Latest / Becker’s Healthcare Podcast / The Strategic Role of Vascular Surgery in Improving Patient Outcomes and Strengthening Health System Performance

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The Strategic Role of Vascular Surgery in Improving Patient Outcomes and Strengthening Health System Performance · Becker’s Healthcare Podcast

• 0:00
  Hi, everyone. This is Brian Zimmerman with Becker's
• 0:02
  Healthcare. Thank you so much for tuning in
• 0:04
  to the Becker's Healthcare podcast.
• 0:06
  Today, we're going to talk about the strategic
• 0:08
  role of vascular surgery in improving patient outcomes
• 0:11
  and strengthening health system performance.
• 0:14
  Joining me for today's discussion is doctor William
• 0:17
  Shoots, a vascular surgeon at Texas Vascular Associates
• 0:20
  in Dallas and Plano, Texas and former executive
• 0:23
  board member of the Society for Vascular Surgery,
• 0:26
  and doctor Robert Moller, a vascular surgeon and
• 0:29
  chief of surgery at McLaren Flint in Flint,
• 0:32
  Michigan, and executive board at large member of
• 0:34
  the Society for Vascular Surgery. Doctor Schutz and
• 0:37
  doctor Moller, thank you so much for being
• 0:39
  here today.
• 0:40
  Great to be here. Thank you for having
• 0:41
  us.
• 0:42
  Excellent. So let's get into it. Let's start
• 0:44
  with a a a bigger introduction than what
• 0:47
  I just gave each of you. I'm gonna
• 0:48
  tap on tap on each of you to
• 0:49
  share just a bit more back about yourself,
• 0:52
  your professional background, and the and the work
• 0:54
  you're doing today.
• 0:56
  Doctor Molner, let's begin with you.
• 0:58
  Oh, thanks. Again, it's great to be here.
• 1:00
  I've been in private practice,
• 1:02
  with the Michigan Vascular Center in Flint, Michigan
• 1:05
  for twenty eight years. So this is where
• 1:06
  I landed right out of my fellowship at
• 1:08
  Vanderbilt.
• 1:09
  Been here ever since, and it's been a
• 1:11
  great opportunity. We're sort of one of the
• 1:13
  largest and oldest groups in the country.
• 1:15
  Started in 1963.
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  So the group's been around a while and
• 1:19
  provided services to the hospitals.
• 1:21
  I've been in
• 1:23
  gauge with clinical research. I've had education of
• 1:26
  vascular fellows and surgical residents and medical students.
• 1:29
  So it's been a good run for me,
• 1:31
  and, hopefully, we can have a great discussion
• 1:33
  here today because I think vascular surgery has
• 1:36
  a lot to offer. Yep. You're excited to
• 1:38
  get into it today, and and kudos to
• 1:40
  you for landing and finding a home right
• 1:42
  out right out of the gate. So well
• 1:44
  done, doctor Molnar.
• 1:45
  Doctor Schutz, go ahead. Same question to you.
• 1:47
  Oh, well, I'm going to sound like the
• 1:49
  Texas clone of doctor Molnar.
• 1:52
  I, I'm in private community practice in in
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  the Dallas Metropolitan Area, and it was my
• 1:57
  first job out of fellowship, and I've been
• 1:59
  here for thirty five years.
• 2:01
  Our group has grown pretty big too just
• 2:04
  as Michigan Vascular has. We currently have 21
• 2:06
  surgeons, and we're expanded to 24 surgeons this
• 2:09
  year.
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  We cover six counties and over 20 different
• 2:12
  hospitals providing,
• 2:14
  all facets of vascular care. Similar to doctor
• 2:17
  Molnar, I've been involved in a resident,
• 2:19
  medical student and fellowship teaching,
• 2:22
  as well as been,
• 2:24
  active in both vendor sponsored research and unsponsored
• 2:27
  research as well.
• 2:29
  I'm former secretary of the Society of Vascular
• 2:31
  Surgery and a former executive board member. I
• 2:34
  had the privilege of serving along with doctor
• 2:35
  Molnar, our current board member, for many, many
• 2:37
  years,
• 2:38
  and I'm president-elect of Texas Surgical Society,
• 2:41
  our, local surgical,
• 2:44
  society here in Texas.
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  I am proud to say that, I'm currently
• 2:48
  the task force chair for a combined
• 2:51
  society of vascular surgery, American College of Surgeons
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  quality program, which is the vascular verification program,
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  and I've been very active in getting this
• 2:58
  program developed, launched, and now,
• 3:00
  out the door for subscriptions.
• 3:03
  Excellent. Well, it it it's a pleasure to
• 3:05
  have you both on.
