PowerLiving with Kimberlee Langford
PowerLiving with Kimberlee Langford
Elevating Kidney Health Awareness: A discussion with Dr. Qasim Butt on the challenges, lifestyle links, and future perspectives
Ready to elevate your understanding of kidney health? Then you're in the right place. We're joined by the passionate Dr. Qasim Butt, MD, an interventional nephrologist, who discloses the silent danger of kidney disease, the link between lifestyle choices and its development, and the challenges faced by underinsured patients. Dr. Butt's fervor for kidney disease awareness is contagious and he advocates for a more focused approach towards early detection and management of this often overlooked condition.
We unravel the maze of identifying and handling high-risk patients in the world of kidney disease. Regular screenings, predictive tools such as the CDC's KFRS, and integrated EMR communication play a pivotal role in this journey. Get ready to delve into the realm of value-based care, a promising approach that could potentially improve patient outcomes and transform healthcare.
Hang on tight as we navigate the exciting developments of VR and AI in nephrology. Imagine transforming the dialysis experience with VR or predicting hospitalizations with AI - we're on the cusp of this reality. Learn how Dr. Butt utilizes telehealth, which is a real gamechanger in providing specialty care to remote areas. There are limitations, yet the journey is promising. Don't miss out on this enlightening discussion on the future of nephrology with one of my favorite nephrologists to follow!
Oh, hey, hey, I think I'm alive. How are you, Dr Butt?
Speaker 2:Hello, how are you doing Kimberly?
Speaker 1:I'm so excited to get to chat with you tonight, happy to introduce everybody. If everybody doesn't know you already, dr Kossim Butt, one of my favorite specialties in nephrology. If you would mind, just take a minute and share a little bit about yourself and what you do.
Speaker 2:Yeah, so I'm Kossim Butt. I'm an interventional nephrologist. I practice both interventional and clinical nephrology. I did that for about 11 years or so, left my practice and now what I'm doing is I'm working part-time clinically at UT Health San Antonio two weeks of the month. I do some telehealth in Arkansas and inpatient care, and then I also do consulting with technology companies fractional medical director of a device company called Aliyo, the Aliyo SmartPatch that's actually for patient monitoring and dialysis patients at ZKD I also do. I'm also chief nephrologist for Deloree and AI, which is the AI company that helps you, helps to identify risks for companies, whether it be insurance, dialysis, things like that, and also what else do I do Other consulting with other companies as well.
Speaker 1:I love watching you because it seems like you've got your thumb on the pulse of what's hot and really on the cusp of what's valuable in nephrology.
Speaker 2:Yeah, well, it's kind of cool. I'm in a weird spot in my life where I'm kind of getting into it. Well, I've been into it for a few years now, but I've got to network a lot, I've got to meet a lot of people, I've got to see new devices come out, or the people that are bringing new devices out, but also the change in the payment schemes that are going on, the value based care players in the market too. So it's been super cool to kind of do that. And you know like I host some webinars on kidney care as well too, so that's kind of fun.
Speaker 1:Your content is fantastic. The way that you quickly, you know, talk about the pathophysiology and distuts really the mark of an expert, in my opinion. You take some and nephrology is complex pathophysiology and to distill that down a way that people can grab it and then do something with it, I think that's pretty cool.
Speaker 2:Thank you, I appreciate that. I appreciate that.
Speaker 1:Yeah, but also I know we were talking a little bit earlier and one of the most common questions we get when we're talking to folks, you know, kind of as we were talking earlier, our specialty at specialty care management is looking through data to find people who either have kidney disease or who probably have kidney disease, or who probably have it and it's undiagnosed. And you know, sometimes we find those folks who are sitting at stage four, even stage five, and the question they often ask is, once they get it it's oh my gosh, how come nobody ever told me? And sometimes they've been told and sometimes they haven't. But there's a lot of reasons for that and that's you know. It's not nefariousness and nobody's trying to hide anything. But maybe you can share a little bit about with your experience and what you've seen as well. You know why is it that dialysis and kidney disease sneaks up so insidiously on folks?
Speaker 2:Well, I think, after there's several factors there, like especially when I started my practice, when I started in practice in 2010,. I think a lot of it was the older doctors that were kind of hanging on to these people and an arbitrary in their head and saying, okay, that crack needs to, now it's time for you to see an apologist. You see what I'm saying?
Speaker 1:So I'm waiting too late because they're going to take that's their patient, right.
Speaker 2:Yeah, that's their patient. But also they're like I can handle it, it's not a big deal. And then later on you know deciding okay, now it's getting serious, now it's time for you to see an apologist. You see what I'm saying? Kind of an old school when I came to that kind of stuff. Then you know of course there's patients that just don't follow. You know that, you know. You know they decide at 55, I'm going to go to a doctor for the first time because my arm is hurting or you know, or having chest pain or whatever. And then they show up and they've been diabetic probably for 10, 20 years, and then even know it. And so all of a sudden you check their labs and their GF arm cracking off right, and so that's the other type of person as well too. And of course you know the biggest problem I think we have is diet in this country. Obviously that's the problem.
