Latest / Medsolve Dynamics / Running a Cancer Program in 2026: Capital, Operations, and the Job Behind the P&L
Transcript
- Yoel Bakas: Hey Jeff, how you? hope you're doing well. Thanks for being here. I appreciate the time. I know ⁓ you're a busy guy, I'm excited for everyone to hear some of your thoughts. I've known you for a really long time. I'm eager to get into this conversation have some of the the knowledge that i've been fortunate enough to get from you to be shared with other people so i really do appreciate the time in and you being here so thank you Jeff Siupik: No, absolutely. Looking forward to it. Yoel Bakas: I thought we'd start with at high level from, where you sit with running a cancer program and maybe you can just tell me a little bit so that everybody knows what I know about, your background and what you do and running the cancer program. What are some of the biggest that you're seeing with that space in this particular moment? Jeff Siupik: Okay, so yeah, I've been a leader in the oncology space for over 25 years, been in the field of oncology for over 35. in my current role, I am to oversee all the operations currently. And the biggest that we are facing right now ⁓ is the balance growth and control and expenses. And that's a really line to follow just because if you're in the growth phase, you may be hiring service lines that you want to add, but by doing that, you're adding labor expense to get prepared for the increase in volume. But then if that service line up slower than you thought, ⁓ ⁓ &L looks a little worse just because you've added expense and didn't really offset it with revenue. Yoel Bakas: I know when we've talked in the past, you've a lot operational efficiency ⁓ as a big word and a big buzzword there, right? ⁓ I think there's an opportunity for programs ⁓ to improve how they're doing on efficiency. I'd love to your take that and why you think it's so important. Jeff Siupik: Yeah, think it's important because ⁓ the end result, hopefully you're running at the highest level efficiency that you can. I caution that if you use the ⁓ stoplight. measures red light meaning bad yellow you're in the middle and green you're fine-tuned. Just because you're one of the colors doesn't mean you need to react. For instance, just because you're green and that you're running efficient doesn't mean that your staff's not running in the red line of their mental capacity. Maybe they are so ⁓ stressed they are so at the peak of their performance that adding one more person might put you in the light green or yellow Yoel Bakas: Mm-hmm. Jeff Siupik: but their satisfaction and their retention might be better because you're not running that way. And likewise, just because you're in the red, maybe that service line just doesn't have the volume to push you up to the next color. So I think you need to look your system as a whole and see why you're at those certain levels. Yoel Bakas: Yeah, no doubt. think, I mean, you on people is so important, right? I mean, I've been, as you know, in the for 20 years and there's two things that always keep coming back as for me One is patients obviously, and the importance of making sure that that's ultimately what you're focused on. And the second is the people that are treating and running the departments have to be happy and they have to be in a good space because that's ultimately it makes all the difference in how those patients are treated, right? So I think it's ⁓ important ⁓ make sure that ⁓ happening and that leadership is really focused on that as they run these cancer programs. Jeff Siupik: No, you're right. just because a department might be in the green, the patients are going to pick up that their stress that they're at their, at their breaking point. So, executives need not to just look at the color. They need to look at ⁓ the ratio and, the satisfaction of that department. Yoel Bakas: Yeah, yeah, no doubt, we've talked in the past about the disconnect that exists between the executive floor or the C-suite and the clinical teams. And, I would like to get a little bit of depth into ⁓ why that exists and, what you think can do about Jeff Siupik: Sure, and the why might seem very simple. The C-suite is looking at P&L, they're looking at numbers, the clinical team is looking at high quality patient care and compassionate care, right? So you might have a finance person that wants to keep driving numbers and volume, which is better for the organization. And... they might be putting the onus on some of the frontline managers in those departments as responsibility for volume. I just don't think that that. really should be the case. The volume should be coming from your brand recognition, your marketing efforts, your physician relationships with the outside community, and your frontline manager's responsibilities are to treat that patient with the highest quality and compassion that they have. So I think the disconnect is that sometimes leaders put the volume expectations on the frontline leaders when it really should be on the system. Yoel Bakas: how do you ⁓ manage of things, if you have a clinical team that's fundamentally focused on the patients and patient delivery and care, and you have a C-suite that's fundamentally focused on volumes and the number, where does the marketing, the referrals, the recognition, who does that? I mean, where is that focus and how do you make sure that it gets the attention it needs? Jeff Siupik: Well, there's