BackTable Vascular & Interventional

In this episode, host Dr. Bryan Hartley takes us on a deep dive into the origin story and mission of Pulmera, a medtech company dedicated to transforming the field of bronchoscopic lung cancer diagnosis by retrofitting existing fluoroscopy machines into cone beam CT-like scanners. Dr. Hartley is a vascular and interventional radiologist and co-founded Pulmera, alongside interventional pulmonologist Dr. Harmeet Bedi at Stanford.Pulmera is developing a novel approach to enhance physicians’ ability to diagnose lung nodules accurately through innovative technology. Dr. Hartley shares insights into the challenges of existing diagnostic methods, the inspiration behind Pulmera, and the technology’s potential to combine the best of 3D imaging and endoscopy techniques. Dr. Hartley discusses the benefits for both patients and physicians, such as improved diagnostic yields and patient outcomes, and introduces an investment opportunity for the BackTable community to be part of this revolutionary project. The episode also explores the broader implications of this technology across various medical specialties beyond pulmonology.---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---SHOW NOTES00:00 - Introduction02:18 - Personal Journey: From Vanderbilt to Stanford Biodesign06:11 - Pulmera’s Mission: Enhancing Diagnostic Accuracy in Lung Biopsies15:02 - Introducing a Game-Changing Technology for Bronchoscopic Procedures22:09 - Challenges and Breakthroughs in Portable CT Imaging27:44 - Economic Impact of Enhanced Diagnostic Procedures29:48 - Building a Team and Securing Funding for Innovation31:30 - Understanding Investment Opportunities and Equity Financing---RESOURCESDr. Bryan Hartley’s email:bryan.hartley@pulmera.comDr. Bryan Hartley’s cell:423-432-0612Pulmera:http://www.pulmera.com/Stanford Biodesign Fellowship:https://biodesign.stanford.edu/programs/fellowships/innovation-fellowships.htmlBackTable Innovation Episode #1 - Needs Driven Innovation with Dr. Todd Brinton (Stanford BioDesign):https://www.backtable.com/shows/innovation/podcasts/1/needs-driven-innovationBackTable Innovation Episode #30 - Host Stories with Dr. Bryan Hartley and Dr. Eric Gantwerker (Stanford BioDesign):https://www.backtable.com/shows/innovation/podcasts/30/host-storiesBackTable VI Episode #422 - Pathology 101: Solid Advice for Percutaneous Biopsies with Dr. Andrew Sholl:https://www.backtable.com/shows/vi/podcasts/422/pathology-101-solid-advice-for-percutaneous-biopsies

In this episode, Dr. Jos van den Berg discusses the benefits of joining the Critical Limb Ischemia (CLI) Global Society, including discounts on Amputation Prevention Symposium (AMP) meetings, access to a specialized journal, and participation in Multidisciplinary CLI Network (MCLIN) discussion boards.Dr. van den Berg is an interventional radiologist at University of Bern in Switzerland and Europe Office Chairman and Member of Board of Directors for CLI Global Society. Dr. van den Berg also serves as a reviewer and editorial board member of multiple high-impact scientific journals.With members across the globe, the CLI Global Society emphasizes a multidisciplinary approach to combat CLI, aiming to prevent amputation and death through education, patient advocacy, and awareness about CLI. Dr. van den Berg also sheds light on the complexity of CLI management in Europe due to varied reimbursement systems among countries and the society’s efforts to tackle these challenges. The episode also touches on the society’s future goals, including expanding its global presence and continuing to offer extensive resources and networking opportunities to its members.---CHECK OUT OUR SPONSORSBD Advance Clinical Training & Education Programhttps://page.bd.com/Advance-Training-Program_Homepage.htmlReflow Medicalhttps://www.reflowmedical.com/---SHOW NOTES00:00 - Introduction02:08 - Meet Our Guest: Dr. Jos van den Berg05:42 - Deep Dive into CLI Global Society07:53 - Exploring the Impact and Initiatives of CLI Global Society14:42 - Challenges and Differences of CLI Management in Europe21:08 - Innovations and Future Endeavors in CLI Treatment23:45 - Closing Thoughts and the Importance of Membership---RESOURCESCLI Global Society:https://www.cliglobalsociety.org/Multidisciplinary CLI Network (MCLIN) Global CLI LIVE Meeting (every 2nd Friday of the month, 7am EST):https://www.cliglobalsociety.org/education/mclin/#myaccountAMP CLI Meeting:https://www.hmpglobalevents.com/amptheclimeeting

Dr. Blake Parsons discusses the role of spinal cord stimulation in treating vascular issues and diabetic neuropathy. They highlight the effectiveness of Nevro 10 kHz therapy in providing long-term pain relief and sensory improvements. Topics include outpatient care, future of spinal cord stimulation, multidisciplinary approach, and interventional radiologists managing complex cases.

