Latest / Becker’s Healthcare Podcast / Dr. H. Kurtis Biggs, Orthopedic Surgeon and Founder of the Joint Replacement Institute in Florida

Transcript

Dr. H. Kurtis Biggs, Orthopedic Surgeon and Founder of the Joint Replacement Institute in Florida · Becker’s Healthcare Podcast

• 0:02
  - Just five years ago, a big portion of
• 0:04
  - what's now being done in ambulatory surgery centers
• 0:07
  - wasn't considered outpatient work. The cases have changed,
• 0:10
  - the tech has changed, the patient expectations have
• 0:13
  - changed, and the leaders who are thriving are
• 0:16
  - the ones who saw it coming.
• 0:18
  - Becker's twenty third annual Spine Orthopedic and Pain
• 0:21
  - Management Driven ASC Conference
• 0:23
  - exists for exactly that kind of forward looking
• 0:25
  - practitioner.
• 0:27
  - Here, Becker's hosts more than 1,000 attendees, 275
• 0:31
  - physician and ASC speakers, and three days of
• 0:34
  - sessions that move between the clinical, the operational,
• 0:37
  - and the strategic, and the CME credits to
• 0:39
  - show for it.
• 0:40
  - It. Join us June eleventh through the thirteenth
• 0:42
  - at the Swiss Hotel in Chicago, and come
• 0:45
  - ready to think about what's next. Register on
• 0:47
  - our events page at beckershospitalreview.com
• 0:50
  - by clicking on the events tab in the
• 0:52
  - upper right.
• 0:56
  - This is Carly Beam with the Becker Spine
• 0:58
  - and Orthopedics podcast. And joining me today is
• 1:01
  - doctor Curtis Biggs, an orthopedic surgeon and founder
• 1:04
  - of the Joint Replacement Institute in Florida. Doctor
• 1:07
  - Biggs, thank you so much for being here
• 1:09
  - today.
• 1:10
  - Thank you.
• 1:11
  - And so to start, I'd love if you
• 1:13
  - could just briefly introduce yourself, talk about your
• 1:16
  - organization,
• 1:17
  - and what's and what's really commanding most of
• 1:20
  - your attention as a leader right now.
• 1:23
  - Yes. So we're a, I would say, mid
• 1:25
  - to small size practice here in Naples, Florida.
• 1:28
  - We've been around now for eighteen years. I
• 1:31
  - started as a solo practice, and we've, slowly
• 1:33
  - grown,
• 1:34
  - to,
• 1:36
  - five provider
• 1:37
  - surgeons and six mid levels as well as,
• 1:40
  - four physical therapists.
• 1:42
  - We service,
• 1:43
  - hand
• 1:45
  - to
• 1:46
  - everything in between to to, toes,
• 1:49
  - including total joints and a procedural pain management.
• 1:52
  - So, we try to cover things. We have
• 1:54
  - a,
• 1:55
  - private practice,
• 1:56
  - ancillary services,
• 1:58
  - full line, and they're,
• 2:01
  - so we are we're trying to maintain that,
• 2:04
  - independence. I think that's what's
• 2:06
  - the the biggest,
• 2:08
  - part
• 2:09
  - of the leadership part of this is
• 2:12
  - trying to stay independent,
• 2:14
  - trying to find ways to work
• 2:16
  - within the confines of
• 2:18
  - our insurance contracts and overhead and the difficulty
• 2:21
  - with
• 2:22
  - the human resources side of finding
• 2:25
  - qualified employees
• 2:27
  - that are willing to work.
• 2:29
  - I think that's a that's been a challenge
• 2:31
  - for sure.
• 2:32
  - Yeah. And I'd love to definitely touch more
• 2:34
  - on
• 2:35
  - these challenges. I'd love to just kinda first
• 2:37
  - talk about, you know, this the the aspect
• 2:40
  - of independence.
• 2:41
  - You know, obviously, groups like yours and ASCs,
• 2:44
  - they're under constant pressure from the health care
• 2:47
  - system, and, you know, you see constantly,
• 2:50
  - you know, some groups they might look at
• 2:52
  - different consolidation
• 2:53
  - options,
• 2:54
  - band with a health system or hospital. And
• 2:57
  - I'd love to hear your playbook for staying
• 3:00
  - independent
• 3:01
  - and financially
• 3:03
  - viable, especially as a smaller group?
• 3:06
  - It's very challenging.