Speaker 1:Obesity yes.
Speaker 2:Obesity, obesity, obesity, diabetes, the whole nine, you know those kind of incinitously sit there in your body. And you know again, some people when they get checked for the first time at 45 and they get their CT stage three or four, there's a lot of issues there. Then of course I deal with an engine population. So some of them may have not had health insurance and you know, they all of a sudden finally get to a doctor and you know, run an engine clinic at UT that I'm at, and so you know, you see them and they're like, okay, now I can finally take care of myself, kind of thing. So I think there's various components there Also. I just think that I also just don't think that kidney disease has gotten a priority Right and on the radar of most people. I just want to. Long time ago I did a video called kidney disease is sexy, you know, in the sense that, like diabetes not diabetes heart disease and cancer Get all the attention.
Speaker 1:A lot of trust, yeah.
Speaker 2:And then they get all the attention that that goes to show the American Heart Association, all the work they've done and everything. Also cancer with the American Cancer Association and all that kind of work that they've done and just the awareness out there. But also those two diseases scare the crap out of people. Right, heart disease and all that kind of stuff came out because in 1950s men just grabbed their chest and died right in the scare the crap people and that's how people's awareness and cancer course scares this crap out of everybody.
Speaker 2:So kidney disease is not, and it's because it's not. It's an insidious disease, it's a quiet disease and we only have I'm not saying it's not in consequential. We have 500 or 600,000 people in on dialysis in this country and you know that's. I guess most people don't know someone on dialysis, you know. So that's not something that's in their face as much.
Speaker 2:They know someone who had a heart attack. They know someone that had had cancer, yeah, but at the same time they don't know someone that had kidney disease. Now, of course, in certain neighborhoods you do, like the, my neighborhoods that you know, like they, them, I'm now they didn't get a lot of people know what dialysis is, but most neighborhoods you just don't see that.
Speaker 1:Or to your point earlier. I mean, sometimes you see the ads on for dialysis facilities and they're in the ads, they're brightly lit and people are smiling, and it's not like that. Yeah, yeah, yeah.
Speaker 2:I think most people are clueless about what actually dialysis is. An experience of dialysis, including most patients, you know I'm saying, and so it's a. It's not, it's not as well known, but that's the inherent problem with it. When you have like the costs of dialysis or so high right, like it's 1% of the CMS population, medicare population represents over 8% or something like that of all of Medicare costs, which is ridiculous if you think about it. So that's so. That's why we finally got attention and finally the government came to realize, hey, this is costing us too much, and so now we finally getting some attention on that way.
Speaker 1:So oh, you get me going there here's an interesting one.
Speaker 1:just just to highlight the difference in terms of cost, we had a member who was on a trip and to a. They went to Jamaica and had dialysis there in Jamaica at a Fresenius maybe I shouldn't say that at a dialysis facility same dialysis facility, the same company, same equipment, sometimes even the same nurses because they travel and this member lived in the northeastern part of the United States, in Jamaica. Her dialysis session was $250 cash per session. The same treatment at home, $8,000 per session. It's just a huge difference in terms of what, and people don't see that they don't.
Speaker 2:Yeah, yeah, yeah. Well, I think the parts of Mexico it's like, some of the times it's cash pay but it's twice a week, right, and it's just that's what they can afford or that's what the government can provide or whatever. So it's interesting to see it getting to know it in different parts of the world. It's kind of fascinating.
Speaker 1:Or yeah, or where are the parts of the country People do home dialysis. And interesting when you survey nurses and doctors, most of us. If we had our choice, if we had to have dialysis, I imagine you would probably do home dialysis right and patients, it's different, right.
Speaker 2:Most patients they don't know and so I think that they think of as overwhelming Like. I think like when you're talking about kidney disease, like, unfortunately, when I'm talking about kidney disease, I'm addressing five different things every time I'm talking to a patient. So that's overwhelming, right. So it's like I gotta talk about your diabetes, your high blood pressure, your kidney disease, your acid levels, your anemia, and so I'm like spitting so much stuff. It's complex, it's complex and that's another component of why I think most people don't know about kidney disease, because it's such a complex disease. It's not like the heart, which is a pump no offense, cardiologists but like or cancer, which is kind of. You can wrap your mind around a growing mass on you in some way, right. But kidney disease you can't understand metabolic acidosis or are either poignant or you know potassium, phosphorus.
Speaker 1:It looks like a team for me.
Speaker 2:Yeah, yeah. So there's so many things there to throw in there. So I think that's part of one of the reasons too, that it's just so hard a concept, so hard to explain, you know.
