McCahill urges medical entrepreneurship, measurement

February 4, 2010
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The new director of surgical oncology and assistant director of the Lacks Cancer Center at Saint Mary’s Health Care, Dr. Laurence McCahill has been in town for just a few months. But he said he is struck by a lack of health care entrepreneurship in a city that is trying to tout its health care prowess.

“Since I’ve been here, what I haven’t seen is any of the spin-offs of a growing health care industry,” said McCahill, whose undergraduate degree from Duke University is in biomedical engineering. “I think businesses need to look at how do they capitalize on health care as a major industry?”

Manufacturing companies that diversify into making medical devices are doing a fine thing, but “that’s too simplistic,” said McCahill. “I was interested to learn that Steelcase has a health care furniture line. That’s one company that’s thinking ahead.

“You’ve got three solid healthy hospital systems that are growing, and an independent research center that’s working amongst the three of them. You’ve got a really neat thing here.

“I haven’t been to many places where there’s cranes up in the air, multiple things being built — and they are all around health care. But there is a lot of business opportunity there.”

At the Lacks Cancer Center, McCahill is bringing change to the way gastrointestinal cancer patients experience care — changes he instituted in his previous post in Vermont.

“What I’m going to be initially overseeing is the development of new multidisciplinary cancer programs,” McCahill said. “Almost two-thirds of patients need something beyond surgery. … It’s really important that patients and physicians get together before treatment gets started and discuss the best options for the individual patients.”

In multidisciplinary teams, doctors and nurses join with the patient to map out a plan of care. The patients works with a “nurse navigator” whose job “is really to streamline care for patients, help educate patients, and minimize the time the patient has to be away from family or work,” McCahill explained.

He developed this system at the University of Vermont, where he was an associate professor of surgery and director of the Gastrointestinal Multidisciplinary Clinic from 2006 until he came to Grand Rapids in October. A similar system is already well established for breast cancer, he added. It’s an approach that is becoming more important as cancer treatment encompasses a variety of methods, he said.

“If you’re trying to get the best outcomes for patients, you really want to get everyone on the treatment team on board at the beginning,” McCahill said. “We created a GI multidisciplinary program at the University of Vermont in early 2007, and we were really able to achieve more efficient care.”

“I’m an engineer by background, so I’m really into measuring things, and we were able to achieve faster care for patients. … They got their staging completed sooner, they got treatment under way sooner, and they got their last treatment completed sooner, when everyone was on board from the beginning.”

The team approach also trimmed costs by avoiding unnecessary duplications of tests ordered by different doctors, he said.

“In the old system, when physicians did all the ordering, over 60 percent of patients had an unnecessary test done,” he said. “When we had a nurse navigator coordinating the care, that dropped down to 6 percent. We think that’s an eye-opening number, both for businesses and for insurers. Honestly, it’s not rocket science to the business people. It’s obtaining efficiencies and measuring your processes of care.

“No one in medicine ever puts together a system where you actually measure what you do. That’s what I hope to bring new to the table is how do you measure the health care process? I really think health care measurement is going to be its own industry in the future.”

Measuring care for breast cancer patients is another project McCahill has underway. With a $1.1 million National Institutes of Health grant, he is overseeing a study of the quality of breast cancer surgery at sites nationwide. The grant is one of 200 awarded under the American Reinvestment and Recovery Act.

“We are going to look at the incidence of breast conservation being performed for small tumors,” he said. Breast cancer patients require second surgeries between 20 percent and 50 percent of the time because cancer cells are left behind in the area surrounding the tumor. The two-year study will measure the incidence of second surgeries in patients at sites in Vermont, Wisconsin, Washington and Colorado. The grant is bolstering employment both at the Van Andel Institute, where the data will be scrutinized, and at Saint Mary’s, McCahill said.

A native of Chicago, McCahill attended Duke’s medical school. “My father actually passed away from cancer while I was in college, and I had to figure out how to pay for medical school,” he said. “I ended up going on a Navy scholarship.”

He served in the U.S. Navy from 1996 to 2000 in Okinawa and in Washington, D.C. That was followed by a surgical oncology fellowship in Los Angeles before he joined the University of Vermont.

McCahill lives with his wife, Julie, a pharmacist, and their four children, ages 4 to 13, in Grand Rapids Township. — Elizabeth Slowik

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