Latest / Becker’s Healthcare - Clinical Leadership Podcast / Redefining Neurosurgery Through Outpatient Innovation with Dr. Elad I. Levy

Transcript

Redefining Neurosurgery Through Outpatient Innovation with Dr. Elad I. Levy · Becker’s Healthcare - Clinical Leadership Podcast

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  - The strategic agenda facing hospital and health system
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  - leaders right now is not a short list.
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  - Growth in a consolidating market, sustainable margins in
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  - 400 speakers across four days of sessions that
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  - Not in the abstract, but against the real
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  - decisions they'll face heading into the next year.
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  - It's the kind of event you leave with
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  - a clear sense of where you stand and
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  - what comes next.
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  - So join us November second through the fifth
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  - at the Hyatt Regency in Chicago,
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  - and come ready to do the hard thinking.
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  - Register on our events page at beckershospitalreview.com
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  - by clicking on the events tab in the
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  - upper right.
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  - Hi. My name is Paige Twenter. I'm an
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  - editor at Becker's Hospital Review. I am so,
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  - so excited to be joined by doctor Eli
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  - Levy.
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  - He is,
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  - the chair of nurse surgery
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  - at University of Buffalo and director of neurosciences,
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  - also in Buffalo, New York. So I'd really
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  - just love for you to please introduce yourself
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  - and tell us a bit about your organization.
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  - Paige, thank you for having me on this
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  - podcast.
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  - So as you mentioned, I'm the chair of
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  - the department of neurosurgery at University of Buffalo
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  - and the director of I run the neurosciences
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  - for Kaleida Health
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  - in Western New York. But interestingly,
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  - we recently added a whole another dimension
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  - of care for the community, which is the
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  - first
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  - ambulatory neurosurgery
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  - center or ANSC
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  - in The United States.
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  - Can you take us a bit through that
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  - process? What what was that like?
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  - So it it was an amazing process to
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  - get here. So when I became chair a
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  - little over a decade ago, we had nine
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  - neurosurgeons.
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  - The department now grew to over 22
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  - neurosurgeons,
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  - either full time or or or community neurosurgeons.
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  - And as we grow, we need more space.
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  - So what happens are that some of the
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  - younger faculty are doing cases at 9PM
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  - or late in the day.
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  - And we went to the hospital and said,
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  - can you build more OR and angio suites
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  - for the neurosurgery department?
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  - And they weren't in a position to do
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  - that. So we said, okay. What if we
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  - migrated
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  - some of the cases that already go home
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  - same day or cases that should be ambulatory
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  - into an outpatient sector? Can you build us
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  - an ambulatory surgery center? And they said, well,
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  - we have others, and it you know, perhaps
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  - this isn't the right time.
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  - So I said, that's okay. If you won't
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  - do
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  - it, can we do it ourselves? And you
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  - would have thought I was a Jimmy Fallon
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  - monologue
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  - or Rodney Dangerfield or pick a comedian of
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  - choice. But, after the laughter, they said, sure.
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  - Go ahead and do it. So we did,
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  - and we built
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  - a three ORs,
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  - the first biplane neuroangiography
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  - suite, and the first privately held gamma knife
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  - radiation unit in The United States in a
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  - multidis in in a full spectrum,
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  - full gamut ambulatory neurosurgery
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  - center.
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  - So with so many firsts, obviously,
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  - you know, other neurosurgery
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  - centers will be kind of looking at you
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  - all kind of as the model, or you're
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  - kind of piloting it for, you know, others,
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  - what metrics are you tracking to, like, measure
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  - your success with the ASNC
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  - or with other kind of firsts? Love that
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  - question. So, yeah, what metrics, what KPIs? So
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  - we publish. So in two and a half
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  - years, we published eight peer review papers. So
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  - first one, which was really important, is patient
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  - satisfaction.
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  - In our first series for neuroangiography,
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  - which, again, typically is done only inpatient,
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  - We're the only outpatient ambulatory neurosurgery center to
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  - do diagnostic neuroangiography
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  - routinely.
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  - Of the patient responders, we had a hundred
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  - percent five out of five patient satisfaction.
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  - We published that data that's out there in
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  - the peer review literature,
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  - Then we published our turnovers
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  - in that suite, and we averaged about twelve
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  - minutes. Compare that to any hospital. So our
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  - other KPI is twelve minute turnovers.
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  - And then we did a lot of firsts.