• 3:08
  - I have to say. That's been the biggest
• 3:10
  - change since 2020,
• 3:12
  - has been the the just magnitude of our
• 3:15
  - overhead has gone up so significantly,
• 3:19
  - be it in the demands of the employee
• 3:22
  - employees
• 3:23
  - of what they're requiring,
• 3:27
  - or pay
• 3:29
  - and which has been tough. And then the
• 3:30
  - overhead of the actual physical
• 3:33
  - purchasing powers of of supplies
• 3:36
  - and,
• 3:37
  - our our machines, our computers, our IT,
• 3:40
  - it's just been,
• 3:42
  - it's very challenging because we're we're getting reduced.
• 3:44
  - The surgeons are getting reduced every year.
• 3:47
  - Our overhead has gone from 47 to almost
• 3:49
  - 70%
• 3:50
  - in a matter of five years.
• 3:52
  - Mhmm. And they're not asking your employees to
• 3:55
  - take that hit. It's always the surgeon. And
• 3:57
  - so it's been very challenging.
• 4:00
  - In private practice, you're seeing the rise of
• 4:02
  - some of the concierge in the orthopedic world,
• 4:05
  - the services that are provided outside of what
• 4:07
  - Medicare and commercial insurances and and a little
• 4:10
  - bit more attention to detail. So those would
• 4:11
  - be cash out of pocket services.
• 4:14
  - That's another way for the private practice to
• 4:16
  - retain
• 4:17
  - some form of autonomy is to try to
• 4:19
  - keep that flow going.
• 4:22
  - So those are those are,
• 4:24
  - really been a a challenge. And when we
• 4:26
  - see the the residents that are coming out,
• 4:29
  - I think that it's a stark number of
• 4:31
  - only 29%
• 4:33
  - or so of graduates are going into private
• 4:35
  - practice.
• 4:36
  - It just makes it very challenging long term
• 4:38
  - for a private practice to survive if we
• 4:40
  - can't replace those that retire.
• 4:43
  - So it's it's a dying breed, unfortunately.
• 4:46
  - Yeah. And, you know, I've spoke with other
• 4:48
  - surgeons about, you know, you know, these,
• 4:50
  - early career surgeons. You know, you're saying that
• 4:53
  - more of them seem to lean towards a
• 4:56
  - health system and hospital employment models. But I'd
• 4:59
  - love to just kind of hear from your
• 5:00
  - perspective or maybe even just a bit of
• 5:02
  - a pitch of what makes working for an
• 5:04
  - independent group such as yours,
• 5:07
  - so the advantages.
• 5:10
  - I think the the advantage is autonomy, where
• 5:12
  - you can choose to do
• 5:14
  - the cases that you like, work in the
• 5:17
  - even subspecialized
• 5:19
  - into an area that you like. You're not
• 5:21
  - governed or monitored by a large,
• 5:24
  - hospital system that can come in and tell
• 5:26
  - you what you're gonna do, what
• 5:28
  - what implants you're gonna do, what days you're
• 5:31
  - gonna work, what, there there is a lot
• 5:33
  - to be said for that. And,
• 5:36
  - you know, we as in private practice, we
• 5:38
  - can't we can't pay employed doctors or new
• 5:40
  - guys coming out based on RBUs because
• 5:43
  - it doesn't it doesn't equate like it does
• 5:45
  - when you're working for a hospital system who
• 5:48
  - have
• 5:49
  - other income sources within the system of which
• 5:51
  - they can match they can buffer that
• 5:54
  - outlay of pay to that to that provider.
• 5:58
  - So you have to
• 5:59
  - add the potential for owning surgery centers,
• 6:03
  - the ancillaries,
• 6:04
  - although they're getting weaker and weaker for DME
• 6:06
  - and MRI,
• 6:07
  - it's still the potential is still there.
• 6:11
  - So those are the parts that you have
• 6:12
  - to really emphasize of you are controlling your
• 6:15
  - own destiny
• 6:16
  - and, picking your path, which you can't necessarily
• 6:19
  - do as an employee.
• 6:20
  - Got it. And, you know, I'm wondering, you
• 6:22
  - know, despite all these challenges, where do you
• 6:24
  - see the biggest opportunities for growth in your
• 6:27
  - practice? Is it in, you know, those ancillary
• 6:29
  - services or the ASC?
• 6:32
  - The ASC is the the best investment
• 6:34
  - that I think most of us could make.
