Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Joseph Craft, Cardiologist and President of Medical Staff at St. Luke's Hospital

Transcript

Dr. Joseph Craft, Cardiologist and President of Medical Staff at St. Luke's Hospital · Becker’s Healthcare - Clinical Leadership Podcast

• 0:03
  It's so important for leaders at the top of organizations to keep learning,
• 0:07
  stay sharp, grow their networks,
• 0:09
  help our audience better do this in a more simplified, personalized,
• 0:12
  and meaningful way. Becker's Healthcare has launched my bhc,
• 0:16
  it's your trusted Becker's healthcare experience and more with content,
• 0:19
  connections, events and learning opportunities.
• 0:22
  Join the community free of charge@www.my dot becker's hospital
• 0:27
  review.com and we'll see you there.
• 0:33
  Welcome everyone to the Becker's Healthcare podcast series.
• 0:37
  I'm Ryan Muhammad with Becker's Healthcare.
• 0:39
  I'm thrilled to have with me today Dr. Joseph Kraft from St. Luke's Hospital.
• 0:44
  Dr. Kraft is so nice to talk with you today. How are you?
• 0:48
  I'm, I'm well. Thank you for having me on. I've, uh,
• 0:51
  enjoyed listening to some of the other podcasts that you guys have published,
• 0:54
  and I think it's great what you're doing.
• 0:56
  I appreciate you trying to share the word about heart health.
• 0:59
  Oh, yeah, absolutely. Thank you so much for those kind words,
• 1:02
  and we are so excited to have you on today. Uh, to begin,
• 1:05
  would you mind please introducing yourself and telling us a bit about your
• 1:08
  background?
• 1:10
  Sure. My name is Joe Kraft. I'm a cardiologist in St. Louis, Missouri. Uh,
• 1:14
  I trained,
• 1:15
  I did college at University of North Carolina and I did medical school at Wake
• 1:20
  Forest University.
• 1:22
  I did a residency in internal medicine and a chief resident year at Vanderbilt
• 1:26
  University, and I did a cardiology fellowship at Washington University in St.
• 1:31
  Louis on board certified in internal medicine, cardiology,
• 1:36
  echocardiography, and nuclear cardiology. And, uh,
• 1:40
  I'm a general cardiologist. I love taking care of patients. Um,
• 1:43
  that's what gets me out of bed in the morning.
• 1:45
  But I also have an interest in the business of healthcare,
• 1:48
  including everything including policy, finance, uh,
• 1:52
  technology and population health.
• 1:55
  And so I've had the pleasure of holding some leadership positions. Uh,
• 1:58
  currently I'm the president of the medical staff at St. Luke's Hospital at St.
• 2:01
  Louis. St. Luke's is, um, an independent health system,
• 2:07
  uh, of medium size. We have a 30 locations throughout the St.
• 2:10
  Louis metropolitan area. Um, high, very high quality place.
• 2:14
  We pride ourselves on that, uh,
• 2:17
  Medicare five star rating for the flagship hospital.
• 2:19
  We have a alliance in partnership with Cleveland Clinic, and, um, we have a,
• 2:24
  a mix of, uh, employed physicians and private physicians. And, um,
• 2:29
  culture is very important to us.
• 2:32
  Yes, absolutely.
• 2:33
  Thank you so much for sharing that background knowledge and with all of your
• 2:37
  experience in healthcare. The one thing I wanted to ask you first is,
• 2:41
  what are the top three biggest issues in cardiology today?
• 2:47
  Well, I'm sure, uh,
• 2:48
  you'd get a lot of different responses from different people in the field,
• 2:51
  but some of the things that I think are interesting and I think are dynamic
• 2:56
  features in our world, uh, day-to-day,
• 2:59
  both for the folks of those of us who work in the trenches and see patients
• 3:02
  every day, but also for the folks who step back and look at, uh,
• 3:06
  cardiovascular care from a bird's eye view,
• 3:08
  maybe around the country or around the world.
