Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
What happens when patient care meets business reality?
Michelle Eichelmann, Executive Director for Oncology Services at St. Luke's, shares her journey from chiropractor to healthcare administrator and discusses the challenges of running a cancer center in today's healthcare environment.
• Originally from St. Louis with a doctorate from Logan College of Chiropractic
• Specialized in symptom management and acupuncture for oncology patients before transitioning to leadership
• Oversees medical oncology, radiation oncology, infusion centers, research, tumor registry, and navigation
• Identifies cost containment as a major challenge while maintaining quality care
• Explains that standardized treatment guidelines (NCCN) dictate cancer therapies, not cost considerations
• Discusses how hospitals often operate at financial losses while continuing to serve communities
• Describes the shift toward value-based medicine and quality metrics driving reimbursement
• Emphasizes transparent communication and trust-building as essential leadership qualities
• Shares optimistic but cautious perspective on AI's potential to improve healthcare efficiency
The Friends of St. Luke's philanthropic organization helps fund millions of dollars in free care annually. To contribute, visit the Office of Development at St. Luke's website.
Hello, this is Jason Edwards and this is Doc Discussions. I'm here with Michelle Eichelman. Michelle is the leader of our Cancer Center and she's new to St Luke's here, so I thought it would be a good opportunity to get to know her a little bit better and get her take on hospital administration in general and running a cancer center. So welcome Michelle. Thank you, it's great to be here. You bet Now, where are you from originally?
Speaker 2:I am originally from St Louis. Is that right Born and raised? Yeah, okay yeah.
Speaker 1:So of course you know the knee-jerk question where'd you go to high school? That's worthless for me because I don't know any of the high schools.
Speaker 2:That is a common question in St Louis. Yes, st Louis thing. So Kirkwood High School is where here.
Speaker 1:It probably was popular back then. It's certainly popular now. It was yes. And then? What did you do after high school? Where did you go to?
Speaker 2:I went to well Missouri State in Springfield and did my undergraduate and actually athletic training Really yeah, so did that and then became a mom after I graduated, so stopped school and then went back when she was two to get my doctorate.
Speaker 1:Really, I didn't know you had your doctorate. You're too humble, so where did you get your doctorate?
Speaker 2:in At Logan. Okay, in Kaepernick. Yes, very cool. Yes, so I am not your traditional healthcare administrator, by any means.
Speaker 1:Yeah, you took a path there I did. Now I'm going to ask you if you know a name. There was a guy named Brian Mahaffey. Yes who was like a legend down there for athletes who had injuries. Are you familiar with Brian?
Speaker 2:I am, I am he's Super nice guy, yeah, yeah.
Speaker 1:And he may have even played baseball for the Bears down there. I can't remember if he did or not.
Speaker 2:I don't know if he did or not either, but yeah, I am very familiar with him.
Speaker 1:Yeah, great guy. So anyway, so you got your doctorate through Logan College of Chiropractic, chiropractic medicine. Is that the right term? Yes, it is, and St Louis is a big town for chiropractors. I mean, a lot of people use them and certainly we produce plenty of them to the school. But that's you know. I would assume you go to school and then you get out and then like, what do you do? Because you got to hang up your own shingle and be a business person too.
Speaker 2:You do, and I actually started a business out in St Charles County and by happenstance my daughter was going to grade school with a lady who worked for another organization that was hiring chiropractors. So I actually that's how I got into the hospital business was started working for a hospital as a chiropractor and then shortly into that term I was asked to step into a leadership role and all that was from history from there. So I was still seeing patients part-time for most of the probably the first 10 years of my career at that organization and then slowly but surely kind of transitioned out of that and went into full-time leadership.
Speaker 1:Yeah, it would be tough to you know, take all the years and the hard-spent hours training and just throw it aside and go straight into administration, and I would assume there was some internal struggle, you know, trying to figure out which way to go with that.
Speaker 2:There was, and I actually was very unique in my practice. So even when I practiced chiropractic, my focus was really symptom management and oncology patients.
