Latest / Becker’s Healthcare Podcast / N. Nicole Moayeri, MD, MS, Neurological Surgeon at Cottage Health

Transcript

N. Nicole Moayeri, MD, MS, Neurological Surgeon at Cottage Health · Becker’s Healthcare Podcast

0:02
This is where health care leadership comes together.
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Becker's sixteenth annual meeting brings more than 3,500
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hospital and health system executives and nearly 800
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speakers to Chicago April.
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This year's event includes keynote conversations with Dallas
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Cowboys legend Troy Aikman and former president George
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w Bush. For the agenda and event details,
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visit beckershospitalreview.com
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and click on the events tab in the
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upper right. We're looking forward to hosting you
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in Chicago.
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This is Carly Beam with the Becker Spine
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and Orthopedics podcast. And today, I'm thrilled to
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be joined by doctor Nicole Moeri at Cottage
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Health. Doctor Moeri, thank you so much for
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being here today.
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My pleasure. Thank you for having
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me. And so before we dive into our
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questions, could you just introduce yourself and tell
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us a bit about your background?
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Sure. Yeah. I'm a neurosurgeon
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here in Santa Barbara Cottage Health for the
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last four years.
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I'm the director of neurosciences.
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And my background really started, you know, years
1:05
ago here in California at Stanford University,
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which,
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drew me out from the East Coast. And
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I got my bachelor's in medical degrees there
1:15
and then went to Boston for my residency
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at MGH.
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And that's how I met my colleague who
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is here in Santa Barbara who,
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has been practicing here a lot longer than
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I have. After a brief time in academia,
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I decided to come back to California and
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practiced in Northern California for
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over twenty years, developing my skills and then
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got recruited here just about four years ago
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to develop their brain tumor and epilepsy program.
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That's awesome. So it sounds like you've really
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spanned the country in terms
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of your work and experience.
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Yeah. Yeah. I have enjoyed the experience on
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both coasts as they say. Yeah.
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Definitely.
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And what are you most excited about right
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now in,
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your work and in, neuroscience and neurosurgery?
2:02
Well, I I think that there are really
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some interesting,
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technologies that are evolving now as we all
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hear about AI all the time. I think
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in in my experience, I've been fortunate to
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consult for a couple companies that are using
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AI in
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both medical imaging and in,
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with natural language
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natural language processing
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to analyze radiology
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reports.
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And I think these technologies are really gonna
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hold a lot of prop, you know, promise
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for us, for our patients
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in terms of identifying
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diseases that might have been missed,
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the follow-up that isn't happening and ensuring that
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it happens.
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Things of that nature are really gonna transform
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medicine.
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Then there's biotechnology
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that's gonna be, you know, it has been
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and will continue to transform how we care
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for our patients. And I'm particularly interested in
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how we can address
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malignant brain tumors with
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the new, immunotherapies
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and
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engineered cells. So,
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that's some research,
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opportunities that we're exploring with the scientists at
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UCSB right now.
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And so it's those sort of, you know,
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forward looking,
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developments are just really exciting for someone
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who's spent many years battling diseases that are
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difficult to to to battle. But I think
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in the future, it will hold some promise
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for us.
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Absolutely. And, you know, what you're saying about
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imaging too, especially, I've also heard from from
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spine surgeons how AI has helped them with,
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you know,
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just reading and understanding,
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MRI imaging, etcetera,
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reducing the need
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for radiation. And I'm wondering, can you give
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an example maybe of
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one way that AI has significantly
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improved
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how you're
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handling some of the clinical cases you're working
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with today?
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Yeah. Like like I was mentioning, the natural
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language processing
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technology, which is is
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sort of the initial stages, which is now
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developed into,
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our large language models,
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allows us to really look at huge amounts
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of data and say, you know, which patients
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have this diagnosis and what
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what what's the severity of their disease and,
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gathering that data, then we can actually analyze
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what's the best approach
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to their
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disease and how often do they need follow-up
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and
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and where are the
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higher risk categories for that disease. So I
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think just having that immense amount of data
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will really guide us into how we
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advise our patients and and track them,
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in a way that's really
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based on data and outcomes and not just,
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on a individual
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physician's impressions or
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experience.
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So for example, for us,
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one thing that I've seen in my, you
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know,
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prior practice is that a patient might be
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diagnosed with a small brain aneurysm
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and that aneurysm
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is very unlikely to rupture.
