SBI Podcast
The official podcast of the Society of Breast Imaging (SBI). This quarterly podcast will cover different breast imaging themes each year. The theme for the first year is: Breast Imaging Economics.
SBI Podcast
Unlocking the Economics and Future of Breast Imaging: A Conversation with Dr. Karla Sepulveda and Dr. Dana Smetherman
Unlock the secrets behind the economics of breast imaging and its transformative impact on patient care. Join Dr. Karla Sepulveda in the debut episode of the Society of Breast Imaging podcast as she discusses the inspiration and vision that led to the creation of this series. This episode sets the stage for a comprehensive exploration of the financial challenges in breast radiology, with esteemed guest Dr. Dana Smetherman, the new CEO of the American College of Radiology, sharing her remarkable career journey and insights into the future of radiology.
This quarterly podcast will cover different breast imaging themes each year. The theme for the first year is: Breast Imaging Economics.
Hello, I'm Carla Sepulveda, professor of Radiology at Baylor College of Medicine in Houston, texas. I currently serve as Section Chief of Breast Imaging and Medical Director of the Breast Center at Baylor St Luke's Medical Center. Welcome to the inaugural Society of Breast Imaging podcast. I'd like to start with some background on how this podcast has come to life. One year ago, I had the opportunity to do a podcast for the Texas Radiological Society on the economics of breast imaging. I had the privilege of interviewing Dr Dana Smetherman for that podcast. It was a wonderful experience. In this age of quick news cycles and social media blurbs, it was such a pleasure to take the time for a thoughtful, more in-depth conversation about important issues impacting our field and how we take care of patients, and Dr Smetherman provided a fantastic interview with intelligent and insightful commentary. However, what was even more gratifying than the interview was the reception the podcast received once it was released. Several listeners sent emails to let me know how much they enjoyed the podcast and I realized the broader demand for content like this. I shared the podcast with Dr Mimi Newell, who was president of the SBI at the time, and I inquired if there might be an opportunity to do something similar with the SBI. Dr Newell kindly connected me with SBI staff and here we are at the start of what I hope will be an informative and interesting series covering topics for members of the breast imaging community. Thank you to Dr Newell and the SBI for supporting the concept Over the course of this past year.
Speaker 1:Dr Alyssa Cubison has joined me in the planning effort. We worked collaboratively to plan a quarterly podcast schedule. There are so many fascinating topics to cover in our field that it was difficult to decide which issues should be discussed first. We ultimately decided to organize the series based on an annual theme and for the first year we selected economics. I would also like to take a moment to acknowledge Hannah Chadha, a second-year medical student at Georgetown University, who is considering a career in radiology. She also joined the effort in this past year and is providing technical and podcasting expertise. With that background, I would now like to introduce the guest star of the show for our inaugural episode, dr Dana Smetherman. I didn't get enough. After our interview last year and with her new position as the American College of Radiology CEO, I thought she would be the perfect person to help kick off this series. Welcome, dr Smetherman. Thank you for joining us.
Speaker 2:Well, thank you. I greatly enjoyed last year when we had a chance to speak and am very honored to be the inaugural speaker this year. You're right, there is so much going on in our specialty and always plenty, plenty to discuss, so absolutely my pleasure and a privilege, thank you.
Speaker 1:If you wouldn't mind. I always like it when the speakers introduce their background. It gives speakers a chance to perhaps highlight things that they thought were important on their journey to where they are now.