• 3:11
  One of the things that we struggle with is what I like to call therapeutic
• 3:15
  optimization. Uh,
• 3:18
  when we develop therapies to try to help people for various heart conditions,
• 3:22
  and there's, there's so much heart disease out there, uh,
• 3:26
  we have a hard time translating that from established, qualified,
• 3:30
  good quality evidence to widespread adoption and access to
• 3:35
  patients who need those things. So numbers have been diff have,
• 3:40
  have been quoted differently,
• 3:42
  but there's a lot of reports to suggest that it takes 10 to 15 years
• 3:46
  until high quality publications are available to
• 3:51
  physicians,
• 3:52
  even published in large white paper guidelines accepted by professional
• 3:56
  societies before those same therapies are widely adopted.
• 4:02
  Um, so we have a gap.
• 4:03
  We have a gap between evidence-based and widespread use,
• 4:07
  uh, and availability to patients.
• 4:10
  There were a lot of people who felt that the,
• 4:13
  on the introduction of electronic health records in the mid two thousands were
• 4:17
  gonna solve a lot of those problems. Unfortunately,
• 4:21
  electronic health records really have been mostly disappointing with respect to
• 4:25
  their ability to impact population based healthcare in a, in a large way,
• 4:29
  whether that is the population of a PHY single physician's
• 4:34
  panel or a small practice or, uh, you know,
• 4:37
  thinking about the country as a whole.
• 4:40
  So I think one of the things that's interesting is there are, uh,
• 4:44
  with the introduction of a lot of AI tools, artificial intelligence tools,
• 4:48
  there,
• 4:49
  there may be an opportunity finally for us to accelerate
• 4:54
  the rate at which we as a medical community adopt highly qualified
• 4:59
  therapies to make a difference. Here, I'll give you an example in,
• 5:04
  in taking care of patients with congestive heart failure,
• 5:06
  those people with heart failure, we call with a reduced ejection fraction.
• 5:10
  We now have a pretty commonly accepted four drug regimen,
• 5:15
  um, that has well-established use,
• 5:19
  is endorsed by all the cardiology professional societies. Um,
• 5:24
  however, if you look at nearly every group of physicians, uh,
• 5:29
  almost any way you slice the pie, you can see that, um, use of one of those,
• 5:34
  or maybe two of those medications, uh, is relatively commonly done.
• 5:39
  But getting all three or all four medications,
• 5:43
  and even this is include excluding people who are allergic or having
• 5:46
  intolerances. We just haven't gotten there yet.
• 5:49
  Some of this information is newer,
• 5:51
  but we want to accelerate the timeline to adoption.
• 5:53
  We know that there is a big difference sometimes adding years of life
• 5:58
  going from two of these heart failure medications to four of these heart failure
• 6:02
  medications. So, um, one of the tools that we're using, and I don't have,
• 6:07
  I have no disclosure, no financial disclosures, but I think it's interesting,
• 6:10
  one of the tools that we're using in our health system is called cardio care.
• 6:14
  Cardio care is a software tool.
• 6:17
  It's part of the Edwards Life Sciences family of companies and
• 6:21
  cardio care, as an example, uh, has the ability to pull out,
• 6:25
  to extract a lot of data from, as an external software piece,
• 6:30
  from the electronic health record,
• 6:32
  and analyze it in a sophisticated way and give us reports of how
• 6:37
  many patients from our population are on the four drug regimen who would qualify
• 6:42
  based on their ejection fraction and their symptoms. It's a,
• 6:46
  it's a really robust reporting tool. It's very insightful,
• 6:50
  and it can be updated in real time. Um,
• 6:52
  and it can be given this information be provided to physicians,
• 6:56
  to nurse case managers, um,
• 6:58
  to population health teams to try to help impact care and deliver
• 7:03
  care to a larger group of folks. So I use that as an example, and I,
• 7:08
  I hope that's one, uh,
• 7:10
  one insight into what the next year or two or five could look
• 7:15
  like as we try to make high quality cardiovascular care, more dynamic,
• 7:20
  more responsive to, um,
• 7:23
  data that gets published and help our patients live longer and live better.
• 7:28
  Yeah, absolutely. Thank you so much for all of that insight. I,
• 7:32
  like you said at the very beginning, I can definitely, uh,
• 7:35
  I hear a lot of different answers to this question, but you know,
• 7:38
  I'm excited that you spoke about something that I don't hear about too often.
• 7:42
  And keeping in mind those big issues,
• 7:45
  how do you see heart care evolving over the next 18 months?
• 7:49
  Do you think that some of those issues will be solved by then?