• 3:07
  Let's get into it. And let's begin here.
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  Sort of really wanted to
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  doctor Schutz, maybe we'll start with you. Really
• 3:12
  think about the role of vascular surgeons within,
• 3:16
  health care systems, the broader health care system.
• 3:18
  What what role do vascular surgeons play, especially
• 3:21
  in the context of what we're we're talking
• 3:23
  about, you know, improving patient outcomes, strengthening overall
• 3:27
  performance?
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  Doctor Schutz, let let's begin with you on
• 3:30
  this.
• 3:31
  You know, Brian, that's a great place to
• 3:32
  start because there's a lot of, misunderstanding of
• 3:35
  the vaccine, what vascular surgeons do and where
• 3:38
  we do fit, you know, both in in
• 3:40
  the hospital and outside of the hospital. You
• 3:42
  know, vascular surgeons
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  take care of all aspects of vascular disease,
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  arterial, venous,
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  and, and we,
• 3:49
  not only take care of of patients using
• 3:52
  stands and balloons, but we're also able to
• 3:54
  offer surgical treatments as well when that is
• 3:56
  necessary.
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  And we take care of different kinds of
• 3:59
  patients, the the patients that come in with
• 4:01
  an acute urgent situation
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  as well as patients that have chronic diseases
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  that need managed and monitoring as well.
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  But there's more to it than that.
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  Our presence is is,
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  essential
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  for other service lines within the heart within
• 4:16
  the hospital to work and function at a
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  high level. You know, think about it. Blood
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  vessels run through all parts of our body.
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  Blood vessels are everywhere. And if those blood
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  vessels get injured or have a problem, you're
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  going to have to have a vascular surgeon
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  there to take care of it. And think
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  about what service lines we we support.
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  It's,
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  emergency medicine, orthopedics,
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  trauma, spine,
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  neurosurgery, cardiac surgery, neurology, oncology, and I could
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  keep going on. But those were the ones
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  that, are most in need of vascular services,
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  for highly complex or for,
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  acute emergent conditions.
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  And when a a hospital doesn't have a
• 4:56
  a highly functional, well developed
• 4:58
  vascular service line, and they're not able to
• 5:00
  take, you know, care of complex patients.
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  And that means that patients are being transferred
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  out of hospitals. And when those patients are
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  transferred out because there's not adequate vascular care
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  to support these other service lines or to
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  or to take care of vascular emergencies.
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  And two things go out the door. One
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  is revenue for the hospital, and the second
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  thing is reputation.
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  Some really, really strong points, and I think
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  a good framework for us to think through
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  this. And and and
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  forgive the obvious metaphor, but sounds like vascular
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  surgeons are really running, like, much like blood
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  cells all throughout the organization.
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  You're touching so many different service lines and
• 5:37
  specialties.
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  Doctor Molnar, with that setup in mind,
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  can you talk a little bit about or
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  expand upon how vascular service lines enable growth
• 5:46
  across other major service lines? I think doctor
• 5:49
  Soods sort of sort of alluded to some
• 5:51
  of that there. But specifically in regards to
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  growth, can you expand on that, doctor Moller?
• 5:56
  Certainly. And agreed completely with, Bill's assessment. Certainly,
• 6:00
  a strong vascular surgery service line is critical
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  to any hospital's efforts to increase its market
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  share,
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  especially if complex and high margin cases.
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  Hospital executives know all too well that financial
• 6:12
  margins
• 6:13
  are are kinda slim. And to provide the
• 6:16
  needed community care, you have to really maximize
• 6:18
  gain from your winners. And this is what
• 6:21
  vascular surgery service lines enable us to do.
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  If there is a strongly supported vascular surgery
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  service line, it could really align with the
• 6:29
  mission of the institution and enable growth across
• 6:32
  all their major service lines. For example,
• 6:35
  specifically, again, if you wanted to increase your
• 6:38
  operative spine program,
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  both orthopedic and neurosurgical spine surgeons really rely
• 6:43
  on vascular surgeons to obtain their exposure for
• 6:46
  these procedures.
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  For hospitals to provide complex cardiology and cardiothoracic
• 6:51
  procedures,
• 6:52
  vascular surgeons are needed to address the inevitable,
• 6:56
  ischemic
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  extremities or life threatening bleeding complications that are
• 7:00
  associated with these interventions.
• 7:02
  So vascular surgery service line really is the
• 7:05
  infrastructure
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  that allows for some of these most profitable
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  service lines, and Bill named a few. Trauma's
• 7:11
  a big one. If you get a gunshot
• 7:12
  wound to the palpitio artery, they're gonna need
• 7:15
  a vascular surgeon.
