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Becker’s Healthcare Podcast
Samuel O. Jones IV, MD, MPH, FACC - Director, Inpatient EP Services, The Chattanooga Heart Institute, Memorial Hospital
00:13:40
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- [00:00]
A
This is Laura Dardo with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Samuel Jones, who is the director of inpatient EP services at the Chattanooga Heart Institute Memorial Hospital. Dr. Jones, it's a pleasure to have you on the podcast today.
- [00:14]
B
Thank you, Laura. Looking forward to it.
- [00:15]
A
Absolutely. Now, I'm excited for our discussion to dig a little bit deeper into some of the cool things that you're doing at the Heart Institute. I think certainly such an important time and interesting and innovative time for heart care. But before we do that, can you introduce yourself and tell us just a little bit more about your background?
- [00:33]
B
I'm Sam Jones. I am a clinical electrophysiologist here at the Chattanooga Heart Institute with Memorial Hospital. I've had a few roles over the years. I've been in the service line EP for Common Spirit Health for several years. Then I've had various roles within the American College of Cardiology, focusing on some of our registries, quality improvement advocacy, as well as strategy. Overall, it really fits into the niche and things I'm interested in, including how we're going to transform care. ASCs are something that we've been looking at very carefully, that we may talk about more today. Certainly how we're going to adopt AI is something I've been following. And then just overall, the future of our specialty.
- [01:18]
A
Absolutely. You know, and that's a lot, a lot to cover, but I think we'll dive right in here. So what are the top three trends that you're focused on right now in health care as well as heart care? Thinking about ASCs, which is. Love to hear some of the big things that are on your mind today.
- [01:33]
B
I would say the first one that I think everyone in medicine is really worried about, especially in cardiology, is workforce, which really means access for patients. Because right now we have the epitome of a supply, demand, mismatch, meaning that we've got a lot of patients who want to see us. We've got patients that are getting older and they're just sicker. We've never seen patients quite like this before. They've got more chronic diseases, so they take up a lot of time. There's a lot of complexity there. And with all of this supply, with all this demand that we're having of these patients coming, how are we going to actually address it? Because we may just not have enough clinicians, at least in our current model, to take care of it. They talk about within cardiology right now that we're kind of shifting older. We've got A gray tsunami. In other words, all the gray hairs may not be around in 2019. They said 27% of cardiologists were, were over the age of 61. And so you've got a lot of cardiologists that are getting ready to retire. Unfortunately, now that would be okay if we had the training pipeline to accommodate for that. But every year we don't have enough coming out of training than we do that are going to be leaving. And the pathway to get to being a cardiologist or to even being other subspecialists within cardiology is just so long, it takes a while for us to even address that. Right now they're saying that we're probably going to lose about 547 cardiologists every year just because those that are leaving and those that are coming in. So I think that's a big thing that we're going to have to, we're going to have to really think about how do we address this problem. The second thing I would say is AI. Probably there's not a talk that you hear right now that AI isn't part of that. But I think AI is not just the image acquisition. This is one of the things in cardiology that we have it doing so much for us in the imaging space, but really it's going to be how can we use it in other things, how can we use it to address some of these workforce issues that could be with some of our documentation, whether that's with ambient AI, scribes, care, navigation. I think scheduling is something that can really be used for triage. And so there's a lot of administrative type functions for AI that we're going to be able to use as well as just clinical decision support. And if we do that right, then maybe we can help with some of the workforce issues just by getting everyone to really focus at the top of their license as part of the cardiovascular care team. So that's going to be a big thing, but making sure that we're also watching AI very carefully. I think the third thing is just a transformation that we're seeing across all medicine. One time, especially in cardiology, we were tied to the hospital. It's. And everything happened within those walls of the hospital, but that's no longer gonna be the case. And we're seeing sort of a transformation and a translocation of care that's gonna go out. We mentioned ASCs already, ambulatory surgery centers. We've seen that happen in other specialties, whether it's with gastroenterology and orthopedics and all of those same things, those same principles for why things are moving out of the hospital will happen in cardiology as well. So how do we do that? How do we make sure we're doing that in a safe way? Because it can just be about making sure that we're saving money across the board, although that is a big part of it. But how are we actually expanding access and the experience for the patient? And in that same area of care transformation, it's going to be more use of telehealth, it's going to be using more diagnostic, rhythm and device care to help us really get to patients really where they are, rather than have them come to us.
- [05:17]
A
I love that. I think all of three things you talked about are critical. Whether it's from the workforce transformation and access to care for patients, thinking through how AI can help address some of those issues, but also understanding what the risks are involved and how you can smartly integrate that more broadly into cardiovascular care teams. And then finally looking at that transformation across all medicine. Going into the outpatient setting, I think is critical because if you aren't able to transition the right cases into that space, it seems like you're not meeting some of the goals in terms of quality and value in bending the cost curve in healthcare and more, and really working smartly with the teams that you have. And so I think that's a really interesting analysis and overview. And if we were to dig just a little bit into the workforce trend you mentioned, how do you see realistically the impact of losing that 500 to 700 cardiologists coming through to retirement, you know, over the next several years? Like, how are you proactively thinking about that and what does the field need to do in order to make sure that, you know, you're in a place where people can still get the care that they deserve?