Speaker 2:Of course. So, as you mentioned, I recently started a new job as the first woman CEO of the American College of Radiology and it has been just fantastic so far. I feel like I'm still a little in the drinking from the fire hose phase, but it's been such a fun ride so far and have really, really enjoyed meeting my new colleagues on the ACR staff. I will have to say that I knew it was a wonderful group of people from my many years of experience with the college, but even I was blown away by what a talented and diverse group of people they are. So that's the first thing. As far as introducing myself well, I grew up in New Orleans and actually Houston, quite familiar with the Baylor system and St Luke's, went to high school in New Orleans and then actually went away to Boston for college, came home to New Orleans for medical school, I got a master's in public health Both of those degrees, my MD and my MPH at Tulane a master's in public health Both of those degrees my MD and my MPH at Tulane went away to do a neurology residency in Connecticut and, as I've said many times, saw the dark and realized that neurology probably wasn't the right field for me. And, after some introspection and talking with mentors and other friends and colleagues, decided to switch into radiology and never looked back. Clearly it was 100% the right decision and so I was really lucky, honestly, that Ochsner in New Orleans, where I had done my internship, happened to have an unexpected opening at the PG2 level and I was able to interview that over my vacation time that I had at Christmas. And so, as though it were meant to be, I wound up starting my radiology residency there and then actually continued there for 32 years and I will say, as far as, like you know, my journey, I certainly did not go through my career thinking that being the CEO of an organization like the ACR was my end game, but I will say that I really did try to take advantage of, you know, kind of whatever interesting opportunities came my way. So you know I have joked that when you work in one place for such a long time, you have the chance to be on pretty much every committee, and I was on a lot of committees and was in the leadership role. But I, you know I was able to develop expertise and quality and safety. I was able to learn a lot about medical staffing and, you know credentialing and all of these things. I was along to learn a lot about medical staffing and credentialing and all of these things. I was along the way. I was the vice chair for quality first and then a vice chair for clinical affairs Over time in my department I was the breast imaging section head before that and for many years and really loved all of those operational roles.
Speaker 2:And around 2012, I was asked if I would consider becoming a member of the Ochsner Health System Board and I did and that was another really transformational experience. I think in my career I learned a whole lot about healthcare in ways I'd never really thought about it before, not just from kind of the operational systems perspective, but also the greater healthcare landscape, and really started to develop an interest in healthcare economics. I was again fortunate enough to have many opportunities to be a volunteer in lots of different organizations RSNA, rankin-ray Society, the SBI and then the ACR. Starting off in my local chapter, the Radiological Society of Louisiana, eventually became an officer and a counselor from Louisiana and then sort of did a lot of different things in the ACR, some within the Breast Commission where I eventually became the chair of the Breast Commission, some in the economics committee side, economics commission side rather. I was also a clinical image reviewer for breast ultrasound accreditation and, just you know, kept trying new things and learning new things along the way.
Speaker 2:It was quite unexpected to me that I would develop an interest in healthcare economics. It was not something that was on my radar, which just goes to show you. I mean, if somebody had told me when I graduated from medical school you know, about 25 years from now you're going to decide to get an MBA I would have said, oh, there is no reality that I can imagine in which I would want to do that. I mean, I don't want to be a business person, but anyway, it turned out that it actually was a significant area of interest for me, and so I did wind up getting an MBA when I was in my early 50s and, as I said, just continued to just learn and when interesting new opportunities came my way, and then obviously the most recent one being the opportunity to throw my hat in the ring for the ACR CEO, which I started, as I said, about two months ago.
Speaker 2:My husband and I have now moved to Arlington, virginia, and have settled in pretty well. I will tell you that in Louisiana my commute was never more than seven minutes, but I knew if I ever moved anywhere else that was not going to be the case. So a little more of a commute here in Virginia, but it hasn't. It hasn't been too bad, not too bad at all, and so. And so here we sit, here we sit.
Speaker 1:Yes, here we sit and thank you for that. I always think that that pathway and that journey you know just as, as you said, I definitely not a straight line Definitely the zigzag that leads us where we end up, and I love to hear the different things and I appreciate very much the different experiences you had in the ACR. That I think helped to make you very effective as CEO because you've been in those different positions and understand what those volunteers usually are doing there and I think that insight helps you to lead. So what I'd like to do now is sort of transition into some of the topics that I've selected for this discussion, and the first one that I'd like to start with is economic outlook and top economic trends for breast imaging. I'd like to hear your thoughts on that?
Speaker 2:Yes, absolutely. So you know, I think if we look at radiology in general and breast radiology, radiology in general and breast radiology specifically, we are in, I would say, in some ways, the enviable position of having just a tremendous amount of demand for our services and expertise. And so we think just sort of take a step back and think of that at the highest economic level you know that is. It is really an enviable position to be so much in demand. But on the flip side, that brings challenges right Because we really don't have the workforce to handle that. So but I do think, as we think about how healthcare has progressed over the last maybe 25, 30 years, the idea that we would have such robust and effective ways to find preclinical disease I think also is a huge economic opportunity and I think that breast radiology has really led the way there.