Dr. Mark Lessne and Dr. John Martinie discuss the importance of collaboration between interventional radiology and surgery in treating biliary diseases. They emphasize the need for comprehensive patient care, decision-making in interventions, and the impact of multidisciplinary approaches on patient outcomes. The conversation highlights challenges in biliary decompression, balancing minimally invasive techniques with surgery, and the role of compassionate consent in patient care plans.

In this episode of the BackTable MSK Podcast, Dr. Dana Dunleavy interviews Dr. David Prologo about his perspective on current advancements in MSK interventions, including steerable spine needles, thermocouples for radiofrequency ablation, and the growing importance of advocacy and longitudinal follow up for patients with chronic pain. Dr. Prologo is an interventional radiologist at Emory University.Dr. Prologo starts by describing the evolution of interventional radiology’s role in MSK interventions. He explains that establishing solid referral networks is crucial to building this service line, and he gives examples of how new interventionalists can highlight their skills to others. Then, he describes a new steerable needle that allows operators to safely enter the vertebral body with a transpedicular approach and subsequently navigate directly to the location of interest. This device is especially useful when lesions are located in tricky areas where the trajectory of a straight needle would have difficulty reaching. He also discusses different devices for bone tumor ablation and his preferred methods for targeting lesions that are located at varying locations in the spine. For lesions below T5, he uses fluoroscopy for better visualization of the axial plane. For lumbar lesions, he emphasizes the importance of correlating and cross-checking vertebral levels with pre-procedural MRI.Dr. Prologo also discusses lessons learned from his extensive experience in spine interventions, especially from prior complications. He explains how thermocouple monitoring can give real time feedback on internal temperature during radiofrequency ablation, the necessity of understanding the ablation zone, and the importance of longitudinal follow up. He cites specific cases of patients struggling with chronic pain and how he advocated for each case.---CHECK OUT OUR SPONSORMerit Spinehttps://www.merit.com/merit-spine/---SHOW NOTES00:00 - Introduction02:09 - Dr. Prologo’s Career and Leadership Roles09:52 - Interventional Radiology’s Role in MSK Interventions13:37 - A Primer for Steerable Vertebral Needles21:40 - Increasing Standardization and Accessibility of Bone Tumor Ablation26:37 - Advanced Pain Management in Interventional Radiology’ Book30:24 - Thermocouples in Radiofrequency Ablation35:45 - Prior Complications and Importance of Longitudinal Care44:24 - SIR EDGE 202452:31 - Accessing Targets for Basivertebral Nerve Ablation1:01:17 - The Role of Advocacy in Patient Care---RESOURCESOsseoflex Steerable Needle:https://www.merit.com/product/osseoflex-sn-steerable-needle/STAR Tumor Ablation System:https://www.merit.com/product/star-tumor-ablation-system/Osteocool OsteoCool Radiofrequency Ablation System:https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.htmlOptaBlate Bone Tumor Ablation System:https://providers.strykerivs.com/products/optablate‘Advanced Pain Management in Interventional Radiology’ by J. David Prologo and Charles E. Ray Jr:https://shop.thieme.com/Advanced-Pain-Management-in-Interventional-Radiology/9781684201402Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist:https://pubmed.ncbi.nlm.nih.gov/24745905/SIR EDGE 2024:https://www.sirweb.org/learning-center/meetings/sir-edge/‘The Catching Point Transformation’ by J. David Prologo:https://www.catchingpoint.com/

Dr. Matthew Lungren, an expert in AI and healthcare, discusses the transformative potential of AI in patient care, clinical workflows, and medical research. He emphasizes the importance of AI as a tool for healthcare professionals to focus on patient care. The discussion covers AI's impact on employment, insurance companies, and resources for healthcare professionals to engage with AI technologies actively.

