Announcer: Welcome to Business Life 360 with Kristi K., where we cover trends and impact in the world of business.

We get to know CEO leaders and innovators, and we see firsthand how business and life connect.

(Music) Business like 360 with Kristi K. is made possible in par by KeyBank National Association trustee for the Walter E Terhune Memorial Fun and ProMedica Toledo Hospital, celebrating 150 years of serving our community.

Also by viewers like you.

Thank you.

Kristi K:Welcome to Business Live 360.

I'm your host, Kristi K. On this episode, we're talking about the intersection of healthcare innovation and business, specifically as it ties to patients accessin new and innovative health care offerings and associated reimbursement.

We're going to discuss innovation in prostate health as well as Parkinson's disease and essential tremors.

All are increasing in our region, and we'll talk with an expert in health insurance to put it all together and help us navigate this intersection of healt care, innovation and business.

So kick back, relax, and join me.

It's all here.

Right here, right now.

This is business life 360.

Prostate health i a growing concern for many men.

We now head out on location to discuss conditions such as a large prostate and prostate cancer.

What?

Doctor penis and chair of the University of Toledo Medical Center, Departmen of Urology, and a Kenneth Kropp Endowed Professor of Neurology at the University of Toledo College of Medicine and Life Sciences.

Kristi K:Also joining us is Doctor Michael Ellis, chief medical officer at the University of Toledo Medical Center and a professor of medicine.

He's also a board certified internal medicine and infectious disease physician who's going to further discuss trends and innovation in medicine.

Let's head out on location.

Doctor Antoine, thank you for being with us today.

We're really excited to hear more about your expertise.

Dr. Sindwani: Thank you ver much for having me here, Kristi.

Kristi K:Well, let's start with the general.

Tell us more about the urology practice.

Dr. Sindwani: I loved urology because you do clinic, clinic procedures, surgeries.

You have longitudinal care and you have a good relationshi established for long term with your patients.

Kristi K:There are two areas I'd like to talk about today for our viewers who may be intereste in specific issues with urology, including prostate cancer as well as an enlarged prostate.

So why don't we start, first of all, with the enlarged prostate?

Let us know kind of an overview of what that is.

Dr. Sindwani: Absolutly.

So enlarged prostate is a very common problem.

Enlarged prostate will present with symptoms of urinary obstruction and some irritation of the bladder.

Kristi K:Now, this is not cancerous, is it?

Dr. Sindwani No, it's the benign enlargement.

Very good question.

You have to differentiate between the two.

Kristi K:Now when you're talking about the enlarged prostate, I feel like in days past maybe there wasn't a methodology, a procedure and innovation that men could have done that would really change and improve some of those symptoms.

Now, today, that is not the case.

Is that.

Dr. Sindwani: Correct?

That's very, very correct.

So enlarged prostate, also called BPH, has undergone revolutionary, advancements in treatment part.

Old days there used to be just surgery, open surgery.

Then came what is called Roto-Rooter.

Which was basically going through the urethra with a hot knife and scraping the prostate from inside.

So that channel that was squished now is made around again.

So you can remove excess tissue from inside.

Then there were certain innovations that started happening, because when you did that Roto-Rooter, there was a lot of bleeding, the risk of incontinence.

And any time there was a lot o heat dissipated to the tissues, it can damage the nerve that go alongside the prostate.

So there was a risk of, you know, sexual dysfunction, risk of stricture formation, which is kind of scarring within the urethra.

So all these things kind of led to innovations, but the latest and greatest right now, which is on the horizon and has been approved for the last three years in the United States, is called acquisition.

Kristi K:Aqua ablation.

Dr. Sindwani: Aqua ablation.

So more so aqua water ablation using water.

So it's nothing but a glorified term for, you have pressure jet for your, deck washing.

Right?

That's exactly what it is.

Kristi K:And how are outcomes.

Dr. Sindwani: Outcomes are excellent because patient you do not have thermal energy.

So there's no damage to the nerves.

And I think this i the next generation of treatment when it comes to large prostate.

