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Welcome everyone to the Becker's Healthcare podcast series.
I'm Ryan Muhammad with Becker's Healthcare.
I'm thrilled to have with me today Dr. Joseph Kraft from St. Luke's Hospital.
Dr. Kraft is so nice to talk with you today. How are you?
I'm, I'm well. Thank you for having me on. I've, uh,
enjoyed listening to some of the other podcasts that you guys have published,
and I think it's great what you're doing.
I appreciate you trying to share the word about heart health.
Oh, yeah, absolutely. Thank you so much for those kind words,
and we are so excited to have you on today. Uh, to begin,
would you mind please introducing yourself and telling us a bit about your
background?
Sure. My name is Joe Kraft. I'm a cardiologist in St. Louis, Missouri. Uh,
I trained,
I did college at University of North Carolina and I did medical school at Wake
Forest University.
I did a residency in internal medicine and a chief resident year at Vanderbilt
University, and I did a cardiology fellowship at Washington University in St.
Louis on board certified in internal medicine, cardiology,
echocardiography, and nuclear cardiology. And, uh,
I'm a general cardiologist. I love taking care of patients. Um,
that's what gets me out of bed in the morning.
But I also have an interest in the business of healthcare,
including everything including policy, finance, uh,
technology and population health.
And so I've had the pleasure of holding some leadership positions. Uh,
currently I'm the president of the medical staff at St. Luke's Hospital at St.
Louis. St. Luke's is, um, an independent health system,
uh, of medium size. We have a 30 locations throughout the St.
Louis metropolitan area. Um, high, very high quality place.
We pride ourselves on that, uh,
Medicare five star rating for the flagship hospital.
We have a alliance in partnership with Cleveland Clinic, and, um, we have a,
a mix of, uh, employed physicians and private physicians. And, um,
culture is very important to us.
Yes, absolutely.
Thank you so much for sharing that background knowledge and with all of your
experience in healthcare. The one thing I wanted to ask you first is,
what are the top three biggest issues in cardiology today?
Well, I'm sure, uh,
you'd get a lot of different responses from different people in the field,
but some of the things that I think are interesting and I think are dynamic
features in our world, uh, day-to-day,
both for the folks of those of us who work in the trenches and see patients
every day, but also for the folks who step back and look at, uh,
cardiovascular care from a bird's eye view,
maybe around the country or around the world.
One of the things that we struggle with is what I like to call therapeutic
optimization. Uh,
when we develop therapies to try to help people for various heart conditions,
and there's, there's so much heart disease out there, uh,
we have a hard time translating that from established, qualified,
good quality evidence to widespread adoption and access to
patients who need those things. So numbers have been diff have,
have been quoted differently,
but there's a lot of reports to suggest that it takes 10 to 15 years
until high quality publications are available to
physicians,
even published in large white paper guidelines accepted by professional
societies before those same therapies are widely adopted.
Um, so we have a gap.
We have a gap between evidence-based and widespread use,
uh, and availability to patients.
There were a lot of people who felt that the,
on the introduction of electronic health records in the mid two thousands were
gonna solve a lot of those problems. Unfortunately,
electronic health records really have been mostly disappointing with respect to
their ability to impact population based healthcare in a, in a large way,
whether that is the population of a PHY single physician's
panel or a small practice or, uh, you know,
thinking about the country as a whole.
So I think one of the things that's interesting is there are, uh,
with the introduction of a lot of AI tools, artificial intelligence tools,
there,
there may be an opportunity finally for us to accelerate
the rate at which we as a medical community adopt highly qualified
therapies to make a difference. Here, I'll give you an example in,
in taking care of patients with congestive heart failure,
those people with heart failure, we call with a reduced ejection fraction.
We now have a pretty commonly accepted four drug regimen,
um, that has well-established use,
is endorsed by all the cardiology professional societies. Um,
however, if you look at nearly every group of physicians, uh,
almost any way you slice the pie, you can see that, um, use of one of those,
or maybe two of those medications, uh, is relatively commonly done.
