Latest / Becker’s Healthcare Podcast / Balancing Innovation, Research, and Patient Care in Oncology with Dr. Ted Teknos

Transcript

Balancing Innovation, Research, and Patient Care in Oncology with Dr. Ted Teknos · Becker’s Healthcare Podcast

• 0:00
  - Hello, and thank you so much for tuning
• 0:02
  - into the Becker's Oncology Leadership Podcast.
• 0:06
  - I'm Elizabeth Gregerson, a reporter here at Becker's.
• 0:09
  - And today, I'm talking to doctor Theodoros
• 0:12
  - Technos from University Hospitals.
• 0:15
  - Doctor Technos is president and scientific director of
• 0:18
  - University Hospital Seidman Cancer Center and the Jane
• 0:22
  - and Lee Seidman Chair in Cancer Innovation.
• 0:24
  - Doctor Technos, thank you so much for taking
• 0:26
  - the time to speak with me today.
• 0:28
  - Thank you, Elizabeth. It's a it's a privilege
• 0:30
  - and honor to be here.
• 0:32
  - Before I dive into all my questions for
• 0:34
  - you, I'd love if you could share just
• 0:36
  - a bit about your background and your roles
• 0:38
  - at University Hospitals for our podcast audience today.
• 0:42
  - Sure. I'd be happy to. So,
• 0:44
  - you know, my name shortened is TED Technos.
• 0:48
  - Mhmm. Theodoros is my full Greek name.
• 0:51
  - So I'm a trained otolaryngologist
• 0:54
  - head neck surgeon. So I I did my
• 0:56
  - training,
• 0:57
  - in the Harvard system and then did a
• 0:59
  - fellowship in head neck surgery at Vanderbilt University.
• 1:02
  - I
• 1:03
  - spent the first half of my career as
• 1:05
  - a practicing
• 1:07
  - otolaryngologist,
• 1:08
  - head neck surgeon, and microvascular
• 1:10
  - free flap surgeon,
• 1:11
  - then transitioned into leadership roles in cancer programs.
• 1:15
  - Really the second half of my career. I
• 1:17
  - continue to practice,
• 1:19
  - both head neck surgery and reconstructive
• 1:22
  - surgery,
• 1:23
  - but now am the president of University Hospital
• 1:26
  - Seidman Cancer Center,
• 1:28
  - and I'm also the deputy director
• 1:31
  - of the Case Comprehensive Cancer Center. So my
• 1:33
  - role at really is to oversee
• 1:36
  - all cancer related services
• 1:39
  - across our 20 hospital system,
• 1:42
  - and as well oversee the ambulatory,
• 1:45
  - and clinical trial functions of our cancer program.
• 1:49
  - Perfect. Thank you for kinda setting the stage
• 1:51
  - for what that looks like, at university hospitals.
• 1:55
  - While we're focusing on that, I'd love if
• 1:57
  - we could just start off hearing about what
• 1:59
  - your biggest priority at university hospitals is right
• 2:02
  - now.
• 2:03
  - Well, I think, you know, the success of
• 2:05
  - any cancer program really is its people.
• 2:09
  - So, you know, my focus today as it
• 2:12
  - has been yesterday and will be tomorrow
• 2:14
  - is really to
• 2:16
  - recruit and retain the absolute best and brightest
• 2:20
  - that the field of oncology has to offer.
• 2:23
  - So in my tenure here,
• 2:25
  - since,
• 2:26
  - 2017,
• 2:27
  - I've recruited over a 100,
• 2:30
  - oncologists into our program from various parts of
• 2:32
  - the country and across the world. And I
• 2:35
  - think really recruiting
• 2:37
  - the right,
• 2:38
  - phenotype of clinicians and clinician scientists,
• 2:42
  - and creating a culture
• 2:44
  - of compassion and innovation
• 2:47
  - is what separates
• 2:49
  - exceptional cancer centers from
• 2:51
  - from good cancer centers. So,
• 2:54
  - my my priority
• 2:56
  - will always be really recruitment and retention of
• 2:58
  - talent.
• 3:00
  - Absolutely.
