The Future of Healthcare: “Eradicate inaccurate hospital-based laboratory test results” with Greg Bullington
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Greg Bullington. Greg is CEO & Co-founder of Magnolia Medical Technologies, a medical device company with a mission to eradicate inaccurate hospital-based laboratory test results for critical conditions such as sepsis, which can lead to harmful patient misdiagnoses, mistreatments and significant preventable hospital costs.
Greg has extensive industry expertise in the medical device, biotech and healthcare technology sectors. Over the past 18 years he has led strategy and product commercialization engagements at more than 50 companies, ranging from Fortune 100 corporations to venture-backed and early-stage startups.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
I started my career in the strategy consulting industry and was fortunate to work on a number of high-stakes projects for disruptive technologies in the healthcare sector. At the time, active immunotherapy was an exciting and completely novel approach to cancer treatment, and it served as my initial exposure to new product commercialization in the healthcare industry. I also worked with the large health insurers, so I was able to gain a strong understanding of the payer perspective as well.
In my work within healthcare, I was energized by the opportunity to positively impact patient health, and ultimately, people’s lives. That opportunity to make a difference was magnified when, in 2007, I met Dr. Richard Patton, chief of pathology at UW Medicine/Northwest Hospital & Medical Center in Seattle, Washington. We first got together in a small office attached to the pathology lab in the back corner of the hospital. He pulled a bag of off-the-shelf blood collection supplies out of a drawer and told me about a growing concern over false-positive blood culture tests that often resulted in misdiagnosis of sepsis and his ideas for eliminating contamination in blood culture collection. His concern centered on the impacts of antibiotic therapies prescribed to patients based on erroneous test results. In some cases, Dr. Patton had seen antibiotic complications ultimately lead to patient deaths. Through his concerns, he saw an opportunity to make improvements and positively impact patient care and, in turn, their lives. We did some quick simple math based on the number of false-positive results at his hospital, and we immediately recognized how meaningful it would be if we could significantly impact this problem at scale. I became deeply committed to solving this important problem at a global level, and this mission became the foundation upon which Magnolia Medical Technologies was built.
Can you share the most interesting story that happened to you since you began leading your company?
The interesting stories aren’t my own, they come from a broad range of people I’ve talked to over the years who are eager to share their personal experience with false-positive sepsis test results. Sadly, I’m aware of many patients that have had serious medical consequences including C. diff infection, acute kidney injury and complications associated with unnecessary extra time in the hospital that could have been avoided. Sometimes these stories hit close to home for me — like the late-night call from my mother asking me to overnight a box of our devices to the hospital at which my uncle was being treated. There was concern he had sepsis, and he already had a history of clinical confusion over his conditions. Obviously, I couldn’t bring devices in the front door for treatment, but I certainly wanted to in order to ensure that if he received positive sepsis test results, they were accurate.
Can you tell our readers a bit about why you are an authority in the healthcare field?
Over the past 18 years, I’ve worked extensively in the healthcare and technology industries, leading product commercialization and strategy engagements for a wide variety of companies in biotech (novel immunotherapy), healthcare insurance, wellness and enterprise software sectors. I co-founded Magnolia Medical Technologies more than 10 years ago with Dr. Richard Patton, a prominent physician with decades of experience and national leadership roles within the pathology community. As CEO of Magnolia, I’ve led all commercial aspects of company development since inception. This has included clinical trial design and execution, publication of clinical data encompassing results from more than 50,000 patients, product development for a broad roadmap (more than 200 products) and commercial launch. I’ve also conceptualized and led the overall intellectual property strategy for our portfolio, which currently consists of more than 60 issued patents and an additional 50 are pending.
What makes your company stand out? Can you share a story?
Magnolia was started with a very focused sense of purpose — to help prevent the misdiagnosis of sepsis, a leading cause of death in U.S. hospitals. We are driven to innovate in order to create a new standard of care. Our path began with the invention of the Initial Specimen Diversion Device® (ISDD®) for blood culture collection and contamination reduction. It’s now in its second generation called Steripath® Gen2 ISDD.
False-positive test results for sepsis are a significant hidden healthcare problem in the U.S., and on average, more than one million patients have false-positive blood culture results annually. To solve this preventable error, Magnolia’s flagship product, Steripath, has been clinically demonstrated to reduce false-positive diagnostic test results for bloodstream infections by up to 92%.1,6
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
One of the U.S. healthcare system’s significant pain points is unnecessary antibiotic treatment, which contributes to antimicrobial resistance. Decades of research shows that false-positive blood culture results routinely lead to inappropriate and unnecessary antibiotic treatments. Often, these misdiagnoses increase the use of powerful antibiotics, which are associated with complications and extended patient length of stay as well as risk for hospital-acquired infections and conditions known as HAIs / HACs.