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  If you have a strong cardiology or cardiac
• 7:19
  program,
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  you need vascular surgery to be available and
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  and to help plan for these cases and
• 7:25
  take care of the inevitable iatrogenic
• 7:28
  issues that occur with them. Same with orthopedics
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  or stroke centers. So to accept more complex
• 7:34
  and challenging cases,
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  which, again, as Bill alluded to, really significantly
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  increases the case mix index and, thus, hospital
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  margins,
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  you need a well rounded and supported vascular
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  surgery service line. As a matter of fact,
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  a a recent study by Johnson
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  in 2019,
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  it's demonstrated that the case mix index for
• 7:55
  cases with vascular surgery involvement was 5.4
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  versus 2.1
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  for cases that did not have vascular surgery
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  involvement.
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  And for all of these service lines, early
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  and planned vascular surgery involvement provides better outcomes
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  at lower cost than unplanned or emergent con
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  consultations
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  do.
• 8:16
  Excellent. Well, I I think we've established
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  sort of the the importance from an operational
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  and clinical
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  perspective of having a strong vascular
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  service line. But I also and we've touched
• 8:26
  on this a bit, but curious if we
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  could paint the picture a little bit more
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  clearly in terms of what this looks like
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  when vascular coverage isn't strong.
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  Again, like some of that, doctor Molnar, the
• 8:37
  the stats that you mentioned in some of
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  the previous comments
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  sort of get to this a bit, and
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  and there's some here that's probably intuitive. But
• 8:44
  I would love for listeners if we can
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  sort of paint a a very specific picture
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  of what it looks like when coverage isn't
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  strong. And, doctor Schutz, maybe you could you
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  could start us there. And then,
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  conversely, what does it look like when this
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  goes well? What what what what how does
• 8:57
  intervention improve outcomes like link lift stay and
• 8:59
  readmission? So a two part there for you,
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  doctor Schutz.
• 9:02
  Okay. Thank you very much.
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  First of all, I I think it's important
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  to point out that when vascular coverage is
• 9:09
  weak or fragmented,
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  health systems are paying for this in ways
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  that really don't show up on a financial
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  report, but they add up quickly.
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  I think the most immediate problem is what
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  happens when an unplanned vascular
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  complication occurs
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  and there's not a vascular surgeon with the
• 9:24
  right skills available there. But there was a
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  recent very robust systemic review of 27 studies
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  that was published,
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  and this had thousands of patients, thousands of
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  patients,
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  in this study. And it demonstrated that when
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  a vascular surgeon is called in during a
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  case rather than planned in advance, the blood
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  loss is dramatically higher,
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  more than double in some series,
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  over two two thousand milliliters compared to a
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  thousand milliliters.
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  Oftentimes increase significantly,
• 9:53
  complication rates go up, and when complication rates
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  goes up, everything else goes up with them.
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  What does that mean? It means, like, length
• 10:00
  of stay,
• 10:01
  ICU utilization,
• 10:02
  readmissions, and mortality.
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  So you can see how all of this
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  could be unrecognized,
• 10:07
  hits to the bottom line. I that is
• 10:10
  a direct consequence of not having robust vascular
• 10:13
  care, available.
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  But it's not just the emergent
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  conditions that are leading can lead to problems
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  and poor poor outcomes and, and as I
• 10:22
  hit on the bottom line as well. When
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  vascular surgeons,
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  are involved in case planning with other disciplines
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  in advance,
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  we see much much better results.
• 10:33
  For instance, vascular
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  complications can be avoided
• 10:36
  before they happen. And when that happens, there's
• 10:39
  no complication.
• 10:40
  So preoperative collaboration
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  has been shown to directly
• 10:44
  be associated with shorter operating times, less blood
• 10:47
  loss, better postoperative outcomes,
• 10:49
  in multiple areas in regards to, like,
• 10:52
  hemorrhage,
• 10:54
  loss of blood flow, or what we call
• 10:55
  ischemia.
• 10:56
  And then even in,
• 10:58
  oncologic surgery where there's a lower rate of
• 11:02
  positive margins
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  in cases where vascular surgeons have been involved.
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  So, operationally, that means shorter hospital stays,
• 11:10
  fewer patients who need to be stepped up
• 11:12
  to the ICU, few fewer thirty day readmissions,
• 11:15
  which can trigger penalties,
• 11:17
  and fewer cases that turn from your teen
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  in catastrophic, and all that has a direct
• 11:21
  operational
• 11:22
  cost attached to it.