Speaker 1:Yeah, and I think I know it's always interesting and part of what we do with folks is really helping them. Most of the folks that we reach out to with our kidney disease management prevention program is really aimed at helping them see where they are. And you know they all have access to the labs, right? There's a lot of reasons we talk to people about you know, a lot of times that lab that helps you figure out, okay, where are my kidneys functioning? How fast are my kidneys filtering?
Speaker 1:That GFR sometimes is buried. They don't know what it means. Or back in the day, just a couple of years ago, as a matter of fact, I was talking with a colleague earlier today about the inequities in terms of kidney care. And you look at how we calculated the GFR with age and sex and race, and there's still some providers and facilities that are using race in that equation and whatnot and people don't know what that means, right and so or you know some labs won't give you a number for your kidney function, the GFR, until it drops under 60. So they think that that's okay.
Speaker 2:Yeah, yeah, yeah.
Speaker 1:And you know most people I mean your kidney function can drop like what we were talking about earlier, just because you're getting older, or maybe you ran a marathon and the other one is too like we talked about.
Speaker 2:Why is it going to tech? Because, you know, sometimes I've seen GFRs drop pretty rapidly in diabetics. You know what I'm saying. It's kind of a homework, like GFR is 35, and then all of a sudden it's 25, and then it's 20.
Speaker 1:And then the year or hyper filtration Interesting. I haven't seen very much of it. We had a group just recently that had the most per capita folks at high risk that I saw, with high, you know, gfrs of 164 or hypertension, obesity, and nobody knows to watch out for that. If you understand the GFR, they just think, oh, I got extra credit. It's really good.
Speaker 2:Yeah, yeah, yeah, with a name obviously. Well, it's complex too because it's based off of muscle mass. So you like, occasionally you'll see people get a BK and their cryotinine gets better. I'm like no, it's because they've just lost a lot of muscle mass. You know what I'm saying? Like you?
Speaker 1:know it went down.
Speaker 2:It went from 1.5 to 1.3 or 1.2. And you're like oh, the cry got better. I'm like, no, they just lost their leg. So they lost the cryotinine, muscle mass and stuff like that. So but yeah, it's a complex organ system. It's a complex methodology, so I think that's one of the reasons. That's some of the reasons why most people don't know about it.
Speaker 1:Right? Yep, absolutely. So what do you think I mean in terms of if people you know do have something like this in place or sometimes you know most folks in an employer-sponsored health plan, they're being followed by an internist or a family practice doctor who they don't specialize in nephrology, but when they do have a patient who looks like their GFR is falling or who's fallen, what you know from a nephrology standpoint, what's the Goldilocks window, if you will, for making a referral to nephrology, for a timely and appropriate I would say, like you know you do.
Speaker 2:I would say most PCPs do a pretty decent job, but I would say, like you know, checking those microalbumin-crattian ratios or those urine-protein-crattian ratios is crucial.
Speaker 1:Which are commonly missing in labs.
Speaker 2:Yeah, they're commonly. I mean, they should probably be checked every six months just to make sure, especially in a diabetic. But you know, when the GFR gets less than 60, I think that's an inappropriate time to refer them to an nephrologist. I think that's usually an inappropriate time. Of course there's other things going on. There's protein area or if there like humitary or something like that, you can get them there earlier. But of course I think getting them there at that CKB3B phase is kind of crucial. You know, the logic now is go upstream, right, get them early, get them early. Of course there could be a, you know, issue of getting too early sometimes, you know that could be a thing. But for the most part I think it's better to screen in and screen out right now. So let's get them in.
Speaker 1:Yeah, I see that a lot and in fact, one of the things that we do with our program is once folks I mean cause, obviously, when folks have kidney disease, the hard part is figuring out who, of those folks with kidney disease or high risk for silent kidney disease, who are the folks that are actually gonna progress to dialysis. How do you target your efforts at those folks? And one of the things that we do is we watch. For once a member gets to stage 3B, we use I don't know, have you seen the CDC tool, the KFRS, kidney failure risk score?
Speaker 2:Yeah, I've seen that before I haven't utilized it myself. Canada, yeah.
Speaker 1:Yeah, there's a group of no, I can't remember what theirs is. I looked at it. While they have a really awesome platform for developing the risk score for the likely, the statistical likelihood of a particular member actually progressing, but you know, a lot of times to get that, you know, to be able to figure that out in a most accurate manner, you gotta have the more data points, obviously, and we find that you're in that. You're an albumin or the pro-genuria of any degree, whether it's a dipstick or a quantitative study, it's just missing.
Speaker 2:Oh yeah, no, it's the yeah, you're right, it's just not there. It's just not there sometimes and maybe some people just not checking it, and you know sometimes, you know, I wonder, at least on an annual basis it'd be very useful even in those non-diabetics, you know, those hypertensive, the obese, you know that kind of thing. Just gonna screen in and, just to make sure, get them on the eyes of a nephrologist, so but yeah, and that appropriate referral I think is so important.
