Latest / Becker’s Healthcare Podcast / Anthony J. Tortolani, MD, FACS, FACC, Cardiac and Thoracic Surgeon and Professor Emeritus of Clinical Cardiothoracic Surgery at Weill Cornell Medical College

Transcript

Anthony J. Tortolani, MD, FACS, FACC, Cardiac and Thoracic Surgeon and Professor Emeritus of Clinical Cardiothoracic Surgery at Weill Cornell Medical College · Becker’s Healthcare Podcast

• 0:00
  Hello. This is Francesca Matthews with the Becker's
• 0:02
  ASC review podcast.
• 0:04
  I'm thrilled to be joined today by doctor
• 0:06
  Anthony Tortellani, a cardiac and thoracic surgeon and
• 0:09
  professor emeritus,
• 0:11
  in in clinical cardiothoracic
• 0:13
  surgery
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  at Weill Cornell Medical
• 0:16
  College. Doctor Tortellani, thank you so much for
• 0:18
  being here today.
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  My pleasure. Hopefully, it will be assisting you.
• 0:24
  Well, great. To start us off, could you
• 0:26
  please introduce yourself and tell us a little
• 0:28
  bit about your background?
• 0:31
  I I am
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  Emeritus professor. I
• 0:35
  spent
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  almost all my career either as chair chief
• 0:39
  of cardiothoracic surgery or as chairman at different
• 0:41
  hospitals,
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  almost all within the Cornell network. And
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  I was involved with building
• 0:50
  the first ambulatory surgery center at Northwell. I
• 0:54
  was involved with
• 0:56
  building
• 0:58
  the ambulatory when we converted a floor at
• 1:00
  New York Presbyterian Hospital to ambulatory surgery
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  and in the building of
• 1:06
  the ambulatory
• 1:07
  surgery center, which included cardiology
• 1:10
  at Methodist Hospital, which was a hospital that
• 1:12
  joined our network.
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  And
• 1:15
  ultimately, at a safety net hospital,
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  I was part of
• 1:20
  a strategic planning that decided
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  committee, which decided not to build
• 1:25
  a, ambulatory surgery center because they didn't have
• 1:28
  the funds nor the patient population to support
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  it. So I have a lot of experience
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  in
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  developing and running of ambulatory surgery centers.
• 1:38
  Gotcha. So quite a a wealth of experience
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  there.
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  What are the top three trends that you're
• 1:45
  following in health care today?
• 1:48
  Well, I I and this was discussed in
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  some detail at the annual meeting.
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  The great concern about not having enough caregivers,
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  primarily anesthesiologists,
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  nurses,
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  and nurse anesthesia,
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  assistants,
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  that is a real problem that's gonna get
• 2:05
  worse
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  over the next seven or eight ten years
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  unless,
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  we increase the number of anesthesiologists
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  we're training.
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  This year, there are 1,400,
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  medical students interested in going into anesthesia in
• 2:20
  this country,
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  and we had no positions for them.
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  And they expect within the next ten years,
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  we're gonna be short about
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  thirty
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  six
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  thirty six,
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  I'm sorry,
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  no, about 5,000 or 6,000 anesthesiologists
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  across this whole country.
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  So we're looking at a major problem. I
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  think the important thing is much of the
• 2:45
  anesthesia
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  that's provided in ambulatory surgery can be provided
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  for by
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  Nurse Nestys
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  at the head of the bed with anesthesia
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  anesthesiologist
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  in close proximity.
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  I think so that will be
• 3:01
  the short term solution.
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  But I think that's
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  a trend that we have to fix. I
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  think the second trend is
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  a decrease
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  in profit margin at hospitals. I don't mean
• 3:14
  that hospitals are making money to put money
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  in people's pockets. I mean
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  that
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  to grow
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  hospitals, you need to have a profit margin
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  to build buildings and develop programs.
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  And what's happening today in medicine,
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  with
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  limitations in Medicare and Medicaid
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  and the introduction of AI into medicine, which
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  I'll talk about in a few minutes, is
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  going to increase
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  the cost.
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  And I don't know how we can increase
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  cost unless we increase profit margins, which at
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  least in the major medical centers
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  in New York is not happening.
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  So that's a trend I'm concerned about.
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  And the third trend is
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  the invasion
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  of for profit
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  organizations
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  into medicine,
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  whose primary
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  concern is not patient care, but its primary
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  concern is making profit for
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  the equity
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  holders
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  in that company.
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  So, I think those are the
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  overall major concerns
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  that I have with the three trends I
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  see
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  about medicine, but not actually within the practice
• 4:28
  of it. Those are the outside concerns that
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  I see.
• 4:32
  Mhmm. Absolutely. And that all definitely resonates with,
• 4:36
  you know, the folks I speak to over
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  here at Becker's every day and just some
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  of the conversations that I've been having.