Speaker 2:So I did a lot more acupuncture than I did the traditional chiropractic and supplement support for patients that were undergoing cancer treatments, and that was really how I had my love of oncology and realized that was a patient population that I really wanted to serve. So when I had the opportunity many years ago to go into a leadership role within oncology, that was a really special calling because you know, as a physician you are impacting lives, but it's kind of, you know, one here, two there, four there, five there versus really when you run a program, that impact is so much greater and I feel like I have that I was given the gift to really look at things from the healthcare side a little differently. So my mindset's always been about how do we prevent versus react, and I think that really that's where healthcare goes. Today we're looking at all the value-based medicine programs and it really is looking at okay, how do we manage those patients? Instead of waiting for them to become so sick they are hospitalized?
Speaker 1:Yeah, I think that's the way things are going slowly, not fast enough. But doctors and healthcare providers, they're trained in how to deal with sick people but they're trained less so on how to keep people from getting sick, you know, like one step forward in the supply chain and it would be nice if we were able to develop systems to keep people out of trouble. I mean we do by, you know, keeping patients' blood pressures low and their cholesterol low and things like that. But we can hopefully do a better job in the future at kind of getting further ahead of problems. I agree in the future at kind of getting further ahead of problems. I agree, and actually I know people personally and certainly plenty of patients who've had good success with acupuncture, whether it's for nausea or pain. Are there other things that it can be used for?
Speaker 2:Nausea, fatigue. The peripheral neuropathy associated with chemotherapy has been beneficial. The peripheral neuropathy associated with chemotherapy has been beneficial. Even bone mat pain was really beneficial use with acupuncture in patients, and so that was very rewarding. It really was. But like I said, you know, just taking a different.
Speaker 1:My life took a little different spin, which you know you think you have your life planned out and then it's not have your life planned out, and then it's not yeah, and it keeps taking different turns doesn't it, and so in your current role, and what's your?
Speaker 2:official title Executive Director for Oncology Services here at St Luke's.
Speaker 1:I would have never got that. I'd just say you lead our cancer center, so can you give us an overview of your role as the administrator of the cancer center?
Speaker 2:and kind of describe a typical day. Sure, so I have oversight for oncology from a medical oncology perspective the infusion center, radiation oncology, and then the research component of it, tumor registry navigation. So anything, really anything to do with cancer falls under my responsibility. And my typical day a lot of meetings, and so I spend a lot of time in meetings. But really looking at program development, strategic planning, where are we going to move next? Where's cancer moving and how do we keep in front of that and make sure that we're keeping St Luke's program, you know, right in the forefront of where cancer is going and, from a market perspective as well, really driving that to make sure we're meeting the market where they need to be and where we need to be to help them.
Speaker 1:Yeah, and there's. I mean everything changes, right, Nothing stays the same. And so what do you think the current biggest challenges are for either hospitals or cancer centers or cancer care?
Speaker 2:Honestly, cost containment is really a challenge. It's the drugs are very expensive. The margin continues to decrease on what we are being paid for those and what we pay for them, decrease on what we are being paid for those and what we pay for them. And so I think that's probably the biggest challenge is how do you look at care? That's in a more holistic approach, thinking about that cost containment and it's not just the cost containment of I mentioned the drug, but it's, you know, staff. How do you make sure you have your staffing ratios correct that are safe but yet you know, productive and then just really thinking about like, how do you grow?
Speaker 2:Where do we have opportunity? That makes the most sense. I think those probably are the big ones. And you know cancer changes. We know that daily and just some of the changes in treatments have been very different. So I think it's going to be that tough transition where you've had a lot of change in therapies that are costing a lot more than they did prior. So, by specifics, car T, it's expensive, but it's also the future of cancer. So just really being creative on how we meet the demand and be fiscal responsible.