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  - So now we're doing
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  - endovascular
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  - care for brain aneurysms
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  - under conscious sedation in the ambulatory center, the
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  - only place. And we recently,
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  - did a live carotid stent. So now we're
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  - doing carotid stents, intracranial
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  - venous stents,
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  - diagnostic angiography, brain aneurysms,
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  - as well as
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  - complex cervical spine, anterior, posterior, complex lumbar spine,
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  - anterior and posterior,
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  - as well as functional neurosurgery for epilepsy
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  - and also neuromodulation
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  - for stroke rehab.
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  - So we have some devices and implants that
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  - we're doing there. And then as I also
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  - mentioned in January,
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  - we opened the first outpatient gamma knife unit
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  - in a freestanding
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  - ANSC.
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  - So lots of firsts.
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  - Yeah. What what's the next first that's planned?
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  - The next first that's planned is gonna be
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  - some crani craniotomy,
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  - so,
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  - basic tumor surgery. Again, we're not talking about
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  - giant deep seated tumors. We're talking about
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  - relatively superficial place, benign tumors where a patient
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  - could go home the same day.
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  - Certainly, we follow-up with them. They can't go
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  - home alone. They go home to a responsible
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  - a responsible
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  - setting.
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  - You mentioned
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  - earlier,
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  - you know, when you started about a decade
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  - ago, there were nine neurosurgeons and others
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  - 22. And, obviously, it's the program has grown
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  - a lot over the past few years.
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  - What would you say are some of, like,
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  - the hallmarks
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  - of Kaleida Health's
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  - neurosurgery
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  - department?
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  - Like, what what's kind of sponsoring this innovation?
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  - What what supports that? So
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  - the ethos, the bedrock, the cornerstone of this
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  - department has always been leading edge in innovations.
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  - The former chair, Nick Hopkins,
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  - is considered sort of the the father or
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  - godfather of neuroendovascular.
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  - So bright coils and stents for brain aneurysm,
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  - AVM glue.
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  - When I was a fellow in 2001,
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  - the concept of intervention for stroke, right, stroke
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  - intervention, Stentrivers,
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  - now sort of commonplace,
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  - That started right here in Buffalo. So we
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  - for a decade and a half, we were
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  - publishing papers, dozens and dozens of papers. And
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  - in 2015,
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  - I was a US principal investigator
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  - in the endovascular
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  - arm for a New England trial New England
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  - Journal of Medicine trial called Swift Prime.
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  - And that article,
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  - with several others,
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  - made stroke intervention the new standard of care.
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  - It's not that long ago. Right? 2015.
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  - So Buffalo
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  - and Gates Vascular Institute, which is the hospital,
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  - and University of Buffalo
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  - sort of was this epicenter for stroke intervention
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  - research. And that was sort of our hallmark,
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  - cutting edge endovascular.
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  - So now we leverage that. You know, recently,
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  - I was the PI of the COMMAND trial
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  - for brain computer interface and endovascular
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  - BCI.
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  - We've sort of leveraged this ability
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  - to innovate, do a lot of neurosurgery under
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  - conscious sedation.
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  - And now we said, hey. There's a bottleneck
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  - in a hospital.
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  - We we can't get the cases, and we
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  - can't get all our surgeons, and we can't
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  - care for the patients
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  - in a timely fashion. We need to decompress.
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  - Orthopedics
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  - did that ten years ago, right, with cataracts,
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  - outpatient,
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  - OB GYN, ENT, general surgery. Why is neurosurgery
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  - the only specialty
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  - that has not migrated
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  - appropriate
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  - patients to the outpatient center?
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  - So we did that. And the other piece
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  - is we don't we're an academic group, and
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  - I'm very grateful to be a part of
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  - University at Buffalo.
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  - So we're the only ANSC
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  - that
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  - is approved for resident training.
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  - So we have residents who work with us
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  - here and are part of the university that
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  - train there, and that's approved by the RRC,
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  - resident review committee.
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  - And
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  - we do genomics,
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  - multi omics, clinical trials. We're listed on clinicaltrials.gov.
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  - So now we're sort of an epicenter
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  - for global
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  - neuroimplantable
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  - startup research, clinical trials that you don't have
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  - to go to a hospital for. Right? Mini
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  - implants.
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  - Well, I mean, as you mentioned, like, orthopedics
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  - did years ago, OB GYN did years ago,
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  - and, obviously,
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  - just overall, more and more health care is
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  - moving to the outpatient spaces or just generally
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  - outside hospital
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  - walls, even if it's not like in a
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  - formal brick and mortar structure.
