Q&A: Radiologist Juan Batlle, MD, on Building a Cancer Care Center of Excellence

The Miami Cancer Institute (MCI) started nearly 10 years ago as a collection of widely distributed service lines without an identifiable physical presence. The idea was to bring together local and regional cancer experts from every medical discipline and every support service. The vision was mass collaboration around providing world-class cancer care to patients from across the Southeastern U.S. as well as Latin America and the Caribbean. 

In 2017, MCI’s founding institution—seven-hospital Baptist Health South Florida—gave MCI a place to call its own. And what a place it is: a $430 million, 395,000-square-foot facility housing sections for every aspect of cancer care. Research and teaching are underway here too, through Baptist Health’s affiliation with the Herbert Wertheim College of Medicine at Florida International University. 

Among the independent physician groups contributing to this wide-reaching, highly coordinated fight against cancer is 73-rad Radiology Associates of South Florida (RASF), which has served Baptist Health for many years. Last summer the group became part of MEDNAX Radiology Solutions. This spring, RASF’s Juan Batlle, MD, who serves as chief of thoracic imaging at MCI, took our questions on his role in the effort, RASF’s relationship with MEDNAX so far and how physician groups can help bring excellence in cancer care to their respective local markets. 

imagingBiz: Before we get into the nuts and bolts, can you discuss how the program is making a difference in the lives of patients and their families? 

Juan Batlle, MD: Of course. I can start by saying that the program has made a striking difference in the lives of our patients and their families. For example, in the absence of a screening program, most patients with lung cancer go to the doctor only when they have troublesome symptoms. By then the disease is already in a late stage. Between two-thirds and three-quarters of patients with lung cancer are stage 3 or 4 by the time the cancer is detected. Those patients start with their therapy options in handcuffs. You can’t do as much for the patient when they’re already so far down the line. 

The major trials (investigating low-dose CT) did a very good job showing that screening can actually flip those percentages. Instead of catching most lung cancers late, the screeners were actually catching 67 percent to 75 percent of them early. Here at the MCI, we found that almost all our metrics fell in line with what the researchers found. About 1 percent of patients had what turned out to be a confirmed cancer on their first screening exam. Right off the bat, for every 100 people coming in for a screening, we found cancer. And most of these were early stage, either stage 1 or stage 2.

What is very important to note is that lung cancer, in its early stages, is in many ways like breast cancer. There is a surgical cure for it. If you catch a lung cancer early enough and remove it, you save the patient from having to undergo chemo or radiation or both. The tumor is out and the patient is on his or her way. So we’ve really been able to dramatically improve the lives of many of our patients and their families. 

Can you describe RASF’s early participation in a cancer-care center of excellence and the impact so far? 

To give you just a few specifics from my section, thoracic imaging, we started by bringing in talented individuals from throughout the Baptist system. These weren’t just physicians. It was also administrators, nurses and people who work for Baptist Health’s corporate division. Together, we decided to set up one of the first programs of low-dose CT lung cancer screening. This came not long after December 2013, when the U.S. Preventive Services Task Force began recommending annual screening for lung cancer with low-dose CT [in adults between 55 and 80 who have a history of heavy smoking]. This is something that had been done only sporadically outside of academic medical centers. 

We basically started our program from scratch. RASF had been doing some CT lung screenings, but in an un-systematic way. Certain physicians knew that lung screening was important for high-risk patients, but we only saw 10 or less of these patients per month. Once we started tapping into the full capabilities of MCI, we were able to share and leverage nurse navigators, software to manage the data and other critical components. We quickly ramped up the program to where we were completing at least five to 10 screenings every single day. We quickly got up to nearly 2,000 patients a year. 

What are some of the must-have components for a radiology practice looking to help set up a center of excellence for cancer care? 

Firstly, it might be trite to say it, but it’s absolutely true that a team approach is by far the most important component. A single radiologist is not going to be able to create something on their own. It really does require a multidisciplinary, all-hands-on-deck effort. You need oncologists, surgeons, and a hospital administration that buys into the concept and who supports you to name a few.

Secondly, access is critical. You have to offer your services at reasonable prices and have the ability to help patients with financial assistance where possible. You have to make sure they have access to the care you’re offering. In the case of lung-cancer screening, for example, it’s not just the CT scan. If the patient has a nodule and it needs to be biopsied, that patient, who had a relatively low-cost CT screening, may end up needing a more expensive procedure. 