Speaker 1:And then you know, making sure a lot of these folks because of their multi-morbid you know inputs there where they have a lot of doctors in the mechs and sometimes especially I see cardiology and nephrology they're really trying hard to manage this patient who often has, you know, fluid volume issues and helping these folks to really make sure that the nephrologist is steering the ship, so to speak. Yeah, you know how do you interplay with, especially like cardiology? Where do you find that?
Speaker 2:Well. So I'm gonna make a comment that I think, like I've realized in the last year or two that I think is so crucial. So I think you know, with the trend towards value-based care or even giving adequate care, I think we can't really get adequate care unless we have, like, integrated healthcare, and so what I mean by that is not just integrated as coordinated, but like honestly, the same damn EMR Like it makes the life so much easier, or communications between those EMRs easily. You see what I'm saying.
Speaker 1:Yes.
Speaker 2:So I'm not giving a shout out to Epic, but Epic is probably the best platform out there as far as EMRs. But I'm at my university clinic. I have two clinics right now One at the UT clinic that's in the periphery, and then the university clinic Right. The university clinic is all everyone's in house. So you'll see the cardiology note, you'll see the hospital admission, you'll see labs, you'll see imaging, everything on that patient. So I know that yesterday the patient had a cardiac ablation. I know that three months ago the patient was admitted to the hospital and this happened to me. So I'm becoming a bigger proponent of integrated healthcare, especially with EMRs. And you know, like because I you know like I'm my other clinic everyone was in private practice I'd have to weigh on a fax or like a PDF being emailed which is so stupid and not accessible and not.
Speaker 2:It's not keeping, it's not keeping yeah, anaborius and can't be arranged in a data set, so I can't see trends of creatinine over time, whereas, absolutely yes, I can see the creatinine did this during this time and then this and this, and I can see that. So I'm a big fan of integrated healthcare, especially the EMR integration. I think we have to work harder on that because that communication is just not there otherwise, and I don't know like to me, that it makes such a big difference when I under.
Speaker 2:It gives me a far better picture of my patient. When I'm not doing, when I'm in a different clinic that doesn't have that, I'm just getting a snapshot of the patient. I have no idea what the PCP said. I have no idea who started the medication or decreased the medication and why they did it. So it's like it's a far better. But that's my little spiel that I've realized that really does help like a lot.
Speaker 1:Yeah, absolutely.
Speaker 2:And that's to me is the biggest communication, the communication between there and I don't. Do I pick up the phone and call a cardiologist every once in a while, you know I do or the PCP absolutely once in a while I do. And again, when you're an integrated platform, you can communicate with them via like little messaging in chat, so it implements care a little bit better. I'm sorry, it's just true.
Speaker 1:Absolutely. While you're delivering care, instead of having to take a time out and go shuffle through a bunch of papers in your yeah.
Speaker 2:Absolutely. Or call some random cardiologist number, leave a message with their medical assistant and then maybe they'll call back, you know, maybe, and so the coordinated care like that point is so huge to me and I like this point. So that's how I think so.
Speaker 1:Yeah, I think you're right. So and you talked about this earlier and I know you're big into value-based care and you have a role in that, and a lot of people have some mixed feelings.
Speaker 2:It's the only thing in value-based care to be honest with I'm not in value-based care at all, I just happen to be very knowledgeable about it. I've presented on it. It doesn't count.
Speaker 2:Oh, ok, but I've done all that, though, but because of my well, interesting enough, my old practice was getting in a value-based contract, but I left them before they was actually implemented. And then my new scenario they're not in a value-based contract, so it's like, but I'm still knowledge about it and what's going on in the market and who the players are, and all that kind of stuff.
Speaker 1:But, interestingly enough, I'm not going to be. I would love to get your input on it because I have some mixed feelings about it. I mean, it sounds really good and if it worked in the altruistic manner when we really did what we want to do, it makes a lot of sense. I just don't see much of it out in the day-to-day, in the actual work of health care.
Speaker 2:But I think we're in the beginning stages of value-based care and for your audience who don't know what that is, I look at it as a new payment scheme for physicians and health care systems and dialysis units and all that where people go at risk. So essentially, instead of just being paid every time you see a patient or do dialysis or a patient or do a surgery on a patient you go at risk, meaning if you have better results on the patient, you get paid more. Now in those models, typically you get a capitated payment, probably every quarter or so, a certain amount every quarter, saying this is your patient. If you do well on that patient, meaning you save for hospitalizations, you have better mortality, guess what? Your payments may go up or you may get a bonus. If you do bad, you can actually have a downside and actually have to pay or not have an increase in your capacity.