• 7:53
  I, I, i see. I guess I would say, um, I would, I I'd say there's, uh,
• 7:57
  challenges, concerns, and there are opportunities.
• 8:01
  Let me kind of highlight one of the challenges.
• 8:03
  So we have workforce challenges in, in cardiology,
• 8:06
  as many of your listeners may know. As of 2010,
• 8:13
  the baby boomer group started hitting Medicare age and we have an aging
• 8:17
  population,
• 8:18
  and roughly 10 to 12,000 people reached 65 years old in the
• 8:23
  United States every single day. And as we get older,
• 8:28
  cardiology tends to be care of mostly older folks. Um,
• 8:33
  and so we anticipate a lot of increased care needs. So,
• 8:38
  um,
• 8:39
  the challenge though is that we have a cardiology workforce that is not growing.
• 8:43
  So among cardiologists in the United States,
• 8:46
  we lose about anywhere from 500 to a thousand cardiologists that's been
• 8:50
  estimated per year out of the workforce. And that's for a lot of reasons.
• 8:55
  One of those is because at present,
• 8:57
  about 60% of cardiologists are over the age of 55, 20 5% are over the age of
• 9:01
  65. Those numbers are going to increase.
• 9:05
  We have long training timelines.
• 9:07
  People start into medical school in this era a little later in life,
• 9:12
  a couple years later in life than they did 15, 20 years ago. Um,
• 9:16
  we have physicians who are field burnout for lots of reasons,
• 9:20
  have been worked very hard, COVID didn't, nothing did nothing to help that. Um,
• 9:24
  so we have some people who are scaling back their work.
• 9:27
  Some people are retiring early, and that's resulted in the shorters.
• 9:31
  At the same time, we have an arguably bigger problem in the United States, uh,
• 9:35
  that we have a tidal wave of nursing shortages coming.
• 9:40
  It's estimated that around 2026 we'll have anywhere from
• 9:44
  300,000 to 500,000 nursing positions open and unfilled in the
• 9:49
  United States. It is very challenging to hire nurses right now.
• 9:54
  So on the supply side, uh, for the,
• 9:57
  for the expected increase need of our population,
• 10:01
  we're gonna have less people to do that.
• 10:03
  So there are gonna be lots of clever ways. I hope,
• 10:06
  I hope there'll be lots of clever ways to try to increase that. There's some,
• 10:09
  uh,
• 10:10
  activity on the legislative side in trying to increase the number of approved
• 10:14
  and paid for, uh, residency positions.
• 10:18
  There are some medical schools that have been ex have been growing and expanding
• 10:21
  and trying to graduate more doctors. There will be a lot of extension,
• 10:25
  including the use of nurse practitioners and physician assistants and
• 10:30
  physicians leading those care teams to try to take care of all of our folks.
• 10:34
  But that will for sure be it. So that's for sure a challenge.
• 10:38
  I think one of the things that's interesting that will happen in that same
• 10:41
  context is
• 10:45
  roughly 85% of the,
• 10:46
  of the cardiologists in the United States are employed or tightly aligned with
• 10:51
  health systems.
• 10:51
  That's a flip from the way things worked 25 years ago when it was around 25% of
• 10:56
  cardiologists had such alignments.
• 10:58
  So health system and cardiology care teams are working tightly together,
• 11:02
  and they are working in,
• 11:04
  in the context of a changing kind of care venues.
• 11:08
  So for example, we anticipate the inpatient cardiology needs,
• 11:13
  hospital-based cardiology care to increase around 5%,
• 11:17
  maybe 6% over the next decade. That's a national estimate,
• 11:22
  but the outpatient care needs, we expect to grow 25%.
• 11:26
  Health systems historically have been very focused on
• 11:31
  bricks and mortar patient heads and beds.
• 11:34
  What do we do on the inpatient side?
• 11:37
  And many have not been really focused on seeing the outpatient
• 11:42
  realm of care as their future.
• 11:45
  And I think all of us are gonna have to sort of adopt a mindset that the
• 11:49
  outpatient realm where we care for patients is really gonna be our future.
• 11:54
  So how are we gonna get to that and our health system's gonna be able to make
• 11:58
  that transition effectively. You know,
• 12:00
  their health systems are under financial strain. It's a, it's a tough industry.
