Ep. 546 IR Practice Development: Residency to Real-World with Dr. Quinn Meisinger

In this episode, host Dr. Ally Baheti interviews interventional radiologist Dr. Saher Sabri and vascular surgeon Dr. Frank Arko about their perspectives on a July 2023 New York Times article about the ethics of peripheral arterial disease (PAD) treatment in outpatient based labs (OBLs) and ambulatory surgery centers (ASCs). --- SHOW NOTES Dr. Arko emphasizes the importance of approaching articles as an unbiased reader. He acknowledges that sensationalism in the news is common, and while bad actors do exist, he personally knows talented OBL/ASC practitioners. He also notes that the article fails to mention that the majority of these practitioners follow society guidelines to provide appropriate and effective treatment for their patients, rather than prioritizing financial gain. He believes that most non-surgical specialists have the clinical insight to know when patients would be better candidates for open bypasses as opposed to endovascular interventions. Dr. Arko describes the split response to the article within vascular surgeons on social media, based on their personal philosophies of open versus endovascular interventions for PAD. Dr. Sabri believes that PAD and critical limb-threatening ischemia (CLTI) are not very well known by the general public, this article was a missed opportunity to bring attention to these conditions and disparities in treatments depending on patients’ geographic locations and ethnicities. The article may have the effect of scaring patients away from seeking treatment for PAD and CLTI, as well as receiving care at OBLs, which were originally founded to make interventions more efficient and patient-friendly. Additionally, the article could foster divisiveness between vascular surgeons, interventional radiologists, and interventional cardiologists and as a result, increase barriers to collaboration. It is important to differentiate between PAD and CLTI and the stage at which patients present to medical care. Limb salvage rates and decisions to intervene and/or amputate are multifactorial and are not as straightforward as the article may imply. Both doctors agree that specialty societies share the responsibility of monitoring their members for overuse of interventions. In terms of rebates and volume discounts from device companies, the doctors discuss the ethics of cost savings that benefit a hospital system versus savings that benefit a physician-owned OBL. Dr. Arko recognizes that financing an OBL with device company partnerships can be a smart business decision if devices are used appropriately and only when indicated. He speaks about the need for societies to support more randomized control trials that compare the effectiveness of each atherectomy device. We also discuss implications for insurance coverage of PAD/CLTI interventions. Dr. Sabri believes that it is unfortunate when insurance companies become the decision-maker of patient treatments. --- RESOURCES “They Lost Their Legs. Doctors and Health Giants Profited” (NY Times, July 2023 article): https://www.nytimes.com/2023/07/15/health/atherectomy-peripheral-artery-disease.html BEST-CLI: https://www.bestcli.com/ “Blocked Artery in Your Leg? Here’s What You Should Know” (ProPublica, June 2023 article) https://www.propublica.org/article/what-to-know-about-peripheral-artery-disease Outpatient Endovascular Interventional Society (OEIS): https://oeisweb.com/ Society of Vascular Surgery (SVS) Position Statement: https://vascular.org/news-advocacy/articles-press-releases/svs-response-new-york-times-article-overuse-interventions

