1 00:00:00,320 --> 00:00:02,879 Hello. This is Francesca Matthews with the Becker's 2 00:00:02,879 --> 00:00:04,179 ASC review podcast. 3 00:00:04,639 --> 00:00:06,480 I'm thrilled to be joined today by doctor 4 00:00:06,480 --> 00:00:09,679 Anthony Tortellani, a cardiac and thoracic surgeon and 5 00:00:09,679 --> 00:00:10,740 professor emeritus, 6 00:00:11,439 --> 00:00:12,900 in in clinical cardiothoracic 7 00:00:13,279 --> 00:00:13,779 surgery 8 00:00:14,160 --> 00:00:15,765 at Weill Cornell Medical 9 00:00:16,245 --> 00:00:18,245 College. Doctor Tortellani, thank you so much for 10 00:00:18,245 --> 00:00:19,144 being here today. 11 00:00:19,925 --> 00:00:23,304 My pleasure. Hopefully, it will be assisting you. 12 00:00:24,804 --> 00:00:26,565 Well, great. To start us off, could you 13 00:00:26,565 --> 00:00:28,484 please introduce yourself and tell us a little 14 00:00:28,484 --> 00:00:29,545 bit about your background? 15 00:00:31,109 --> 00:00:31,769 I am 16 00:00:32,710 --> 00:00:34,329 Emeritus professor. I 17 00:00:35,509 --> 00:00:36,009 spent 18 00:00:36,869 --> 00:00:39,429 almost all my career either as chief of 19 00:00:39,429 --> 00:00:42,409 cardiothoracic surgery or as chairman at different hospitals, 20 00:00:43,864 --> 00:00:47,324 almost all within the Cornell network. And 21 00:00:48,184 --> 00:00:50,125 I was involved with building 22 00:00:50,905 --> 00:00:54,504 the first ambulatory surgery center at Northwell. I 23 00:00:54,504 --> 00:00:55,964 was involved with 24 00:00:56,700 --> 00:00:57,200 building 25 00:00:58,059 --> 00:01:00,219 the ambulatory when we converted a floor at 26 00:01:00,219 --> 00:01:03,359 New York Presbyterian Hospital to ambulatory surgery 27 00:01:03,979 --> 00:01:05,920 and in the building of 28 00:01:06,700 --> 00:01:07,359 the ambulatory 29 00:01:07,819 --> 00:01:10,079 surgery center, which included cardiology 30 00:01:10,834 --> 00:01:12,915 at Methodist Hospital, which was a hospital that 31 00:01:12,915 --> 00:01:13,974 joined our network. 32 00:01:14,834 --> 00:01:15,334 And 33 00:01:15,875 --> 00:01:18,454 ultimately, at a safety net hospital, 34 00:01:18,834 --> 00:01:19,894 I was part of 35 00:01:20,354 --> 00:01:22,295 a strategic planning that decided 36 00:01:22,674 --> 00:01:24,694 committee, which decided not to build 37 00:01:25,170 --> 00:01:28,129 a, ambulatory surgery center because they didn't have 38 00:01:28,129 --> 00:01:30,930 the funds nor the patient population to support 39 00:01:30,930 --> 00:01:32,709 it. So I have a lot of experience 40 00:01:32,769 --> 00:01:33,269 in 41 00:01:33,810 --> 00:01:36,469 developing and running of ambulatory surgery centers. 42 00:01:38,725 --> 00:01:41,225 Gotcha. So quite a a wealth of experience 43 00:01:41,365 --> 00:01:41,865 there. 44 00:01:43,365 --> 00:01:45,444 What are the top three trends that you're 45 00:01:45,444 --> 00:01:47,064 following in health care today? 46 00:01:48,564 --> 00:01:50,965 Well, I I and this was discussed in 47 00:01:50,965 --> 00:01:52,745 some detail at the annual meeting. 