← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Why Acute Kidney Injury Is Now a Top Patient Safety and Financial Priority
00:19:14
Loading summary
Transcript16 lines
- [00:00]
A
This is Scott Becker with the Becker's Healthcare Podcast. I'm thrilled today to be joined by one of the best and smartest leaders I get to work with that I've known for decades. We're joined today by Todd Dunn. Todd's the chief executive officer of Acurin Akron Medical, and he's gonna talk to us today about total kidney injury and why acute kidney injury has become an incredibly important issue in an imperative PR health systems and people. Todd, we're going to talk about acute kidney injury, and many of us aren't familiar with why this has become so important and why it has financial implications the way that it does. Before I get started with that, take a moment to introduce yourself and talk a bit about your career and what you do.
- [00:44]
B
Well. Thanks, Scott. And always good to connect with you. As you know, it's just lovely to reconnect, I think. Scott, I would describe myself, and it's often dangerous to do that as I'm a transformer, really. I absolutely love figuring out how to make innovation what we do. So transformation is what we get. And I've had the privilege in my career of really working through that. And you and I are about to have a more common connection. Our good friends at Taylor and Francis are going to publish a book that I just finished working on called the Innovator's Journey. But really that's a reflection, Scott, of my career. And how do you really innovate within a health system to turn something into reality? And for years, I've just always felt that health systems need innovation, systems that drive transformation. So it's been a relentless focus of mine, especially when I was with, had the gift of being at Intermountain Healthcare, as you know, and then being with Atrium Healthcare, where I was just under great leadership, that allowed me to push and do things that I really love, which is where I really implemented Acurin for acute kidney injury that we'll talk about in a minute. But that's where Gene woods, who you know, incredible leader, Jeff Rose, Scott Rismiller, all these amazing leaders, pushed us and pushed me personally to think about quality of care, access to care, and innovating to that end. And on a personal note, I would say that I've always believed that empathy is the heartbeat of healthcare. And I've been fortunate in all of my roles to let that be the driver of the work at Acura. And it's my driver, why it resonates with me. And I've always thought that, you know, if we were empathetic, we could bring kindness and healing to the world. And that's what I love so much about being in healthcare and trying to do what I can do to make a difference.
- [02:53]
A
And Todd, I've watched your career for a long time, an incredible journey, incredible impact. And thank you for joining us today. Take a second on acute kidney injury, this is increasingly been called out, is both a patient safety issue and a cost driver for hospitals. And we see it up front and close and personal with a colleague of mine. From your perspective, what's the real impact that Aki acute kidney injury is having today and what have you learned through your work in this area?
- [03:26]
B
I think you called out the most important thing first, Scott, is it's a patient harm. Now, CMS declared a patient harm back in August of 2024 and it would be alarming for most people to hear this number. Last year data tells us that there were 3.2 million acute kidney injuries in the US alone. That's one every 10 seconds. It's just alarming what you mentioned. You and I both know people who have gone to hospitals with perfectly good kidneys and may be left with chronic kidney disease. And it's mainly because we give our clinicians, I would argue, archaic tools to take care of the kidney that we can dive into. And so first of all, it's a patient harm. I think it's a really prevalent patient harm because we're still giving a blood test that tells you your kidneys are already in trouble and a catheter that was invented in the 1930s. The other thing I think I've really learned, Scott, is the risk of long term harm to a patient. But then when you look at the data to your point, the length of stay, the readmit rate, escalation of dialysis, nose productivity and all those things that negatively impact a hospital system are so associated with this that it's mind blowing. So I've just been fortunate to be able to dive in and learn a lot and work with some pretty great systems to try to help solve the problem.
- [05:02]
A
And talk for a second there, Todd, about what are some of those common blind spots that organizations don't really think about in terms of addressing acute kidney injury. What are some of the blind spots?