2 Elo 202356min

In this episode, host Dr. Michael Barraza interviews Dr. Zola N’Dandu, an interventional cardiologist at Ochsner Medical Center in Louisiana, about building a successful critical limb ischemia (CLI) program. --- CHECK OUT OUR SPONSORS Boston Scientific Lab Agent https://www.bostonscientific.com/en-US/customer-service/ordering/lab-agent/contact.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-labagent-hci&utm_content=n-backtable-n-backtable_site_labagent_1_2023&cid=n10013205 Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES Dr. N’Dandu’s current practice is about 65% peripheral artery disease, with a focus on critical limb ischemia. He discusses how he developed his current CLI focus by traveling and attending conferences, after his formal training. It was during one of these conferences that Dr. N’Dandu was inspired to further get involved with the patients in the wound care center at Ochsner. This interest led to the start of his CLI team. The episode then shifts towards Dr. N’Dandu’s process of building his CLI team. His commitment to this endeavor helped bring more like-minded people to his team. Having a centralized and committed team has helped Dr. N’Dandu streamline his patient visits, reduce the number of appointments needed for each patient, and greatly decrease the burden on the patients. Dr. N’Dandu then discusses the evolution of CLI in the last decade and how there are now more medications, therapies, and data available to support patient care. Procedural advancements have also been immensely helpful. Things like radial-to-pedal, 3rd and 4th generation stents, proliferative therapy with stents, drug-coated balloons, and bio-absorbable stents are all advancements in CLI treatment. Additionally, obtaining more data on each therapy will help refine the treatment algorithm for CLI. As the conversation shifts towards aspects that still need to evolve in CLI treatment, Dr. N’Dandu emphasizes that our treatment of no-option-CLI patients needs to change. One of the treatments that he uses for these patients is deep vein arterialization, a technique that was first discovered in 1912 but still has more potential for growth. DVA involves shunting arterial blood to the veins, which works for CLI, as studies show that it increases angiogenesis and perfusion of the tissue. As Dr. N’Dandu discusses the specifics of his DVA technique, he emphasizes that new advancements are being made every day, so it is crucial to have a cohesive team that can follow up with patients.

31 Heinä 202334min

In this episode, host Dr. Aaron Fritts interviews Jason Newton - an attorney with 14 years of private practice defense experience and current General Counsel at Curi - about cybersecurity in medicine and healthcare. --- SHOW NOTES Jason begins by introducing how he became an expert in cybersecurity law. Dr. Fritts and Jason then segue to the present day threats of ransomware in healthcare, beginning with a birds eye view and progressively getting more granular. They cover the topics of staffing shortage, how threat-actors are akin to present-day pirates, and the chief risk of ransomware. We learn that healthcare is the most common target of ransomware from threat-actors and how “big fish” are not only the main targets, meaning many smaller health entities are also under real threat. Jason explains well documented reports which detail the intense interest in health information of several US targets such as government leaders, military personnel, celebrities, and popular athletes. Dr. Fritts and Jason underscore how money is the central driving force behind ransomware attacks on healthcare. Jason also takes a deep dive into how threat-actors engage in social engineering to ensure their success. Troubling enough, Jason also shares how threat-actors (on average) have already infiltrated health systems 66 days prior to the day the breach has been discovered. Essentially health systems will only see threat-actors when these hackers want to be seen and demand ransom. ChatGPT, AI, and deep-fake technology is also discussed and how it can be used by threat-actors to bolster their ransomware attacks on healthcare. Jason also mentions the need for health systems to invest in cybersecurity insurance and the inverse relation between “secure” and “easy”. Health systems’ responsibility to secure their data is paramount to mitigating and avoiding ransomware. Jason highlights the necessity of training, the fact that people can be the weakest link in security, and how it is critical for everyone to approach their email inbox with a “no-trust” policy. Anti-phishing software can also be a very helpful addition to health systems looking to bolster their cybersecurity. Mr. Newton supplies some helpful training, consultation, and investigation resources from the Cybersecurity and Infrastructure Security Agency. While we hope this discussion may be helpful, there are no guarantees that the information and resources shared will prevent and/or mitigate bad outcomes, and no guarantees or endorsements are made. Although Jason is an attorney, he cannot and does not offer legal advice to external parties and an attorney-client relationship is not established with listeners of this podcast. Please contact your personal or corporate attorney if you require legal advice. --- RESOURCES Cybersecurity and Infrastructure Security Agency website: https://www.cisa.gov/resources-tools