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  Now when vascular surgeons are collaborating with our
• 11:27
  peers in whatever the realm is, whether it's
• 11:30
  trauma, whether it's a structural heart, like with
• 11:32
  ECMO,
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  whether it's our oncologic surgeons or urologic surgeons,
• 11:37
  and we have a very complex challenging case,
• 11:39
  so we come together as a team to
• 11:41
  work through that case. And we get that
• 11:43
  patient through the case skillfully,
• 11:47
  safely without complications.
• 11:49
  It's just it's just a glorious event to
• 11:51
  take something that's,
• 11:53
  so high risk and so complex and have
• 11:55
  a good outcome.
• 11:57
  And the fact that you can develop these
• 11:58
  multidisciplinary teams with vascular involvement,
• 12:01
  you're able to increase your case index.
• 12:04
  It's been shown that these complex cases with
• 12:07
  vascular surgeons involved have a significantly higher case
• 12:10
  mix index.
• 12:11
  It's like 5.6
• 12:13
  versus 2.1 for the routine cases that vascular
• 12:16
  surgeons aren't involved. So, again, it's it's a
• 12:19
  multiplier. It allows the hospital and and its
• 12:21
  other service lines to do more complex cases
• 12:24
  right there without sending them out.
• 12:27
  Yep. Thank you so much, doctor Shus. Doctor
• 12:28
  Molnar, yes. Let's move to you. Get your
• 12:31
  take here in terms of the complications that
• 12:33
  can be prevented here. What else would you
• 12:35
  add? And I would invite any any additional
• 12:37
  commentary too around sort of what
• 12:40
  the the the good picture looks like when
• 12:42
  when you've got strong vascular coverage as doctor
• 12:45
  Schutz started to to sort of paint that
• 12:47
  picture as well.
• 12:49
  Yeah. I've been fortunate to be part of
• 12:51
  a strong vascular
• 12:52
  team. And and, again, it is very
• 12:55
  number one, it's rewarding to be able to
• 12:57
  work with our colleagues in such a way.
• 12:59
  I know for our surgical oncologists,
• 13:01
  it's great that they will consult us often
• 13:04
  before a big procedure because they recognize that
• 13:07
  if they're gonna do that Whipple procedure, which
• 13:09
  is, again, a high
• 13:11
  complex case, high index case,
• 13:13
  but there might be portal vein involvement with
• 13:16
  the tumor, and they might need to shave
• 13:18
  the portal vein or reconstruct the portal vein.
• 13:20
  It's much better that we're engaged at the
• 13:23
  front end of that so that we're either
• 13:25
  scrubbed with them when when that part of
• 13:27
  the case is coming or we're on standby
• 13:29
  so they know we're not in our up
• 13:32
  to our elbows and and other, you know,
• 13:34
  things going on that we've sort of set
• 13:37
  that time aside to be there for them.
• 13:39
  And as doctor Schutz said, I mean, there's
• 13:42
  decreased blood loss. There's better outcomes. It it
• 13:45
  just a well oiled machine, and that's what
• 13:48
  a hospital
• 13:49
  administration wants. I mean, they want their service
• 13:52
  lines to be protected
• 13:54
  not only
• 13:56
  from potential complications, but when those complications occur,
• 13:59
  which I don't care what you're doing or
• 14:01
  what service line you're in. As Bill said,
• 14:03
  there's blood vessels all over the body, and
• 14:06
  I'm not sure what the number is. I
• 14:08
  think it's 60,000 miles of blood vessels within
• 14:10
  the human body. It's it's an amazing thing.
• 14:13
  But if it's the ICU putting in lines,
• 14:16
  if it's the anesthesiologist
• 14:19
  putting in a cordis, if it's your general
• 14:21
  surgeon
• 14:21
  or an obstetrician gynecologist putting in a trocar,
• 14:25
  those things are gonna happen. That trocar can
• 14:27
  get into that aorta. And if you don't
• 14:29
  have a strong team ready to take care
• 14:32
  of that, you're gonna have increased
• 14:34
  risk to loss of life and limb. And
• 14:36
  so it is a beautiful thing. The inevitable
• 14:38
  is gonna happen, but if you don't have
• 14:40
  a strong team in place to take care
• 14:42
  of those
• 14:43
  complications, you're gonna have bad outcomes.
• 14:46
  If you don't have any vascular surgeons at
• 14:48
  all, you're gonna have to transfer some of
• 14:49
  those patients as Bill had alluded
• 14:51
  to, which number one, puts them at an
• 14:53
  increased risk. If you have an ischemic limb
• 14:56
  and it's not taken care of, you have,
• 14:57
  you know,
• 14:59
  hours to get that addressed. And if you
• 15:01
  have a massive hemorrhage issue, you have minutes.