several lines marketing that most organizations probably do. They probably do, you know, paid marketing, then there's earned media, earned marketing that ⁓ places cover you for free just because you're a good organization or a physician has done something or ⁓ has given talk ⁓ on ⁓ or That's great. You know, it's free. It's brand recognition. Then most organizations, not only in healthcare, but other organizations also have liaisons that go out and try to tell the community what we have to offer or what your system has to offer. So that's another way that, the marketing and the volume can come in. just really good, and also patience, right? Patients we hear that a good experience, they'll share with their friends and family. However, a negative experience spreads faster than a positive experience. So making sure that your frontline is giving the best compassionate quality care. Yoel Bakas: Yeah. Yeah, and goes back two things, right? One is the happiness of the staff and how staff is functioning. And then the other one is making sure that there's a story to be told that resonates with both the physicians and the community and the patients in terms of why you, why they should pick your center versus others. So. It's I think a holistic view if you want to think about it that way ⁓ of ⁓ at the program and building it. Jeff Siupik: Yeah, absolutely. Yoel Bakas: I know you've bought one or two pieces of equipment in your career ⁓ and been involved in those decisions in terms of ⁓ the that are considered when one is making capital decisions. What do you think differentiates the people that get those capital decisions ⁓ right the ones that don't? Jeff Siupik: Boy, yeah, that's a good question. And you're right. I'm very fortunate that in my, in my career, it's mainly been radiation oncology, but I've also ⁓ spanned into surgical and medical oncology, but a linear accelerators life spans between 10 and 12 years. I've probably put in over eight or 10 of them in my career. And, PET CT is very popular in the oncology space. So ⁓ those are very heavy equipment. So really have to look at your ⁓ system on what they might be referring to that unit. If it's a PET, a MAMMO, an MRI or a linear accelerator. Look at your internal. diversity of physicians, if it's medical oncology, if it's urology, if it's surgical oncology, try to look at historical. You can even look at referring patterns before you had that technology and pull data of how many referrals you've made to that piece of equipment and then do your own internal ROI, with some growth that would happen. Because once you have it, your group tends to use it more because you have it. Yoel Bakas: from the vendor side I've seen and I've been involved in hundreds of those purchase decisions, And sales and ⁓ it's always interesting to look at it now from the other side of the and think about the things that I used to think about when I was selling things and how those tie ⁓ with, programs today. And there's ⁓ a lot of different nuances to consider, but ultimately what you said about referral patterns and volume patterns and how the physicians are using the technology and what the workflows are going to be and what the program is trying to do. It, I always thought those were important on the vendor side and now I see that they are critical. And if you don't get those right, you end up with a piece of technology that maybe is underutilized or that's not going to deliver on what you're trying to do. and the cost of boatload of money to either buy or support, because you have both sides of that that you have to manage. Jeff Siupik: No, you're right. And I didn't touch on, but you just did just because you have that capital outlay for the equipment. there are ongoing expenses. Service contracts are in the six figures. And then there's software license that you have to ⁓ And then there's staff that you've hired to, to man that machine. so. It's not only the heavy piece of equipment cost, it's also the ongoing cost. And there are some things that facilities can do if you've purchased it and you may have missed the mark. There's things that you can do to help offset some of your fixed expenses and get creative like block leases. Yoel Bakas: it is a creative way to about that, tool or device that maybe is underutilized or that's not producing. And how do you pivot that into something that can be ⁓ revenue generating? obviously right now, we're seeing the reimbursement changes are people, especially freestanding I'm hearing 10 to 30%, ⁓ of reimbursement hit and everybody's trying to figure out what to do and I'm hearing a lot of send a note to Dr. Oz, which I think is great. But I think that will affect things maybe next year. the question in my mind is what can practices do today to offset that? And I think that block lease idea or revisiting service contracts or ⁓ getting really ⁓ about the capital of equipment becomes really important this year until ⁓ maybe it gets addressed next year. Jeff Siupik: Yeah, and what also puts some pressure is keeping up with the market and the competition, right? If you want to be touted as the leader in oncology, your physicians want to be proud and offer everything to their patient load. So there's also pressures to keep up with the market where you might act a little too sooner than you might have to just because of that external pressure. Yoel Bakas: you just brought up ⁓ with the market. That leads to question. Every day I open the news