48 00:01:53,340 --> 00:01:56,000 The great concern about not having enough caregivers, 49 00:01:56,219 --> 00:01:57,280 primarily anesthesiologists, 50 00:01:57,979 --> 00:01:58,479 nurses, 51 00:01:59,259 --> 00:02:01,040 and nurse anesthesia, 52 00:02:02,379 --> 00:02:02,879 assistants, 53 00:02:03,739 --> 00:02:05,899 that is a real problem that's gonna get 54 00:02:05,899 --> 00:02:06,399 worse 55 00:02:06,965 --> 00:02:09,444 over the next seven or eight ten years 56 00:02:09,444 --> 00:02:09,944 unless, 57 00:02:11,284 --> 00:02:13,145 we increase the number of anesthesiologists 58 00:02:13,685 --> 00:02:14,344 we're training. 59 00:02:14,645 --> 00:02:16,425 This year, there are 1,400, 60 00:02:18,085 --> 00:02:20,885 medical students interested in going into anesthesia in 61 00:02:20,885 --> 00:02:21,544 this country, 62 00:02:22,409 --> 00:02:24,669 and we had no positions for them. 63 00:02:25,289 --> 00:02:27,930 And they expect within the next ten years, 64 00:02:27,930 --> 00:02:29,389 we're gonna be short about 65 00:02:29,930 --> 00:02:30,430 thirty 66 00:02:31,849 --> 00:02:32,349 six 67 00:02:33,129 --> 00:02:34,109 thirty six, 68 00:02:34,495 --> 00:02:35,314 I'm sorry, 69 00:02:36,094 --> 00:02:38,594 no, about 5,000 or 6,000 anesthesiologists 70 00:02:39,055 --> 00:02:40,275 across this whole country. 71 00:02:40,735 --> 00:02:43,455 So we're looking at a major problem. I 72 00:02:43,455 --> 00:02:45,375 think the important thing is much of the 73 00:02:45,375 --> 00:02:45,875 anesthesia 74 00:02:46,810 --> 00:02:50,110 that's provided in ambulatory surgery can be provided 75 00:02:50,329 --> 00:02:51,310 for by 76 00:02:51,849 --> 00:02:52,669 Nurse Nestys 77 00:02:54,250 --> 00:02:56,509 at the head of the bed with anesthesia 78 00:02:57,049 --> 00:02:57,549 anesthesiologist 79 00:02:58,009 --> 00:02:58,989 in close proximity. 80 00:02:59,615 --> 00:03:01,395 I think so that will be 81 00:03:01,694 --> 00:03:03,155 the short term solution. 82 00:03:03,935 --> 00:03:05,074 But I think that's 83 00:03:05,534 --> 00:03:07,455 a trend that we have to fix. I 84 00:03:07,455 --> 00:03:09,395 think the second trend is 85 00:03:09,694 --> 00:03:10,275 a decrease 86 00:03:11,710 --> 00:03:14,030 in profit margin at hospitals. I don't mean 87 00:03:14,030 --> 00:03:16,669 that hospitals are making money to put money 88 00:03:16,669 --> 00:03:18,449 in people's pockets. I mean 89 00:03:18,750 --> 00:03:19,250 that 90 00:03:19,870 --> 00:03:20,530 to grow 91 00:03:21,150 --> 00:03:23,490 hospitals, you need to have a profit margin 92 00:03:23,710 --> 00:03:26,050 to build buildings and develop programs. 93 00:03:26,694 --> 00:03:28,555 And what's happening today in medicine, 94 00:03:29,655 --> 00:03:30,155 with 95 00:03:30,615 --> 00:03:32,635 limitations in Medicare and Medicaid 96 00:03:33,415 --> 00:03:36,694 and the introduction of AI into medicine, which 97 00:03:36,694 --> 00:03:38,534 I'll talk about in a few minutes, is 98 00:03:38,534 --> 00:03:39,435 going to increase 99 00:03:39,814 --> 00:03:40,555 the cost. 100 00:03:41,240 --> 00:03:43,000 And I don't know how we can increase 101 00:03:43,000 --> 00:03:46,280 cost unless we increase profit margins, which at 102 00:03:46,280 --> 00:03:48,219 least in the major medical centers 103 00:03:48,599 --> 00:03:50,620 in New York is not happening. 104 00:03:51,560 --> 00:03:54,139 So that's a trend I'm concerned about. 