• 15:03
  So without a strong team in place that
• 15:05
  can come and respond and take care of
• 15:07
  the institution,
• 15:09
  you know, we're we're sort of known as
• 15:10
  the firemen. Things happen. We go, and we're
• 15:12
  the first responders to take care of it.
• 15:14
  And we're often overlooked, and people don't recognize
• 15:16
  that. But there's not a service line within
• 15:19
  the hospital
• 15:20
  that we don't touch and help,
• 15:23
  enable them to do their trade.
• 15:25
  Excellent. Well, doctor Moller, doctor Schutz, truly appreciate
• 15:28
  you coming on and sort of really helping
• 15:30
  our listeners understand,
• 15:32
  the value
• 15:33
  of vascular surgery and the value of having
• 15:35
  strong vascular surgeon teams. If if our listeners
• 15:39
  if a hospital executive out there listening to
• 15:41
  this, those listening to this, remembers one thing
• 15:44
  from from our conversation today. What would you
• 15:46
  like that to be? Doctor Molner, let's begin
• 15:49
  with you.
• 15:50
  Yeah. I think, you know, again, strong administrative
• 15:53
  support for a vascular service line is win
• 15:55
  win for everyone.
• 15:56
  I mean, first off, it's the biggest win
• 15:58
  comes for the patients because
• 16:00
  they have better outcomes.
• 16:02
  Some cases that might not have been taken
• 16:05
  on or addressed before now can be with,
• 16:07
  again, the assistance of the vascular surgery team.
• 16:11
  And
• 16:11
  the vascular surgeons, of course, benefit because they
• 16:14
  can increase their portfolio of of complex cases
• 16:17
  that are provided. But the hospital
• 16:20
  really needs that infrastructure, and I think the
• 16:23
  administration,
• 16:24
  if they have a great strong vascular
• 16:27
  service line, congratulations.
• 16:29
  And if they do have that, I'd encourage
• 16:31
  them to continue to engage with them
• 16:33
  and to see how they can advance going
• 16:36
  further. If they don't, I should suggest you
• 16:39
  should consider that because I think that's where
• 16:41
  your growth is gonna be. That's where you're
• 16:43
  gonna have growth of complex cases, and you're
• 16:45
  gonna have decreased complications
• 16:48
  and and, better overall outcomes with increased margins.
• 16:52
  Excellent. Thank you so much, doctor Molnar. Doctor
• 16:54
  Schutes, what are your your final thoughts here?
• 16:56
  I agree with everything doctor Molnar beautifully said.
• 16:58
  I'd like to to let the health care
• 17:01
  executives just think about this for a second.
• 17:03
  You know, vascular surgery
• 17:05
  is not a cost center.
• 17:07
  It's the infrastructure that makes your highest value
• 17:10
  service lines possible
• 17:12
  as we've discussed, before in the way that
• 17:14
  we support these service lines.
• 17:16
  There's data that shows that,
• 17:18
  has been
• 17:20
  published that shows vascular surgery
• 17:22
  often generates
• 17:23
  6% of a health system
• 17:26
  systems gross margin,
• 17:27
  but only uses 3% of the inpatient
• 17:30
  volume.
• 17:31
  That's a exceptional efficiency.
• 17:34
  And as doctor Molnar
• 17:36
  mentioned,
• 17:37
  investing
• 17:38
  in your
• 17:39
  vascular surgery
• 17:41
  is a very forward thinking view
• 17:44
  that will provide great returns
• 17:46
  to your system.
• 17:48
  And that is going to be even more
• 17:51
  challenging
• 17:52
  to systems that wait.
• 17:53
  There's projected to be a significant
• 17:55
  shortfall of vascular surgeons in the next twenty
• 17:58
  to ten to twenty years.
• 18:00
  So if you don't start now,
• 18:02
  you're going to be way behind,
• 18:04
  when it's time to to play catch up
• 18:06
  with the increasing number of patients that are
• 18:08
  gonna require vascular care.
• 18:10
  Yeah. Building these this strong service line isn't
• 18:13
  gonna get easier in the future, but it
• 18:15
  better better start immediately. Well, again, one final
• 18:18
  thank you to both of you. It was
• 18:20
  a pleasure having this conversation.
• 18:22
  Truly appreciate it. I I also wanna thank
• 18:24
  our sponsor, Society for Vascular Surgery, for helping
• 18:27
  us put this podcast together.
• 18:29
  You can tune in to more podcasts from
• 18:31
  Becker's Healthcare
• 18:32
  by visiting our podcast page at beckershospitalreview.com.