Kristi K:Let's talk now about prostate cancer and some of the innovations there in terms of surgeries that may be required.

Or if one has a diagnosis of prostate cancer.

What are some of the options available?

Dr. Sindwani: Some of our, innovations now is that yo try to treat the prostate cancer fully, rather than removing the whole prostate.

You can treat where you found the cancer.

So how do you do that?

It's noninvasive, is called high Fuu, which is high intensity focused ultrasound.

So what does that mean?

Once again, a fancy term.

The way I can tell my patients is when we were kids, we had a magnifying glass.

And you if you have a paper, if you focus your sunrays right at the focal length, it'll burn a hole, right?

If the paper is too close, nothing happens.

Too far, nothing happens Kristi K:That's a great analogy.

Dr. Sindwani: Right?

So we do exactly same thing instead of sun rays.

In this case you have ultrasound waves that you can focus the doubt making a cut.

And you can focus righ where you found the cancer with imaging guidance, real time where the cancer was found.

And you can burn just the area where cancer was found.

So minimum damage or no damage to the nerves, no damag to the sphincter and no damage.

So no incontinence afterwards.

Minimizing risk of erectile dysfunction afterwards, minimizing risks to recovery and having patients go through secondary procedures, outpatient procedures.

No hospital admission required.

And select patients can get that done.

So not everybody can have it done because you need to find the cancer early.

So that's where getting your PSA check comes through important.

So make sure you have your PSA done annually.

Because if your cancer is found early and there's only one focus or only on one side, you can do high fu sparing yourself a big surgery.

Kristi K:Well, doctors and want to thank you for this information.

You are making a huge impact on men's health and a special thank you for our fathers, our grandfathers, our husbands, our sons in all you're doing.

Dr. Sindwani: Kristi, thank you so much for having me on your show.

Appreciate it.

Kristi K:Thank you.

Doctor Michael Ellis, thanks for joining us today.

Dr. Ellis: My pleasure.

Kristi K:It's great to have you here.

So you're the chief medical officer here at the University of Toledo Medical Center, as well as a professor at the College of Medicine and Life Sciences.

Yes.

So, want to get your perspective today?

It's great to have you joining us.

We're talking today a lot about innovation in health care.

And as a board certified internal medicine and infectious disease doctor, I would love your insight on the increased innovation that's occurring in today's world in health car and kind of how that's evolving and what you've see through your years in medicine.

Dr. Ellis: Right?

Yeah.

So innovation in medicine, I would say the the big thing I would say is tempo, the, the, the rapidity of the changes that we see in technology and diagnostics and therapeutics is mind boggling.

I think people, by and large, are more informe than they have ever been about, medicine and therapeutics and diagnostics.

And I think that they have a high expectation, for cutting edge technology.

And that's what we try to bring here in Toledo.

Kristi K:It's true with disease management as it is today.

I do think that there are expectations patients have that the innovation is really increasing with the evolution of kind of like, diseases that we're now seeing that maybe we hadn't seen before.

And to that point, we were, as we've talked with doctors in Downey, talking about what has evolve in the world of prostate health.

And we'd love to get your feedback on that.

In terms of, what you're seeing here at the University of Toledo Medical Center and the Colleg of Medicine and Life Sciences, as it ties to urology and innovation.

Dr. Ellis: Right?

Yeah.

So, Doctor Sindwani and his team, of outstanding physicians, are you know, bringing world class, technology to the Toledo area.

And, you know, again, patients are so informed, they're able to, get on the internet and find, find their own ideas about their own medical problems.

And it's just important that we bring those things, to our patients in the area.

Kristi K: Well, and here at the University of Toledo Medical Center and with the association with the medical school as well, you're seeing so much in terms of research and surgical advancements.

And I want to talk specifically to about neuroscience, neurology, and some of the things that are occurring here as i tied to cutting edge technology and everything from from tremors to Parkinson's disease.

Kristi K: So tell us more about some of the the evolution, if you will, in terms of innovation in that area.

Yeah.