105 00:03:55,504 --> 00:03:57,284 And the third trend is 106 00:03:57,824 --> 00:03:58,485 the invasion 107 00:03:59,104 --> 00:04:00,245 of for profit 108 00:04:01,745 --> 00:04:02,245 organizations 109 00:04:04,705 --> 00:04:05,525 into medicine, 110 00:04:06,064 --> 00:04:06,884 whose primary 111 00:04:07,919 --> 00:04:10,159 concern is not patient care, but its primary 112 00:04:10,159 --> 00:04:12,259 concern is making profit for 113 00:04:12,719 --> 00:04:13,459 the equity 114 00:04:14,159 --> 00:04:14,659 holders 115 00:04:15,039 --> 00:04:16,019 in that company. 116 00:04:16,879 --> 00:04:18,419 So, I think those are the 117 00:04:18,800 --> 00:04:20,419 overall major concerns 118 00:04:20,720 --> 00:04:23,295 that I have with the three trends I 119 00:04:23,295 --> 00:04:23,795 see 120 00:04:24,495 --> 00:04:28,095 about medicine, but not actually within the practice 121 00:04:28,095 --> 00:04:30,335 of it. Those are the outside concerns that 122 00:04:30,335 --> 00:04:30,995 I see. 123 00:04:32,574 --> 00:04:36,194 Mhmm. Absolutely. And that all definitely resonates with, 124 00:04:36,769 --> 00:04:38,129 you know, the folks I speak to over 125 00:04:38,129 --> 00:04:39,569 here at Becker's every day and just some 126 00:04:39,569 --> 00:04:41,350 of the conversations that I've been having. 127 00:04:42,209 --> 00:04:44,129 What are you most excited about right now 128 00:04:44,129 --> 00:04:46,050 in health care overall or in the ASC 129 00:04:46,050 --> 00:04:48,389 space specifically either? Well, I think 130 00:04:49,535 --> 00:04:51,394 if you keep in mind my concerns, 131 00:04:51,694 --> 00:04:53,794 I think what's really exciting is 132 00:04:54,095 --> 00:04:54,834 the involvement 133 00:04:55,294 --> 00:04:57,555 in artificial intelligence in medicine. 134 00:04:58,095 --> 00:04:59,555 And I think it can be 135 00:04:59,935 --> 00:05:00,834 very important 136 00:05:01,375 --> 00:05:04,199 and I think it's obvious that it's going 137 00:05:04,199 --> 00:05:04,860 to be important 138 00:05:05,279 --> 00:05:05,779 in 139 00:05:06,199 --> 00:05:06,699 the 140 00:05:07,120 --> 00:05:07,620 administrative, 141 00:05:08,040 --> 00:05:09,180 the supply chain 142 00:05:13,000 --> 00:05:14,060 and the administrative 143 00:05:16,774 --> 00:05:18,475 hierarchy and organization within 144 00:05:19,654 --> 00:05:20,154 medicine. 145 00:05:20,774 --> 00:05:23,415 But I think what's exciting to me is 146 00:05:23,415 --> 00:05:25,574 not the business side of it, but the 147 00:05:25,574 --> 00:05:26,794 tremendous, tremendous 148 00:05:28,134 --> 00:05:31,194 influence they're having in basic science research. 149 00:05:32,269 --> 00:05:33,089 It's unbelievably 150 00:05:33,470 --> 00:05:33,970 important, 151 00:05:34,430 --> 00:05:37,389 their role in basic science research at the 152 00:05:37,389 --> 00:05:38,850 cellular and subcellular 153 00:05:39,310 --> 00:05:39,810 levels, 154 00:05:40,830 --> 00:05:42,850 which is being directly applied 155 00:05:43,949 --> 00:05:44,449 into 156 00:05:44,990 --> 00:05:46,129 clinical care. 157 00:05:47,435 --> 00:05:49,514 They're import in there, and they can do 158 00:05:49,514 --> 00:05:51,214 help us do massive research, 159 00:05:52,235 --> 00:05:54,314 and it's ongoing at the present time. I'm 160 00:05:54,314 --> 00:05:56,634 not talking about six months or ten years 161 00:05:56,634 --> 00:05:57,774 ago. I'm talking about 162 00:05:58,074 --> 00:06:00,314 now, today, yesterday. If you look at the 163 00:06:00,314 --> 00:06:01,134 Journal of 164 00:06:01,595 --> 00:06:02,095 Nature, 165 00:06:02,810 --> 00:06:05,129 which is the foremost journal in the world, 166 00:06:05,129 --> 00:06:06,270 or Nature Medicine, 167 00:06:07,850 --> 00:06:10,330 what AI is doing to help us do 168 00:06:10,330 --> 00:06:11,470 research is unbelievable. 