28 Heinä 202337min

In this episode, we delve into the career of Dr. Thomas Sos, a renowned figure in the field of Interventional Radiology (IR), and the triumphs and challenges he faced in the formative years of interventional radiology. --- CHECK OUT OUR SPONSOR Philips SymphonySuite https://www.philips.com/symphonysuite --- SHOW NOTES The episode starts with an introduction to Dr. Sos, whose accomplishments include serving as SIR President from 1986-1987, receiving the SIR Gold Medalist in 2009, authoring 140 publications and 60+ book chapters, as well as winning the SIR Foundations in Leadership and Innovation award this past year. Dr. Sos reflects on his educational journey, starting with his medical degree from Harvard and continuing with diagnostic radiology residency and an IR fellowship at Cornell. As one of Cornell's first IR fellows, he discusses the intensity of his early training and his reasons for choosing this specialty. His fellowship years coincided with the formation of SIR and the rapid evolution of the field, offering him a chance to be part of its groundbreaking developments. He then traces his professional path, highlighting his work at Cornell and Brigham, his role as the youngest IR progressor at Cornell, and his position as the Divisional Chief of Cardiovascular IR. An important turning point in his career was a coronary angioplasty course in Zurich, Switzerland, which led to his collaboration with cardiothoracic surgeons and cardiologists. He remains an active participant in major conferences to share knowledge about angioplasty. Then, Dr. Sos discusses his shifting focus to peripheral vascular disease. As his work in IR began to draw attention, surgeons started acknowledging the growing influence of IR in medicine. This realization resulted in more surgeons learning about angioplasty and a collaboration between SIR and the Society for Vascular Surgery (SVS).

24 Heinä 20231h 33min

In this episode, co-hosts Drs. Ally Baheti and Mike Barraza interview Dr. Ted Wen of Texas Radiology Associates and Dhruv Chopra of Collaborative Imaging about perspectives and helpful technology when managing an independent radiology practice. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES Dr. Wen shares reasons why he and his colleagues chose to keep their practice independent. The fast-growing group spent eight years doing due diligence about private equity (PE) to decide if that was the right model for them. Dr. Wen met with PE firms around the country to explore the process of transitioning into PE practice ownership and its implications for current colleagues and future physician hires. Selling to PE would disproportionately benefit senior partners, who were ready to be bought out, over junior partners who would not qualify for the same deal. Additionally PE management could have the power to raise minimum RVU requirements and enforce highly restrictive noncompetes. Texas Radiology Associates ultimately decided that in order to compete in the radiology marketplace as an independent practice, they needed to make significant investments in technology to better serve their patients. They started to connect with Collaborative Imaging to pursue this mission. Dhruv notes that PE has the potential to bring in financial support, strategic relationships, and pathways to growth, but he also warns the audience that not all PE contracts are transparent nor designed to benefit physicians. Workflow, staffing, and collaboration with referring doctors can be extremely difficult when firms value cost savings and RVUs over patient care. All of these stressors have negatively impacted the radiology burnout rate. Dhruv describes the start of Collaborative Imaging, in 2018, as an attempt to integrate a revenue cycle management (RCM) system with radiology workflow at Texas Radiology Associates. This provided a cost-efficient solution that frees up funds to invest in other areas of the practice. Collaborative Imaging is currently working on an AI-driven system to notify patients of actionable findings that come up in their imaging. They are also exploring technology that will adapt the style of radiology reports to different referrers’ preferences. Both guests discuss the common inefficiencies that independent radiology practices face, including RCM, clarification over patients’ payment plans, and office wait times. Collaborative Imaging is working with practices around the country to build solutions. Radiology groups can contribute a percentage of their revenue into Collaborative Imaging and receive dividends, or they can license the RCM solution. --- RESOURCES Ep. 277- Private Equity and the Radiology Job Environment with Dr. Ben White: https://www.backtable.com/shows/vi/podcasts/277/private-equity-the-radiology-job-environment Texas Radiology Associates: https://texasradiology.com/ Collaborative Imaging: https://collaborativeimaging.com/