Speaker 2:And as we think about medicine transitioning to healthcare, people living longer, healthier lives, finding disease early, I really feel like breast radiology, breast cancer, is almost the poster child for that and we're starting to see that take off in other areas as well. I would say lung cancer screening is the obvious next one, and then, you know, certainly colon cancer screening has been very widespread. But now we're going to have reimbursement for CT colonography, which I think will offer another way for patients who may not have access to people who can come and, you know, bring them to and from their appointment and have sedation have access to that. But so, you know, I really do think that economically, breast imaging has huge potential and will continue to have huge potential. We also have advanced technology like MRI. That, I think, is really making a big impact, a big impact. Now I think it will be interesting to see, now that the MQSA has mandated that density information.
Speaker 2:What is going to happen to supplemental screening? Now all women are going to know if they are at higher risk for breast cancer and they'll know that they might benefit from supplemental screening. Many states already had legislation that mandated this, but now of course, this is going to be for everyone. That, I think, is going to put another, higher demand on our services to be able to provide that high-risk screening, whether it be ultrasound or a breast MRI or even potentially, in the not too distant future, contrast enhanced mammography. But the economic challenge for our patients really is that although some states have mandated that there's coverage and that of course doesn't apply to Medicare patients, others have not. And with that MQSA change, patients will now have the knowledge, but they may not have the means to pay for that supplemental screening out of pocket. So I think we're going to have to really see what happens there. I would also say you know one of the other.
Speaker 2:I don't know if it's unanticipated, but outcomes of the Affordable Care Act is that although we now have the lowest rate of uninsured people in the United States that we've ever had in our history, it's down to about 7%, which is remarkable and is obviously a positive.
Speaker 2:But we now have an even more fragmented payer landscape right, and so we have some programs that are national, like Medicare, some that are state by state, and then we have different rules as far as payment with all of those different payers.
Speaker 2:And although you know for now I would say reimbursement for screening mammography without out-of-pocket expense is pretty much uniform across all of the different payers, but not the case for supplemental screening, and patients can be very confused by this, because they may have what they think is the same insurance one year and the next and all of a sudden find that a service that was covered at a certain level, maybe without even out-of-pocket expense, is no longer covered the following year, and that's hard for individual patients to keep up.
Speaker 2:It's certainly hard for us as healthcare providers, health systems or private practice whatever, to be able to even have that conversation with the patient and say, oh, you know, I know that your particular plan of this particular insurance covers this, this and this, and you'll have a deductible for this part and a co-pay for that. And so I think you know, if we think about the macro level, the demand for our services is high and it's going to get even higher. But we may really find our patients very confused and even distressed about whether or not they're going to be able to pay for some of those supplemental screening tests out of pocket.
Speaker 1:So Absolutely Great point.
Speaker 1:And I could see where you know we we followed it pretty closely in Texas when we had the breast density legislation and I remember coming together in Houston for meetings and I think we were somewhat surprised that we were anticipating that big uptick in supplemental screening and sort of with time we were surprised that it wasn't happening as much as we had anticipated and we were trying to think through why that is as much as we had anticipated and we were trying to think through why that is.
Speaker 1:Was it a matter of conversation and education on the part of the radiologists for the referring physicians to really make the case that when we talk about that in the report, that really we're recommending it and pushing for it? I think some of the radiology community, as you're saying, just because we're so busy as we are, we're almost concerned about it, about that increase in potential volume, and yet we know this is such a powerful tool to get to the patient and to screen them further. So I absolutely think this will be an interesting thing to follow now that September 10th has passed. I also the other point I like about what you're saying is I think it it brings up the patient here and the political getting confused and if there is a movement to make that apparent to our legislators, where that could be a political, very powerful political point, to make the case that we do get that broader coverage on a national level for supplemental screening.
Speaker 2:Yeah, I think what we've learned is that if we really want to be able to have all patients have access to supplemental screening, it probably will require national legislation.