But getting all three or all four medications,
and even this is include excluding people who are allergic or having
intolerances. We just haven't gotten there yet.
Some of this information is newer,
but we want to accelerate the timeline to adoption.
We know that there is a big difference sometimes adding years of life
going from two of these heart failure medications to four of these heart failure
medications. So, um, one of the tools that we're using, and I don't have,
I have no disclosure, no financial disclosures, but I think it's interesting,
one of the tools that we're using in our health system is called cardio care.
Cardio care is a software tool.
It's part of the Edwards Life Sciences family of companies and
cardio care, as an example, uh, has the ability to pull out,
to extract a lot of data from, as an external software piece,
from the electronic health record,
and analyze it in a sophisticated way and give us reports of how
many patients from our population are on the four drug regimen who would qualify
based on their ejection fraction and their symptoms. It's a,
it's a really robust reporting tool. It's very insightful,
and it can be updated in real time. Um,
and it can be given this information be provided to physicians,
to nurse case managers, um,
to population health teams to try to help impact care and deliver
care to a larger group of folks. So I use that as an example, and I,
I hope that's one, uh,
one insight into what the next year or two or five could look
like as we try to make high quality cardiovascular care, more dynamic,
more responsive to, um,
data that gets published and help our patients live longer and live better.
Yeah, absolutely. Thank you so much for all of that insight. I,
like you said at the very beginning, I can definitely, uh,
I hear a lot of different answers to this question, but you know,
I'm excited that you spoke about something that I don't hear about too often.
And keeping in mind those big issues,
how do you see heart care evolving over the next 18 months?
Do you think that some of those issues will be solved by then?
I, I, i see. I guess I would say, um, I would, I I'd say there's, uh,
challenges, concerns, and there are opportunities.
Let me kind of highlight one of the challenges.
So we have workforce challenges in, in cardiology,
as many of your listeners may know. As of 2010,
the baby boomer group started hitting Medicare age and we have an aging
population,
and roughly 10 to 12,000 people reached 65 years old in the
United States every single day. And as we get older,
cardiology tends to be care of mostly older folks. Um,
and so we anticipate a lot of increased care needs. So,
um,
the challenge though is that we have a cardiology workforce that is not growing.
So among cardiologists in the United States,
we lose about anywhere from 500 to a thousand cardiologists that's been
estimated per year out of the workforce. And that's for a lot of reasons.
One of those is because at present,
about 60% of cardiologists are over the age of 55, 20 5% are over the age of
65. Those numbers are going to increase.
We have long training timelines.
People start into medical school in this era a little later in life,
a couple years later in life than they did 15, 20 years ago. Um,
we have physicians who are field burnout for lots of reasons,
have been worked very hard, COVID didn't, nothing did nothing to help that. Um,
so we have some people who are scaling back their work.
Some people are retiring early, and that's resulted in the shorters.
At the same time, we have an arguably bigger problem in the United States, uh,
that we have a tidal wave of nursing shortages coming.
It's estimated that around 2026 we'll have anywhere from
300,000 to 500,000 nursing positions open and unfilled in the
United States. It is very challenging to hire nurses right now.
So on the supply side, uh, for the,
for the expected increase need of our population,
we're gonna have less people to do that.
So there are gonna be lots of clever ways. I hope,
I hope there'll be lots of clever ways to try to increase that. There's some,
uh,
activity on the legislative side in trying to increase the number of approved
and paid for, uh, residency positions.
There are some medical schools that have been ex have been growing and expanding
and trying to graduate more doctors. There will be a lot of extension,
including the use of nurse practitioners and physician assistants and
physicians leading those care teams to try to take care of all of our folks.
But that will for sure be it. So that's for sure a challenge.
I think one of the things that's interesting that will happen in that same
context is
roughly 85% of the,
of the cardiologists in the United States are employed or tightly aligned with
health systems.