Dr. Ellis: So the the hallmark of academic medical centers and academic institutions, for medicine, we usually divided into three major categories.

So clinical care education and research.

And those are all intertwined so that our patients, our clinical patients, experience, education, they can be part of an education process, but they can also be, have cutting edge therapeutics and research, a protocols, open to them as well.

So, having the clinical care, the education and the research take place in one institution with providers and faculty members who, who are world class, that gives the best care to our patients in the area.

Kristi K: Well, and how fortunate we all are to have that talent pool right here with us.

Yeah for sure.

So we want to thank you and your team very much for being a part of business life.

360 today for advancing medicine and all of the methodologies that you have done here at the University of Toledo Medical Center.

So thanks for being with us today.

Dr. Ellis: You're welcome.

My pleasure.

Krist K: Welcome back to the studio.

Billing, reimbursement and healthcare innovations don't always go hand in hand.

Here to help us understand the often complex world of operations in healthcare insurance, is executive vice president and president of Paramount Healthcare for Medical Mutual of Toledo.

Laurie Johnston Laurie has been in the health care insurance business for decades, and I can't think of anyone better to help us sor through some of the complexities facing consumers and patients in the insurance industry.

So, Laurie, welcome to Business Live 36.

Great to have you here.

Lori Johnston: Thank you.

Kristi K: It's great to be here.

Let's talk as we are on this show about some of the key innovations in healthcare that you are seeing, and specifically as those start to tie to billing and reimbursement.

Lori Johnston: Yes I think one of the challenges, you know, between those two topics, right, billing and reimbursement and innovation, one of the challenges have been that as researchers and physicians and, and pharmacy companies, as they try all new things, they're usually not always covered.

I think sometime insurance gets a bad name for, oh, they don't want to pay for anything, which really isn't true, but they really do rely on, a lot of the government recommendations and a lot of the scientific evidence.

And so many times things aren't reimbursed from a insurance perspective of until they've really gone through all of the testing and, and really been proven to be effective.

And so I think that's what's, you know, makes it such a hard position, because if you're a patient and there's something new, you can trial, you want to do whatever you can do and trial it, and then you find ou your insurance doesn't cover it.

And that becomes very frustrating.

And there's also challenges as it comes to things like pharmaceuticals as well.

Kristi K: I want to talk a little bit about that.

So a new drug comes on the market.

We all see the TV spots on those and hear them on the radio.

New drugs are on the market.

It sounds like something that would help us, but how do we know if it's going to be covered?

And do we have to skip a meal so that we can pay for our medications?

Lori Johnston: Yes.

Many of the, man of the new drugs on the market, you said it well are seen on TV, you know, long before there may be added to the formulary of your employer's health insurance.

And, and so I think one of the things that's challenging is that sometimes those drugs then are used for something other than their original intended purpose.

I think that that's an area that gets frustrating for, for people to understand well why it is covered, why isn't it covered for me?

And, and really the, you really have to understand exactly how your plan works and kind of what the true science says aroun what the drug was created for.

Kristi K: So if you are at a corporation and your company does offer certain drugs on the formulary of choice and some of the procedures, then you can get that procedures that is that kind of theoretically correct?

Lori Johnston: It is theoretically correct.

I think, you know, it's it's different for commercial insurance than it is for Medicare.

So for Medicare, the center for Medicare Services, CMS, they se what is allowable to be covered for Medicare beneficiaries when it's a commercial, health insurer, the employer really dictates what they want to cover o behalf of their employee group.

Kristi K: One of the segments that's on this show is we're talkin a little bit more about prostate cancer advancement and large prostate advancements and also, deep brain stimulation for those with Parkinson's disease and essential tremors.

So if someone is watchin this show, they're seeing those, those wonderful, innovative technologies that may be game changers for them.

How does a patient meet sort of that intersection between provider access and coverage in terms of health care?

Lori Johnston: Well, this is where it gets very tricky for a member, because first off, I think that sometimes as new procedures like those come out and come to the market, they may be in a given community only offered by certain physicians.

And so s the first thing is to understand is that physician even in your covered network.