Speaker 1:Yeah, and for the listeners out there, one of our first episodes was with Mark Fessler and he kind of describes bispecifics and CAR-T. But in general it's kind of like chemotherapy but it's different. But it's a systemic therapy and so it's given to patients with different types of cancers and they're really great but they're not cheap.
Speaker 2:No, they are not.
Speaker 1:One of the issues that every business has dealt with is prices of labor. You know, people's salaries have gone up and prices of drugs have gone up, but that has outpaced reimbursements. And so what a lot of people may be surprised to know is, I think in 2024, about one third of hospitals lost money, and many hospitals have lost some money year over year. I know for sure I think it was Cleveland Clinic. One year lost a billion dollars, and so hospitals do not have the same profit margins, and in many years we'll do a ton of work and still lose money. It's just a tough business to be in. It is and it's not. It's a business, everything's a business, but it's more than a business, and so the hospital's still willing to even lose money several years in a row to keep the lights on and serve the community. And so it's a business.
Speaker 2:But it's scary because healthcare in rural areas is not easy to find, and so it's something that we definitely need to, as the United States Health Task Force team, needs to really be thinking about. How are we going to continue to serve patients, and I think, creatively? Is it virtual visits, is it? You know what is that? To make sure we're meeting that need.
Speaker 1:I'd seen something I'd never seen before. A patient from Ozark County which, if you're not familiar, it's in kind of central Southern Missouri came up to my clinic. I may have even had a mutual friend personally I can't remember how it worked, but they found their way to St Louis and their insurance company covered their hotel stay because there was no hospital that could do what we were doing in their area. I was shocked that the insurance company was covering their stay at the Drury Inn or wherever it was. But I guess that's what you have to do. If these small hospitals who don't have the ability to kind of withstand year after year losing money, you know you got to do something, yeah, and so yeah, and so you have this.
Speaker 1:so you have two things changing at once, kind of to a greater degree than ever before. You have the economics, with inflation and everything that came after that changing, but you also have new treatment modalities changing. So it's a difficult. I mean, it's a difficult job, you know yours is, and kind of trying to navigate that, and so I've got a lot of respect, you know, for you and what you do. I know it's not easy, and so when we talk about cost containment, we're not talking about picking a therapy that's, you know, cheaper for the hospital but an inferior treatment for the patient.
Speaker 2:Absolutely not. No, there are clear guidelines on what treatments are to be given to patients, so there's something called the NCCN guidelines and that really dictates across the United States what treatment should be initiated for a first-line treatment for breast cancer stage three. Blah, blah, blah, blah blah. So it depends on the type of tumor, the staging of the tumor, and it is very definitive on what you try first. You know what that first line of treatment is and then, if the patient doesn't succeed on the first line of treatment, what is the second line of treatment? It is very spelled out. So when I say cost containment, it's really more looking at supplies, looking at staffing and efficiency in staffing or efficiencies in documentation. That's where we have opportunity to contain costs, not in the treatment modality itself. So much it's really standard.
Speaker 1:And so, yeah, it's things like if, instead of buying a box of gloves at a time, maybe you can buy 10,000 boxes of gloves for the hospital and you get some savings on that. Maybe this brand has equal quality than that brand, but it's a little bit cheaper.
Speaker 2:Exactly.
Speaker 1:Things like that.
Speaker 2:So when you look at tubing, vendors come out with different tubing and sometimes the newer tubing actually is less expensive because they're doing it more production and it's just keeping up with those current trends on what's being used and wherever the pricing is best, but yet safest. So we always, when we look at it, we were I just came from a meeting that we were looking at something from the infusion center and pharmacy, infusion pharmacy and it's not the cost only only it's the cost, the safety to our pharmacy staff, the safety to our infusion staff, the safety to our patients and then cost.
Speaker 1:And you know I'm going to throw in a plug here.
