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Well, thank you for tuning in again to
the Becker's ASC podcast. This is Alan Condon,
and I'm delighted to be joined today by
doctor Neil Kaushal, who's the executive director of
general GI and endoscopy
at OU Health in Oklahoma
City. Doctor Kaushal, pleasure to have you on
the podcast with us. Before we dive in
and pick your reins a little bit, I'd
love to hand the floor over to you
to just hear a little bit more about
your role, your background, and what's going on
at OU Health.
Thank you so much for having me, Alan.
As you mentioned, I am the director of
general gastroenterology
and endoscopy at OU Health, and I've been
in this role for about a year now.
I was recruited from California where I worked
in a system level at Adventist Health as
a gastroenterologist
and a system level medical director.
And the main purpose of my recruitment to
OU Health was a growth and development of
the gastroenterology
service line, especially from the general gastroenterology
perspective.
So what we're trying to do is optimize
our current endoscopy lab operations and also lay
the sound work for expansion
around the Greater Oklahoma City area to ambulatory
endoscopy centers, starting with our own satellite hospital,
which we own, which is about 20 miles
north of the city in a community called
Edmond.
Fantastic. Yeah. Thank you so much. So I
think that's a great point for us to
start. I think, obviously, you'd recruited out of
Adventist Health, I believe, about a year ago.
Now, Landon, though, all you helped the real
intention to grow the the GI program, particularly
in the outpatient space I gather. But we'd
love to hear a little bit more about
what you're focusing on right now and what
are your, immediate intentions to grow the program
over the next year or so?
That's a great question. So our first and
foremost goal is to take what we have
currently, which is a large scale inpatient endoscopy
unit where we conduct general GI procedures, interventional
GI procedures,
combined endoscopic and even minimally invasive surgical procedures
and take a good look at that operation
and figure out the things we do well
and then figure out the things where there's
opportunities to improve. And then once we do
that, then we can use that as a
framework and a template
to then build in the outpatient setting. So,
for example, one of the things we're doing
on the inpatient side is creating a dedicated
GI hospitalist program.
So this is gonna be inpatient focused gastroenterologists
who are pretty much solely devoted to providing
inpatient GI care, which will then translate to
our other complement of gastroenterologists
being able to focus on outpatient work and
more of the bread and butter general gastroenterology
practice that we can then use to expand
around the city. So it's kind of a
2 part operation there that all really dovetails
together organically very nicely.
Gotcha. And I I guess when you came
in,
the last year or so, you you spoke
a little bit about firstly identifying
areas which OU Health does particularly well in
the GI space and then some of the
areas that you're particularly looking to improve. So
could you give us a little bit more
insight into what you're talking about there?
Yes. Absolutely. So the particular areas that we
do well are that we have some incredible
endoscopists.
We have are fortunate to have some of
the most skilled professionals areas
of
interventional gastroenterology. We're really on the forefront and
the cutting edge of a lot of technology
in advanced therapeutic procedures. Some of the areas
where we do have room for improvement in
growth
are improving inpatient length of stay for patients
who are admitted to the hospital with especially
general GI related admission DRGs.
So taking this patient population, figuring out how
we can
improve their throughput, get them the essential care
that they need and do that faster while
still maintaining quality and high standing,
and then developing
methods to translate that to the outpatient setting
as well.
Gotcha. So it's certainly a exciting time to
be in health care, but no doubt, particularly
in the GI space when you think about,
the advent of technology and on where things
are going in the outpatient arena. But I
guess when you think about
health care or the GI space, is there
any 2 or 3 trends that you're particularly
focused on and thinking about for the future
and why?
Yes. Absolutely. The first and foremost trend that
is really on our minds right now is
colon cancer screening.
And this has been a a really nice
development actually both in through social media, popular
culture, and with the newish or newer guidelines
advocating for colon cancer screening starting at age
45 as opposed to age 50. So in
terms of the technical aspects of this and
the system level aspects of this, there are
now more ways to for people to have
access to colon cancer screening, whether that is
via stool testing in the at home, in
their own setting. There are now FDA approval
coming in for
serum blood work based colon cancer screening assays.
And, of course, the the gold standard, which
we consider so far being screening colonoscopy.
And within screening colonoscopy,
the world of artificial intelligence is now really
playing a big role in polyp detection
and increasing adenoma detection rates to provide better
outcomes for patients. So now there is a
lot of work being done on the outcome
studies level to see how these new technologies
are improving our colon cancer screening rates and
our national programs and then how that can
translate to better survival and and increased prevention
for colon cancer. So that's really the main
thing that we at OU Health are also
focusing on in the outpatient setting as we
look to grow our ambulatory
endoscopy operations.
Gotcha. So AI and colon cancer screening, we've
heard a lot about this from,
great gastroenterologists
over the last couple of years or so.
Are you someone who's particularly excited about AI
in general? You want to think further afield
and outside of the g GI space?
Yes. I am. Overall, I am excited, but
it does it does come with its share
of challenges as well. So so far, artificial
intelligence has been used as a as an
adjunct diagnostic tool, and I think that that's
where it can really excel.
For example, there are
there are vendors and the medical device companies
that are really pushing AI and colon polydetection.
And some of that, I think, is a
really good thing because it could possibly lead
to better screening
and improve adenoma detection rates. However, at the
same time, it should we should exercise caution
as as the GI community in implementing these
technologies
system wide or even nationwide and and almost
even leaning on them a little bit too
much and maybe using them as a crutch
rather than continuing to develop educational pathways to
improve colonoscopy techniques
and improve the
the manual both art and science of colonoscopy.