Speaker 2:you know, there's so much going on in Washington right now of which I am much more highly aware than I was in the past because, obviously everyone here sort of eats and breathes politics and we obviously have a very important election coming up, but so I don't think we have a whole lot of updates on that. But I think for the breast imaging community to know that if we really want to get to that place where all women have that same access, it's almost certainly going to require something on the national level like legislation. Now that doesn't mean that we shouldn't advocate in our states, and and I've my, my thinking has changed about that too, um, but, uh, you know, I've, I have, uh, I think, adopted more of a don't let perfect be the enemy of good. If we have opportunities to improve things for some patients in the States, you know, I think we probably have to try. But I think we also have to be blinders off and know that it's not going to necessarily solve it for all of the patients, and we have to make sure the patients are aware of that.
Speaker 2:And you know so I also would understand why some people would say, no, no, it's better just to wait to have national legislation. Yes, you know it's so, it's it's not easy. Yeah, the important thing is to be well-informed and realize that just because you get the legislation in your state that even would require payment without cost sharing, that it will not solve the problem necessarily for all of your patients. Yes, yes, okay, excellent, and it really rang true with me as somebody from Louisiana. It hasn't been the awareness and the demand for supplemental screening, even with density. Legislation that comes into play in states is not uniform in different communities right, there are some communities that seem like they're very aware and advocate very strongly.
Speaker 2:I think we saw some of those more in the Northeast but but our experience in Louisiana was similar to yours. We did not have I'm not saying we didn't have some patients when it went into their reports, but it was not as many as we had anticipated Exactly.
Speaker 1:It is interesting and when you talk about the Northeast, I sense I remember the meetings at the time and there was just more of a culture particularly of screening, ultrasound and really encouraging that and finding the workflows where it was integrated and communicating, educating patients, referring providers, so that it's multifactorial for sure, but looking forward to see, but looking forward to see, and of course Connecticut was the first state, and so they may have had some very passionate advocates who had really raised the awareness.
Speaker 2:I'm not sure, but I would have to say our experience in Louisiana was more like what you described.
Speaker 1:Yes, Okay, we are going to move to the second topic, and I know that you happen to have both a medical degree and a public health degree I think you also might have mentioned that in the introduction and so I'd like to take a moment to talk about the economics of health inequities. And when I think about this, I want to sort of look at it from two angles One, ensuring access to the tools we use for screening and supplemental screening, and then, as a second point, ensuring access and identifying high-risk patients in underrepresented minority groups. So I'd like to hear your thoughts.
Speaker 2:Absolutely Well. This is certainly something that has always been, throughout my career, extremely important to me. You know, obviously in the New Orleans area we are a majority minority population. So you know, many times I feel like these are our patients and I think we were really cognizant of the fact that we would see, for instance, our African-American patients presenting at a younger age, often with those aggressive triple negative tumors. And you know so we were very early advocates and very strong advocates for annual mammography beginning at age 40. But so you know, and we do know, that in virtually every ethnic group other than women of Caucasian background, that that peak incidence of breast cancer is at a younger age. Now a lot of the studies, you know they were never designed to look at different ethnic subgroups, they weren't powered to do that and so sometimes the ages kind of, I think, got overwhelmed by the larger women of Caucasian descent. So it's a little. It took time to really be able to ferret out some of that data, but I think over time it became quite apparent.
Speaker 2:Know, we were investing in the late 2000s and 20 teens a lot in building our primary care network and building it very thoughtfully and trying to make sure that it was. You know, we were well distributed across the geographic area, embedded clinics in all different kinds of neighborhoods and we made the decision. It was a fantastic partnership in any sizable primary care OBGYN clinic to have an embedded screening mammography unit and a lot of those in the early days, before we even had an EHR, we they were walk-in and so we took that approach rather than mobile vans. I know people have had different approaches. What we chose to do, that one and we had this really, really strong partnership with our primary care colleagues and that has been very effective because a lot of times those patients who may have jobs where they don't have benefits or where it's difficult to get time off, if you've got them right there in your hands and you're there for another appointment and it's due.