Speaker 1:Many times we lose money in treating a patient, but we pick the right thing to do even if the hospital loses money and we have the Friends of St Luke's, which is the philanthropic arm of the hospital, and St Luke's gives away millions and millions of dollars of free care every year and one of the ways we help fund that is through. The Friends of St Luke's does a lot of really good things for the community and it has a really good reputation and gives high quality care. And if you're listening and want to contribute to that, it's through the Office of Development at St Luke's and you can just type in Friends of St Luke's and I think if you're looking for a place to put your hard-earned money, it's a great cause and it helps a lot of your friends and neighbors.
Speaker 2:I would agree. I know we've had patients benefit from those. No doubt about it.
Speaker 1:So how does a cancer center stay in the forefront of innovation and treatments such as immunotherapy, precision medicine, and what role do you play in kind of facilitating that?
Speaker 2:So I think keeping current and really focusing on disease site specific. So I think if we have medical, if medical oncologists are really focused on that specific disease site, they will keep up with current trends and I think that's really critically important. So that's one of the things that we're working on here. And then you've got that expert, they're going to drive that piece of it and then my job is to figure out how to make it work, and so sometimes we can and sometimes we can't. But really focusing on using staff like you mentioned the staff and the cost of staff and so using staff to top a license that's really a common theme in healthcare right now is, you know, if we're using a nurse, let's make sure that nurse is doing nursing duties, not clerical duties.
Speaker 2:And so just being really smart on how you do things. I think standardizing processes helps tremendously to, you know, reduce the drag on the team and then really just having good workflow. I really think that's going to be critically important making sure that you know you have a lean process in place to really to drive that. And I think without that, that's where you're going to start seeing systems fails if there isn't that standardization.
Speaker 2:I think the other really big piece staring at us right now is value-based medicine. So the enhanced oncology model with CMS, I think value-based medicine with UnitedHealthcare or Anthem that are going to be coming down the pike, kind of similar like they've done with orthopedics. You know you get paid based off of what you're doing. So if you're doing a total knee, you're going to get this much money and I mean we're not there yet but it's marching that way where you're going to be given kind of this money to take care of a patient and I think it will help level play. You know level set the playing field as far as each facility, but it's going to force us to really be thinking smartly about how we do things and reporting out on quality metrics. That will be critically important. So that's where I feel like I have the opportunity to drive change here is to really align our documentation, our reporting structures as far as quality metrics, so that we can be ready when those things are available to us.
Speaker 1:So value-based medicine is like we're not going to. You know the insurance company is not going to reimburse you for every needle that you use to sew something up or every you know piece of suture. You're just getting this lump sum to take care of this problem and it simplifies things and it kind of makes a lot of sense. You know it's like you can use however many sutures or staples or whatever it is that you're using, just get the job done and this is how much you know you'll be reimbursed.
Speaker 2:Is that accurate? It's not there for oncology at this point. So, really, orthopedics, so hip replacements are kind of at a standard this is your price for the hip replacement. And that has changed the way we do business. I mean, we used to keep patients in the hospital a long time after a hip replacement or knee replacement, and those patients don't stay in the hospital that long anymore, and it really was a result of a value-based medicine program that said we're going to pay you this much money and so you need to figure out how to make that right. And so I'm not saying that that oncology is there now, but what they're starting to do is say okay, how many times are your patients getting readmitted to the hospital? Because that's not okay for us to have all these patients constantly being admitted. You know, after treatment, what are you doing? That is different.
Speaker 2:there should be different that would not cause those patients to end up in the ER all the time or to be admitted. So I think that's really where oncology is going at this point is quality of care, like when is it time to stop pause, get palliative care involved and then really make a decision on what's right for the patient versus just continuing to move forward.
Speaker 2:I think we've done that for years and so I think that's some changes that are going to be, you'll see, happening. They're measuring, obviously, the inpatient admissions, the ED visits, quality metrics like ECOG scores and those kinds of things that are going to, you know, distress screening. Those are going to be what's being reported out and then really that will help us determine what's the right thing for the patient it out and then really that will help us determine what's the right thing for the patient.