• 3:01
  - I feel like we can't talk about recruitment
• 3:03
  - and talent without, you know, the pressure that
• 3:06
  - that brings,
• 3:08
  - when we look towards, you know, workforce struggles
• 3:10
  - right now. Are there any other pressures that
• 3:13
  - cancer centers or oncology service lines even are
• 3:16
  - facing
• 3:17
  - right now that maybe aren't getting talked about
• 3:20
  - enough?
• 3:21
  - Boy, there are so many pressures now. It's
• 3:24
  - like, where do where do we even begin?
• 3:26
  - You know, the pressures are coming at us,
• 3:28
  - you know, from all directions.
• 3:30
  - So I think, you know, one of the
• 3:31
  - things that really isn't appreciated probably by the
• 3:35
  - public and our lawmakers,
• 3:38
  - as much
• 3:39
  - is that for most
• 3:41
  - urban cancer centers in which, you know, let's
• 3:44
  - be honest, most cancer centers are in urban
• 3:46
  - areas.
• 3:47
  - About two thirds of our patients
• 3:50
  - are on some form of government insurance, whether
• 3:53
  - that be Medicare,
• 3:55
  - Medicaid, or even subsidized accountable,
• 3:58
  - care act,
• 4:00
  - plans.
• 4:01
  - So,
• 4:02
  - you know, as the government is trying to
• 4:04
  - rein in costs
• 4:06
  - for, the Medicare system,
• 4:09
  - you know, the the proposed cuts and reimbursements,
• 4:13
  - $3.40
• 4:14
  - b pricing, which has been proposed, and then
• 4:17
  - these Medicaid work requirements
• 4:20
  - really are
• 4:21
  - an existential threat to the to the cancer
• 4:24
  - centers across the country.
• 4:26
  - When you look at,
• 4:28
  - you know, the fact that, again, two thirds
• 4:30
  - of our reimbursements are coming from governmental payers,
• 4:34
  - you know, the loss of any reimbursement
• 4:36
  - or any of the benefits that $3.40 b
• 4:39
  - pricing
• 4:41
  - provides us
• 4:42
  - would be
• 4:43
  - catastrophic, I think, to cancer centers across the
• 4:46
  - country. So that is a pressure that I
• 4:49
  - don't think people really
• 4:51
  - appreciate, and that's just from our clinical operations.
• 4:54
  - Then, you know, for those of us who
• 4:56
  - have very large basic science
• 4:59
  - components to our to our work,
• 5:02
  - you know, the the cuts in,
• 5:05
  - NIH funding,
• 5:06
  - the delay in releasing
• 5:09
  - the funding that's already been approved,
• 5:11
  - and then some of the proposed regulations
• 5:14
  - where scientists can only
• 5:17
  - obtain and maintain two
• 5:20
  - r o one grants,
• 5:21
  - you know, rather than some of our scientists
• 5:23
  - who have four, five, even more.
• 5:26
  - R o one grants
• 5:27
  - will really make it hard to
• 5:30
  - continue to
• 5:32
  - fund and,
• 5:33
  - and expand our research base, which is really
• 5:37
  - crucial to
• 5:38
  - discovery and identifying the next,
• 5:41
  - you know, the next most promising
• 5:44
  - agents for our cancer patients. So I think,
• 5:47
  - you know, the pressures really
• 5:48
  - are twofold, Elizabeth. It's Mhmm. Reimbursements on our
• 5:51
  - clinical side, which, you know, are which really
• 5:54
  - threaten our operations,
• 5:56
  - and then all the NIH cuts and and,
• 5:59
  - you know, and proposed changes, which
• 6:02
  - threaten a academic mission in a in a
• 6:04
  - very serious way.
• 6:06
  - Thank you for sharing. I feel like you
• 6:08
  - did such a great way of kind of
• 6:10
  - framing that for the audience and also showing
• 6:12
  - how those things are connected,
• 6:14
  - right, to not just cancer, but then also
• 6:16
  - wider, you know, health care operations. So I
• 6:19
  - appreciate you kind of sharing that insight.