Blood culture results play a critical role in determining if antibiotic treatment can be deescalated for patients on a sepsis protocol. Treatment is often continued for patients with positive blood cultures, even when contamination is suspected. Reducing false-positive blood culture results can guide appropriate treatment and significantly reduce unnecessary antibiotic therapy.
In addition, healthcare costs are growing at an unsustainable pace, both for hospitals and patients. Steripath is helping to disrupt this trend by significantly reducing hospital costs. Five studies published in leading peer-reviewed medical journals, along with eight clinical abstracts presented at major national medical society conferences have demonstrated Steripath’s impact.1,2,3,7 Specifically, the value of preventing misdiagnosis of sepsis based on false-positive test results delivers an average of more than $4,500 in cost savings per instance, which equates to billions of dollars in completely avoidable costs to the U.S. healthcare system each year.
Are you working on any exciting new projects now? How do you think that will help people?
Yes, Magnolia is always innovating and refining our product strategy to improve patient care and help solve challenges for the healthcare system today and in the future. We have products in development to address new patient populations and use case scenarios. We’re excited to introduce these to market soon.
In addition, two new major peer-reviewed studies conducted by researchers at University of Houston and Massachusetts General Hospital/Harvard Medical School have recently been published.4,5 These studies prove Steripath can reduce hospital costs and improve patient safety by reducing length of stay and risk of hospital-acquired infections and conditions.
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
- Data is king — and takes (lots of) time to collect.
There is a natural skepticism about the ability of new products to deliver real results — particularly in the medical device space. Clinical data turns skeptics into supporters. But, it takes significant resources and extensive amounts of time for researchers to effectively design, gather, analyze, synthesize and ultimately publish results in peer-reviewed journals. Working with the best institutions and most reputable investigators has served us well — and, we have learned that the clock moves slowly.
- Change is hard. Period.
The status quo is difficult to overcome, especially in the acute care environment. Hospitals have specific approaches to evaluating if and when to introduce change, which can be a slow and cumbersome process. Data and evidence get you to the table, but finding champions to partner with to directly challenge an organization to “do the right thing” is the key to driving change.
- Innovate… confidently.
One of our five core values is “belief” — knowing that the work we do makes a difference for the patients and providers we serve. It also extends to believing in ourselves and our ability to persevere (another core value) when we run into inevitable roadblocks. We have a broad array of examples where innovating confidently has provided a path to the success we’ve envisioned. We are excited to share some strong examples in conjunction with new product launches later this year.
- “It’s all about the people”
Bill Ayer, the former CEO of Alaska Airlines, is a legend in the Pacific Northwest. I had an opportunity to meet Bill a number of years ago and asked him about Alaska Airlines “secret sauce.” Without pause, he said “it’s all about the people” — and proceeded to explain how Alaska has created superior results in a notoriously difficult industry based on the collective personality and culture of the organization.
I’ve been very fortunate to bring a team of exceptionally talented and capable people together. We are all highly committed to driving adoption of a new standard of care for sepsis testing accuracy. The milestones we’ve achieved as a company are a direct reflection of the vast breadth and depth of skills of our core team.
And, it’s not only the team that comes into the office every day that helps propel our mission. I’ve received valuable input and advice from countless individuals — friends, mentors, advisors and other key opinion leaders I’ve met along my journey. Magnolia’s mission is such a compelling one that it draws people in and inspires them to contribute. I’m grateful to this broader Magnolia team that has helped bring this important technology to patient care — and truly believe, “it’s all about the people.”
- Never quit
I’m a big fan of Ben Horowitz’s book “The Hard Thing About Hard Things.” I consult it often for the sage advice and comical anecdotes it provides — always keeping one of the most important takeaways front of mind:
“Whenever I meet a successful CEO, I ask them how they did it. Mediocre CEOs point to their brilliant strategic moves or their intuitive business sense or a variety of other self-congratulatory explanations. The great CEOs tend to be remarkably consistent in their answers. They all say: ‘I didn’t quit.’”
Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high-income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
Three reasons the U.S. healthcare system is ranked so poorly are challenges with accurate diagnoses, unnecessary antibiotic utilization and hospital-acquired infections/conditions attributable to extended length of hospital stay, all of which drive up costs for both hospitals and patients.