Speaker 1:And it seems like they're using their dollars as leverage to try to get best practice, you know, to try to drive higher quality, which is a smart thing to do. It won't be implemented perfectly for sure, but it's kind of, and there's good and bad parts of it as well. But I think overall it's the right idea. But it does put a lot of stress on hospitals and certainly the hospitals that can run leaner. You think of, like, for the people who aren't in the medical field, something like the Toyota production. Toyota, you know, production, I mean it's kind of famous for having this well-oiled machine where they can produce a Camry with, you know, maximal efficiency and kind of minimal drag and to try to take whatever process you're using in the hospital and do the same thing have an efficient system, I guess to say.
Speaker 1:That's a perfect analogy yeah, yeah, the um and so the other part, um, you know a lot of your job's managing people and the people um. In oncology, it's a multi multidisciplinary team, and so you have to ensure collaboration amongst oncologists, nurses, researchers, um. How do you um facilitate that? Um? Do you have a certain style, or what are your thoughts on that?
Speaker 2:I'm a very transparent person so I like just to be very upfront with everyone about things. I love to look at process mapping. So I've done that with one of our medical oncologist team already just to understand like who's doing what jobs and does that make sense and is there something that we can automate to make it better? So I think from a physician perspective, really just being very transparent, having an open door policy they're the clinicians, so ultimately they know what's best. But trying to balance that operational side and that clinical side has been, I think, something I've really made an effort to ensure that that is a smooth process for our providers. So I think from that perspective, and then I think from a clinical like from the frontline coworkers again, it's communication, transparency. You have to build trust before you can make change in teams, and so I really think trust is probably a really good thing. Getting to know people on personal levels is gonna be critically important for me and I think, for the coworkers too.
Speaker 1:Yeah, I mean, fortunately doctors have, you know, very small egos and are easy to deal with, kind of across the board.
Speaker 2:Well, I will say this practice at St Luke's has been a great team.
Speaker 1:Honestly the group we have in the cancer center is top to bottom awesome and they're very practical. But you're right, I mean, in any organization you have to sometimes ask people to do hard things and it's only with kind of a longer relationship that you can trust it or they can trust you, that you have their best interest in mind. And it's a difficult job to navigate.
Speaker 2:I mean, I know Well, and I think the why, I think you know you can ask someone to change, but if they understand the why behind the ask, it's a little easier to take than just making change, and so that's why I say open communication is really critically important.
Speaker 1:Yeah, yeah, there's a famous quote. It's something along the lines of somebody can endure almost any how if they have a why. I might be mispronouncing that, but anyway. But yeah, if there's a rationale behind it and it makes sense and you realize that the world's bigger than just you. As a healthcare provider, you're doing things for the team. Sometimes you have to change and a common thing would be, like surgeons, they all may have a different set of instruments they use, but usually you want that standardized for surgeons and sometimes you've got to not have your favorite tool in the toolbox or have the other guy's tool in your toolbox, just so there's not mistakes, and everybody doesn't have a different set.
Speaker 2:You know, trying to standardize things, Well, and I think all of us are here for the same reason we came into healthcare because we wanted to help people, yeah, and so I think ultimately the patient's in the center of the equation, and I think as long as everyone understands that and that we're trying to do what's right for the patient and make it seamless and safe for the providers, then I think it's probably easier to accept that change when you know what the common good is.
Speaker 1:Yeah, for sure, Do you miss seeing patients Gosh?
Speaker 2:no, I thought I would. I think for a while, I did I. I really enjoy the challenge of healthcare administration, so I I think this probably was where I should have landed a long time ago. But no, I feel like I get to impact the lives of patients in a much broader sense now than I ever have been.
Speaker 1:Yeah, yeah, it's, it's a double-edged sword because there can be a lot of difficult situations when dealing with patients directly. Um, but it's also very rewarding. I mean, I get more cookies and more hugs than, like, most people do, and that's really great. Um and so um. But I appreciate your honesty. That's, it's um, it's um, it's, it's, it's uh. From my perspective, I, even though I have a lot of challenging conversations with patients, I think your job is more challenging than mine on a day-to-day basis.
