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At athenahealth,

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we know your ambulatory practice wants healthier, a

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teams to focus on what matters

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when clinicians need it most. That means fewer

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clicks, more time for patients, and stronger bottom

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See how simpler is healthier@athenahealth.com.

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This is Laura Dirda with the Becker's Healthcare

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Podcast. I'm thrilled today to be joined by

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doctor Mario Gussol, director of interventional cardiology fellowships,

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director of transcatheter valve therapies, and interventional cardiologist

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at Allina Health Minneapolis Heart Institute. Doctor Kosil,

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it's a pleasure to have you on the

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podcast today.

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Thank you for having us, Laura. My pleasure.

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Absolutely.

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Now I'm excited to have you on because

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it'll be fun to hear just some of

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the great things you're doing at Allina and

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really how you're thinking about the future. But

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before we dive in, can you introduce yourself

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and tell us just a little bit about

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your background?

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Yeah.

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Happy to. I'm an, interventional cardiologist here at

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the Minneapolis Heart Institute, Allina Health.

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And as you probably know, some of us

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specialize a little bit in, structural heart disease.

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So most of my practice, I would say,

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sixty, seventy percent is probably structural heart disease,

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which,

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includes the,

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valve interventions like, say, MitraClip,

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Pascal,

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TAVR

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devices, tricuspid replacement devices, pulmonary replacement devices,

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watchmen,

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these kind of interventions.

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I'm also, a director of the,

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fellowship program, so I'm always,

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at the pulse of what, the younger folks,

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are feeling right now and in which direction

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they wanna go when they apply to our

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fellowships, interventional and structural,

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and, yeah, have some administrative roles, here in

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our practice too.

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My my history is that I actually trained

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in Germany first,

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and then I did some training in United

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States at the Mayo Clinic,

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and this is my, second, private practice or

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academically oriented private practice appointment.

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That's fantastic to hear. You know? And interesting

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to

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understand that dynamic, what's leading the fellowship and

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having your,

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figure on the pulse of what some of

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the up and coming generation and newer training

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physicians are thinking about. What have you noticed

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over the

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last, couple years? Is there any trends or

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or things that,

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have come up that are different than they

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were in the past?

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Yeah. I I think that,

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we in our training programs,

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we we certainly have

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seen an impact of, for example, the, COVID

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pandemic.

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There was some impact on training.

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I would say we have observed a little

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bit less,

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independence

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of,

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trainees coming out of that,

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you know, two, three, four years

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than than we saw before.

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There is, I think,

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the

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current trainees often try to cover multiple

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subspecialties

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during their fellowships

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and may, you know, be a little bit

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of undecided or unfocused

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on, you know, their training trajectory,

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where, you know, years ago, we have seen

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folks, you know, clearly

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voicing the interest in structural heart disease. We

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can sometimes now see folks saying, like, oh,

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I'm also interested in advanced heart failure or

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always interested in advanced

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coronary procedures.

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And I always find that very difficult to

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accomplish.

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And I think due to the

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job market being a little bit more uncertain

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than it was years ago,

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my feeling is that some,

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fellows or trainees are trying to cover

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as many subspecialties

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as possible to actually, you know, have a

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maybe competitive advantage over other applicants

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where I think most of us still feel

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like if you focus and follow one passion,

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you probably have a better success.

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That makes a lot of sense. You know,

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it's just fascinating to hear about those trends.

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And speaking of trends,

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what are some of the top three or

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so that you're following in health care right

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now? What's top of mind for you and

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and some of the big priorities you're thinking

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about heading into the next year?

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Yeah. I think one of the,

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exciting

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things or trends for me is certainly in

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for many people,

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artificial intelligence and how that is integrated in

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our daily practice. I mean, there's so many

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exciting,

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studies or exciting projects out there in our

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field. For example, how much information can you

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get from an EKG alone,

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in order to make even therapeutic decisions on

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patients or finding

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undiscovered

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disease processes.

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But I also find

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artificial

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intelligence simply in our

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daily operational efficiencies very interesting. And that's I

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think I'm even more interested in that.

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What I mean by that is, for example,

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we integrated,

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about a year ago, Ambient AI into our,

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clinic visits.

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And I have to say that that for

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me was a game changer.