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But if it's not monitored and followed,
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we don't know if that aneurysm is growing.
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And it's not uncommon for those patients to
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get lost to follow-up. So if we can
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capture them, put them back into a surveillance
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system
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and make sure that they're not getting lost
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and that they do get the treatment before
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their aneurysm grows and ruptures, then I think
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we, you know, our system will be, more
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fail proof and will be safer for our
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patients. And
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overall, I think that's a technology. Well, it's
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already in existence. I helped develop it with
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a company called Illuminate,
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and we just,
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are presenting the data in the coming months
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at the International
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Stroke Conference. So I think, you know, this
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is a technology that could help,
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health systems across the country to improve
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their surveillance of patients with
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otherwise
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small,
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aneurysms that could in the future become,
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significant to their health.
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That's really fascinating. So it sounds like you're
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really using these tools
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to catch the problem and prevent it from
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becoming
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a bigger issue down the line. Exactly. That's
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my you know, I believe in prevention.
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It's always better than, treating the disease after
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it's happened. So,
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we are definitely interested in identifying patients that
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we can treat when they're gonna have a
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better outcome.
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Yeah. And, you know, a lot of my
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conversations with spine surgeons and pain management physicians
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this year, a lot of them emphasize just
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the importance of collaboration
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with other specialties including neurosurgery. And I'd love
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to know just kind of to what extent
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have you been focusing on just collaborating not
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only with spine surgeons, but,
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just other specialties as a whole and kind
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of taking that all full patient approach to
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care.
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Yeah. That's a great question. I think collaboration
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is the most important part of medical care
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because none none of us know everything. And
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and increasingly, we're more and more specialized in
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our fields.
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So for example, a patient with a pituitary,
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adenoma pituitary tumor
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is not going to be managed,
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exclusively by me. It's going to be managed
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with the help of an endocrinologist,
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with the help of an ophthalmologist.
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And so we've really developed here at Cottage
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in just the last,
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three and a half years an outstanding team,
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a collaborative team that treats patients with those
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disorders.
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Similarly for brain tumors, when you have someone
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with a metastatic tumor or primary tumor,
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the difference, of course, metastatic, it comes from
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elsewhere and goes to the brain. Primary tumors
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arise in the brain initially.
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Those patients are treated not just by the
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neurosurgeon, they're treated by neurologists,
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neuro oncologists, oncologists,
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radiation oncologists.
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So those collaborations
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are ongoing every single week. We have a
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tumor board, multidisciplinary
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tumor board
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and the decisions that are made in that
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collaborative manner
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always are better. And,
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so I think,
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you know, that's my
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joy is being able to have such great
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colleagues. It's been a really pleasant experience being
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here in Santa Barbara because the physician,
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you know, quality of physician care is exceptional.
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So that's one of the things we're trying
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to get the word out to our community,
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to know that they don't have to travel
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to a major city. They can stay here
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and and get the care they need.
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Absolutely. And, you know, I'm wondering just kind
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of sticking on the same kind of track.
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What's an interesting lesson that you've learned from
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working with spine surgeons, spinal neurosurgeons, or orthopedic
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spine surgeons? And then
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vice versa,
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what is something that you think you know
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spine surgeon or and orthopedic spine surgeons should
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really be kind of aware of, in terms
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of what you're doing on your end?
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Well, I I work very closely with my
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orthopedic spine colleagues here. We,
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share cases when there's an area
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of,
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specialization
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such as a spine, you know, tumor issue
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that arises.
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The orthopedic spine surgeons will get me involved.
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If I have a traumatic
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spine injury that, you know, I'm not doing
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the level of fusions that they're doing, instrumented
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fusions, then I will get them involved. And
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that way together, if it requires both of
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our specialization,
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then we, you know, we will do the
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cases together.
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And I think that's really the key is
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everyone
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knows what they're good at and has a
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level of confidence and comfort that they can
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provide that exceptional care of their patient.
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And then together we can do,
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the parts that we're really best equipped to
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do. And so those sort of relationships are
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critical. And, you know, I have I have
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those great relationships with our orthopedic spine colleagues
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here as well as, you know, other neurosurgeons
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in our group.
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Definitely. And, yeah, I'd love to hear, you
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know, besides, you know, AI, what are some
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other big health care trends that you're gonna
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be following headed into 2026?
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Yeah. So as I mentioned, the biotechnology
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trends. And I I think, you know, financial
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trends are really interesting to me these days
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as, I left a a prepaid health care
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system and entered into private practice and now,
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in a group practice.