Speaker 1:There's still more money in the dialysis chair, not to be cynical.
Speaker 2:No, I mean, I think, like as far as the Dallas unit, well, the thing is it's not fully implemented yet. So the schemes of you know are what is it called? Groups of it here and there, but the money is there, obviously. But the way I look at value-based care and the metrics and the initiatives, I'm kind of hoping it scares people straight in a weird way, cause I think a lot of nephrologists don't know what to do. I don't know the practices. Okay, I gotta do value-based care. I don't know how to do it. Let me partner with the players out there. There's Triumph. Some of that is cricket of monitoring and they're not being paid to keep people.
Speaker 1:They're not being paid for the work of prevention. They're not being paid for the work of what no?
Speaker 2:and that's what I'm wondering, too, like. I think, like, are they gonna not even mention but better outcomes? Right, they're not being paid for it, but in a weird way, I think they're scared straight into it, do you?
Speaker 1:see what I'm saying.
Speaker 2:All of a sudden like an optimal start is a thing now.
Speaker 1:Yes.
Speaker 2:And for early referring for a GFR of 20 to a transplant center is a thing now, not gonna be wrong. It was a kind of a thing before, but now it's a thing. You know what I'm saying.
Speaker 1:Now it's a thing that you're gonna be paid for.
Speaker 2:Paid for or just you're scared straight into not getting, not having that patient. Go to the hospital and initiate dialysis right.
Speaker 1:Or whatever Cause. It's a metric that you're being watched for.
Speaker 2:And even like a transplant bonus. So you're familiar with that with the CMS models like that's $15,000, I can go to a physician if they get a patient a transplant right. So that's a huge initiative there, you know, getting patients in earlier. We are seeing more patients come in earlier, breeding, refer earlier than I did 15 years ago. Now because of that, the push for home dialysis, you know, I think there is kind of a scare there, Like I need to get my home dialysis right now We've seen a slide up tick in home dialysis or PD first.
Speaker 1:But yeah.
Speaker 2:I mean it's not there yet. Don't get me wrong, but I'm just curious as to.
Speaker 1:So maybe just need more time to cook, huh.
Speaker 2:Yeah, I think so. I mean you have to change the giant mindset of people or giant like a huge group think, and so that's very hard. But it's going to be over the next few years how these actually play out and how much value based care actually takes over. Right now, the biggest value based player is going to be Medicare Advantage plans. It's not going to be these KCEs that are these CKCC models that CMS came out with. It's going to be the MA plans, right? So the MA plans are going to be more value based, with the head of the MA plans probably going to be the PC, the PCP, right? Yeah, I just said most in those scenarios.
Speaker 1:But yeah.
Speaker 2:I agree with that. Yeah, true, I was just saying yeah, true, yeah, so. But yeah, it's going to be interesting to see I'm generally optimistic about it just to see what happens and the new agents coming out, like you have, the SGL2 is going to run and all that kind of thing.
Speaker 1:So you go, get us going, because in the business of health care benefits, as you know, sglt and your SGLT2 is your GLP1s the tremendous pleotropic effects that those provide, how it helps protect the vasculature, which obviously has a role in protecting hearts and kidneys, and whatnot. In the business of benefits, these drugs scare the heck out of the architects of health care because they're so expensive.
Speaker 2:Well, the ozympics in particular are just ridiculously expensive, right, but like the farzegas and carjarians, as I see more acceptance of I think. So I'm looking at a nuts from the payment perspective, but it's from the nephrologist perspective it's nice to have another tool in the arsenal besides the traditional ACE and ARB that we've done for 20 years Absolutely. And so my goal on every patient and I kind of really practice value-based care, not in a model, but kind of in my notes so my goal is to have a RAS inhibition with either ACE and ARB and an SGL2.
Speaker 1:So that's my goal. That's the standard of care, right yeah.
Speaker 2:To me it's least those two. I don't add the finarone, just so you know. I just not because I'm against finarone at all. It would be a tertiary age, a third line agent for me. But typically I don't like to overwhelm my patients with more and more meds and cause confusion. So my goal is to at least have double therapy, two therapies on board RAS inhibition and the SGL2 inhibition.
Speaker 1:We've had quite a few members who have had trouble getting those meds now, because they're so popular for weight loss and then they don't have them. It's really difficult right now.
Speaker 2:But that's SGL, the SGL2.
Speaker 1:Yeah.
Speaker 2:The Zempix and all those kind of things. Yeah, I mean, that's another discussion. I don't necessarily put my patients on those, In the sense I let the PCPs make that call. Do you see what I'm saying?
Speaker 1:Well, I see.
Speaker 2:Yeah.
Speaker 1:So maybe it's a matter of helping them to have a discussion, helping the member have a discussion about why not put them on a different SGL2.