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  - What I'm wondering is
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  - for leaders listening to this podcast who are
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  - wanting to, kind of following your footsteps and
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  - also
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  - direct their nurse surgery service lines outpatient,
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  - what are some maybe common
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  - obstacles
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  - they might face? Like, what what was something
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  - you had to achieve? Or
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  - Great question. So the biggest
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  - obstacle is a lot of these are inpatient
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  - only codes. Right?
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  - So what do you do with IPO codes?
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  - So this is where I think there's a
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  - great synergy between academic medicine
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  - and clinical practice.
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  - So we wrote many of the papers on
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  - diagnostic angiograms
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  - or aneurysms under conscious sedation. Our spine team
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  - has written many papers. So when we went
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  - to the payers, we said, we think we
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  - can do this safely. We would like to
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  - do a little pilot project, ten, twelve patients.
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  - We published, so in the peer review literature,
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  - our first series of brain aneurysms, about a
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  - dozen.
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  - We wanted to show safety.
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  - And because we had a decade of
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  - publishing and peer review and showing safety, and
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  - this was our data,
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  - the payers were willing to sort of say,
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  - okay. We we we believe you can do
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  - this. And when we did do this,
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  - now they're actually driving care to the AMSC
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  - because of the patient satisfaction, which we published,
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  - five out of
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  - five. No overnight stays.
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  - Time in the center.
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  - No cancellations for emergencies. Right? We don't do
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  - emergencies at the outpatient center. That's for the
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  - hospital.
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  - So I think the biggest obstacle if people
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  - are gonna replicate this, and we're happy to
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  - help people replicate this, is
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  - demonstrating to the payers that this is you're
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  - gonna bend the cost curve positively
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  - because our cost of care
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  - is a fraction
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  - of what the same cost of care is
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  - in the hospital.
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  - Patients want this.
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  - And it's just it's just where where the
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  - field needs to move to decompress the hospital
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  - so you can do
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  - the cases that need to be done in
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  - the hospital
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  - not three months from now, but weeks from
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  - now.
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  - My last question for you is, where do
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  - you see the most opportunities for organizational growth
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  - over the next year?
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  - So we've had 20 plus centers and c
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  - suites get on planes or cars and walk
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  - through.
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  - The biggest opportunity is this will be scaled.
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  - Right? This cannot be an n of one.
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  - So, yes, we're training the next generation.
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  - Other centers are coming. It has to happen
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  - because the health care system cannot continue the
• 11:30
  - way it is.
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  - Again, bottlenecks in the hospital. We need to
• 11:34
  - decentralize.
• 11:35
  - We need to decentralize clinical trials.
• 11:38
  - You know, the amount of bureaucracy and time
• 11:40
  - it takes to get trials through major centers
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  - is challenging. This can be expedited in an
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  - outpatient center.
• 11:47
  - The cost of care, again, is a fraction.
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  - So whether
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  - neurosurgeons
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  - or hospitals want this to happen, this is
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  - happening because the opportunity is is not is
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  - much more than just
• 11:59
  - a volume opportunity. It's a cost of care.
• 12:01
  - It's a patient satisfaction. It is a decompression.
• 12:04
  - It is an epicenter for clinical trials research.
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  - So it's habits. What I say is the
• 12:09
  - train is leaving the station.
• 12:11
  - Whether you're gonna be whether you're on it
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  - or not is your choice. Right? It's leaving
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  - the station. We don't talk about the well-being
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  - of the care team. Certainly, patient well-being
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  - is first and foremost.
• 12:22
  - But you have and and Becker's has talked
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  - about this. You talk about physician burnout, early
• 12:27
  - retirement,
• 12:28
  - high suicide rates in in in some of
• 12:31
  - these specialties
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  - because
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  - it's hard. What we do is hard, and
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  - the one commodity you can spend but never
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  - buy is time. So if you're if you're
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  - in a hospital that's doing ninety minute turnovers
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  - or two hour turnovers, you're getting home at
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  - 09:00. You do the same volume at this
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  - outpatient center. Now you're getting home at 03:00.
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  - You can see your family. You can go
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  - to the gym. You can have balance in
• 12:53
  - your life.
• 12:54
  - So
• 12:55
  - the quintuple aim involves not only patient well-being,
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  - but care team well-being, the health care team
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  - well-being. And I think we're trying to address
• 13:04
  - all of that.
• 13:05
  - Well, I'm excited to see, you know, continued
• 13:09
  - ROI that and efficiencies and safeties you guys
• 13:12
  - are gonna be recording over next few years,
• 13:15
  - decades, etcetera. So I just wanna say thank
• 13:16
  - you so much for joining us.
• 13:19
  - Well, thank you for having me.