For example, false-positive diagnostic test results for sepsis are a hidden healthcare problem in the U.S., with an average of 40% of all positive cultures used to diagnose a condition turning out to be false. The impact of these erroneous diagnoses is that often patients with false-positive test results are unnecessarily treated for sepsis, which leads to inappropriate and avoidable antibiotic therapy and extended stays in the hospital.
Unnecessary antibiotic treatment can also lead to secondary infections like C. diff, multi-drug resistant organisms (MRDOs) infections, acute kidney injury and other antibiotic associated complications.
Extended hospital stays not only increase hospital bills but also increase risk of HAC/HAIs.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
1 . Drastically reduce diagnostic errors that lead to treatment variance and variability.
More than 70% of clinical decisions are made based on diagnostic test results. When those results are inconsistent, inaccurate and unreliable, how do we expect physicians to make the right decision? We need to start out with “the right answer, the first time” to prevent medical misadventures that are costly clinically and also economically both to the patient and to the system.
2. Enhance collaboration with Centers for Medicare & Medicaid Services (CMS), private payers and industry.
While progress has been made over the past decade, the pace of collaboration needed to support new and innovative technologies that improve outcomes and reduce costs must be significantly increased.
3. Improve sophistication of hospital financial analytical capabilities.
In today’s healthcare environment, innovations have to deliver dramatically improved clinical results while significantly reducing costs. The former is easy to quantify. The latter is not. Hospitals have robust information systems, but translating data into a format that is easy to identify cost savings and financial impacts of new innovations is a significant challenge to overcome.
4. Continue expansion of quality metric and transparency programs.
Major strides have been made in overall quality metric reporting. While not always perfect, out-of-the-gate, programs that encourage and reward strong performance for delivering better outcomes should continue to grow and expand in influence.
5. Truly implement “pay for performance” models.
While there has been much talk over the years about “risk sharing” and “outcomes-based” payment models, willingness of hospitals to jump in the pool remains rare. For instance, we offer to work with a hospital’s finance team to quantify institution-specific cost savings. Once the hospital comes up with numbers from its own internal systems, we then offer to go fully “at risk” from a pay-for-performance standpoint. While this is an irrefutable win-win payment model, hospitals today are generally still reluctant to try something new.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
It all comes down to a commitment to driving change. As noted previously, change is hard and often met with resistance, so it truly takes grit and commitment to bring to fruition.
As technology continues to improve, I believe many of the roadblocks and barriers that prevent prioritization of change (e.g. access to synthesized information and insights) will continue to decrease.
I’m also excited to see what happens in the electronic health record (EHR) analytics space over the next five years. EHRs will help make the healthcare system, each individual’s treatments and the results of prevention strategies more transparent. I believe this will help inform patients and show those that are impacted by false-positive test results where the system broke down, which will push our healthcare system to change and be more accountable for preventable errors.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
From a medtech perspective, MedTech Strategist and Medtech Talk offer in-depth overviews and outstanding insights on trends and specifics relevant to my industry. Modern Healthcare, Beckers and other industry media outlets also provide good access to timely information.
I also value attending annual conferences put on by leading industry service providers including Cooley’s Healthtech Growth Conference, Wilson Sonsini Goodrich & Rosati Medical Device Conference and the annual J.P. Morgan Healthcare Conference, to name a few. These are good venues to learn about successful strategies that companies in our space have employed and also engage with other leaders to benefit from their perspective and insights.
- M. Rupp, et al; Reduction in Blood Culture Contamination Through Use of Initial Specimen Diversion Device. Clinical Infectious Diseases (August 2017
- M. Bell, et al; Effectiveness of a Novel Specimen Collection System in Reducing Blood Culture Contamination Rates. Journal of Emergency Nursing (April 2018)
- F. Zimmerman, et al. Reducing blood culture contamination using an initial specimen diversion device. American Journal of Infection Control (January 2019)
- E. Skoglund, et al. Estimated clinical and economic impact through use of a novel blood collection device to reduce blood culture contamination in the emergency department: A cost-benefit analysis. J. Clin. Microbiol (January 2019)
- B. Geisler, et al. A Model to Evaluate the Impact of Hospital-Based Interventions Targeting False-Positive Blood Cultures on Economic and Clinical Outcomes. Journal of Hospital Infection (March 2019)
- D. Chang, et al. (2017). Impact of Blood Culture Diversion Device and Molecular Pathogen Identification on Vancomycin Use. Society of Healthcare Epidemiology of America (SHEA) Conference.
- See https://magnolia-medical.com/steripath/evidence/
How can our readers follow you on social media?
Thank you so much for these insights! This was so inspiring!