And so some of that's understanding your plan and what's covered.

And then if it trul is medically necessary to do it, sometimes you can get coverage out of network.

If they're, for example, the only one that that does that certain, thing.

Kristi: And if they hear a procedure like the prostate enlargement procedure, we just heard about it on the show.

What should they do?

Should they say, okay, I'm going to assume it's not covered, s I'm not going to call on that.

Should they go ahead and make a call to their member services department?

How should they proceed?

Us.

Lori Johnston: So two ways.

One, I think many times the physician's office has got a lot of experience and understanding, but you got to appreciate they deal with a lot of insurance companies.

But then also I think that the, the actual patient should call and ask and if it's not covered to understand why it's not from a patient's perspective, they really need to advocate for themselves, and they need to not be afraid to push, you know, pus back to the insurance company, push back to the physician, and just to make sure.

And so I think always asking and not just assuming is the right way to go.

Laurie Johnston, thank you for being with us today and for enlightening us to all of these very complex issues facing us today.

Kristi K: Thank you.

Laurie Johnston has a wealth of experience and a breadth of knowledge in this often confusing healthcare insurance world.

Thanks again to Laurie for the insight and for all she does to help consumers and members get access to innovative health care, and to navigate reimbursement for these new and impactful, even life changing health care innovations.

Kristi K: In the worl of neuroscience and neurology.

Parkinson's disease affects approximately 1 million Americans today.

Essential tremor, also a movement disorder, is even more common than Parkinson's disease.

Well, let's head out now to talk with two renowned expert in neuroscience and neurology.

Doctor Alister Hoyt is a boar certified neurological surgeon at the University of Toledo Medical Center and an associate professor of surgery at the College of Medicine and Life Sciences at U. Toledo.

Also joining us is Doctor Jennifer Amstell, a board certified neurologist and movement disorder specialist, and is also an assistant professor of neurology at the College of Medicine and Life Sciences at U. Toledo.

And now let's head out on location.

Thanks for joining us today on business 368.

We're really looking forwar to hearing about the innovations as you've been a part of doctor AMS.

Give us an understanding of kind of definitionally, what is Parkinson's disease?

What are movement disorders?

Dr. Amsdell: Sure.

So movement disorders are a very broad category of neurological conditions.

Generally they're chronic problems where the primary symptom or problem for the patient is going to be related to their movement, whether that's extra involuntary movements like tremors, shakiness, or other extra movements that someone might have or lack of movement or difficulty moving.

And that encompasses a lot of different diseases.

Two of the most common, and one that we're talking about today are going to be Parkinson's disease and essential tremor.

Parkinson's disease is actually from a part of the brain that creates a chemical called dopamine that slowly makes less and less of that dopamine chemical with time.

That chemical, dopamine is very important for us to be able to control our movements and move in the ways that we want to.

Kristi K: And, Doctor Hoyt, tell u more about the surgical options that are availabl for those who are coming to you for essential tremors or Parkinson's, for example.

Dr. Hoyt: So these diseases hav been around a long time, okay.

As long as humanity's been around.

And while they're probably more prevalen now because of some exposures, people have been thinking about ways of treating them for a long time as well.

So actually, beginning in the late 1800s, people began to think about surgeries to trea symptoms of Parkinson's disease because there were no good drugs for treating those problems.

At that point.

By the time we got to the 1920s, the most kind of modern iteration of that surgery had come about, where peopl put probes down into particular areas of the brain and lesion, little areas of the brain specific regions.

And by doing that they could substantially improve the symptoms of Parkinson's disease or a central tremor in the 1980s.

People said, hey, instead of destroying that bit of tissue, how about we leave electrical contacts in that space and we stimulate that tissue with electricity?

And then when we turn the stimulation off, we have not lost that tissue.

It's still there.

And that's exactly what deep brain stimulation is.

It's leads that go down into these specific parts of the brain and stimulate those specific parts to produce the effect that we want.

Kristi K: As you see patients in the office after they've had DBS let's say, how are their results and what are the outcomes they're seeing.

