Hello. This is Francesca Matthews with the Becker's
ASC review podcast.
I'm thrilled to be joined today by doctor
Anthony Tortellani, a cardiac and thoracic surgeon and
professor emeritus,
in in clinical cardiothoracic
surgery
at Weill Cornell Medical
College. Doctor Tortellani, thank you so much for
being here today.
My pleasure. Hopefully, it will be assisting you.
Well, great. To start us off, could you
please introduce yourself and tell us a little
bit about your background?
I am
Emeritus professor. I
spent
almost all my career either as chief of
cardiothoracic surgery or as chairman at different hospitals,
almost all within the Cornell network. And
I was involved with building
the first ambulatory surgery center at Northwell. I
was involved with
building
the ambulatory when we converted a floor at
New York Presbyterian Hospital to ambulatory surgery
and in the building of
the ambulatory
surgery center, which included cardiology
at Methodist Hospital, which was a hospital that
joined our network.
And
ultimately, at a safety net hospital,
I was part of
a strategic planning that decided
committee, which decided not to build
a, ambulatory surgery center because they didn't have
the funds nor the patient population to support
it. So I have a lot of experience
in
developing and running of ambulatory surgery centers.
Gotcha. So quite a a wealth of experience
there.
What are the top three trends that you're
following in health care today?
Well, I I and this was discussed in
some detail at the annual meeting.
The great concern about not having enough caregivers,
primarily anesthesiologists,
nurses,
and nurse anesthesia,
assistants,
that is a real problem that's gonna get
worse
over the next seven or eight ten years
unless,
we increase the number of anesthesiologists
we're training.
This year, there are 1,400,
medical students interested in going into anesthesia in
this country,
and we had no positions for them.
And they expect within the next ten years,
we're gonna be short about
thirty
six
thirty six,
I'm sorry,
no, about 5,000 or 6,000 anesthesiologists
across this whole country.
So we're looking at a major problem. I
think the important thing is much of the
anesthesia
that's provided in ambulatory surgery can be provided
for by
Nurse Nestys
at the head of the bed with anesthesia
anesthesiologist
in close proximity.
I think so that will be
the short term solution.
But I think that's
a trend that we have to fix. I
think the second trend is
a decrease
in profit margin at hospitals. I don't mean
that hospitals are making money to put money
in people's pockets. I mean
that
to grow
hospitals, you need to have a profit margin
to build buildings and develop programs.
And what's happening today in medicine,
with
limitations in Medicare and Medicaid
and the introduction of AI into medicine, which
I'll talk about in a few minutes, is
going to increase
the cost.
And I don't know how we can increase
cost unless we increase profit margins, which at
least in the major medical centers
in New York is not happening.
So that's a trend I'm concerned about.
And the third trend is
the invasion
of for profit
organizations
into medicine,
whose primary
concern is not patient care, but its primary
concern is making profit for
the equity
holders
in that company.
So, I think those are the
overall major concerns
that I have with the three trends I
see
about medicine, but not actually within the practice
of it. Those are the outside concerns that
I see.
Mhmm. Absolutely. And that all definitely resonates with,
you know, the folks I speak to over
here at Becker's every day and just some
of the conversations that I've been having.
What are you most excited about right now
in health care overall or in the ASC
space specifically either? Well, I think
if you keep in mind my concerns,
I think what's really exciting is
the involvement
in artificial intelligence in medicine.
And I think it can be
very important
and I think it's obvious that it's going
to be important
in
the
administrative,
the supply chain
and the administrative
hierarchy and organization within
medicine.
But I think what's exciting to me is
not the business side of it, but the
tremendous, tremendous
influence they're having in basic science research.
It's unbelievably
important,
their role in basic science research at the
cellular and subcellular
levels,
which is being directly applied
into
clinical care.
They're import in there, and they can do
help us do massive research,
and it's ongoing at the present time. I'm
not talking about six months or ten years
ago. I'm talking about
now, today, yesterday. If you look at the
Journal of
Nature,
which is the foremost journal in the world,
or Nature Medicine,
what AI is doing to help us do
research is unbelievable.
But I think it also
is really important
in the application in clinical medicine.
And there, it's helping us it's helping radiologists
to read,
X rays and PET scans and MRIs more
accurately
and at the
cellular level, which we've never been able to
do before.
So I think that's happening, which makes
us able to diagnose the diseases
much earlier
at a time when it's curative
with minimal invasive therapy with less surgery, meaning
more cases being done in ambulatory surgery by
coincidence.
So I I think
it's been great, and it's also been assisting
us in clinical decision making.
So it was written recently that we're gonna
go from generative
care, which is what we're doing now. Somebody's
at the bedside looking at the patient, looking
at the x rays, looking at the blood
work and making decisions
to precision medicine,
which is diagnosis made at the cellular and
subcellular level,
which makes it much earlier in the disease
process,
which increases the chances of cure, especially in
cancer or heart disease.
And
finally,
it will help
in applying
to a degree
surgery
to
the care and decision making. So we're going
to go from generative
to precision
to personal care where the care will be
for the individual,
not for the people who have, let's say,
lung cancer, but for that particular individual and
that individual's
particular cancer problem. So I'm very excited about
that. Really excited about it.
Yeah. Absolutely. The advancements
that AI is is bringing to to research
and
to diagnosis are incredible. I feel like I
read a new stunning headline every day.