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  What are you most excited about right now
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  in health care overall or in the ASC
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  space specifically either? Well, I think
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  if you keep in mind my concerns,
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  I think what's really exciting
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  is the involvement
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  in artificial intelligence in medicine.
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  And I think it can be
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  very important
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  and I think it's obvious that it's going
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  to be important
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  in
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  the
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  administrative,
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  the supply chain
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  and the administrative
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  hierarchy and organization within
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  medicine.
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  But I think what's exciting to me is
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  not the business side of it, but the
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  tremendous, tremendous
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  influence they're having in basic science research.
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  It's unbelievably
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  important,
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  their role in basic science research at the
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  cellular and subcellular
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  levels,
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  which is being directly applied
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  into
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  clinical care.
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  They're import in there, and they can do
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  help us do massive research,
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  and it's ongoing at the present time. I'm
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  not talking about six months or ten years
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  ago. I'm talking about
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  now, today, yesterday. If you look at the
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  Journal of
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  Nature,
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  which is the foremost journal in the world,
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  or Nature Medicine,
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  what AI is doing to help us do
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  research is unbelievable.
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  But I think it also
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  is really important
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  in the application in clinical medicine.
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  And there, it's helping us it's helping radiologists
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  to read,
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  X rays and PET scans and MRIs more
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  accurately
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  and at the
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  cellular level, which we've never been able to
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  do before.
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  So I think that's happening, which makes
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  us able to diagnose the diseases
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  much earlier
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  at a time when it's curative
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  with minimal invasive therapy with less surgery, meaning
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  more cases being done in ambulatory surgery by
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  coincidence.
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  So I I think
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  it's been great, and it's also been assisting
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  us in clinical decision making.
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  So it was written recently that we're gonna
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  go from generative
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  care, which is what we're doing now. Somebody's
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  at the bedside looking at the patient, looking
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  at the x rays, looking at the blood
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  work and making decisions
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  to precision medicine,
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  which is diagnosis made at the cellular and
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  subcellular level,
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  which makes it much earlier in the disease
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  process,
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  which increases the chances of cure, especially in
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  cancer or heart disease.
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  And
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  finally,
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  it will help
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  in applying
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  to a degree
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  surgery
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  to
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  the care and decision making. So we're going
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  to go from generative
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  to precision
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  to personal care where the care will be
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  for the individual,
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  not for the people who have, let's say,
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  lung cancer, but for that particular individual and
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  that individual's
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  particular cancer problem. So I'm very excited about
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  that. Really excited about it.
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  Yeah. Absolutely. The advancements
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  that AI is is bringing to to research
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  and
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  to diagnosis are incredible. I feel like I
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  read a new stunning headline every day.
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  Let me just add to that for a
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  sec because I said it, but I did
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  maybe didn't say it clearly.
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  AI is allowing us to make the diagnosis
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  that much
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  earlier, which means we don't need to do
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  so much invasive surgery. The surgery would be
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  less and less invasive.
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  Mhmm. Yeah. No. And I know that that's
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  that's you know, just there's huge implications there
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  for
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  the overall, like, efficiencies and cost and experience
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  of of everything we know about health care.
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  So,
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  yeah, and
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  kind of moving to a different different area
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  here. But how are you thinking about growth
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  over the next twelve months?
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  I think that with the growth in cardiology
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  in outpatient
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  facility
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  is going to continue to grow. More and
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  more
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  cardiac
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  invasive cardiac therapeutics will not be done by
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  surgeons, but would be done by cardiologists
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  or cardiologists
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  with surgeons
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  in an outpatient theater
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  like the TAVERs, for instance, and Stenten,
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  and pacemakers,
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  and,
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  AICDs,
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  and
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  diagnostic,
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  insertion of diagnostic catheters, which
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  will defibrillate patients
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  at home. So I think,
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  we will be doing we will be filling
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  the ACSs more and more with all sorts
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  of therapy and diagnostic
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  procedures.
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  I think the critical thing
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  is to be able to backfill the ORs
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  and hospitals
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  with appropriate cases
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  so they can continue to be successful
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  and take care of
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  a different type of patient. I think we're
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  going to need less hospital beds, more chemotherapy
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  is being done on the outpatient basis.
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  They're not going into the hospital to get
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  chemotherapy.
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  And certainly in cardiology
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  and pulmonary and GI, more and more of
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  that's done
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  in ambulatory surgery or ambulatory catheter or pulmonary
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  labs. So
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  it's truly a time of great change. And
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  I think
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  the key thing is being
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  for the large
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  academic medical centers and the hospital
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  systems, which is at least in New York,
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  it's growing. Those programs are growing tremendously. The
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  independent hospitals disappearing
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  except
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  in areas of poverty
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  and the underserved,
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  where
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  their care is not at the same level
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  as in the big systems. The big systems,
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  they're not going into
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  the poor communities and taking over those small
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  inadequate hospitals. That's a real problem.