169 00:06:12,250 --> 00:06:14,029 But I think it also 170 00:06:14,569 --> 00:06:16,029 is really important 171 00:06:16,795 --> 00:06:18,975 in the application in clinical medicine. 172 00:06:20,714 --> 00:06:23,295 And there, it's helping us it's helping radiologists 173 00:06:24,314 --> 00:06:24,975 to read, 174 00:06:25,514 --> 00:06:27,835 X rays and PET scans and MRIs more 175 00:06:27,835 --> 00:06:28,335 accurately 176 00:06:29,589 --> 00:06:30,970 and at the 177 00:06:31,430 --> 00:06:33,750 cellular level, which we've never been able to 178 00:06:33,750 --> 00:06:34,410 do before. 179 00:06:34,949 --> 00:06:38,009 So I think that's happening, which makes 180 00:06:38,550 --> 00:06:40,649 us able to diagnose the diseases 181 00:06:40,949 --> 00:06:41,689 much earlier 182 00:06:42,985 --> 00:06:45,404 at a time when it's curative 183 00:06:45,865 --> 00:06:49,465 with minimal invasive therapy with less surgery, meaning 184 00:06:49,465 --> 00:06:51,865 more cases being done in ambulatory surgery by 185 00:06:51,865 --> 00:06:52,365 coincidence. 186 00:06:53,064 --> 00:06:54,845 So I I think 187 00:06:56,290 --> 00:06:58,949 it's been great, and it's also been assisting 188 00:06:59,090 --> 00:07:01,030 us in clinical decision making. 189 00:07:02,050 --> 00:07:04,449 So it was written recently that we're gonna 190 00:07:04,449 --> 00:07:05,509 go from generative 191 00:07:06,530 --> 00:07:08,290 care, which is what we're doing now. Somebody's 192 00:07:08,290 --> 00:07:11,250 at the bedside looking at the patient, looking 193 00:07:11,250 --> 00:07:13,345 at the x rays, looking at the blood 194 00:07:13,345 --> 00:07:14,644 work and making decisions 195 00:07:16,064 --> 00:07:17,524 to precision medicine, 196 00:07:18,064 --> 00:07:21,024 which is diagnosis made at the cellular and 197 00:07:21,024 --> 00:07:22,324 subcellular level, 198 00:07:22,865 --> 00:07:25,425 which makes it much earlier in the disease 199 00:07:25,425 --> 00:07:25,925 process, 200 00:07:26,370 --> 00:07:29,009 which increases the chances of cure, especially in 201 00:07:29,009 --> 00:07:30,870 cancer or heart disease. 202 00:07:32,290 --> 00:07:32,790 And 203 00:07:34,449 --> 00:07:34,949 finally, 204 00:07:37,970 --> 00:07:38,949 it will help 205 00:07:41,295 --> 00:07:42,274 in applying 206 00:07:43,774 --> 00:07:44,514 to a degree 207 00:07:44,894 --> 00:07:45,394 surgery 208 00:07:46,175 --> 00:07:46,675 to 209 00:07:46,975 --> 00:07:49,694 the care and decision making. So we're going 210 00:07:49,694 --> 00:07:50,995 to go from generative 211 00:07:51,375 --> 00:07:51,954 to precision 212 00:07:52,279 --> 00:07:54,520 to personal care where the care will be 213 00:07:54,520 --> 00:07:55,340 for the individual, 214 00:07:55,879 --> 00:07:58,199 not for the people who have, let's say, 215 00:07:58,199 --> 00:08:01,080 lung cancer, but for that particular individual and 216 00:08:01,080 --> 00:08:01,819 that individual's 217 00:08:02,360 --> 00:08:05,639 particular cancer problem. So I'm very excited about 218 00:08:05,639 --> 00:08:07,660 that. Really excited about it. 219 00:08:08,574 --> 00:08:10,354 Yeah. Absolutely. The advancements 220 00:08:10,735 --> 00:08:13,294 that AI is is bringing to to research 221 00:08:13,294 --> 00:08:13,794 and 222 00:08:14,095 --> 00:08:16,814 to diagnosis are incredible. I feel like I 223 00:08:16,814 --> 00:08:19,235 read a new stunning headline every day. 224 00:08:19,694 --> 00:08:21,055 Let me just add to that for a 225 00:08:21,055 --> 00:08:22,334 sec because I said it, but I did 226 00:08:22,414 --> 00:08:23,714 maybe didn't say it clearly. 227 00:08:25,019 --> 00:08:27,120 AI is allowing us to make the diagnosis 228 00:08:27,259 --> 00:08:27,919 that much 229 00:08:28,379 --> 00:08:30,959 earlier, which means we don't need to do 230 00:08:31,019 --> 00:08:33,340 so much invasive surgery. The surgery would be 231 00:08:33,340 --> 00:08:34,559 less and less invasive. 232 00:08:35,820 --> 00:08:38,059 Mhmm. Yeah. Yeah. And I know that that's 233 00:08:38,059 --> 00:08:40,544 that's you know, just there's huge implications there 234 00:08:40,544 --> 00:08:41,044 for 235 00:08:41,424 --> 00:08:44,164 the overall, like, efficiencies and cost and experience 236 00:08:44,225 --> 00:08:46,544 of of everything we know about health care. 237 00:08:46,544 --> 00:08:47,044 So, 238 00:08:48,144 --> 00:08:48,965 yeah, and 239 00:08:49,345 --> 00:08:51,424 kind of moving to a different different area 240 00:08:51,424 --> 00:08:53,825 here. But how are you thinking about growth 241 00:08:53,825 --> 00:08:55,350 over the next twelve months? 242 00:08:57,009 --> 00:08:59,590 I think that with the growth in cardiology 243 00:09:00,370 --> 00:09:01,029 in outpatient 244 00:09:02,529 --> 00:09:03,029 facility 245 00:09:04,450 --> 00:09:06,610 is going to continue to grow. More and 246 00:09:06,610 --> 00:09:07,110 more 247 00:09:08,955 --> 00:09:09,455 cardiac 248 00:09:10,394 --> 00:09:13,035 invasive cardiac therapeutics will not be done by 249 00:09:13,035 --> 00:09:15,215 surgeons, but would be done by cardiologists 250 00:09:15,915 --> 00:09:16,735 or cardiologists 251 00:09:17,115 --> 00:09:17,855 with surgeons 252 00:09:18,555 --> 00:09:20,335 in an outpatient theater 253 00:09:21,410 --> 00:09:24,550 like the TAVERs, for instance, and Stenten, 254 00:09:25,170 --> 00:09:26,309 and pacemakers, 255 00:09:26,610 --> 00:09:27,110 and, 256 00:09:28,450 --> 00:09:28,950 AICDs, 257 00:09:29,490 --> 00:09:29,990 and 258 00:09:31,649 --> 00:09:32,149 diagnostic, 259 00:09:33,889 --> 00:09:36,710 insertion of diagnostic catheters, which 260 00:09:37,355 --> 00:09:39,054 will defibrillate patients 261 00:09:39,834 --> 00:09:41,615 at home. So I think, 262 00:09:43,034 --> 00:09:45,514 we will be doing we will be filling 263 00:09:45,514 --> 00:09:48,475 the ACSs more and more with all sorts 264 00:09:48,475 --> 00:09:50,014 of therapy and diagnostic 265 00:09:50,315 --> 00:09:50,815 procedures. 266 00:09:52,100 --> 00:09:54,279 I think the critical thing 267 00:09:54,899 --> 00:09:56,980 is to be able to backfill the ORs 268 00:09:56,980 --> 00:09:57,720 and hospitals 269 00:09:58,419 --> 00:09:59,799 with appropriate cases 270 00:10:00,419 --> 00:10:03,079 so they can continue to be successful 271 00:10:03,699 --> 00:10:04,919 and take care of 272 00:10:05,995 --> 00:10:07,834 a different type of patient. I think we're 273 00:10:07,834 --> 00:10:11,054 going to need less hospital beds, more chemotherapy 274 00:10:11,355 --> 00:10:13,294 is being done on the outpatient basis. 