• 6:22
  - Shifting gears just a little bit,
• 6:25
  - actually, kind of a lot. It wouldn't be
• 6:27
  - a Becker's health care podcast if I didn't
• 6:29
  - bring up AI, so I'm gonna squeeze that
• 6:31
  - in now.
• 6:32
  - How are you thinking about AI?
• 6:35
  - Are you feeling like it's genuinely
• 6:37
  - changing care?
• 6:39
  - Is the hype outrunning the reality?
• 6:42
  - Are there safety concerns? Kind of what is
• 6:44
  - your strategy or mindset when it comes to
• 6:46
  - that technology right now?
• 6:49
  - Yeah. I mean, I think there's no question
• 6:50
  - that artificial intelligence
• 6:52
  - is,
• 6:53
  - you know, is the next industrial revolution.
• 6:56
  - There's no question
• 6:57
  - that it's gonna
• 6:59
  - markedly
• 7:00
  - change how health care is delivered, you know,
• 7:03
  - in our country and around the world.
• 7:05
  - You know, you know, we have created because
• 7:08
  - we know how much this is going to
• 7:09
  - impact
• 7:10
  - health care delivery,
• 7:12
  - a system wide,
• 7:14
  - task force
• 7:16
  - to be able to implement AI
• 7:18
  - changes into our health care system
• 7:21
  - and optimize its use.
• 7:23
  - I think AI has already
• 7:26
  - started to positively
• 7:27
  - influence our care
• 7:29
  - delivery model.
• 7:31
  - The most obvious is, you know, the use
• 7:33
  - of AI agents,
• 7:35
  - to facilitate our in office
• 7:38
  - documentation.
• 7:39
  - You know, we have Ambient,
• 7:41
  - AI listening for our physicians.
• 7:43
  - So as they're interacting with patients,
• 7:46
  - you know, they can use,
• 7:48
  - this Ambient AI technology
• 7:51
  - for,
• 7:52
  - documentation,
• 7:53
  - for note generation,
• 7:55
  - and really allowing them to connect more personally,
• 7:58
  - with their patients. And I can tell you
• 8:00
  - from our physicians, even those that were reluctant
• 8:03
  - adopters,
• 8:04
  - they, at this point, couldn't imagine life without
• 8:07
  - these AI agents helping them with their, with
• 8:10
  - their notes. So it's it's already,
• 8:13
  - you know, improved
• 8:15
  - that documentation
• 8:16
  - component
• 8:17
  - and improved, I think, you know, the physician
• 8:20
  - patient relationship in a meaningful way. I think
• 8:23
  - the other way that we're employing it
• 8:26
  - is,
• 8:27
  - you know, really to more accurately and and
• 8:30
  - efficiently enhance our billing capabilities.
• 8:33
  - So, you know, there's no question that
• 8:36
  - we're using AI to generate bills and also
• 8:39
  - to more efficiently deal with denials.
• 8:42
  - So, you know, there we have,
• 8:44
  - you know, mechanisms in place where where our
• 8:46
  - first pass denials
• 8:48
  - have decreased significantly due to AI assistance. And
• 8:51
  - then when claims are denied,
• 8:54
  - you know, AI can generate very
• 8:57
  - strong evidence based,
• 8:59
  - rebuttal letters, which could be used,
• 9:02
  - for reimbursement. So we've seen our first pass
• 9:05
  - denials go down significantly with the use of
• 9:07
  - AI,
• 9:08
  - and then we're more successful
• 9:10
  - in appeals as well with that use.
• 9:13
  - I think the other places where we've begun
• 9:16
  - to employ AI with some really meaningful results
• 9:19
  - is in identifying patients who may be at
• 9:23
  - high risk
• 9:24
  - for,
• 9:25
  - readmission
• 9:27
  - based on,
• 9:28
  - large language models that sit over our EMR
• 9:31
  - and can identify patients who potentially
• 9:34
  - could end up either in our EDs
• 9:37
  - and and or, readmissions. So,
• 9:40
  - you know, we've got these systems in place.