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Obviously, the notes are not maybe as personal

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as,

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they are when I dictate them personally,

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but I find the value that I,

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give to the patient by simply extending my

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visit time by sometimes five, ten, maybe even

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fifteen minutes

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is

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definitely

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compensating for maybe a note that is not

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as

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nicely written than than a personal dictation.

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The summaries are excellent.

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I can literally leave my

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patient room, and within a minute, my note

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is written. It is such an

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effective, efficient,

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tool that I now have at my hands

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at my iPhone, basically.

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Yeah. And in in addition to the ambient,

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artificial intelligence,

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I hope that further tools that are similar

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to that could

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help us in our daily practice as well

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to make, patient visits

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and all the work that comes with it

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after,

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much more efficient. So I'm I'm really excited

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to see,

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more

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integration of,

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artificial intelligence in our operational

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efficiencies. I'm excited about about that, I think,

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very much.

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Absolutely. I and, you know, as AI is

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so interesting,

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especially looking about technology,

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and and what it could potentially do. For

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you as a a physician, what are some

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of the considerations

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that you have to think about both on

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the opportunity side as well as the risk

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side when you're bringing more AI into the,

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clinical practice?

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Yeah. I think we,

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you know, I think that, we

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struggle with, efficiencies. Right? I mean, on a

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daily basis,

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for example, in our health care system, we

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still

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do a lot of manual processes when we

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try to do schedule optimization,

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for example, cath lab or the operating rooms.

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And I think that with the limitations in

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staffing, for example,

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and the increase in volumes of,

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certain procedures,

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that those kind of operational efficiencies,

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especially scheduling,

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are,

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you know, immense opportunities where I think, you

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know, artificial tensions or at least,

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you know, processes like this can can help

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us. Where manual processes are probably,

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you know, not effective enough.

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The danger, of course, is if you,

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integrate

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artificial intelligence in more,

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or gets it closer to

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patient care. Obviously, the concern is always,

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the control,

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of the artificial intelligence outcome or the analysis.

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And I understand that patients have concerns there,

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and I think that

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every health care system has to obviously,

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provide,

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safety security there if, you know, AI bots

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are inside the,

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electronic medical records,

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helping with such efficiency that we don't, you

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know, lose any,

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patient safety

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or data safety. And I think that's still

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certainly a concern,

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but I think the opportunities

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are immense because,

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overall, I think health care systems

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need help in order to,

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create the most efficient system and more most

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effective systems.

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Otherwise, we will not be able

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to cope with the patient volumes,

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appropriately.

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That makes a lot of sense.

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Fantastic to kind of think through all of

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those things. I know there'll be a lot

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of work around that, heading into the next

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couple of years or so. Are there any

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other trends that you're thinking about or following

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right now or anything that you're really excited

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about?

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Yeah. I mean, I I think,

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and I think maybe last year we talked

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about that already. I'm I'm still very much

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excited about the trend,

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towards,

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the value based care.

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And maybe some people,

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say patient first care. I think those are,

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other words being used,

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also.

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We know that there's,

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obviously

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a big payer shift towards value based care

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and maybe even towards

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capitation.

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I think

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that that are,

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in that shift, there are great opportunities,

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also

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great risks for health care systems because they

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may not have the data integrity or data

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granularity

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to, you know, compete on that level yet.

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And I think we approached that last year

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as well, but I I still think that

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in that process of really being patient focused

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and value focused,

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that there are great opportunities

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for us to

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select

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the the appropriate interventions and treatments for patients

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that create the greatest value for the patient.

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And, hopefully,

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both on the payer side and the health

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care system side,

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we see a win win situation.

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I'm still excited about that, and, working in

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in on those

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value based care systems and contracts, I think,

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for me personally, is is is an exciting

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trend still.

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Absolutely. That's amazing to hear. And, you know,

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I I love that kind of,

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analysis of how we're thinking about value and

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what it really means for the patients and

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and bringing the patient front and center into

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everything that you're doing. I think, you know,

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as we look at this evolution, how do

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you see things playing out over the next

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couple of years or so, especially given some

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of the exciting things that are happening, being

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able to collect more data and have more

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information on patients as well as, you know,

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the the real drive in health care across

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the board to have better quality as well

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as figure out how to lower cost in

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a smart and meaningful way. Do you see

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this effort accelerating, or where do you see

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things headed?