Speaker 2:If you can just say, head right down the hall and get your mammogram today. So that I think for us really turned out to be a very effective strategy. And we were delighted to see, when we had the ability to look at the demographics, that, if anything, our African-American patients were being screened at a higher rate and had better compliance than a lot of our other groups certainly never worse. So for us that was a very effective strategy and we often partnered with federally qualified health centers you know just all different kinds of things and that sort of became our model and I think it was also interesting and for me personally, very rewarding to be on our board at that time because we really, as we grew and we grew rapidly, I think really changed our kind of mindset about what it meant for us to be a 501c3 organization, what commitment we had to our community at every level, but including things like healthcare equity, and we were also in the situation as being one of the earliest states in the Gulf South to have the Medicaid expansion. Now I will tell you and I've told this story before to others, it's a very interesting story.
Speaker 2:I remember when that happened. And about six months after it happened, we had a new Democratic governor who was elected, john Bel Edwards, and he, within days of his inauguration, signed the Medicaid expansion into law in Louisiana. And I remember about six months later, the secretary of the Department of Health was being interviewed about what had happened and she said she was quoted as saying that and we've already done like a thousand screening mammograms and found 25 breast cancers. And I remember sitting there thinking, oh my gosh, you know, that is wow, right, four or five times what you would normally expect to find in your typical screening population. I knew what our, you know, cancer detection rate was and it was really a light bulb moment for me because I was like, oh my goodness, like we are newly screening all of these previously uninsured patients for these diseases and it's not just going to be breast cancer, it will be other types of cancer, it will be hypertension, it will be vascular disease, lots of different things, and it will be vascular disease, lots of different things.
Speaker 2:And you know, I think we really did see out, see it, bear out that truly uninsured patients do not really access the health care system.
Speaker 2:They really wait until they've got a, you know, probably near life or death situation, right Something's very advanced disease, and then they're handled by safety net hospitals and once they have access to insurance they will start having that regular care. And so you're almost certainly going to see a big uptick in detection of all different kinds of diseases and utilization of all different kinds of services. And you know, over time, if that continues, you would think it will come down to the level of the rest of the population and I do think that that in some ways is contributing not just that phenomenon but just the expansion of the number of insured people to a lot of the workforce shortages that we are seeing. So anyway, but I certainly have been lucky to have opportunities where I feel like we were able to really, in the positions I had previously, support those kind of activities and feel like we're doing what we could to try to address the healthcare inequities in our community.
Speaker 1:Yeah, I really appreciate the idea of embedding in primary care clinics and I think that's so smart and I wonder if it was part of your position where you were, because I imagine the primary care physicians didn't necessarily ask for it, you more suggested. This would be a great idea.
Speaker 2:So, yeah, that's good. It's got a really interesting history and I will I'll take you through it a little bit because I think it's important, as you think about as a radiologist or radiology leader, like building those relationships is can be a really important and powerful thing. So, um, originally I approached the OBGYN clinic and and we did it sort of as a first pilot, um pretty early on, and I said I'd like to, and honestly I was in the section head just for a few years and we frequently had um complaints about not having good access for screening mammography. But of course within the department it was like well, it's a screening, there's no urgency. If people have to wait a couple of weeks, you know what does it matter? But outside of radiology that was viewed, you know, very negatively and patients wanted to have good access and so, and so I was kind of racking my brains how do we do this? And so I approached first OBGYN and they, they were not interested.
Speaker 2:And so then I went to a friend of mine who had just recently had trained with me and had just recently become the head of primary care, which was still in its very, very earliest phases at Oxnard, and I said, look, I just need two exam rooms next to each other. That's all I need. Like, I'm going to put a, we're going to carve a hole in the wall, we'll put a door there, we're going to put a mammo unit on one side and we'll lock that door. That's on that side. You don't even have to build a wall. We'll just lock the door so that it can't be opened, and and we'll use the other room as a waiting room. And I said that's all I need. That's what. We're just going to put a few chairs. We're going to have signs where the patients, you know it says you know, sign in here, take, take a gown, take this plastic bag. We didn't even have full changing booths, we just had like the little you know like wall and it had a you know like a shower curtain thing. You'd change it, they'd hold it in their lap and they would sign in when they got there. It was a HIPAA compliance sign-in sheet and we'd take them. First come, first serve. And if it looked like and we didn't have a lot of chairs, really like five or six chairs, but if you got there and there you can't, you can't, you know, stay today for your exam. You can take this pamphlet, call this number, we'll get you scheduled for your screening mammogram.