Speaker 2:Yeah. I mean I'm on the way I practice it. I do compartmentalize, I mean I don't try to take care of the entire patient, right, because typically again, I'm an integrated health system with the UT, so I have an endocrinologist on board, I got a cardiologist on board so I lead diabetic management, oftentimes to the endocrinologist yeah.
Speaker 2:And it's kind of nice because I can see their note right there and I see what they're doing you see what I'm saying and I can see the A1C's they're pulling, so I can see the trend of getting better or getting worse. So but yeah, I guess most people don't have that, so maybe they'll be apt to start those medications and do those things.
Speaker 1:But yeah, particularly if they're being managed by a PCP or a family practice doctor who doesn't it's not.
Speaker 2:They may be older, they may not be as innovative, they may be in a rural part. And I always say this it's interesting how you practice medicine is dependent on where you practice medicine, right.
Speaker 2:So, like I was talking earlier, I did some job in Spokane, washington different type of medicine. I trained in Louisiana at USU Shreveport different type of medicine. I lived in San Antonio and practiced here different type of medicine. I did some jobs in Arkansas different type of medicine. So it's like, it's not dramatic but it's subtle and so it really depends on where you are and who you're with and stuff like that. True.
Speaker 1:Great points. So, that being said, what's hot? I know you've got your. You mentioned one of them Is it allele the device?
Speaker 2:Oh yeah, I can show you.
Speaker 1:Hold on a second, hold on a second For dialysis and for folks with CHF. I understand too right.
Speaker 2:Yeah, let me show you. Let me show you.
Speaker 1:Oh, oh god.
Speaker 2:All right, so Nephrology Medical Director for Leo and we make the smart patch OK. So the smart patch essentially is this it's a patch that goes directly on your fistula, on your access. You set it on your access to arm or arm or whatever. Over here you have light sensors, you have acoustic sensors, accelerometer, all that kind of stuff as well, and this can noninvasively measure. It's FDA approved for measuring potassium, hemoglobin, hematocrit, skin temperature and something else.
Speaker 1:So, false.
Speaker 2:Yeah, false as well too.
Speaker 1:So I hear that it would measure phosphorus. Did I see that? No?
Speaker 2:no, no, they're fine-tuning the algorithm actually to measure other electrolytes. I can't discuss those, but yeah, they're actually fine-tuning it. But essentially what this is? It sits on your arm every three hours or so. You know, with those, those right readings on on the, on the, on the physician and physician side, you can actually see those readings on a chart, in the flow chart, and then you can set up notifications If, if, for certain ranges, you see what I'm saying and say, hey, call me if the hemoglobin drops below certain thing or whatever. And then you don't want to, we don't want to create what do they call a notification fatigue. You know, when you always use the same, so you set your own and you get, then you get your own notifications there, but it gives you those trends that you oftentimes didn't have before, right, yes, you can keep an eye on your patient 100%.
Speaker 2:And so like those long weekends right, yeah, those long weekends, you know the high quality on those days. And Tuesdays, right After the, after the long, you know what's the, you know you could maybe get a reading that potassium is high on Sunday night. Go to the ER. Or potassium is high, take some little kelma, get that potassium down until you can make it to the next day. Do you see?
Speaker 1:what I'm saying yeah, absolutely.
Speaker 2:And so that you get these alerts that actually go there and so. But I love about this company is it's very, it's a very well run, but also just very motivated to help those in kidney care and in the CKD market as well too. So it's but it's it takes. It takes medicine from a reactionary to real time Right. All of a sudden, I know what's going on with the patient at all times, right. So big and I'm big into, like, remote patient monitoring, and that's what this display is, is the remote patient monitoring play. I'm excited to see how nephrologists and even nurses respond to it. You know, again, I think, a mindset wise, changing from a reactionary form of medicine to a real time form of medicine is going to be interesting to see. If you can do that. It's a very much a value based play, right? So those kinds of metrics can help prevent the hospitalization, right.
Speaker 1:Absolutely so. That's what.
Speaker 2:I'm. That's what I love about it, as opposed to just waiting for it to happen and then be like, okay, let's try to do better. Or a heart attack.
Speaker 1:I know we had a young girl, 26 years old, with her potassium just through the roof and it took forever just because of the delay and getting the, the readings, and then it was, and then getting medications that were approved. That's a whole nother wax there, but yeah, so that's exciting and what actually commercially available too.
Speaker 2:So if anyone's interested in knowing about us, you can message me or let me know. We should measure the company, but it's something where you're actually getting on people's arms Hopefully soon so that's awesome.
Speaker 1:So, how do people reach out to you if they, if they have questions about that?
Speaker 2:Oh, they can just reach out to me on LinkedIn If that's something they're on. You obviously get a report on LinkedIn, but you can just reach out to me directly and I can let you know more about it. And you know, if we're looking for partnerships now, we're looking for people who generally want to, you know, do something in value based care and and in the latest in technology. You know so.
