelve months?

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I think that with the growth in cardiology

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in outpatient

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facility

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is going to continue to grow. More and

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more

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cardiac

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invasive cardiac therapeutics will not be done by

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surgeons, but would be done by cardiologists

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or cardiologists

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with surgeons

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in an outpatient theater

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like the TAVERs, for instance, and Stenten,

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and pacemakers,

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and,

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AICDs,

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and

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diagnostic,

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insertion of diagnostic catheters, which

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will defibrillate patients

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at home. So I think,

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we will be doing we will be filling

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the ACSs more and more with all sorts

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of therapy and diagnostic

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procedures.

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I think the critical thing

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is to be able to backfill the ORs

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and hospitals

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with appropriate cases

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so they can continue to be successful

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and take care of

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a different type of patient. I think we're

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going to need less hospital beds, more chemotherapy

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is being done on the outpatient basis.

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They're not going into the hospital to get

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chemotherapy.

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And certainly in cardiology

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and pulmonary and GI, more and more of

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that's done

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in ambulatory surgery or ambulatory catheter or pulmonary

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labs. So

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it's truly a time of great change. And

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I think

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the key thing is being

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for the large

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academic medical centers and the hospital

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systems, which is at least in New York,

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it's growing. Those programs are growing tremendously. The

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independent hospitals disappearing

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except

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in areas of poverty

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and the underserved,

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where

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their care is not at the same level

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as in the big systems. The big systems,

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they're not going into

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the poor communities and taking over those small

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inadequate hospitals. That's a real problem.

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But I think over time, they will be

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incorporated into the big systems. It's not today

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or tomorrow. And I think to do that,

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you need physicians that have to be dedicated

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to those systems. They have to be part

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of the large systems,

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either as employees, which has been that way

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or even maybe I'm reading about whether being

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partners, the partners with large health systems

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and ownership

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of ambulatory surgery centers. And I think that's

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another way of doing it.

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But I think all we're in terms of

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tremendous change in medicine.

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And my biggest concern is what I hear,

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The major, major successful

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hospital systems in the Greater New York area,

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some of them are expanding into Connecticut and

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in Upstate New York, but

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but I also see that their profit margin

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is being really reduced,

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and that's a real concern to me because

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they take their profit and build,

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they don't put it in their pocket. They

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build inventory care centers and they build cancer

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perfusion centers and things like that. So I

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think they're doing the right thing. But

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how to do it

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is going to take a lot of cooperation

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and I think

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the without getting too much into this, I

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think the strategic planners

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and the people who carry out the tactical,

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planners,

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strategic and tactical planners have to come together

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and be unified, not that they do the

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same job, but they have to be coordinated.

335
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Mhmm. Absolutely. Everything you said, especially about the

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new kind of cardiovascular codes that are being

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approved for the ASC setting is,

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you know, definitely kind of huge buzz in

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the industry right now. So I think a

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lot of people are thinking about growth in

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a similar way that you are.

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Is there anything that I haven't asked you

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about that you feel like is important in

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this conversation?

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The

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only thing that I would say is that

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if you're in a world to mute all

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the things we just talked about,

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does not very much reach

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the people,

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our patients in rural communities.

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And 50% of the rural counties in this

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country

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don't have a cardiologist.

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And to get to a cardiologist takes forty

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five to fifty minutes of a car ride.

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So

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it's hard for those people to get care.

359
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And certainly, having worked in

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the inner city and in boroughs as well,

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I I

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see that the level of care of those

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patients is not the same

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as the level of care in the major

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medical center, but not even close. And for

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obvious reasons, I I don't I don't blame

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the caregivers there. I it's just that that

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they can't

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they don't have any profit margin.

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They lose millions and millions and $50,000,000 $100,000,000

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a year taking care of the indigent

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with funds that come from the States.

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So it's very hard to get those people

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the kind of care that other people get.

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It it's not equal.

376
00:14:17,700 --> 00:14:19,700
Definitely. No. And it's something I think about

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a lot as well, having come from more

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of a public health reporting background myself,

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and just we talk about the, you know,

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these advancements. I know that, you know, the

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intersection of what we were talking about earlier,

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AI and cardiology. There's,

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you know, tons of advancements as far as

384
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the the level of care that can be

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provided in that field and what's possible now

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with the emerging technology. And it's it's pretty

387
00:14:41,789 --> 00:14:43,309
stark to read about some of those things

388
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and to also read about, you know, the

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00:14:44,589 --> 00:14:47,149
cases that you're describing of, you know, counties

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where there's no cardiovascular care whatsoever. So there's

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00:14:49,709 --> 00:14:51,914
definitely some major gaps to close within within

392
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the space. It is. But, you know, Amit,

393
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I I don't mean to be pessimistic because

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I look at the advances and I say,

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my god, it's unbelievable.

396
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It's truly unbelievable

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00:15:02,475 --> 00:15:05,514
what happened. I think how to coordinate it

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and do it right so everybody

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00:15:08,259 --> 00:15:10,339
benefits by by it, that's gonna take a

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00:15:10,339 --> 00:15:12,579
lot of thinking and planning. But we certainly

401
00:15:12,579 --> 00:15:14,820
are making advances on the scientific side of

402
00:15:14,820 --> 00:15:15,959
it without a doubt.

403
00:15:16,579 --> 00:15:19,059
Mhmm. Absolutely. And I think, you know, the

404
00:15:19,059 --> 00:15:19,799
rest is

405
00:15:20,404 --> 00:15:23,045
happening in conversations and sort of brainstorming and

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00:15:23,045 --> 00:15:25,445
sharing ideas just like we are today. So,

407
00:15:25,845 --> 00:15:27,684
you know, on that note, that is all

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00:15:27,684 --> 00:15:29,384
I had for you today, doctor Tortellani.

409
00:15:29,764 --> 00:15:31,384
Thank you so much for joining us.

410
00:15:31,925 --> 00:15:33,605
Okay. I hope it's helpful, and thank you

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00:15:33,605 --> 00:15:35,909
for having me. I appreciate it. Yeah. Thank

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00:15:35,909 --> 00:15:37,909
you. It's been a pleasure, and I look

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00:15:37,909 --> 00:15:39,269
forward to connecting with you again in the

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future.