Speaker 2:And a friend of mine, dr Pedro Cazabon, you know he came back and he was like, okay, all right, I'll let you do it. And so, and, and what we did was we put like little pink footprints, you know that, went up to that room and signs, and it was absolutely the beginning of something that was fantastic and a fantastic partnership. That went on from there and primary care just exploded exploded and unfortunately he is deceased now. But um was just a, just a phenomenal leader and a visionary and um did so much for our community and in primary care Um, but uh, you know it was.
Speaker 2:It was interesting because over time those primary care doctors got to feel like it was their mammo unit and they really um, really appreciated it for their patients and were tremendous supporters and so so over the years it really did turn out to be a great project. But as often with these things, that started out because it was like, okay, what can we do so that we can improve our screening access? And basically it was evergreen. We didn't have a schedule, and so then we were able to go back and say we've got same day mammo every day. So anyway, but you know often, as with as with many things in life, you start off trying to solve the pain point and you don't know where it will go, but hopefully it will be something successful.
Speaker 1:That's right. Nice to hear that kind of success that you were able to accomplish, and also the partnership. I appreciate the partnership you had with the primary care team. Okay, next topic and our last one in terms of economics. Economics of opportunistic screening with AI. Oh, wow, yeah, before we do that, I just want to provide just sort of a comment on what that means the use of AI algorithms to opportunistically screen patients for disease who are getting an unrelated medical imaging exam. So a breast imaging example would be vascular calcifications on mammograms being analyzed to predict which woman might be at risk for vascular disease, heart attacks or strokes in the future. And we know I can think of at least one vendor that is seeking FDA approval for their version of this. So I'd love to hear your thoughts on it.
Speaker 2:Yeah. So I think this is another tremendous opportunity for patients and for radiology. So if we think about the amount of information that is in the imaging studies that we do and I think you know breast imaging is a pretty finite area and we'll talk a little bit too about other areas, but again, you know, more women will die of vascular disease than will die of breast cancer- right.
Speaker 2:But it's very hard for me to look at a mammogram and sometimes it's very obvious. You'll have, like a patient on dialysis or something who's got dramatic calcifications. But you know, I'm with my eyes, can't really quantify except, oh, that looks like a lot, or more than you'd see for her age, or oh, this woman doesn't have any like what's in between and how much really in the way of vascular calcifications are there. But it's giving us insight into something beyond just breast cancer, and what AI can do is look at that and not only detect it but also quantify it. And so then, if you have more robust information about outcomes of vascular disease in those patients, you can link those things together and start to say, oh well, if your AI score is this you know, we know from this other data on patients like you you've got a 25% higher chance of having some kind of a vascular event in the next five years or something like that and so I think I think there's tremendous potential. Now if we take it in. You know, breast radiology in some ways it's kind of simple, right? It's one organ system we're really looking for one kind of disease and there may be other things. But you know, beyond the vascular calcifications. It's pretty limited anatomically. But if we look at things like a CT of the chest, abdomen, pelvis, or a CT of the abdomen and pelvis, you know, maybe done for you know, you're worried that someone has a renal stone or obstructing your renal stone. There's a whole lot of other information there. And again, right now a human being can't look at the bones of that person and say, you know, wow, you've got a lot of osteoporosis. If it's really sclerotic or really osteoporotic, you might be able to subjectively say that, but you can't quantify that and turn that into a risk factor. Same thing for vascular disease, probably same thing for things like, you know, fatty infiltration of the liver, and so I do think that the information that we could provide in some ways could wind up even dwarfing what might be available in the rest of the EHR and lab tests and things.