And thirdly, setting up a systematic approach is just as critical. This becomes important, because then your institution can say, “OK, we’ve thought about this or that for our patients. We have a pastoral care section. We have creative ways to address this or that problem. So let’s take this particular action now.” Contrast this with the physician who’s working nearly alone and, as a result, can’t easily call on peers and colleagues for input and feedback. 

How important is it to break down geographical barriers between cancer patients and the best available clinical experts? And along these lines, how can telemedicine play a role in bringing in the right doctor at the right time?  

At Baptist Health, we’re a distributed system to begin with. We’re spread out over a very large geographic area. In heavy traffic it might take two and a half or three hours to get from one end of our geographic span to the other. Imagine setting up multidisciplinary tumor boards, getting together for meetings and all those kinds of things. We had to face that distributed network challenge. And there are entities like MEDNAX and—when you talk about teleradiology—vRad that are well-suited to approach that challenge. They’re distributed by nature. 

They also have scalability. They’re able to add new facilities—potentially small ones that don’t have deep resources on their own—to tackle a challenge like this. For example, let’s say your hospital or your health system can’t hire a nurse navigator to guide your patients through the cancer-care journey. Nor can that provider organization make the ROI make sense to justify purchasing a database they’d need in order to achieve center-of-excellence status. Well, if they’re our partners and thus have access to MEDNAX Radiology Solutions and vRad, it stands to reason that the ROI for the nurse navigator and the database can make sense. Because now they’re tapping into a partner who’s coordinating with multiple constituent facilities. 

MEDNAX Radiology Solutions is well-suited to set a standard that applies nationally or regionally. They’re able to deliver layers of quality care and center-of-excellence oversight on quality assurance. The IT layer is in place so you don’t have 20 different hospitals buying 20 different sets of software and employing 20 different nurse navigators. MEDNAX Radiology Solutions is perfectly suited to manage those kinds of things on the front end and then, on the back end, compliance activities. Compliance is always harder for smaller operations. 

Are you currently using vRad teleradiology services?

Not yet, but that’s the plan for our center of excellence. Using a state-of-the-art technology platform helps to drive radiology centers-of-excellence and our joint vision is to achieve all the goals that we’ve been talking about, leveraging the resources of a national radiology practice in MEDNAX Radiology Solutions. We became a part of MEDNAX Radiology Solutions less than a year ago. Right now we’re in the middle of getting the IT set up. 

How do you expect your day-to-day to change once you’ve got the MEDNAX Radiology piece up and running?

Well, the idea isn’t so much that we’re going to be doing reads from Miami for our cancer-center partners throughout the area. The idea is for us to have local folks who are part of our group working locally with the teleradiology support layered on top of that. Since vRad is a MEDNAX Company and as we’re both operating as our own entities, I think we’ll be working with vRad quite closely. 

In late April, RASF’s president and CEO, Dr. Ricardo Cury, will be hosting a MEDNAX webinar on building a cancer care center of excellence today. What will people miss out on if they don’t attend? 

They’ll miss out on a lot. Dr. Cury is going to go over how, moving deeper into the 21st century, we’re going to have centers of excellence and there will be new ways for radiology groups to get involved. We’re going to have tumor metrics labs, genetics panels, and big data. We’re also going to put these patients into registries so their outcomes can help inform future approaches to care and we will have clinical trials that are much more widely available to patients who could benefit by participating. 

We’re going to have precision medicines – yes, medicines plural. And those precision medicines are going to be guided by imaging and labs. Instead of wasting time with a drug that isn’t going to work for a particular subset of patients, we will redirect those patients to the drugs that are likely to work for them. Those are the things that, before—without a team approach, without a cancer center of excellence pulling everything and everyone together—couldn’t be done. You can’t buy a gene sequencer on your own. You can’t set up AI to look at the radiomics of a nodule on your own. That’s going to take a team effort. It’s going to take a cancer center of excellence. 

To secure a spot at Dr. Cury's webinar, Building a Cancer Care Center of Excellence in the Age of Precision Medicine: Key Strategies for Imaging Leaders, click here.