Speaker 1:So is it primarily, then, going to be physicians, who are going to be the the drivers of the usage of that product, or is there any move? Well, it really depends.
Speaker 2:You know like it's. You know I can't.
Speaker 1:I mean, I would see that dialysis could be used. It right.
Speaker 2:Yeah, so it's going to be. It could be dialysis units, it could be nephrology practices, it could be insurance companies, it could be anyone that cares about the patient not going to the hospital. Do you see what I'm saying? Yeah, or getting better results from that patient. That's where value based care kind of comes into play in many respects, because that's where you know people are at risk, right? So all of a sudden it means something to me when that patient goes to the hospital, right? So that's where, that's where I think it comes into play.
Speaker 1:Nice, nice. Well, and you mentioned earlier too, with VR. I mean, vr is really taken off on a whole lot of fronts.
Speaker 2:Yeah, how does.
Speaker 1:How does VR play in nephrology?
Speaker 2:Well like virtual reality. So I'm a physician advisor to Icon of Health. Icon of Health is a CKD education platform. They actually use something called learning science to actually so that most people so actually for most people actually absorb education Right. So you know I'm big on making content that's readily digest, ready to digestible, but I've also realized that it also depends on the receptive nature of a person, right, their emotional state, where they are language wise or understanding or great or education wise, if they are receptive to those kind of language. So they take it that into account. But also they use virtual reality as well, and virtual reality essentially you can actually put a headset on and they actually have contracts right now where they're actually doing home dialysis training. You see what I'm saying yeah, so you can actually can let yourself, you can actually look around room and how maybe you know your, your dials machine where would they fit, yeah, and so that kind of stuff.
Speaker 2:That's. That's like augmented reality as well too, but not as virtual reality. But it's kind of a cool, kind of a cool play. And again, I've been in a bother them for a few years now and they're they're really growing now as well too.
Speaker 1:So that makes me so happy. I Matter of fact, I was reading an article the other day where they had folks in a dialysis facility. We have a patient. He has just such a hard time sitting there for four hours and, you know, having VR while they're in the dialysis session too.
Speaker 2:I mean, I would, I would think that you could load all kinds of educational and fun content on there, or just get away to be honest with you, get her, yeah, just relax, like throw some mountains out there like a, you know whatever, you know like you could be anywhere.
Speaker 1:I had a patient one time. He loved us. I had a patient one time. He was a young guy and he was hit by a drunk driver when he was 17. Every reason to be angry at the world. And yet every time you see him, he was just Amazing. He still inspires me. Well, I went to go see him one day and he's he's in his bed and he's like man, you know, I've hiked the Hiawatha and I rode this trail down. What's when he's telling me, all these places he went and I'm like how in the world? Well, he did it through VR. Oh, I mean the difference that that made and his ability to cope and his mood and as I mean, you can just see so many, so many different uses for.
Speaker 2:Absolutely. And then you'd like the neural stimulation that it provides special. Maybe the elderly population could have some benefits, you know so loneliness, yeah with, yeah, yeah, anything else you're excited about.
Speaker 2:on the cusp for nephrology I'm also like I'm chief nephrologist for Delorean AI, so it's an AI platform, so it actually is involved. They actually have contracts right now and out. But the identifying patients, like it can go through patient charts and kind of Identify high risk, stratify patients, right, we all know who the high risk is. Yeah, the lowest patients are right, but there's always like this intermediate Column of people that what we call transitional risk. So they're moving from highlight a low risk to high risk, right. So how do you identify those patients, right, to get them early? Right, because that's not any high risk patients are just high risk, you know You're just gonna have to worry about them because there's gonna be high risk. But how do you prevent some? How do you identify someone that's moving and get the sneaky ones.
Speaker 2:Yeah, and get in early before they actually do that. The platform is yeah, platforms really interesting because they're actually, you know, look into, look into give you predictions about hospitalization. What's the likelihood of this patient having hospitalization, having a bad outcome? So give you a tool to actually identify patients early and identify CKD progression and all that kind of stuff.
Speaker 1:I think that's super hot. I think that's it's really where the healthcare is gonna go, yeah and you realize with AI.
Speaker 2:What's fascinating is I'm mostly don't understand what AI is, but AI learns on its own. You know it's so it's really fascinating and it's like it sees things you and I just don't see. You know what I'm saying. It sees patterns and data that we you and I just don't see, like you know, and you know it's nice can only take in so much.
Speaker 2:Yeah, and so if you're your, if your AI and ML has gone through like 10 million patients, 20 million patients or even patients, it sees a lot more than you ever did, right, like?