275 00:10:13,674 --> 00:10:15,274 They're not going into the hospital to get 276 00:10:15,274 --> 00:10:15,774 chemotherapy. 277 00:10:16,714 --> 00:10:18,449 And certainly in cardiology 278 00:10:18,909 --> 00:10:21,709 and pulmonary and GI, more and more of 279 00:10:21,709 --> 00:10:22,529 that's done 280 00:10:24,190 --> 00:10:27,649 in ambulatory surgery or ambulatory catheter or pulmonary 281 00:10:27,709 --> 00:10:28,769 labs. So 282 00:10:29,149 --> 00:10:32,610 it's truly a time of great change. And 283 00:10:32,829 --> 00:10:33,409 I think 284 00:10:33,924 --> 00:10:35,304 the key thing is being 285 00:10:35,605 --> 00:10:36,504 for the large 286 00:10:36,965 --> 00:10:39,545 academic medical centers and the hospital 287 00:10:40,004 --> 00:10:42,004 systems, which is at least in New York, 288 00:10:42,004 --> 00:10:45,365 it's growing. Those programs are growing tremendously. The 289 00:10:45,365 --> 00:10:46,904 independent hospitals disappearing 290 00:10:47,524 --> 00:10:48,024 except 291 00:10:49,090 --> 00:10:50,389 in areas of poverty 292 00:10:50,769 --> 00:10:51,750 and the underserved, 293 00:10:52,210 --> 00:10:52,710 where 294 00:10:53,330 --> 00:10:56,210 their care is not at the same level 295 00:10:56,210 --> 00:10:58,129 as in the big systems. The big systems, 296 00:10:58,129 --> 00:10:59,350 they're not going into 297 00:11:00,610 --> 00:11:03,269 the poor communities and taking over those small 298 00:11:04,654 --> 00:11:06,834 inadequate hospitals. That's a real problem. 299 00:11:07,534 --> 00:11:09,455 But I think over time, they will be 300 00:11:09,455 --> 00:11:12,174 incorporated into the big systems. It's not today 301 00:11:12,174 --> 00:11:14,834 or tomorrow. And I think to do that, 302 00:11:14,975 --> 00:11:17,154 you need physicians that have to be dedicated 303 00:11:18,340 --> 00:11:20,500 to those systems. They have to be part 304 00:11:20,500 --> 00:11:21,639 of the large systems, 305 00:11:22,500 --> 00:11:24,820 either as employees, which has been that way 306 00:11:24,820 --> 00:11:28,200 or even maybe I'm reading about whether being 307 00:11:28,659 --> 00:11:31,559 partners, the partners with large health systems 308 00:11:31,904 --> 00:11:32,805 and ownership 309 00:11:34,625 --> 00:11:37,264 of ambulatory surgery centers. And I think that's 310 00:11:37,264 --> 00:11:38,725 another way of doing it. 311 00:11:39,264 --> 00:11:41,185 But I think all we're in terms of 312 00:11:41,185 --> 00:11:42,805 tremendous change in medicine. 313 00:11:43,185 --> 00:11:45,605 And my biggest concern is what I hear, 314 00:11:45,769 --> 00:11:48,029 The major, major successful 315 00:11:49,850 --> 00:11:52,429 hospital systems in the Greater New York area, 316 00:11:52,970 --> 00:11:55,049 some of them are expanding into Connecticut and 317 00:11:55,049 --> 00:11:56,990 in Upstate New York, but 318 00:11:57,370 --> 00:12:00,009 but I also see that their profit margin 319 00:12:00,009 --> 00:12:01,625 is being really reduced, 320 00:12:02,804 --> 00:12:05,225 