In this episode of the BackTable Podcast, Teri Yates explores the nuances of choosing between an Office-Based Lab (OBL) and Ambulatory Surgery Center (ASC) for private practices. Teri is the CEO of Accountable Physician Advisors, a consulting firm which specializes in OBLs, ASCs, and hybrid models for private-practice physicians. She is also President of DocCentric, a company focused on supporting physicians building and leading their own ASCs.The discussion includes a comprehensive analysis of the financial, regulatory, and operational considerations for physicians contemplating this decision. This includes insights into reimbursement models, Medicare regulations, and the strategic advantages of each model. The episode also touches on the importance of feasibility studies, partnerships with other specialties, and real estate strategies when developing these facilities. The conversation provides valuable advice for navigating the complexities of ASC development and emphasizes the value of maintaining independence and leveraging physician-owned models for long-term success.---CHECK OUT OUR SPONSORReflow Medicalhttps://www.reflowmedical.com/---SHOW NOTES00:00 - Introduction04:19 - Deep Dive into OBL and ASC: Definitions, Differences, and Decisions07:26 - Financial Implications of ASC vs. OBL10:56 - Hybrid Model: Combining OBL and ASC for Flexibility15:14 - Navigating the Complexities of ASC Development20:03 - Real Estate Strategies for OBL and ASC Projects22:50 - Staffing Considerations and Physician Entrepreneur Insights35:17 - Future of OBL and ASC: Trends and Predictions39:43 - Closing Thoughts and Resources for Further Learning---RESOURCESAmbulatory Surgery Center Association:https://www.ascassociation.org/homeOEIS Annual Meeting 2024 Las Vegas:https://oeisweb.com/meetings/2024-annual-meeting/Accountable Physician Advisors (Teri’s consulting firm):http://www.accountablephysicianadvisors.com/servicesDocCentric:https://doccentricasc.com/NOON Development Company:https://noondevelopment.com/BT VI Episode #366 - Navigating OBL & ASC Business: Pitfalls to Avoid with Teri Yates:https://www.backtable.com/shows/vi/podcasts/366/navigating-obl-asc-business-pitfalls-to-avoidBT VI Episode #202 - Staffing the OBL with Dr. Krishna Mannava and Kristin Longwell:https://www.backtable.com/shows/vi/podcasts/202/staffing-the-oblBT VI Episode #129 - OBL / ASC Business Pearls with Dr. Jim Melton:https://www.backtable.com/shows/vi/podcasts/129/obl-asc-business-pearlsBI VI Episode #121 - Office-Based Labs (OBLs) & What You Can Do in Them with Dr. Mike Watts:https://www.backtable.com/shows/vi/podcasts/121/office-based-labs-obls-what-you-can-do-in-themBT VI Episode #42 - Building an Outpatient UFE Practice with Dr. Mary Costantino:https://www.backtable.com/shows/vi/podcasts/36/building-an-outpatient-ufe-practice

In this episode of the BackTable Podcast, host Dr. Ally Baheti interviews Dr. Deepak Sudheendra and Laurie Bouzarelos about the complexities of navigating insurance for procedures performed in vascular and interventional radiology outpatient-based labs (OBLs).Dr. Sudheendra is an interventional radiologist at 360 Vascular Solutions in Dublin, Ohio and Laurie Bouzarelos is the founder and owner of Provider Solutions, a small business which focuses on coaching private practice and business-owning physicians on payor contracting.The conversation illuminates common challenges faced by physicians when negotiating insurance contracts, and it emphasizes the lack of awareness among insurance companies about the roles of IRs and the significance of OBLs. Laurie Bouzarelos shares her expertise on insurance contracting, highlighting the importance of education, strategy, and patient-focused care in achieving favorable contract terms. The episode delves into tactics for contract negotiation, leveraging data for better rates, and the critical role of in-house billing for financial transparency and control. Dr. Sudheendra shares his personal journey and the tenacity required to educate insurance providers about IR and OBLs. He underscores the broader need for healthcare professionals to advocate vigorously for their both patient care standards and their financial interests. The episode also includes practical insights for setting up a fee schedule, understanding market dynamics, and the potential pitfalls in standard contracts.---CHECK OUT OUR SPONSORSVarian, a Siemens Healthineers companyhttps://www.siemens-healthineers.com/Reflow Medicalhttps://www.reflowmedical.com/---SHOW NOTES00:00 - Introduction03:14 - Journey of Insurance Contracting: From Confusion to Clarity10:08 - Art of Negotiation: Laurie’s Unique Coaching Model19:53 - Leveraging Data for Effective Insurance Negotiations25:17 - Power of Negotiation: Changing the Game in Insurance Contracting28:09 - Exploring the Challenges of Physician Negotiations with Insurance Companies31:54 - Power of Personal Advocacy and Site Visits in Negotiations36:45 - Navigating Contract Renegotiations and Understanding Fee Schedules40:56 - Importance of In-House Billing and Vigilant Fee Management52:16 - Final Advice: The Importance of Negotiation and Understanding Your Business---RESOURCESProvider Solutions (Laurie Bouzarelos’ company):https://www.providersolutionsconsulting.com/about

Dr. Osman Ahmed, an interventional radiologist, discusses innovative techniques and materials for upper GI bleed embolization. Topics include different embolization methods, microcatheters, Obsidio Embolic advantages, operator preferences, and procedural nuances. The conversation highlights the evolving technologies and procedural considerations in managing GI bleeds.

Dr. Marcelo Guimaraes, a vascular and interventional radiologist, discusses the benefits of radial access in interventional radiology, emphasizing safety, simplicity, and improved outcomes. He covers topics such as the RAVI Registry outcomes, patient preferences, cost-benefit analysis, and handling challenges like artery spasms. Dr. Guimaraes advocates for radial access as the default method for embolization therapies due to its efficacy across procedures and patient conditions.