Speaker 2:you and I may be looking at blood pressure and anyone sees but this. But the AI is looking at zip code, the patients, from the height of the patient, the race, all the different things, and they're going hey, this is what, this is what I think is going on, you know. So, you know, I do. I know how the AI runs completely myself. No, I'm not the data scientist, but I give my clinical insights into what they're doing and stuff. So that's been a super cool experience with Delorean AI.
Speaker 1:So now that is wicked sexy. That really excites me. Yeah, don't don't like it, don't know enough about it, but I know I'm really excited.
Speaker 2:Skynet. Right yeah, Terminator References making the reference good.
Speaker 1:Well, getting like to your point, if we, you know, if we really want to bend the curve in terms of, you know, some of the highest costs in healthcare today we talk about all the time. If you want to save money on dialysis, don't need it in the first place. So how do you do that Work? It's a triage perspective right, put out the fire, control the cost of dialysis, another dialysis, what do you? Where does that all come from? And and gradually, as we work upstream, hopefully. I mean, it would be really nice to be able to really have this prevent, a truly preventative movement take place, and you know.
Speaker 1:Yeah, absolutely as much of it.
Speaker 2:Yeah, the other. The other component I do is like telehealth and I think telehealth has such a such a big reward if you can do it Right, that's the whole.
Speaker 1:Thing.
Speaker 2:It's gonna do it right. So I actually have found telehealth to be far more useful or not useful, more productive, excuse me in the in, the out in patient setting than the outpatient setting. Meaning I've done telehealth like in, in clinics right. So you see the patient like this and you talk to him stuff. Unfortunately, most of the time of patients skews old, patient population, demographic skews older. So half the time you're just staring at grandma's eyebrows because she can't hold her phone straight. You know so. And then you don't get vitals, you don't get that whole seps of depth of reception, perception of the patient. You know what meds they're taking. So that's something you miss out on. Now, in the inpatient setting, though, it is super cool because literally I just call into a hospital and they have a screen there and they move me room to room and I literally can see patients directly there. There's actually a set of scope attached if I want to listen in, but in that controlled environment I have more. I have more understanding of that patient. You see what I'm saying.
Speaker 1:So what could that do for a rural hospital that doesn't have access to?
Speaker 2:where I'm rooted. This is where I'm like actually doing it in rural, have nephrologist. You see them saying so all of a sudden. That rural hospital Doesn't have to transport that patient, ship that patient out three hours. Oh my gosh, that's huge right, or and they can have a dialysis unit at their facility and we can do dialysis for them. You see what I'm saying.
Speaker 2:Yeah provides that, that that local kind of thing. And then on top of that, like I feel, like I'm I say I'm 95% as effective as I am physically. Do you see what I'm saying? Because of the only thing I'm probably missing out on is the physical touch. And pity to Dima, like in the dependent areas, because I'm very OCD about the Dima and assessment of that. But outside of that, I have access to labs. After the chest x-rays, cat scans, renal ultrasounds, the whole EMR. I have the nurse there that can pit you know, press on for me. She gives me proper assessment of the patient so I actually get to talk to the nurse. So it's a really cool thing. The telehealth component I find it to be a lot, of, a lot of fun. And even then, like to me, it's pretty cool because I can see 15 patients in a half day, and so you know.
Speaker 1:I'm thinking about rural hospitals like you. Go up to Alaska, just get care at all, let alone specialty care, in some of these places it's I've seen, I've remember seeing jobs for Alaska.
Speaker 2:It's fast saying that they'll pay you a full-time salary for every other week, for every other week, or I'm not even full a high salary for every other week.
Speaker 2:They'll fly you in and out, just so they get some doctor in there oh, yeah, yeah but so like telehealth, that'd be ideal for those kind of scenarios, you know, especially for specialists, and I think it's really dependent on the specialty themselves. Like like nephrology is amenable to that, because I'm mostly a lab guy, right like labs and kind of not like a pulmonologist right where you've got to have your maybe listen more and things along there are some settings I would say the pulmonary pulmonary could do, but yes, I agree that maybe certain ones you need that physical, physical thing.
Speaker 1:So very cool. Well, I gotta tell you thank you so much for taking time. I know you worked today in the clinic and and just taking time out, so I'm really glad to get to connect with you. Love the work that you do in just sharing the message in a frog. So I was a sax player and I will tell you, in a band, the saxophone is the sexiest instrument. It is the best interest instrument in a band. Likewise, nephrology, kidneys, I their kidneys, hearts sounds like venom, right, kidneys, hearts, livers but yeah.
Speaker 1:I get the message out there the way that you do to help educate not only patients but, you know, providers is really, really exciting and thanks for sharing yeah, absolutely so, if you don't follow dr custom, but you need to connect with him on LinkedIn. He's got some YouTube, got it? What's your YouTube channel?
Speaker 2:it's your kidneys, your health. So my kid needs your health.
Speaker 1:You gotta follow me on YouTube to. You'll be smarter because of it. Thanks,