Speaker 2:No, I don't know about that. Well, I don't do your job, though.
Speaker 1:And so I would be bad at it. But it's a tough job it really is. But it's a tough job it really is. And I think for people who don't understand what health care administration is or haven't dipped their toe in, that they don't realize how I mean it's. I have a little bit and I mean it can be painful to. You're not always giving people great news. You're kind of giving some tough asks sometimes and it's I think it would be an okay field for somebody to go into, if somebody's you know in college right now. But it's a tough job. I mean it's a tough field.
Speaker 2:Well, healthcare in general is tough. I mean your job's tough too. You, you know, want to do something for a patient, and then the insurance company is telling you you can't. So I think it's challenging in every aspect, whether you're in leadership or whether you're delivering care. It's a challenging field to be in, in general, for sure, and many jobs out there.
Speaker 1:It's not just healthcare. There's a ton of people out there working really hard who have really stressful and difficult jobs, so I'm not negating that at all. So you know, one of the things that you'd previously said is trying to leverage technology to kind of make our system more efficient. We have, you know, people talk about artificial intelligence, ai, robots, intelligence, ai, robots. We're kind of at this point where there's all of this hope for the future and there's all this potential energy, and is this going to go like the way of stem cells that were supposed to cure everything 20 years ago, that really haven't made much change, or is this like 1997 and that we're on the precipice of the Internet kind of changing everything? I honestly I think it's probably closer to the Internet, although there will probably be a short period of discontentment and kind of overvalued expectations. But what are your thoughts on that and how do you think those kind of things will influence health care over the next, let's say, 10 years?
Speaker 2:Wow, that is a loaded question, sorry. So I think AI has a huge opportunity in health care. I think we have to be cautious how we use it. I look at like AI Scribe, which is a dictation. You know an ambient sound where you can have it in your exam room. It picks up your communication and types your note for you and then you can review your note. I think that that's going to be a huge time saver and give physicians a lot of time back that they don't have with their families right now because of that that they don't have with their families right now because of that. I know there's AI that's being used in radiology for over-reading, for bone dent or for breast imaging or even just general imaging.
Speaker 2:You're starting to see some use in that and there's been studies out there that are really advocating for that and that the error of human can be eliminated or drastically reduced because of AI, and I don't know. I don't have the answer.
Speaker 1:I wish I had a crystal ball that I could look into and say but if anybody said anything with certainty on this, they'd be lying yeah.
Speaker 2:I think. I think it's going to have its benefit, I think it's going to improve efficiencies in our healthcare field. But I think, cautiouslyiously we have to walk into that world.
Speaker 1:Yeah. Yeah, there's a really interesting article, if you're interested in this, called AI 2027. It's a website and it's like this kind of doomsday scenario and the main. It's a really well done website, but it just talks about some of the downside risks of this and it's. You know, yeah, we need to be responsible with it, but I think it's the right thing to do with probably a shrinking workforce, certainly in the next 20 years. It's kind of coming online at the right time, but we need to kind of roll it out slowly. I know everybody's favorite thing to do is say how AI is going to replace doctors, and you know everybody's, you know, potentially replaceable. But we'll see how that goes. I think it's something that we can use as a tool, just like we use typewriters and computers. We should, you know, leverage technology where we can and it will help doctors be better doctors. It will help patients ask better questions, and but it's. I think we're kind of on the verge of this. You know, probably pretty dynamic next 10 years or so.
Speaker 2:But we'll see it's going to be interesting. It really will.
Speaker 1:Yeah.
Speaker 2:You know you think about what you can look on chat GPT on your phone and it gives you all kinds of information and with just a few words. So it's going to be a really interesting next 10 years. I agree with you.
Speaker 1:Yeah, and we have a front row seat to it, we do. Well, michelle, I'm so happy to have you here, truly, and thank you for joining me today.
Speaker 2:Thank you.