• 9:42
  - And when a patient is flagged,
• 9:45
  - we actually have,
• 9:47
  - interventions
• 9:48
  - proactively
• 9:49
  - to reach those patients,
• 9:51
  - you know, have them see,
• 9:53
  - one of our acute care clinics whereby if
• 9:55
  - they're being dehydrated, if they're getting dehydrated or
• 9:58
  - if their electrolytes are, you know, are off,
• 10:01
  - we can proactively
• 10:02
  - address those prior to them adding,
• 10:05
  - having to go to the emergency room or
• 10:08
  - worse yet being admitted. So we've seen,
• 10:11
  - you know, significant
• 10:13
  - success in that area.
• 10:15
  - And then finally, I think,
• 10:17
  - the other place where AI has really been
• 10:19
  - a chain
• 10:20
  - a game changer
• 10:21
  - has been in our radiology department.
• 10:24
  - We use AI assisted
• 10:26
  - readings of our,
• 10:28
  - cross sectional imaging.
• 10:30
  - And, you know, in in a system such
• 10:33
  - as ours where we may have over a
• 10:35
  - million
• 10:36
  - scans that occur in a given year and
• 10:38
  - they get put in queues and physicians read
• 10:40
  - them,
• 10:42
  - AI has actually been able to identify,
• 10:45
  - suspicious
• 10:46
  - scans or those that AI identifies as having
• 10:49
  - an abnormality, and those are put to the
• 10:51
  - top of the list
• 10:53
  - so that physicians can review them and confirm
• 10:56
  - or deny that there's an abnormality there. So
• 10:58
  - I think those are the ways that,
• 11:01
  - you know, AI a few of the ways
• 11:03
  - that AI has really improved our workflows.
• 11:06
  - Now the other question you asked was, you
• 11:08
  - know, where is it not working as well?
• 11:10
  - Or where is the hype really,
• 11:13
  - outrunning the reality? And I think
• 11:16
  - we had a lot of hopes and still
• 11:18
  - have a lot of hopes that AI would
• 11:19
  - be able to identify for us, you know,
• 11:22
  - patients
• 11:23
  - for clinical trial,
• 11:25
  - enrollments
• 11:26
  - and, and, you know, trial matching.
• 11:29
  - To date, while there's been some improvements, it
• 11:32
  - really hasn't
• 11:34
  - met the the hype, you know, that we
• 11:36
  - are hoping would help us with. So we're
• 11:39
  - still working on ways to optimize that, at
• 11:42
  - least in our system. And I'm I'm certain
• 11:45
  - that there will be
• 11:46
  - modifications and improvements, but to date, that hasn't
• 11:50
  - really been as,
• 11:52
  - as successful as we'd hoped.
• 11:54
  - And aside from, you know, the clinical
• 11:57
  - improvements that we've seen, there's no question that
• 12:00
  - AI has been assisting our scientists
• 12:02
  - in identifying,
• 12:04
  - you know, novel targets
• 12:06
  - for, drug discovery
• 12:08
  - and really
• 12:10
  - rapidly increasing the pace of discovery.
• 12:13
  - So I think that's another place where it's
• 12:15
  - gonna make a big, big difference and has
• 12:17
  - made a big difference already.
• 12:19
  - Absolutely. And I I know our audience loves
• 12:22
  - to hear those real world examples of how
• 12:24
  - it's actually, you know, creating change,
• 12:27
  - versus, like you said, kind of the optimistic
• 12:30
  - hope for what it can do and what
• 12:32
  - we all hope it will do in the
• 12:34
  - future, to what it's actually doing. So I
• 12:36
  - I love those examples and how they just
• 12:38
  - ranged, you know, from administrative to clinical and
• 12:41
  - and and science. So,
• 12:43
  - it makes me excited to see what happens
• 12:45
  - next, and I know that clinical trying
• 12:48
  - clinical trial matching pieces is a big one
• 12:50
  - for oncology leaders. So fingers crossed that that
• 12:54
  - one gets worked out soon.
• 12:57
  - When you think of the next generation of
• 12:59
  - oncology leaders,
• 13:01
  - is there a challenge that's happening right now
• 13:05
  - that the field maybe hasn't fully tackled yet
• 13:08
  - that you think will
• 13:10
  - be at the hands or laid at the
• 13:12
  - feet of the next generation of oncology leaders
• 13:15
  - to solve?