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  But I think over time, they will be
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  incorporated into the big systems. It's not today
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  or tomorrow. And I think to do that,
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  you need physicians that have to be dedicated
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  to those systems. They have to be part
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  of the large systems,
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  either as employees, which has been that way
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  or even maybe I'm reading about whether being
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  partners, the partners with large health systems
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  and ownership
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  of ambulatory surgery centers. And I think that's
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  another way of doing it.
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  But I think all we're in terms of
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  tremendous change in medicine.
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  And my biggest concern is what I hear,
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  The major, major successful
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  hospital systems in the Greater New York area,
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  some of them are expanding into Connecticut and
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  in Upstate New York, but
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  but I also see that their profit margin
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  is being really reduced,
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  and that's a real concern to me because
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  they take their profit and build,
• 12:08
  they don't put it in their pocket. They
• 12:09
  build inventory care centers and they build cancer
• 12:14
  perfusion centers and things like that. So I
• 12:16
  think they're doing the right thing. But
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  how to do it
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  is going to take a lot of cooperation
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  and I think
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  the without getting too much into this, I
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  think the strategic planners
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  and the people who carry out the tactical,
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  planners,
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  strategic and tactical planners have to come together
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  and be unified, not that they do the
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  same job, but they have to be coordinated.
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  Mhmm. Absolutely. Everything you said, especially about the
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  new kind of cardiovascular codes that are being
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  approved for the ASC setting is,
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  you know, definitely kind of huge buzz in
• 12:54
  the industry right now. So I think a
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  lot of people are thinking about growth in
• 12:57
  a similar way that you are.
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  Is there anything that I haven't asked you
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  about that you feel like is important in
• 13:02
  this conversation?
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  The
• 13:04
  only thing that I would say is that
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  if you're in a world to mute all
• 13:09
  the things we just talked about,
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  does not very much reach
• 13:14
  the people,
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  our patients in rural communities.
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  And 50% of the rural counties in this
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  country
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  don't have a cardiologist.
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  And to get to a cardiologist takes forty
• 13:27
  five to fifty minutes of a car ride.
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  So
• 13:31
  it's hard for those people to get care.
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  And certainly, having worked in
• 13:36
  the inner city and in boroughs as well,
• 13:38
  I I
• 13:39
  see that the level of care of those
• 13:42
  patients is not the same
• 13:45
  as the level of care in the major
• 13:46
  medical center, but not even close. And for
• 13:49
  obvious reasons, I I don't I don't blame
• 13:52
  the caregivers there. I it's just that that
• 13:55
  they can't
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  they don't have any profit margin.
• 14:00
  They lose millions and millions and $50,000,000 $100,000,000
• 14:03
  a year taking care of the indigent
• 14:08
  with funds that come from the States.
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  So it's very hard to get those people
• 14:13
  the kind of care that other people get.
• 14:15
  It it's not equal.
• 14:17
  Definitely. No. And it's something I think about
• 14:19
  a lot as well, having come from more
• 14:21
  of a public health reporting background myself,
• 14:23
  and just we talk about the, you know,
• 14:25
  these advancements. I know that, you know, the
• 14:27
  intersection of what we were talking about earlier,
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  AI and cardiology. There's,
• 14:32
  you know, tons of advancements as far as
• 14:34
  the the level of care that can be
• 14:36
  provided in that field and what's possible now
• 14:39
  with the emerging technology. And it's it's pretty
• 14:41
  stark to read about some of those things
• 14:43
  and to also read about, you know, the
• 14:44
  cases that you're describing of, you know, counties
• 14:47
  where there's no cardiovascular care whatsoever. So there's
• 14:49
  definitely some major gaps to close within within
• 14:51
  the space. But, you know, Amit, I I
• 14:54
  don't mean to be pessimistic because I look
• 14:56
  at the advances and I say, my god,
• 14:58
  it's unbelievable.
• 15:00
  It's truly unbelievable
• 15:02
  what happened. I think how to coordinate it
• 15:05
  and do it right so everybody
• 15:08
  benefits by by it, that's gonna take a
• 15:10
  lot of thinking and planning. But we certainly
• 15:12
  are making advances on the scientific side of
• 15:14
  it without a doubt.
• 15:16
  Mhmm. Absolutely. And I think, you know, the
• 15:19
  rest is
• 15:20
  happening in conversations and sort of brainstorming and
• 15:23
  sharing ideas just like we are today. So,
• 15:25
  you know, on that note, that is all
• 15:27
  I had for you today, doctor Tortellani.
• 15:29
  Thank you so much for joining us.
• 15:31
  Okay. I hope it's helpful, and thank you
• 15:33
  for having me. I appreciate it. Yeah. Thank
• 15:35
  you. It's been a pleasure, and I look
• 15:37
  forward to connecting with you again in the
• 15:39
  future.