307
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Yeah. I think,

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you know, when I, for example, started my,

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masters of healthcare administration training about, you know,

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two and a half years ago, when I

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had my first

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kind of interviews,

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with folks who are in the midst of

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administration,

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I always sensed a great fear of this,

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you know,

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word value based care because people feared

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that health care systems did not have enough

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data

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to actually compete on that level. Right? They

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did they just didn't know

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what the outcomes of patients, what the cost

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that they incur actually are because sometimes that

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granularity is not there. And over the last

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two and a half years or so, I

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I sense that there's

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more excitement, maybe also, of course, of forced

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excitement, but there's more excitement of having

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that granularity

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and getting closer to,

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the goal of actually providing

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enough data to compete on, for these value

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based care contracts, but also,

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maybe even advancing it further where you say,

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well, are we are we getting to contracts

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that are more even on a on a

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capitation

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level? So I think that

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the the sense I have, and I'm obviously

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not in the midst of administration, but I'm

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very clinically focused right now still. But I

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think that I can sense within the physician

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groups, but also in the administrative group, that

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there's this a more,

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let's say, excitement, but also adaptation

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of that process. And I hope it will

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continue, and I hope and that because the

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like you just pointed out, the the most

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important thing here is, yes, we need to

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have healthy health care systems that survive. That's

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a very important aspect of it. But I

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think

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with that trend to value based care, patients

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will have a better experience because it's not

355
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the focus on fee for service. The focus

356
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should and will be

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their

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outcomes, their experience, and the selection of therapies

359
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that lead to that goal. And I think

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it will take a long time. It has

361
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been already a long time, but I can

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sense at least that more and more

363
00:13:29,274 --> 00:13:30,414
physicians and patients,

364
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follow that trend.

365
00:13:32,875 --> 00:13:34,875
That's fascinating to hear. Thank you for digging

366
00:13:34,875 --> 00:13:36,794
a little bit deeper there. Now before we

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wrap up our conversation, how are you thinking

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about growth over the next twelve months or

369
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so?

370
00:13:41,259 --> 00:13:42,059
Yeah. I think,

371
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that's a very good question. Right? And then

372
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and and maybe I, focus a little bit

373
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more here on, you know, my subspecialty

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in structural heart disease because,

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structural heart disease with the interventions that we

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00:13:54,860 --> 00:13:56,000
mentioned in the beginning

377
00:13:56,665 --> 00:13:57,404
is projected

378
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to see a lot of growth in the

379
00:13:59,785 --> 00:14:00,285
next

380
00:14:01,384 --> 00:14:03,644
two, three, four years. Many of the

381
00:14:04,345 --> 00:14:07,465
procedures that were initially in trials and studies

382
00:14:07,465 --> 00:14:08,445
are now commercializing.

383
00:14:09,610 --> 00:14:12,269
We can talk about tricuspid valve interventions

384
00:14:12,649 --> 00:14:13,149
like

385
00:14:13,529 --> 00:14:15,790
the Evoque valve. We can talk about

386
00:14:16,250 --> 00:14:17,470
many TAVR devices.

387
00:14:19,129 --> 00:14:20,269
We can talk about,

388
00:14:21,049 --> 00:14:21,549
devices

389
00:14:21,929 --> 00:14:24,644
that, lead to therapies on the mitral valve.

390
00:14:24,725 --> 00:14:27,785
We have many commercial products on a congenital

391
00:14:27,925 --> 00:14:28,904
side of things.

392
00:14:29,524 --> 00:14:30,985
All of this has now,

393
00:14:31,925 --> 00:14:32,904
developed or

394
00:14:33,524 --> 00:14:36,085
has surfaced in the commercial side of things

395
00:14:36,085 --> 00:14:37,384
is is out of trials.