Let me just add to that for a
sec because I said it, but I did
maybe didn't say it clearly.
AI is allowing us to make the diagnosis
that much
earlier, which means we don't need to do
so much invasive surgery. The surgery would be
less and less invasive.
Mhmm. Yeah. Yeah. And I know that that's
that's you know, just there's huge implications there
for
the overall, like, efficiencies and cost and experience
of of everything we know about health care.
So,
yeah, and
kind of moving to a different different area
here. But how are you thinking about growth
over the next twelve months?
I think that with the growth in cardiology
in outpatient
facility
is going to continue to grow. More and
more
cardiac
invasive cardiac therapeutics will not be done by
surgeons, but would be done by cardiologists
or cardiologists
with surgeons
in an outpatient theater
like the TAVERs, for instance, and Stenten,
and pacemakers,
and,
AICDs,
and
diagnostic,
insertion of diagnostic catheters, which
will defibrillate patients
at home. So I think,
we will be doing we will be filling
the ACSs more and more with all sorts
of therapy and diagnostic
procedures.
I think the critical thing
is to be able to backfill the ORs
and hospitals
with appropriate cases
so they can continue to be successful
and take care of
a different type of patient. I think we're
going to need less hospital beds, more chemotherapy
is being done on the outpatient basis.
They're not going into the hospital to get
chemotherapy.
And certainly in cardiology
and pulmonary and GI, more and more of
that's done
in ambulatory surgery or ambulatory catheter or pulmonary
labs. So
it's truly a time of great change. And
I think
the key thing is being
for the large
academic medical centers and the hospital
systems, which is at least in New York,
it's growing. Those programs are growing tremendously. The
independent hospitals disappearing
except
in areas of poverty
and the underserved,
where
their care is not at the same level
as in the big systems. The big systems,
they're not going into
the poor communities and taking over those small
inadequate hospitals. That's a real problem.
But I think over time, they will be
incorporated into the big systems. It's not today
or tomorrow. And I think to do that,
you need physicians that have to be dedicated
to those systems. They have to be part
of the large systems,
either as employees, which has been that way
or even maybe I'm reading about whether being
partners, the partners with large health systems
and ownership
of ambulatory surgery centers. And I think that's
another way of doing it.
But I think all we're in terms of
tremendous change in medicine.
And my biggest concern is what I hear,
The major, major successful
hospital systems in the Greater New York area,
some of them are expanding into Connecticut and
in Upstate New York, but
but I also see that their profit margin
is being really reduced,
and that's a real concern to me because
they take their profit and build,
they don't put it in their pocket. They
build inventory care centers and they build cancer
perfusion centers and things like that. So I
think they're doing the right thing. But
how to do it
is going to take a lot of cooperation
and I think
the without getting too much into this, I
think the strategic planners
and the people who carry out the tactical,
planners,
strategic and tactical planners have to come together
and be unified, not that they do the
same job, but they have to be coordinated.
Mhmm. Absolutely. Everything you said, especially about the
new kind of cardiovascular codes that are being
approved for the ASC setting is,
you know, definitely kind of huge buzz in
the industry right now. So I think a
lot of people are thinking about growth in
a similar way that you are.
Is there anything that I haven't asked you
about that you feel like is important in
this conversation?
The
only thing that I would say is that
if you're in a world to mute all
the things we just talked about,
does not very much reach
the people,
our patients in rural communities.
And 50% of the rural counties in this
country
don't have a cardiologist.
And to get to a cardiologist takes forty
five to fifty minutes of a car ride.
So
it's hard for those people to get care.
And certainly, having worked in
the inner city and in boroughs as well,
I I
see that the level of care of those
patients is not the same
as the level of care in the major
medical center, but not even close. And for
obvious reasons, I I don't I don't blame
the caregivers there. I it's just that that
they can't
they don't have any profit margin.
They lose millions and millions and $50,000,000 $100,000,000
a year taking care of the indigent
with funds that come from the States.
So it's very hard to get those people
the kind of care that other people get.
It it's not equal.
Definitely. No. And it's something I think about
a lot as well, having come from more
of a public health reporting background myself,
and just we talk about the, you know,
these advancements. I know that, you know, the
intersection of what we were talking about earlier,
AI and cardiology. There's,
you know, tons of advancements as far as
the the level of care that can be
provided in that field and what's possible now
with the emerging technology. And it's it's pretty
stark to read about some of those things
and to also read about, you know, the
cases that you're describing of, you know, counties
where there's no cardiovascular care whatsoever. So there's
definitely some major gaps to close within within
the space. But, you know, Amit, I I
don't mean to be pessimistic because I look
at the advances and I say, my god,
it's unbelievable.
It's truly unbelievable
what happened. I think how to coordinate it
and do it right so everybody
benefits by by it, that's gonna take a
lot of thinking and planning. But we certainly
are making advances on the scientific side of
it without a doubt.
Mhmm. Absolutely. And I think, you know, the
rest is
happening in conversations and sort of brainstorming and
sharing ideas just like we are today. So,
you know, on that note, that is all
I had for you today, doctor Tortellani.
Thank you so much for joining us.
Okay. I hope it's helpful, and thank you
for having me. I appreciate it. Yeah. Thank
you. It's been a pleasure, and I look
forward to connecting with you again in the
future.