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I think,
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you know, what we
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can do in terms of negotiating
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contracts directly with,
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employers would be a really interesting avenue,
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that I'd like to explore further.
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And we're just starting those conversations now at
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Cottage Health
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because I think there is a great opportunity
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there for patients and employers to get,
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a real clear idea of what care is
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available to them in their communities.
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And and for us to improve cost savings
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for them and and for us to become
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more efficient.
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It's there's so many layers that are now
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put on
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physicians and physicians offices to provide,
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you know, additional
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information for insurance companies and pre authorizations etcetera,
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which really is unnecessary work, I believe. And
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I think,
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it is
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just detracting from the delivery of health care.
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So direct contracting with employers
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is of interest. And I think another,
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development that is really important is the human
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side of health care,
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which we can never lose sight of. So,
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you know, the,
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the, kindness, compassion,
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mindfulness
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that not just for the patients,
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but also for the physicians and providers because
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it's how we make it sustainable.
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And our
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palliative care program at Cottage
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and in the community has really,
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I think helped our patients a lot to
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help
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determine what's the best way for them to
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live their life
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and the remaining time they have left, especially
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our patients with brain tumors. So, yeah, I
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think those are two really interesting
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trends
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to follow in health care is,
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the, direct contracting
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and,
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development of palliative care in
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in in medicine.
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Absolutely.
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And then my last question for you was
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wondering, you know, how are you thinking about
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growth in the next twelve to twenty four
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months?
12:59
Oh, yeah. Well, we're planning on a lot
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of growth in the next twelve to twenty
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four months. So, we just recruited a neuro
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oncologist,
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and we're looking for two new
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neurologists to join our group.
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The, you know, access for patients in our
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community, like many, many communities across the country,
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has been
13:19
very difficult
13:21
in certain specialties, neurology being one of them.
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So we're trying to reduce those weights and
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get patients in quickly so they can then,
13:29
if they need, go on to see the
13:31
neurosurgeon in a timely fashion.
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Or not,
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continue in the care, the excellent care with
13:38
the neurologist.
13:40
And so those sort of collaborations
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with the other specialties that we need to
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develop in the community, that's one area of
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growth.
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The other is,
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the sort of opportunities with,
13:52
like I mentioned, that the companies,
13:55
that have some interest in translational research
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and also,
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clinical research. And so I think with our
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new neuro oncologist, we're gonna have some great
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opportunities for that that we previously haven't had
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at this institution.
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And the final thing I think is really
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just getting the word out. We're going to
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be doing a major
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sort of,
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you know, PR campaign,
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developing our website so patients can find us
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and
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our,
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you know, referring doctors can find us so
14:28
that we can ensure that patients get the
14:31
care they need right here close to home.
14:33
Because, you know, we know our organization has
14:36
the the skill set and the technology,
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but I don't think everyone in the community
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knows that yet. So those are, I think,
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gonna help us grow our practice
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and our service to our our,
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you know, counties both north and south of
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us, not just in Santa Barbara County.
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Yeah. Got some sounds like some exciting things
14:58
coming ahead for y'all. Yeah. Very exciting. We
15:01
do have an intraoperative MRI, a cottage. We
15:03
have,
15:04
technologies that haven't, you know, typically been found
15:07
in community hospitals. So this is sort of
15:10
a,
15:12
it's an academic hospital in that we have
15:14
residents,
15:16
but we don't have, you know, research laboratories.
15:19
So
15:20
the idea is that we wanna deliver
15:23
that level of academic medicine care
15:26
with the technologies that we have with, intraoperative
15:30
MRI,
15:31
LIT,
15:32
navigation,
15:33
ultrasound, all the robots, everything that you would
15:36
see at an academic center.
15:38
But we don't have the residents. We have,
15:40
you know, experienced surgeons,
15:43
treating patients. And so we're hopeful that patients
15:46
will recognize that this is a level of
15:48
care that,
15:49
they can't, you know, they really can't get
15:51
it any, just any community hospital and that
15:55
they end up
15:57
deciding it is best to stay closer to
15:59
home with their their families and their loved
16:01
ones.
16:02
Absolutely.
16:03
Well, doctor Moeri, thank you for joining our
16:06
podcast today. I hope you have a great
16:08
rest of your day, and I hope that
16:09
we can connect again down the line.
16:12
Appreciate it. Nice to talk with you. Take
16:14
care.