That's a flip from the way things worked 25 years ago when it was around 25% of
cardiologists had such alignments.
So health system and cardiology care teams are working tightly together,
and they are working in,
in the context of a changing kind of care venues.
So for example, we anticipate the inpatient cardiology needs,
hospital-based cardiology care to increase around 5%,
maybe 6% over the next decade. That's a national estimate,
but the outpatient care needs, we expect to grow 25%.
Health systems historically have been very focused on
bricks and mortar patient heads and beds.
What do we do on the inpatient side?
And many have not been really focused on seeing the outpatient
realm of care as their future.
And I think all of us are gonna have to sort of adopt a mindset that the
outpatient realm where we care for patients is really gonna be our future.
So how are we gonna get to that and our health system's gonna be able to make
that transition effectively. You know,
their health systems are under financial strain. It's a, it's a tough industry.
Those are kind of small margin. Um, it's a small margin business.
Um,
and we see an influx and an increased interest in other,
uh, other groups coming into the outpatient realm.
And among several is includes Amazon, Walmart, uh,
United Healthcares, Optum have been, uh,
moving more into the outpatient care realm.
So it's gonna be very interesting to see if over the next five years there's
some disruption in where we take care of patients and who is taking care
of those patients in that outpatient realm. I think it's gonna be very,
very interesting. My hope is, I guess I,
I'm kind of a glass half full kind of guy, so you, you asked about, um,
you know, you asked about opportunities and threats.
I I hope that this landscape, um, shakes things up. Uh,
healthcare by its nature has not always been very fast moving. And,
and I think it would be really exciting if it were a time of accelerated change
and increasing innovation,
maybe even out from outside of some traditional healthcare players to try to
shake things up and help us take care of people better. For me,
that would be fun. And uh, that would be fun change. That would be exciting.
Yes, absolutely. I completely agree with many things you said. Um,
and we definitely do need some creativity in dealing with some of those issues
arising. Uh, however, before I let you go, doctor,
the last thing I wanted to ask you is what are you excited about and also what
is making you nervous? I know something you mentioned about, uh,
nerve shortages and that can definitely make one nervous .
So,
so the things that I'm nervous about are having an increasingly strained
healthcare system, both on the hospital side where we don't have enough nurses,
where we still struggle with high expenses,
that we don't have enough cardiologists and, um,
support team to take care of the patient care need. That, that's my concern.
What, what I'm hopeful about,
what I'm optimistic about is that there'll be an increasing push to
address these things in new ways. So, um, for example,
if, if we were to take care of patients in a better way,
I mentioned this therapeutic optimization concept.
If we were able to figure out among the thousands of patients,
say in our health system that we care for and that we know have chronic
conditions that we have to manage over time,
if we can figure out who those people are, if we can learn about them,
if we can get data, feedback them in real time,
and now it seems like we're at the advent of having tools to effectively do
that. Um, I think that we can make a major impact in those patients care,
help keep them out of the hospital, help keep them happier and living longer.
We're also starting to see some software applications that are gonna have
increasing opportunity to impact the electronic health records. Um,
despite the best efforts,
many of those electronic health records haven't evolved very fast over the last
15 years or so since they've been available. Um,
there are also artificial intelligence and voice recognition tools that
hopefully are gonna get doctors and nurses less and less
obligated to do data entry, uh, typing all day long and clicking all day long.
Uh,
it is the bane of the existence of those of us who take care of patients every
day and it's a time suck. And we really,
really need to get away from that in order to allow people time,
face-to-face with patients, which is what patients want. If we do those things,
I think we'll have both a happier healthcare workforce and patients who are
better cared for.
Yes. Thank you so much for those final thoughts, doctor.
This has been an amazing discussion.
So I do wanna thank you so much for coming on Becker's Healthcare to, uh,
speak with me today and I look forward to connecting with you again soon.
Right. It's been a pleasure.
Thanks for what you're doing and I'll look forward to the next time.
Thank you.