• 13:17
  - Yeah. Again, this is one that, you know,
• 13:19
  - we could talk about for
• 13:21
  - hours on end.
• 13:23
  - I really think that,
• 13:26
  - you know, the biggest challenge that the next
• 13:28
  - generation of oncology leaders are gonna face is
• 13:30
  - how to
• 13:32
  - how to really prevent what I'm calling the
• 13:35
  - basic or translational
• 13:36
  - science,
• 13:38
  - brain drain that's occurring. Mhmm. I think because
• 13:41
  - of
• 13:42
  - the last two decades of decreasing
• 13:45
  - NIH funding,
• 13:47
  - which really has far has fallen so far
• 13:51
  - behind inflation,
• 13:52
  - you know, and the the very difficult pay
• 13:55
  - lines for NIH grants,
• 13:58
  - a lot of really brilliant
• 14:00
  - young scientists
• 14:02
  - are either
• 14:03
  - choosing not to become
• 14:05
  - scientists at all, you know, when they're making
• 14:07
  - their choices, or those that do pursue,
• 14:11
  - you know, the basic biologic sciences
• 14:13
  - are choosing not to go to academia, but
• 14:16
  - rather go into industry or other
• 14:19
  - parts of the business world. So I think,
• 14:21
  - you know, the
• 14:23
  - the the brain drain for basic scientists is
• 14:26
  - real.
• 14:27
  - And, you know, when you think about it,
• 14:29
  - you know, major academic centers,
• 14:32
  - the traditional centers that we think about,
• 14:35
  - you know, where there's
• 14:36
  - great clinical
• 14:38
  - delivery and then this large basic science enterprise,
• 14:43
  - I'm really worried about their continued existence. And
• 14:46
  - I think the future
• 14:48
  - generation of oncology leaders are gonna have to
• 14:50
  - figure out
• 14:52
  - how do we
• 14:54
  - not only deliver
• 14:55
  - great clinical care, but maintain that academic
• 15:00
  - focus and discovery that's been so
• 15:03
  - important to why The United States has become,
• 15:05
  - you know, the the leader in
• 15:08
  - cancer care delivery around the world.
• 15:11
  - You know, right now,
• 15:13
  - every leader of a cancer program
• 15:16
  - is being pushed in a couple of different
• 15:18
  - directions that, you know, that don't always,
• 15:21
  - align. One is they want, you know, there's
• 15:24
  - a real need for our doctors to be
• 15:27
  - more clinically active,
• 15:29
  - to see more patients because more and more
• 15:31
  - patients are becoming ill as the population ages,
• 15:34
  - to meet RBU requirements
• 15:36
  - so that they can, you know, justify,
• 15:39
  - you know, their salaries. And, you know, we
• 15:41
  - know physicians in academic practices
• 15:44
  - require an investment from the system, you know,
• 15:47
  - to have competitive salaries.
• 15:49
  - So they're they're being forced to be clinically
• 15:52
  - more more active.
• 15:54
  - But then, you know, we also know that
• 15:57
  - research,
• 15:58
  - basic research in particular,
• 16:00
  - is is something that has to be subsidized
• 16:02
  - as well and to a much larger degree
• 16:05
  - than the clinical practice of medicine. So
• 16:08
  - how do centers, you know,
• 16:11
  - keep their academic focus when they're being asked
• 16:13
  - to be more clinical
• 16:15
  - and there's less resources to fund,
• 16:17
  - you know, this gap in in basic science
• 16:20
  - research? So balancing that, I think, is
• 16:24
  - an existential threat for future oncology leaders that
• 16:27
  - we
• 16:28
  - have to address and is something that I
• 16:30
  - know keeps all of us up at night.
• 16:33
  - Absolutely.
• 16:34
  - My favorite way to end conversations with oncology
• 16:37
  - leaders,
• 16:38
  - even ones that, you know, we we work
• 16:41
  - through and talk about the challenges and the
• 16:43
  - stresses associated with cancer care and research.