and that's a real concern to me because 321 00:12:05,445 --> 00:12:07,384 they take their profit and build, 322 00:12:08,245 --> 00:12:09,845 they don't put it in their pocket. They 323 00:12:09,845 --> 00:12:12,985 build inventory care centers and they build cancer 324 00:12:14,004 --> 00:12:16,529 perfusion centers and things like that. So I 325 00:12:16,610 --> 00:12:18,629 think they're doing the right thing. But 326 00:12:19,250 --> 00:12:20,389 how to do it 327 00:12:21,889 --> 00:12:23,430 is going to take a lot of cooperation 328 00:12:24,050 --> 00:12:24,870 and I think 329 00:12:26,050 --> 00:12:27,730 the without getting too much into this, I 330 00:12:27,730 --> 00:12:29,830 think the strategic planners 331 00:12:30,654 --> 00:12:33,154 and the people who carry out the tactical, 332 00:12:34,254 --> 00:12:34,754 planners, 333 00:12:36,414 --> 00:12:38,835 strategic and tactical planners have to come together 334 00:12:39,134 --> 00:12:41,214 and be unified, not that they do the 335 00:12:41,214 --> 00:12:43,315 same job, but they have to be coordinated. 336 00:12:45,070 --> 00:12:47,709 Mhmm. Absolutely. Everything you said, especially about the 337 00:12:47,709 --> 00:12:49,870 new kind of cardiovascular codes that are being 338 00:12:49,870 --> 00:12:51,649 approved for the ASC setting is, 339 00:12:52,110 --> 00:12:54,190 you know, definitely kind of huge buzz in 340 00:12:54,190 --> 00:12:55,549 the industry right now. So I think a 341 00:12:55,549 --> 00:12:57,070 lot of people are thinking about growth in 342 00:12:57,070 --> 00:12:58,610 a similar way that you are. 343 00:12:59,634 --> 00:13:01,394 Is there anything that I haven't asked you 344 00:13:01,394 --> 00:13:02,995 about that you feel like is important in 345 00:13:02,995 --> 00:13:03,654 this conversation? 346 00:13:04,034 --> 00:13:04,534 The 347 00:13:04,995 --> 00:13:07,575 only thing that I would say is that 348 00:13:08,434 --> 00:13:09,954 if you're in a world to mute all 349 00:13:09,954 --> 00:13:11,495 the things we just talked about, 350 00:13:12,100 --> 00:13:13,960 does not very much reach 351 00:13:14,419 --> 00:13:15,080 the people, 352 00:13:15,940 --> 00:13:17,639 our patients in rural communities. 353 00:13:19,460 --> 00:13:22,019 And 50% of the rural counties in this 354 00:13:22,019 --> 00:13:22,519 country 355 00:13:22,899 --> 00:13:24,039 don't have a cardiologist. 356 00:13:24,965 --> 00:13:27,125 And to get to a cardiologist takes forty 357 00:13:27,125 --> 00:13:29,945 five to fifty minutes of a car ride. 358 00:13:30,725 --> 00:13:31,225 So 359 00:13:31,605 --> 00:13:33,205 it's hard for those people to get care. 360 00:13:33,205 --> 00:13:35,785 And certainly, having worked in 361 00:13:36,165 --> 00:13:38,345 the inner city and in boroughs as well, 362 00:13:38,950 --> 00:13:39,529 I I 363 00:13:39,830 --> 00:13:42,629 see that the level of care of those 364 00:13:42,629 --> 00:13:44,330 patients is not the same 365 00:13:45,350 --> 00:13:46,789 as the level of care in the major 366 00:13:46,789 --> 00:13:49,990 medical center, but not even close. And for 367 00:13:49,990 --> 00:13:52,070 obvious reasons, I I don't I don't blame 368 00:13:52,070 --> 00:13:55,024 the caregivers there. I it's just that that 369 00:13:55,485 --> 00:13:56,225 they can't 370 00:13:57,965 --> 00:13:59,825 they don't have any profit margin. 