396
00:14:38,299 --> 00:14:41,500
And I think we expect, of course, that,

397
00:14:41,740 --> 00:14:43,899
many and we see that that many referrals

398
00:14:43,899 --> 00:14:46,159
are now gonna come in to treat patients,

399
00:14:46,700 --> 00:14:49,419
with these major valve diseases and and most

400
00:14:49,419 --> 00:14:49,919
recent

401
00:14:50,379 --> 00:14:52,985
studies with us here, but also,

402
00:14:53,524 --> 00:14:55,225
the most recent, study,

403
00:14:55,524 --> 00:14:58,164
shown at TCT shows that valvular heart disease

404
00:14:58,164 --> 00:14:59,784
is is is

405
00:15:00,085 --> 00:15:01,384
a growing problem,

406
00:15:01,764 --> 00:15:03,065
and it's probably underestimated

407
00:15:03,605 --> 00:15:06,149
and not treated early enough. So, overall, I

408
00:15:06,149 --> 00:15:08,950
think the projections are pretty clear. Structural heart

409
00:15:08,950 --> 00:15:09,450
disease,

410
00:15:10,309 --> 00:15:13,370
glabular heart disease is will see growth.

411
00:15:13,830 --> 00:15:16,549
In that, though, we also have to make

412
00:15:16,549 --> 00:15:19,350
room. Right? We have staffing issues. We have

413
00:15:19,350 --> 00:15:22,085
only so many slots to see patients in

414
00:15:22,085 --> 00:15:24,325
our clinics. We have only so many slots

415
00:15:24,325 --> 00:15:25,865
to treat patients in our,

416
00:15:26,725 --> 00:15:27,544
cath labs.

417
00:15:27,924 --> 00:15:29,924
And for that, I think the trend of,

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00:15:30,085 --> 00:15:31,845
what we, for example, do it here at

419
00:15:31,845 --> 00:15:34,504
the Minneapolis Heart Institute is, to create,

420
00:15:35,379 --> 00:15:38,919
space and and volume shifts into our ASC.

421
00:15:39,860 --> 00:15:41,299
We have an ASC. We were one of

422
00:15:41,299 --> 00:15:43,459
the first ones who adopted it. And I

423
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think that,

424
00:15:44,899 --> 00:15:45,399
trend

425
00:15:45,779 --> 00:15:48,179
is another maybe trend that I'm excited about,

426
00:15:48,179 --> 00:15:50,995
but also to see a shift from, you

427
00:15:50,995 --> 00:15:52,134
know, lower acuity

428
00:15:52,595 --> 00:15:53,095
interventions

429
00:15:53,954 --> 00:15:56,754
from the hospital setting into the ASC and

430
00:15:56,754 --> 00:15:59,315
then providing more space and slots for the

431
00:15:59,315 --> 00:16:01,574
higher acuity interventions and more,

432
00:16:01,990 --> 00:16:04,710
you know, time consuming interventions that are usually

433
00:16:04,710 --> 00:16:05,690
structured interventions.

434
00:16:06,230 --> 00:16:09,370
I think creating that, I wanna say, operational

435
00:16:09,429 --> 00:16:09,929
efficiency,

436
00:16:11,190 --> 00:16:14,250
using the ASC efficiently to shift

437
00:16:14,924 --> 00:16:15,664
and focus

438
00:16:16,445 --> 00:16:17,664
on higher intense

439
00:16:17,965 --> 00:16:20,365
interventions here in our hospital, I think it's

440
00:16:20,365 --> 00:16:21,164
also very,

441
00:16:21,884 --> 00:16:22,945
exciting trend.

442
00:16:24,125 --> 00:16:26,924
That absolutely is fascinating to hear and especially

443
00:16:26,924 --> 00:16:27,629
looking at,

444
00:16:28,350 --> 00:16:30,269
how more things can go into the outpatient

445
00:16:30,269 --> 00:16:32,669
in the ASC. And, it's just been really

446
00:16:32,669 --> 00:16:35,330
cool to see more cardiology in that space.

447
00:16:35,789 --> 00:16:37,470
Doctor Gossel, thank you so much for joining

448
00:16:37,470 --> 00:16:39,230
us on the podcast today. This has been

449
00:16:39,230 --> 00:16:41,389
a a really fantastic conversation, and I look

450
00:16:41,389 --> 00:16:43,514
forward to connecting with you again soon. Thank

451
00:16:43,514 --> 00:16:44,575
you so much, Laura.

452
00:16:46,795 --> 00:16:49,754
At athena Health, we know your ambulatory practice

453
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