So it is kind of a a two
sided coin there that we have to be
mindful of in general.
Yeah. Yeah. Certainly interesting to see where we
where we will be in 2, 3, 4,
5 years down the line with the just
the rapid pace of AI in all in
all sorts of industries, particularly in the health
care space.
Doctor Kaushal, I'd love to hear, outside of
GI, is there any other trend that you're
particularly focused on in health care?
Yes. Absolutely. I think the reimbursement
is it's kind of always at the forefront
of health care around this time of year.
But in terms of growth and development,
the financial piece of that is really important.
So reimbursement is not only from the physician
perspective, but from the institutional
and ASC perspective,
are going to be really important to to
keep an eye on over the next 12
months. One of the things that really ties
into that is actually interest rates and what
the what the national financial
markets are looking like. And a lot of
times, we think of interest rates and we
think of home buying and consumer price index
and a lot of these economic trends. But
in addition, health care is really no exception.
And the borrowing power of institutions and the
ability for institutions to conduct business
is going to be really important to see
how much that can drive growth and development,
especially a new service line rather than sort
of trying to optimize existing service lines. So
to see to monitor what the Fed does
with interest rate is gonna be really important
over the next 12 months.
You know, one other trend that we're following
is not just in GI, but other specialties
like orthopedics and whatnot, for example, is just
the rise in consolidation and no doubt a
rise in competition as well.
Could you,
give us a little bit of insight into
the market in which you operate? Is what
does consolidation
competition look like in the GI space there
in Oklahoma?
In Oklahoma City, the there is definitely a
a large
presence of both private gastroenterology
groups, like large scale private groups,
and the academic medical center, which is the
side that I'm on. At the end of
the day, Oklahoma City itself is a it's
kind of a
smaller, larger city. So a lot of the
physicians
know each other personally. Many of physicians who
are in private practice are part of large
scale GI groups actually trained at OU.
So it is definitely, in my experience, a
generally
teamwork friendly environment.
We do have patients who get their care
at private GI offices and then come to
OU for their subspecialty care and vice versa.
Sometimes patients identify
1 or 2 providers in the community that
patients may be really comfortable with and then
other things they get at o u. Thankfully,
we're all connected in in our information
our our IT based system, so we are
able to share health information
securely and and openly.
But overall in the general landscape across the
US, I think you're right in saying that
the competition has increased significantly
not only for recruiting gastroenterology
physicians
but also competing for patient business. And this
is where we see large scale consolidation efforts
with health systems even
buying out other health systems or hospitals. Like,
Tenant Health, for example, on the West Coast
has been really active in hospital transactions over
the past few months.
And also there is a big presence of
private equity within the GI space with large
scale GI groups like GI Alliance or One
GI, for example.
There all of a sudden these GI groups
have access to private equity based capital, which
can then drive growth and development. Now I
think the key in all of this is
that patient care always has to come first.
So even though gastroenterology
on a national landscape is very much about
a business issue and business development,
I think it it should also be about
patient care first and foremost. And if we
are to consolidate, then how do we do
that in a manner that provides the best
quality and and safety for our patients in
addition to business growth and development?
Yeah. Yeah. Such an important point when it
comes to just really putting the patient first.
And you'd like to your point as well,
we're seeing consolidation on the independent private side
and then also on the health system side.
Like you alluded, the the Tenet transaction, I
believe your previous health system, Advent, has just
acquired 2 hospitals from Tenet in California not
too long ago.
Certainly interested to keep an eye on over
the next coming quarters that we see, really
just a bill in consolidation, it seems like,
after a bit of a lull during the
pandemic.
Doctor Kosho, it's fascinating to to talk to
you so far. I guess, last question before
I let you go. You've you've kinda shed
light on a lot of things so far
in terms of some of the trends you're
talking about in GI reimbursement,
AI, and colon cancer screening.
Is there one thing that you're particularly excited
about when you think about the future of
health care?
You know, I'm most excited about the people
the people aspect because
as you sort of alluded to with with
the pandemic, there were so many changes and
on a massive scale,
especially in health care, but in other industries
as well. And as far as GI care
goes,
like many other companies in many other industries,
this whole
revolution of virtual care has now
it's come to the forefront and it's now
here to stay. And there are so many
brilliant people who
I never knew of or never got the
chance to work with pre pandemic or even
within the past few years that I'm now
learning about and all these new technologies and
devices and innovative companies that have now developed
in the post pandemic era. I'm really excited
about what kind of leaders we are seeing
emerging on on the health care and the
GI landscape.
I'm fortunate to work with several
really brilliant people at my own institution, but
even when I travel to national conferences and
engage with national societies,
it seems like there are so many really
smart people who are devoted to innovation
and
preserving the the sanctity of doing what's best
for the patient, but also
doing so in a way that is really
at the forefront of new technologies,
new growth opportunities, and business development.
And it really that is really what drives
me every day is to work with such
brilliant people on both a local and national
scale in order to problem solve and usher
in this this brand new era of health
care that we have here.
I think that's a perfect little nugget to
end our podcast today. Doctor Kausch, a real,
real pleasure, to make your debut appearance on
the Becker's ASC podcast.
Look forward to certainly connecting with you again
down the line.
Thank you so much. I really enjoyed it,
and I look forward to talking to you
soon.