371 00:14:00,205 --> 00:14:03,805 They lose millions and millions and $50,000,000 $100,000,000 372 00:14:03,805 --> 00:14:05,425 a year taking care of the indigent 373 00:14:08,125 --> 00:14:10,225 with funds that come from the States. 374 00:14:10,740 --> 00:14:13,139 So it's very hard to get those people 375 00:14:13,139 --> 00:14:15,379 the kind of care that other people get. 376 00:14:15,379 --> 00:14:16,519 It it's not equal. 377 00:14:17,700 --> 00:14:19,700 Definitely. No. And it's something I think about 378 00:14:19,700 --> 00:14:21,139 a lot as well, having come from more 379 00:14:21,139 --> 00:14:23,240 of a public health reporting background myself, 380 00:14:23,860 --> 00:14:25,634 and just we talk about the, you know, 381 00:14:25,634 --> 00:14:27,955 these advancements. I know that, you know, the 382 00:14:27,955 --> 00:14:29,714 intersection of what we were talking about earlier, 383 00:14:29,714 --> 00:14:31,235 AI and cardiology. There's, 384 00:14:32,115 --> 00:14:34,455 you know, tons of advancements as far as 385 00:14:34,754 --> 00:14:36,355 the the level of care that can be 386 00:14:36,355 --> 00:14:39,470 provided in that field and what's possible now 387 00:14:39,470 --> 00:14:41,789 with the emerging technology. And it's it's pretty 388 00:14:41,789 --> 00:14:43,309 stark to read about some of those things 389 00:14:43,309 --> 00:14:44,589 and to also read about, you know, the 390 00:14:44,589 --> 00:14:47,149 cases that you're describing of, you know, counties 391 00:14:47,149 --> 00:14:49,709 where there's no cardiovascular care whatsoever. So there's 392 00:14:49,709 --> 00:14:51,914 definitely some major gaps to close within within 393 00:14:51,914 --> 00:14:54,394 the space. But, you know, Amit, I I 394 00:14:54,394 --> 00:14:56,394 don't mean to be pessimistic because I look 395 00:14:56,394 --> 00:14:58,955 at the advances and I say, my god, 396 00:14:58,955 --> 00:14:59,774 it's unbelievable. 397 00:15:00,634 --> 00:15:01,774 It's truly unbelievable 398 00:15:02,394 --> 00:15:05,514 what happened. I think how to coordinate it 399 00:15:05,514 --> 00:15:07,399 and do it right so everybody 400 00:15:08,259 --> 00:15:10,339 benefits by by it, that's gonna take a 401 00:15:10,339 --> 00:15:12,579 lot of thinking and planning. But we certainly 402 00:15:12,579 --> 00:15:14,820 are making advances on the scientific side of 403 00:15:14,820 --> 00:15:15,959 it without a doubt. 404 00:15:16,579 --> 00:15:19,059 Mhmm. Absolutely. And I think, you know, the 405 00:15:19,059 --> 00:15:19,799 rest is 406 00:15:20,404 --> 00:15:23,045 happening in conversations and sort of brainstorming and 407 00:15:23,045 --> 00:15:25,445 sharing ideas just like we are today. So, 408 00:15:25,845 --> 00:15:27,684 you know, on that note, that is all 409 00:15:27,684 --> 00:15:29,384 I had for you today, doctor Tortellani. 410 00:15:29,764 --> 00:15:31,384 Thank you so much for joining us. 411 00:15:31,925 --> 00:15:33,605 Okay. I hope it's helpful, and thank you 412 00:15:33,605 --> 00:15:35,909 for having me. I appreciate it. Yeah. Thank 413 00:15:35,909 --> 00:15:37,909 you. It's been a pleasure, and I look 414 00:15:37,909 --> 00:15:39,269 forward to connecting with you again in the 415 00:15:39,269 --> 00:15:39,769 future.