Speaker 2:And so I think it's a tremendous opportunity for patients and for radiology to be in the driver's seat of some really important public health initiatives, to get more value out of the imaging that we're already doing right and the data that we already have. And so I think, particularly in things where we as a human being can't look at it and quantify it. In some cases maybe not even detect it, quantify it. In some cases maybe not even detect it, but it's there, and then you know. The next step would always be, if you can, you know, link all of that to what we know about other patients and similar patients and then help stratify the next steps for patients and what additional you know imaging and or blood tests, or you know other kinds of diagnostic tests they might need. So so, yes, you know there's not a tremendous amount of data or applications yet, but there are a few.
Speaker 2:And you know, I think, the thought now, now some things are happening a little, maybe more quickly than we might like, and that's like the whole body, mrs. That's where the science, I think, has gotten a little bit ahead of the evidence. But that doesn't mean that there isn't potential there. We just have to, I think, make sure that we always keep the science and the evidence front of mind. Keep the science and the evidence front of mind so that doing things and and not not, as I said, getting a little ahead of ourselves and perhaps detecting things that aren't going to be significant or et cetera, but but nonetheless, I mean what, what an exciting time, right, absolutely.
Speaker 1:I, I, you know, especially with your past experience sort of serving on the health system board, I think one of the think and you touched on these. You know what's, what are the benefits for the patient? You know clearly we can outline, you know, detecting disease earlier. You know, and perhaps maybe not, that wouldn't have even been caught, you know, just on a normal radiology approach. But you have the patient benefit. Then you sort of look at the what is the health system? What does this do for the health system? And you know we think about, okay, does this open the door for additional tests? And you know additional opportunities for biopsies and diagnosis, that in a population health sense the health system would be interested. And then I sort of go to insurance. I'm like, well, what, what is what's insurance going to say about this? What would they? And I could see where we have the case for it.
Speaker 2:With insurance, from the standpoint of it's, it is less expensive to take care of patients when the disease is caught early, right, well, maybe because you got to remember that in the United States after five years the majority of patients are not with the insurer that they had in the first place.
Speaker 2:Oh, I see. So Medicare, you know, does have patients longitudinally and some Medicaid programs, but not necessarily. So that's a bit of a challenge. Now you're right that it should all come out in the wash, right, because the patient where the disease was found and you were insuring the patients when it was found early, even if they're with another insurer five years later where the advanced disease would have shown up but didn't, or five years later where the advanced disease would have shown up but didn't, you know you'll have a similar patient come back to you. So I think if we can encourage insurers to think not just in a yearly renewal cycle but instead, you know, because what goes around will come around. Just because the patient leaves your insurance because they changed jobs or their insurer went to a different insurance provider, you know you're getting somebody else. So you know what I'm saying.
Speaker 1:Like the patients are moving in and out of different plans.
Speaker 2:So you know it will probably be a what goes around comes around situation. But if you only think of it in terms of one year, you could see how an insurer might say, oh, I'm not going to get the benefit of having that screening exam, so anyway. So I think you're right in principle, but sometimes the way it works out I don't pretend to be in the head of insurance companies, but I've thought about this a lot and I do see how and that, and I was not too surprised when I thought, wow, you know, I think about the fact that most people don't keep the same insurance throughout a really long period of time. You could see how somebody looking in the shorter timeframe might be like I just saved somebody else some money and it might be costing me more today, so exactly, Yep, great point to add there.
Speaker 1:Okay, so, if you will allow me, uh, I always enjoy parts of interviews where there are some personal insights, and especially for, I think, more people that are more junior in their career, I think listening to some personal insights of where you are would be particularly informative. So I have a few questions, just two here. So I'd like for you to go back to the day of your med school graduation and we won't discuss the number of years we won't give a date we won't, let me pull my diploma out of the box.
Speaker 1:But I would love to hear what you would tell yourself that self from your standpoint today.
Speaker 2:Yes, I think I would tell myself your path is not going to be the path that you think it is today and, honestly, I was one of those people. I decided, pretty young, young, even though there were no physicians in my family um, that I that this was what I wanted to do and I went straight college med school, you know out into residency, all didn't, didn't take a break, was pretty focused on that all the way through. Uh, so I think I would tell myself your path is not going to be the path that you think it is today, but it's going to be okay.