21 Heinä 202350min

In this episode, host Dr. Michael Barazza interviews Dr. John Smirniotopoulos about genicular nerve ablation, an innovative treatment option for the management of osteoarthritis. --- CHECK OUT OUR SPONSORS OBL Marketing https://oblmarketing.com/ Boston Scientific Nextlab https://www.bostonscientific.com/en-US/nextlab.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-nextlab-hci&utm_content=n-backtable-n-backtable_site_nextlab_1_2023&cid=n10013202 --- SHOW NOTES Dr. John Smirniotopoulos is an assistant professor of clinical radiology in the IR department at MedStar Georgetown University and MedStar Washington Hospital Center in DC. He developed the idea of genicular nerve ablation after consulting with his orthopedic colleagues at Georgetown about various pain interventions. He then formulated a treatment algorithm that begins with a conservative approach, using a nerve block for ablation. If the initial response is limited, a second ablation can be performed within six months. However, if the patient experiences only a short-term response, genicular artery embolization may be considered. Genicular nerve ablation proves to be a valuable therapy for patients who are not yet ready for knee replacements or need to postpone the procedure due to factors like high BMI or recent organ transplant. The therapy uses fluoroscopy or ultrasound to target four trunks of nerves, including the superomedial genicular, superolateral, inferomedial, and the suprapatellar nerves. The procedure is done under conscious sedation, and Dr. Smirniotopoulos aims for 50% pain reduction with his patients which is usually reached at six weeks. Dr. Smirniotopoulos and his team recently conducted a study to evaluate the outcomes of genicular nerve ablation. The results indicated a significant reduction in both the WOMAC score, which measures pain and functionality, and the Visual Analogue Scale (VAS) score, which is a subjective measure of pain. Surprisingly, they discovered that age over 50 was the biggest predictor of positive outcomes, contrary to their initial expectation that BMI would play a more significant role. They attribute this finding to a higher prevalence of advanced OA in the older age group. Additionally, patients under 50 may have more sports-related injuries such as meniscal tears, leading them to return to high-intensity activities sooner than older patients. Dr. Smirniotopoulos has also seen success in performing nerve ablation in the hip, shoulder, SI, and intervertebral joints. This wide application of the procedure makes it a valuable and versatile treatment option for patients. --- RESOURCES Genicular Nerve Radiofrequency Ablation: Is There a Predictor of Outcomes?: https://www.jvir.org/article/S1051-0443(22)01597-4/fulltext

19 Heinä 202349min

17 Heinä 202337min

In this episode, Dr. Michael Barraza interviews Dr. Justin Guan about the SIR Global IR training network. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES Dr. Guan starts the episode by discussing the IR program at the Cleveland Clinic, where the large case volume enables their trainees to get their pick about what types of cases they want to do. Dr. Guan then mentions his recent trip to Seoul, Korea for the Asia Pacific IR conference and discusses how he learned about new IR techniques that have not made their way into the mainstream yet. Dr. Guan highlights how the SIR Global training network was created due to a need for an entity that could globally spread IR education. He believes that there are insufficient training opportunities worldwide, and even within the countries that have these opportunities, there is a huge variation in IR training. Then, Dr. Guan highlights initiatives that the SIR Global training network is trying to implement and their current challenges. These challenges include insufficient IR services worldwide, a lack of public awareness about IR procedures, and a lack of data about differences in IR training across different countries. One initiative aimed to address these challenges is the Global IR Juniors summits, which recently got approval to be held at the SIR conference. At this summit, IRs from around the world discuss what updates and new research from their respective IR societies.. Dr. Guan also discusses how they are currently working on the Global Training Network, which will be a database of different IR physicians to provide opportunities for observership and mentorship and it will serve as a hub for a clinical exchange of IR knowledge worldwide. --- RESOURCES Public Awareness of Interventional Radiology: Population-Based Analysis of the Current State of and Pathways for Improvement: https://www.jvir.org/article/S1051-0443(23)00122-7/fulltext Global Assessment of the Status of Interventional Radiology: https://www.surveymonkey.com/r/ZBVFXQ8

14 Heinä 202318min