and where everybody's talking about AI. Obviously, I've been deep into the conversations in AI and I've taken a very pragmatic view of it, which is you have to understand what problem you're going to solve before you deploy a software solution or an AI solution. Every day it seems like there's a new generation and a new version of AI that's coming out. trying to figure out how they can help maybe reduce staffing or change staffing or improve workflows and everybody's a lot of things with AI but not many people take a step back to look at what problem they're actually trying to solve with the tool first, build that out and then think about the evolution of the tool how it can help with that. can you can tell me a bit what you guys are doing with AI right now Jeff Siupik: Sure. And I think it's important to note that this question comes at a good time because I just came from a conference this week ⁓ there were companies from all over the span. had Google, you had Amazon, you had some developers and AI one of the talks. And ⁓ getting your about how we're currently using it, ⁓ I think it's to tell you Yoel Bakas: I'm sure. Jeff Siupik: What we came away from the conference is right now, AI is really going to be used to allow ⁓ person more time to do more important things or other things. Like for example, we are currently using a software ⁓ records the internal conversation between the patient and the physician. And instead of the physician using a scribe or transcription service or dictation, that software is recording it and then it will pull the pertinent information from that visit. So it might allow the doctor more time to see more patients. It might allow the doctor more time to plan the treatment plan. So that's one example. Also medical records, pulling medical records for oncology only is different than say for a family physician. And so we're using software that will help the medical record gathering process for our oncology patients. Yoel Bakas: Yeah. I think we're just starting in use of AI. ⁓ It does seem like there's a huge opportunity to make things better. patients are going to start using it and more as well on the other side, because I think for patients, it's a way to check things and talk about, understand what it is that their diagnosis is, what their treatment's going to be. I had a really interesting conversation with a physician who told me they were concerned because patients are coming in with a chat GPT or a claude analysis of what's going on. And this physician was like, look, I went to med school and maybe I don't agree with it. And here's a patient arguing with me on this is what the AI technology is saying. if they argue back, then they get lower patient satisfaction scores So it's this really interesting dynamic right now. At the end of the day, think we're just starting and I don't think it's going to go away. I use it every day. we're getting started with the technology. Jeff Siupik: Yeah, and a lot of the medical community, we call it Dr. Google when a patient comes in and they're armed with It's the opposite of OE, right? Operational It slows you down because now the patient is armed with what they believe is ⁓ data they can argue, refute, or maybe sometimes probably confirm with what the doctor's testing. Yoel Bakas: Sure, Yeah, From where you sit, for programs are looking big decisions in the next six to 12 months, and especially in this environment that we're in, what are some of the things you would recommend or tell them to think about to make sure that they're successful. Jeff Siupik: Man, it's, and this isn't staged. I know people that might be watching this might think that we've teed these up, but we haven't. And so what's, what's really interesting about your question is, I am looking at our capital requests and specialty feels that their request is the highest priority, right? And they're the most important person in their world. Right. ⁓ And we, as organization just recently have tried. Yoel Bakas: Of course. Jeff Siupik: to think of a philosophy. Let's get everyone in the room. Let's show them the capital requests. They realize we can't do all of these obviously, but what is best for the organization? What is best for our system? What is best for maybe... outside referrals, what's going to make us stand apart, what's going to make us come up to the competitors and not just your certain specialty. So that's the approach that we're going to take. We're going to in any line of decision making, getting buy-in from the people that you're working with is going to go much further. So if we can get all the physicians, show them our requests, talk about what's best for the system, the organization, and then help them help us make the decision. Yoel Bakas: Did you as a leadership team come together first to figure out what that set of criteria is ⁓ to evaluate it against and through? based on the ⁓ organizational goals, this is sort of the criteria we think really important. That's how we're going to align to them. Jeff Siupik: Yeah, I mean, everybody has a service line that they're responsible for, and then they were bringing the capital requests because it's coming to budget season. We asked the leaders, submit your wish list, let us know what's on top of mind with your physician. And then... They're like, they say we have to have this. Well, everyone says that. And then we just, as a leadership team said, you know what? I think we all need to lay this