Speaker 2:I think, if I had known that at the time, I would have been like, oh my God, I know exactly what I, what I want to do, um, but it's going to be okay and that it's going to be interesting and satisfying and you're going to keep learning throughout your career and it will take you in directions that you are not even contemplating today, but you're going to really enjoy it and it's going to be fulfilling and you are going to basically be because of it, you're going to be a lifelong learner. Yes and so, and I think I, I think I had a fixed destination in my head. It didn't turn out the way that that I would have imagined, which was pretty interesting because up till that point, things pretty much had happened the way that I thought they would. Right, absolutely.
Speaker 1:It's very much of a wise right.
Speaker 2:It's very much of a wise right.
Speaker 1:Yes, yes, yes. Great question, though. Great question, carla. Ok, so, to close, you're not quite at 100 days, but here we go. Tell me for let's, let's say for the next year or two, um, what are your hopes, aspirations, uh, for what you can do in your new position as CEO of the ACR, right.
Speaker 2:Well, um, first of all, it as I said before, it's just such an honor to be in this position and to be leading this organization, this organization as we start our second century. And I really want for the ACR recognizing the workforce shortage, recognizing the volume, I really feel like our role is going to be that fast, easy resource that has the answers for radiologists, because I think people just aren't going to have the time Like when there's a change in MRI regulations or whatever they're going to need to be able to come to us and we have that answer for them. I think of things like the MQSA town hall that we had with the FDA. We need to have, we need to be the people that are providing those resources, whether it's the use of AI, but also the safe use of AI, because I think in breast radiology we've seen, we've had, computer assisted detection for a quarter century and we know its strengths and its weaknesses and we know that there will be things that happen with AI that will be unanticipated, and so I think we need to be as the organization, we need to be that resource, we need to be supporting people in their practices. If there are skill or education gaps, we need to be able to provide them with those skill or education gaps. We need to be able to provide them with those.
Speaker 2:And on the advocacy front, I think we need to continue to advocate for patients and radiologists and for patients to have the benefit of having the expertise of radiologists.
Speaker 2:And so that means radiologists have to be able to thrive. They have to be able to thrive from a payment policy standpoint. They have to know what the standards are. They have to know about new technology. They have to be able to thrive from a payment policy standpoint. They have to know what the standards are. They have to know about new technology. They have to know how to use it safely for patients. So that, if I were going to say my overall vision very much aligned with the vision and mission of the ACR and our strategic plan. I had the chance to go back and look at those when I started, because we did that exercise about three years ago and I looked at it all and I was like you know, I think these things really still do resonate, and so for me that that's really my vision is for us to continue to be that resource at a time when I just feel like radiologists are going to need it.
Speaker 1:Yes, yes. Well, I know so many of us, especially in the breast imaging community, were thrilled to when the announcement happened that you were going to that position and I very much look forward to seeing what happens during your tenure and in over this next first couple of years of your term.
Speaker 2:Yeah, it's, it's uh, it's very exciting and I really appreciate that and I I cannot tell you how uh, how much it meant, uh, you know the outpouring of support, but especially from, uh, my breast radiology colleagues, uh, many of whom have been, you know, friends and allies and mentors, and just you know, I feel like we've all been in the trenches together. So I appreciate you saying that and I and I also, just it was, it was wonderful.
Speaker 1:So Love to hear that. So first, thank you so very much again. Always a pleasure we again. I feel like I could keep going for another hour. Always a pleasure.
Speaker 2:We again. I feel like I could keep going for another hour and thank you. I mean, I know, I know, carla. You are not only, you know, active in the SBI but in the Texas Radiology Society and the ACR and are, you know, just such a strong and wonderful radiologist in your own right and in all of the things that you do. So thank you for your volunteerism and your dedication to the specialty and your patients.
Speaker 1:Absolutely, absolutely. Thank you so much for joining us for this inaugural episode of the SBI podcast. We hope you have found it informative. Please join us for the next episode that will be released in November, where we will discuss the economics of breast imaging as a part of the larger multidisciplinary breast center. We'll also discuss bundling of services and value-based payments. Look very much forward to that conversation. Thank you again for joining us. You.