- [05:15]
B
Well, I hope this isn't taken as too direct. I think one of the biggest blind spots, Scott, is that this isn't on every single quality dashboard in the country. You are blind to what you don't measure. And I think that not enough systems measure this in a formal, very visible way across their system. I Think that's a blind spot that I've experienced and why it's not on every dashboard in the country. Just, I just don't have an answer to that. But that's a blind spot. The other blind spot is I think a lot of systems are just not aware of the old solution sets like a serum creatinine test. Scott tells us if your kidneys can't filter creatinine anymore, some would argue that about you're down to almost one kidney when that happens. And I think that some just, it's a blind spot that they're not aware that that's what we're using as the standard to tell you, oh, Todd Dunn's kidneys are in trouble. The other thing they're using is a Foley catheter that started being marketed by Bard in 1936. It's still fundamentally the same thing. No intelligence to it. I think it's a blind spot, but not in a critical way. It's just because that's what we're used to seeing. It's that old thing of you can't see the forest for the trees. Maybe another blind spot, Scott, is we get so connected to worrying about price versus cost. If you look at the price of a creatinine test, it's low. If you look at the price of a really simple Foley catheter, it's pretty low. But then you ask yourself, don't ask about the price, what's the cost? Because we use that. How many acute kidney injuries do we have? I think it's a blind spot sometimes in our thinking of how we frame it up and the way we look at it. And maybe we make assumptions that it's just part of the normal course of a patient. And those four things can blind us to really transforming what we need to do on behalf of patients in the health care system.
- [07:31]
A
Really thank you for that. And you mentioned earlier that the CMS has now designated aki Acute kidney injury is a hospital harm, putting it further into the middle of the quality and reimbursement conversation. How should leaders think about acute kidney injury in the context of quality metrics, financial risk, long term performance improvement. Then we're going to talk at some point about what we can do about it and what should be done about it. But how should health system leaders look at this now that CMS has designated it as a hospital harm?
- [08:06]
B
The first thing that I say is something that Dr. Reuben Mesa taught me at Advocate. You may have heard him talk about this. The loved ones. One standard, like if Our loved one was in that bed. Would they be thrilled? Would we be thrilled with the tools and solutions and care that they're getting? I think we always have to keep that right in the center of it. Regarding the quality metric. So starting in 2028, hospitals have to start reporting stage two acute kidney injury or above. So the way I think they need to start thinking about it now is what could we possibly do to prevent or to get an earlier recognition of what we could do to prevent going to stage two or stage three acute kidney injury? So we have to think about it. But I'd love where you're going with that, Scott. The first thing they need to do is pull their acute kidney injury data and start creating enormous visibility and dialogue around this so that they get ahead of the CMS penalties. You remember cautis? I mean can you imagine not measuring cautis or falls? This is in the same category of a harm. The cost part, the things that we measure today are connected to this. Length of stay is often a margin erosion problem. A readmit rate is absolutely one you don't get paid if they come back. Especially around cardiac procedures, you escalate to dialysis. So look at this. Those measures and how they radiate to things that you already care about is what I would do and really put that right in the center of your quality and your cost conversations. Because to your point, Scott, you can't isolate either one of those. They interact very well together 100%.
- [09:58]
A
And talk about clinicians, as clinicians are dealing with some of the challenges they have heavy workload, lots of burnout. How can better use of automation and monitoring improve what's going on with kidney care? How can we use automation monitoring to help? Because a lot of things that you're talking about makes so much sense. 3.2 million acute kidney injuries a year, that's a lot. It has lots of long term impact. We've got to deal with it. But people are overwhelmed and just more personal touches are may be needed but hard to do. How can we use automation and monitoring to really reduce documentation burden and get better here at taking care of kidney care and avoiding acute kidney injury?
- [10:44]
B
I think if you look at the head of a bed in the or the icu, you see how we have absolutely automated and digitized the vital signs of the heart and lungs. We have that has taken off the monitoring burden, the documentation burden from teams and also what that does, Scott, the automation, we automate urine flow, we automate the measurement of it, we automate the indication of a problem based on a global standard. And we send that data to your electronic medical record. It moves you from high variability of understanding and work to high reliability. And because you automate it, you basically take the work off the nurse's plate to manage that flow of urine or to document it. But another thing that I think a lot about, Scott, and you so wisely call this out, is the think flow. When you automate manual things, you take the burden off of the think flow, or what some people talk about, cognitive burden, burden. And now you're giving the doctors, in addition to the perfect data they have on the heart and the lungs, you're giving them perfect fluid data and status of the kidney. So you took the manual work away, you gave them highly reliable data to make better decisions. And that's where the value comes in. Now they know a really good picture of fluid status and how your other vital organization, the kidney, which has never been digitized, is now performing. And that just, I read the other day, this is mind blowing to me because my mom was a nurse until she was 75. My brother's still a nurse, that an ICU nurse has at least 100 tasks an hour. And so the study said it takes about five minutes per hour per bed to manage kidney output. Now, if you automate that and take it down to five minutes a day, you give them back time to spend one on one with the patient just like they want to.