out, bring them all together and say, what's good for the organization? What do we need? And maybe that one piece of equipment is gonna help every one of those people where they might not have thought that. Yoel Bakas: I have in my mind, as you're describing this, either the Coliseum, where everybody's coming in to get into this huge fight over their capital equipment, and then they're coming in armed with like some chat GPT or Claude description of why they have to win. You know, it's gonna be like, hey, this is why this has to be the number one thing. Jeff Siupik: And I think we'll hear, yeah, we understand, but we need this, right? ⁓ going to hear that. But, ⁓ it's really just the expectation that we have X amount of dollars. Here is ⁓ five X that Let's work together to decide what we need as a group. Yoel Bakas: Yeah. Yeah, I love that. I love that. And going back to full circle moment to where we started the conversation, everybody gets so busy with treating patients, which is rightfully so what they should be doing and running the cancer center to make sure that those patients can be treated. ⁓ It ⁓ really to find time and space to have strategic conversation and look at what the right thing for the program, the right thing for the organization is, what the right criteria is to look through all of that. It becomes, hard to find the time and the space to do that when you're trying to run a program and run a center and running around putting out fires. And so I think it's great that you guys are doing it. ⁓ I that more places do it and that they rely on others if they need help doing that because I think it's so important to get that right. Jeff Siupik: Yeah, and it's also, a testament to the service line physician that's advocating for themselves because they're passionate about providing the best up-to-date, current technology and care for their patients. So everyone's coming from a good place. We just have to level set that there's just so much money to go around. And it also has to lean into the mission of the entire organization. Maybe you're Board stuff like that, there might be higher level that's directing you to go in a certain path that now, might lead you to a certain decision. Yoel Bakas: You've always been very creative in the way you address some of the of organizations. I think you've always done that in your career. And it creates new ⁓ angles the organization. It creates new sources of ⁓ revenue for the organizations. It helps offset some of the challenges that they're experiencing. How do you find those creative angles and how do you find time? I mean, you're out there fighting fires every day. Jeff Siupik: I mean, that's a good question. Tough question. I like to pride myself on being a change leader, in every org that I've been a part of. I always raised my hand first and, saying that we'll, we'll do this first. We'll be the beta for this. And I think it. It takes your leaders to be on board. Again, I think retention Yoel, for physicians and staff, it is giving them challenges, giving them pride in what they're doing, having them tell their friends and family that they're working on the latest and greatest technology. part of retention is also being viable, right? You have to have a viable company. So I think ⁓ have thought outside the box, you know, for one example in of my organizations I worked for, Yoel Bakas: Sure. Jeff Siupik: You know, we had pet CTs and in turn, it was mainly for our internal patients, but sometimes that can't fill you up as much. And then looked at maybe having our liaisons tell the local community that we can offer diagnostic CT and pets. And if the wait time is longer at your bread and butter radiology places, we can do those. So. Yoel Bakas: Yeah. Jeff Siupik: It was taking buy-in from some of the physician leadership to allow us to do that because we don't want to lose our identity of being oncology provider. But the other thing you can do, if you're looking at it holistically, if you're bringing a patient into your org for just diagnostic imaging, they came to your organization. If something happens down the road, they remember your organization and ⁓ might be, you know, a patient that you might have forever. So I think it's to keep the viability of your organization. going, keeping people happy, and just getting creative of what can we do to generate revenue that we haven't thought of. Yoel Bakas: it's amazing to hear you speak with that level of passion and care for the organizations that you represent that you've led. And I think that's why the organizations have been successful. So it's awesome to see that. ⁓ And I know at the end of the day, it's about the patients and it's about the staff and making sure they feel empowered and that the patients get treated and... That's just ⁓ so rewarding and it's amazing to hear from my perspective. So congratulations on that, Jeff, and thank you again for the time today and for sharing just a little bit of how you think and of the Jeff wisdom with the rest of the world. So I really appreciate it. Jeff Siupik: Well, thank you for those kind words, Yoel. I appreciate our friendship and being friends with you and what you're doing, I think is great for organizations. I ⁓ more need to reach out and maybe find different solutions or better solutions before they act on their decisions. Yoel Bakas: Thank you, thank you, and we're here for them. Alright, thanks Jeff. Jeff Siupik: All right. Thank you. Bye bye.