• 16:46
  - I always like to end with
• 16:49
  - the future and the optimism and the hope
• 16:51
  - and the excitement? Because I know so much
• 16:54
  - innovation is occurring and so much discovery is
• 16:56
  - occurring when it comes to research and care.
• 16:59
  - What's giving you the most hope and excitement
• 17:01
  - about the future when it comes to cancer
• 17:04
  - care right now?
• 17:05
  - Boy, you know, I've, you know, I've never
• 17:08
  - been more optimistic,
• 17:09
  - you know, about the
• 17:11
  - the future of of of us really
• 17:15
  - curing many, many more cancers than we've had
• 17:17
  - the opportunity
• 17:18
  - to beat in the past. I mean, if
• 17:20
  - you look at, you know, the the promise
• 17:22
  - of the last thirty years,
• 17:25
  - you know,
• 17:26
  - just in in the last thirty years, the
• 17:28
  - rate of survival for all cancers has increased
• 17:31
  - by thirty percent. And that is a dramatic
• 17:33
  - improvement, and that's all due to discovery and
• 17:36
  - new and new drug development
• 17:38
  - and,
• 17:39
  - you know, and all
• 17:42
  - of the trappings of
• 17:43
  - investment
• 17:45
  - in research and clinical care delivery and devices.
• 17:48
  - So we're curing more and more patients and
• 17:50
  - I think
• 17:51
  - the speed of discovery is is,
• 17:55
  - increasing
• 17:56
  - ever more rapidly. So I think we are,
• 18:00
  - you know, more than ever celebrating,
• 18:02
  - you know, cancer cures than we have in
• 18:04
  - the past. I think the future is equally
• 18:07
  - bright because even the pace of discovery,
• 18:10
  - you you know, utilizing
• 18:12
  - AI and more rapid sequencing
• 18:15
  - capabilities,
• 18:16
  - to to deliver even more precise medications
• 18:20
  - and therapies
• 18:22
  - promises that we're gonna have, you know, even
• 18:24
  - a better
• 18:25
  - future outlook. And if there's one area in
• 18:28
  - particular
• 18:29
  - that's really exciting
• 18:31
  - is the area of theranostics,
• 18:34
  - whereby, you know, we can create,
• 18:37
  - you know, these therapies that not only
• 18:40
  - help
• 18:41
  - us find malignancies
• 18:43
  - sooner, particularly,
• 18:45
  - and
• 18:46
  - and stage them better, but then deliver very
• 18:48
  - targeted
• 18:51
  - radiation delivery to those tumors in a very
• 18:54
  - precise way,
• 18:56
  - offers great hope for,
• 18:58
  - you know, even less toxic but more effective
• 19:01
  - therapies in the future. So,
• 19:03
  - you know, for all the
• 19:05
  - challenges that we face in cancer care, I
• 19:08
  - think
• 19:10
  - the hope and the optimism has never been
• 19:13
  - greater because
• 19:14
  - these
• 19:15
  - new discoveries are just gonna create more and
• 19:18
  - more
• 19:19
  - opportunities to cure patients who previously had no
• 19:21
  - hope.
• 19:23
  - Absolutely.
• 19:24
  - Well, I am excited to end our conversation
• 19:26
  - on that note because I know,
• 19:28
  - it's one our audience shares regardless if they're
• 19:31
  - in the cancer space or not.
• 19:33
  - Doctor Technos, again, I just can't thank you
• 19:35
  - enough for coming on the podcast, taking the
• 19:37
  - time today to share your insights. I know
• 19:39
  - they're extremely valuable to our audience.
• 19:42
  - Thank you, Elizabeth. It's been a real privilege
• 19:44
  - and honor speaking with you, and I I
• 19:46
  - thank you for the opportunity.
• 19:49
  - And thank you to our listeners for tuning
• 19:50
  - in to Becker's Oncology Leadership podcast.
• 19:53
  - I invite you to check out even more
• 19:55
  - Becker's Healthcare podcasts at beckerspodcast.com.
• 19:59
  - Thank you again to doctor Technos for joining
• 20:01
  - me today and to our listeners for tuning
• 20:04
  - in. Have a great day.