• 12:04
  Those are kind of small margin. Um, it's a small margin business.
• 12:09
  Um,
• 12:10
  and we see an influx and an increased interest in other,
• 12:15
  uh, other groups coming into the outpatient realm.
• 12:17
  And among several is includes Amazon, Walmart, uh,
• 12:22
  United Healthcares, Optum have been, uh,
• 12:25
  moving more into the outpatient care realm.
• 12:28
  So it's gonna be very interesting to see if over the next five years there's
• 12:31
  some disruption in where we take care of patients and who is taking care
• 12:36
  of those patients in that outpatient realm. I think it's gonna be very,
• 12:40
  very interesting. My hope is, I guess I,
• 12:43
  I'm kind of a glass half full kind of guy, so you, you asked about, um,
• 12:47
  you know, you asked about opportunities and threats.
• 12:50
  I I hope that this landscape, um, shakes things up. Uh,
• 12:55
  healthcare by its nature has not always been very fast moving. And,
• 12:59
  and I think it would be really exciting if it were a time of accelerated change
• 13:04
  and increasing innovation,
• 13:06
  maybe even out from outside of some traditional healthcare players to try to
• 13:11
  shake things up and help us take care of people better. For me,
• 13:14
  that would be fun. And uh, that would be fun change. That would be exciting.
• 13:19
  Yes, absolutely. I completely agree with many things you said. Um,
• 13:23
  and we definitely do need some creativity in dealing with some of those issues
• 13:27
  arising. Uh, however, before I let you go, doctor,
• 13:30
  the last thing I wanted to ask you is what are you excited about and also what
• 13:34
  is making you nervous? I know something you mentioned about, uh,
• 13:37
  nerve shortages and that can definitely make one nervous .
• 13:42
  So,
• 13:44
  so the things that I'm nervous about are having an increasingly strained
• 13:48
  healthcare system, both on the hospital side where we don't have enough nurses,
• 13:51
  where we still struggle with high expenses,
• 13:55
  that we don't have enough cardiologists and, um,
• 13:58
  support team to take care of the patient care need. That, that's my concern.
• 14:03
  What, what I'm hopeful about,
• 14:04
  what I'm optimistic about is that there'll be an increasing push to
• 14:09
  address these things in new ways. So, um, for example,
• 14:14
  if, if we were to take care of patients in a better way,
• 14:18
  I mentioned this therapeutic optimization concept.
• 14:21
  If we were able to figure out among the thousands of patients,
• 14:25
  say in our health system that we care for and that we know have chronic
• 14:29
  conditions that we have to manage over time,
• 14:32
  if we can figure out who those people are, if we can learn about them,
• 14:36
  if we can get data, feedback them in real time,
• 14:39
  and now it seems like we're at the advent of having tools to effectively do
• 14:43
  that. Um, I think that we can make a major impact in those patients care,
• 14:48
  help keep them out of the hospital, help keep them happier and living longer.
• 14:52
  We're also starting to see some software applications that are gonna have
• 14:56
  increasing opportunity to impact the electronic health records. Um,
• 15:00
  despite the best efforts,
• 15:02
  many of those electronic health records haven't evolved very fast over the last
• 15:06
  15 years or so since they've been available. Um,
• 15:09
  there are also artificial intelligence and voice recognition tools that
• 15:14
  hopefully are gonna get doctors and nurses less and less
• 15:19
  obligated to do data entry, uh, typing all day long and clicking all day long.
• 15:25
  Uh,
• 15:25
  it is the bane of the existence of those of us who take care of patients every
• 15:28
  day and it's a time suck. And we really,
• 15:31
  really need to get away from that in order to allow people time,
• 15:35
  face-to-face with patients, which is what patients want. If we do those things,
• 15:40
  I think we'll have both a happier healthcare workforce and patients who are
• 15:45
  better cared for.
• 15:47
  Yes. Thank you so much for those final thoughts, doctor.
• 15:49
  This has been an amazing discussion.
• 15:52
  So I do wanna thank you so much for coming on Becker's Healthcare to, uh,
• 15:55
  speak with me today and I look forward to connecting with you again soon.
• 16:00
  Right. It's been a pleasure.
• 16:01
  Thanks for what you're doing and I'll look forward to the next time.
• 16:04
  Thank you.