- [06:29]
B
Yeah, this is going to be a big thing that cardiology has to address. And I think it's going to be a multi pronged approach because you might just look at it and say, let's just train more. Let's just open up a lot of spots. Well, that's not really how it works and that's not how GME works. While there are some things that we can probably do, as I mentioned, because the pathway to become a cardiologist is so long for training that that's going to take a long time, if we can even do that at all. So there may be some things within education, are there ways in which we can shorten some of that training, can we remove some of the barriers so that we can do that? So that's one thing. But I think it's important to know it's not just about the physician, it's about the entire care team. And I think in cardiology we're really blessed more than any other specialty that we have really embrace that idea of how do we use everyone working at the top of their license. And this is going to be critical because without that, we really have no hope for it. Even within that cardiovascular care team though, we need to redesign some things and we need to make sure that we understand what are the care pathways that we can utilize to really become more efficient in the care that we're given. How can we use the technology that's coming on board so that that's helping patients as well? How can we get to more virtual diagnosis with patients with telehealth and some of the other things that are becoming available with technology? So it's going to have to be a multi pronged approach. Definitely looking at the training pathway itself for cardiologists using the cardiovascular care team to the top of the license, instituting the technology and AI and other ways that we haven't done before.
- [08:05]
A
I love that. That makes a lot of sense. It is really helpful to understand the big picture problem and then some of the things that you're doing in the field is doing in order to prepare for the future. Now, speaking of just some of those activities, what are you most excited about right now? What's really exciting for you as you think about what we're able to do today in the cardiovascular space and what's ahead?
- [08:28]
B
Yeah, I think there's a lot to be excited about and you don't always get that message from people, but it really is right now we're living in phenomenal time and there's. While the burden is great, I think that the opportunities then just are going to keep showing themselves more and more. Part of that's just innovation and what we're seeing across the care pathways, how we're able to do things in cardiology with our procedures quicker, safer and not always requiring the same need to be in the hospital and shift those out. So that innovation itself is going to be phenomenal. I think the entire artificial intelligence though, is going to showcase things that we haven't even dreamed of about how that's going to do now we're going to have to monitor that carefully. So while I'm excited about it, I have to admit that I'm also A little bit concerned to make sure that we understand what that AI is going to do for us. And then just looking at the efficiency and the experience that we're delivering to patients, I think this is something that people are starting to realize we have to do this better for patients. We're going to find that with some of the translocation of care outside the hospital, this has become a premium on making sure we're providing that service to patients. In the end, patients can definitely be served better with all of those things. The main thing I'm excited about is just the innovation, whether that's not just from the technology, but just from the overall care delivery of pathways. How do we institute our cardiovascular care team, how do we institute telehealth to really transform this into something that's going to be a better system for patients?
- [10:03]
A
I love that. And that's certainly an inspiring message when you think about how you can do things that you've never thought of before and truly make that experience and the patient journey much better and to some of the outcomes and quality of care I can imagine are ways that you can improve some of those things with AI too. Is there anything you're doing at the Heart Institute right now that you've been just overcome by some of the results or have been really excited by some of the results?
- [10:32]
B
Well, we do have a lot in the imaging space that's going on and I think that this is something where we're seeing by leveraging some of the technologies that's come out, we're able to get the right patient to the right place at the right time. What I mean by that is really in the world of interventional cardiology, before we would have a lot of patients that would come to the cath lab and get a diagnostic catheterization. And it turns out they did not need a stent. We didn't know that until they had a heart catheterization. But because of some of our CT workforce issue, we've been able to actually have patients get a non invasive test. And what we found with this is that by doing this in a, in a very designated way, we have a champion who watches carefully how we're doing with all these. Are we putting the right patients into the CT scanner? How are we adjusting our flows? And with all of that, we're actually having less patients go to the heart catheterization laboratory. But that's okay because a greater percentage of them actually get an intervention, they get a stent. And so I think that's where we need to go overall as a field, we're trying to find out how do we get the patient the right procedure at the right time. And by leveraging that technology, we're absolutely doing that. And so I think that's going to be one of many things that we find that we can continue to do overall. Like a lot of people, we're also looking at how do we get more continuous care going on, what do we do with hypertension management, lipid management, rhythm management, all of those things that patients now have access to at their home. We're not having to wait for them to come in. We actually can get some of that data sent for us so that they're getting a more continuous pathway of care delivery.
- [12:15]
A
That's helpful to understand and thank you so much for digging deeper into that example. Before we wrap up our conversation, how are you thinking about growth over the next 12 months or so?
- [12:25]
B
I think for everyone, it's a big issue. Growth, though, can't just be about how many more procedures are we doing all that. But again, smarter pathways. And I've mentioned that a few times, but I really think that that's critical because the new center of Excellence can't just be what it used to be. I think it's going to have to be efficiency of care to really make sure we're getting the right thing for the patient at the right time. So that comes down to access, shifting care where it belongs at all times and making sure it always stays patient centered. We're going to continue to use a lot of the new technology and AI to do it, but we have to make sure that when we do that, we're still keeping the clinician front and center with all of those things that we're not outsourcing this to artificial intelligence. That is making the decisions for us. You have to know who is responsible and we can't be dependent upon it. We still have to drive that, and I think that's what's going to be really critical for us as part of our growth strategy.
- [13:26]
A
I love that. Dr. Jones, thank you so much for joining us on the podcast today. This has been a really fantastic conversation. I learned a lot and I look forward to connecting with you again soon.
- [13:35]
B
Sounds great. Laura, thank you for the time.