- [12:51]
A
And not only give them back time to spend with the patient, just to give them freedom to actually focus on the important things and not be so exhausted. And the intentionality of making this a core measure, watching it all the time, could drive down the cost of this, can drive down the amount of acute kidney injury. There's so many positive impacts if we get on this like we've gotten on so many other things like falls and other things that you've mentioned and sepsis and other things. Talk a little bit about. You've had this evolution. You're now a chief executive officer. As you look at health systems scaling, innovation, what are the biggest barriers to adoption of technology or other innovation? And what advice would you give to people trying to operationalize new technology and do it at scale and at size?
- [13:39]
B
I think the first thing, Scott, to really good adoption is to understand what's going on in the context of where you would be adopted. If I go back to this the way that Dr. Jeff Rose said, go see the problem, and allowed my team and I, through our innovation system to do it, we spent time in the operating rooms, we spent time in the icu, moving from the OR to the icu, if you will really empathetically go and understand the complexity that teams deal with. Diagnose before you prescribe may be the most succinct way to see it is that you will know the problem in context and you will be able to bring the right product in to solve the problem. And if you align your solution with the problem and the struggles, the teams will typically pull it into their lives versus you having to push it. That's the way I think about adoption in context. The other one is that you really need the data to drive the dialogue. If you don't have the data to say that it's a problem, but even more importantly to prioritize the problem. So you think about this is a harm. Now acute kidney entry is a harm. Get the data, get the ruling. That's another thing that will help in organizational adoption. The other thing I would say is you really need to understand the business model of it. I loved your earlier question also of how does this magnify in a bad way for a hospital system in the quality and financial metrics. And if you pull the data and you realize like not only is this a human problem, like your friend who suffers from chronic kidney disease, but this is a financial problem and payers aren't giving hospitals more money. And so then you look at the margin erosion that this is causing, you have then adoption in context. You have adoption at the administrative and dialogue level between multiple service lines. And then you've got a business reason to transform. And if you get all three legs of those stools, Scott, and you think about everyone in the movie that has to be there, the unifying thing will be the empathy of a system to give you perfect care. And then the driving thing will be we have to do this financially and to avoid harm.
- [16:12]
A
Thank you very, very much. And Todd, talk about you've been beating the drum for the last several years about the importance of acute kidney injury. And I can't tell you how much you appreciate it and what an education I am getting around acute kidney injury and how important is 3.2 million cases a year? Continuous impact? The cost impact is dramatic. The impact on patients lives, if they end up with this and it doesn't get fixed, is a disaster. It's very challenging. What are you most focused on? We're in 2026 now. What are you most focused on for the rest of this year and what are you most excited about?
- [16:48]
B
The thing I'm most focused on, Scott, is Encouraging systems to pull their data and to understand the harm measure. The second thing is for them to see the blind spots that you mentioned, they need to see that their clinical teams are relying on outdated solutions to produce modern care outcomes. And I believe that by focusing on creating awareness to your point around the harm that it's causing patients, because not one hospital wants to harm anyone ever. And then to see that, wait a minute, our clinical teams have the heart and lungs digitized, but we're giving old outdated tools to the kidneys as part of fluid management. If they can see those two things and harness their own empathy, then we have great dialogues with these systems because we're just there to help. The thing that I'm most excited about, Scott, is one patient at a time. You know, We've treated over 125,000 patients now, like I mentioned, Advocate is a wonderful customer. There are many others. We serve the va. So I'm most excited about bringing an amazing transformative solution set a kidney monitoring platform that helps you really monitor, manage and measure the kidneys, that gives you early signal to patient distress. That's what I'm most excited about is because if we can make a difference at the bedside for the patient and the clinical teams, the rest benefit, right? Our company does health systems do in the industry overall. And just like you love to make an impact and help us improve health care, that's our passion at accurate is to help protect kidneys one patient at a time.
- [18:41]
A
Todd, it's incredibly a pleasure to get to visit with you today on the Becker's Healthcare podcast. Incredible innovator, incredible. I want to thank you for joining us today and I want to thank you for Akron to Akron Medical, the company that you lead up. Thank you so much for taking the time and sharing your thoughts with us today. It's always fantastic to visit with you. You're one of a kind, brilliant, great leader and totally on board with what we have to do around acute kidney injury. Todd, thank you so much. Todd Dunn.
- [19:09]
B
Thank you, thank you.