Dr. Amsdell: So generally excellent.

So after a patient has surgery, we actually don' turn the device on right away.

So they go home and they have everything implanted and in place.

But we actually don't turn the device on until 3 or 4 weeks later.

That allows for time for them to heal up, and for any swelling or irritation created on the brain from the surgery to kind of go away.

And then we see them in the clinic by myself, or where one of my colleagues sees them in the clinic, and we actually turn the device on for the first time.

That's generally a long appointment where we spend a few hours together, checking the different amounts of stimulation and stimulating in different ways to find out the best areas that will be beneficial for the patient without creating any kind of side effect.

And most often, after that first visit, they have significan improvement in for Parkinson's, either their stiffness, shakiness and tremor, or for essential tremor patients in their tremor.

Dr. Hoyt: So while that ends up being a very large amount of work for the neurologist to do that, individualize programing and and modification of the stimulation for each patient when we have good placement of the electrodes and good programing in broad terms, we can usually see about a 50% reduction in the severity of Parkinson's symptoms, sometimes greater when we're talking about tremor, either in Parkinson's or an essential tremor.

We can often do better than 70 or 80% reduction.

Kristi K: And when we talk about the Midwest and the prevalence of Parkinson's and some of these disorders that we've just you've just described, why is the number higher here than perhaps in the East or in the South?

Dr. Amsdell: Sure.

So we think that it's most likely related to being a part of the area of the country called the Rust Belt, where we have higher exposure to different chemicals, both industrial chemicals as well as different chemicals associated with farming or pesticides, although we can't say 100% for sure.

There's definitely a higher rate of exposure here, than other places in the country.

And we're learning more and more that likely Parkinson's is related to exposure.

So some of these chemicals at some point in life for some folks.

Kristi K: How much does genetics play a role.

Dr. Amsdell: Sure.

So there are probably in th realm of 30 plus different genes that have been identified tha can cause Parkinson's disease.

However that actually makes up the minority of patients with Parkinson's that actually have a genetic cause.

Most patients we don't find any genes.

And we think that it's most likely related to some exposure at some point in their life.

Krist K: Something that I would like to leave our viewers with is this this notion that it's going to be okay so what is it that you could say to patients that mayb helps them to feel, a bit less anxious about some of those those steps that may be to come?

Dr. Hoyt: What I can sa is, well, surgery is not easy.

Peopl do it all the time and do well.

And these are not all Olympic athletes that are going through the procedure.

These are normal people with normal fears, normal diseases, normal frailties, and those people are the people who leave the hospital one day after their brai surgery, being the same person with some new sore spots.

So the biggest thing that I try to do when we're talking to people in and about surgery is not only lay out those risks and benefits, but explain to them that, yes, it's going to be difficult.

It's difficult like so many other things in life, but it's very achievabl and that the payoff can be big if w if we go through that process.

Kristi K: So thank you both for all you are doing for those patients who need you most.

You are really impacting our world for the better.

Thanks for being on business life 36 day to day.

Dr. Amsdell: Thank you.

Happy to be here.

Dr. Hoyt: Thank you for having us.

Kristi K: Innovation in healt care, surgeries and technology and our providers all contribute to making a large impact on disease management an our lifestyle like never before.

Along with that comes our ability to navigate the world of reimbursement all to live our best and healthiest lives.

And that's a wrap on this episode of Business Life 360.

I'm your host, Kristi K., and we'll see yo on the next business life 360.

Announcer: Connect with Kristi K. on LinkedIn at Kristi K. Hoffman.

And here are the Business Live 360 with Kristi K. Conversation on FM 91 on Thursday mornings.

To watch previous episode and more, visit our website at Morgan Bell 360 and listen to Christie K's podcast, Business Life After Hours.

Wherever you listen to your podcasts.

Business like 360 with Kristi K. is made possible in par by KeyBank National Association trustee for the Walter E Troon Memorial Fun and ProMedica Toledo Hospital, celebrating 150 years of serving our community.

Also by viewers like you.

Thank you.

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