• 6:37
  - It's the best return because we're basically
• 6:40
  - we're doing it in an optimum position at
• 6:42
  - a great facility with
• 6:45
  - we have control,
• 6:47
  - of the cost. We control the cost of
• 6:49
  - the the implants.
• 6:50
  - We control the cost of the employees.
• 6:53
  - So that's the best chance for us to
• 6:55
  - have a return on that investment
• 6:57
  - for our our work that we do.
• 7:00
  - The MRI, since we're not part of a
• 7:02
  - health system,
• 7:03
  - you know, we get paid less for the
• 7:05
  - same the same,
• 7:07
  - same procedure.
• 7:08
  - You know, we we have an MRI here.
• 7:10
  - We get paid a $150
• 7:11
  - of a knee. You go have that MRI
• 7:13
  - at the hospital, they get paid $3.50.
• 7:15
  - So you then have to pay $85 to
• 7:17
  - the radiologist to read it, and the technician
• 7:19
  - has said, you know, $50 an hour to
• 7:21
  - do the
• 7:21
  - to do the test. And so you're really
• 7:23
  - just doing the MRI for convenience for the
• 7:25
  - patient.
• 7:26
  - So there's,
• 7:27
  - the the those traditional ancillaries such as the
• 7:29
  - MRI and the DME are not they're not
• 7:32
  - great moneymakers as they used to be,
• 7:34
  - but the surgery center is our best our
• 7:37
  - our best opportunity.
• 7:38
  - You're gonna see a significant rise in the
• 7:41
  - number
• 7:42
  - of concierge programs. It's becoming much more common.
• 7:46
  - I'm in an area here where a very
• 7:50
  - financially
• 7:51
  - strong area as far as retirees.
• 7:55
  - So there's there are people here that want
• 7:57
  - to,
• 7:58
  - contribute to a concierge program so that they
• 8:00
  - can
• 8:01
  - optimize their recovery process. They can have preferred
• 8:04
  - appointments. They can get surgical times that are
• 8:06
  - a little bit more,
• 8:07
  - how fast they can get in and get
• 8:08
  - things done. So you're gonna see those, you
• 8:11
  - know, come to a head,
• 8:13
  - becoming more popular. I think you're gonna see
• 8:16
  - a lot of people dropping out of insurance
• 8:18
  - companies.
• 8:19
  - Yeah. I think there's just gonna be a
• 8:21
  - a a fee for service that's gonna come
• 8:23
  - around the corner.
• 8:25
  - I'm I probably am only a couple years
• 8:27
  - away from doing that because of the the
• 8:30
  - frustration of of the declining reimbursement.
• 8:34
  - I think those are just options that are
• 8:35
  - out there, and we're gonna see a lot
• 8:36
  - more
• 8:37
  - of that happening.
• 8:39
  - Yeah. I was gonna ask, you know, if,
• 8:41
  - dropping insurers or,
• 8:43
  - Medicare ever was gonna be a consideration. I
• 8:45
  - know you said you're you're gonna be, I
• 8:47
  - guess, couple years out before you make conflict
• 8:49
  - that any
• 8:50
  - final decision. But,
• 8:52
  - you know, if you do make that decision,
• 8:54
  - I'd love to kind of hear how you're
• 8:56
  - you were thinking of approaching this kind of
• 8:59
  - that
• 9:00
  - new balance then with, you know, leaving insurers
• 9:03
  - out of the picture.
• 9:06
  - Well, fortunately, for the patients, they'll have coverage
• 9:09
  - for their procedure under their insurance plan. But
• 9:11
  - as far as what we
• 9:13
  - have, as surgeons, we can then have a
• 9:15
  - flat fee. And you just it's an honest
• 9:18
  - conversation with the patients. I even I have
• 9:20
  - concierge patients, and I tell them this is
• 9:22
  - the protocol.
• 9:23
  - This will be the cost out of pocket
• 9:24
  - to do these this medication protocol and this
• 9:27
  - non opioid,
• 9:28
  - protocol that I've, developed.
• 9:31
  - And
• 9:32
  - if you don't wanna do that, it's understandable.
• 9:34
  - I said, but then,
• 9:36
  - my partner does it a different way. And
• 9:37
  - so if you don't wanna go out of
• 9:39
  - network with me or a fee for service,
• 9:42
  - then I've got my partner. Fortunately, he'll be
• 9:43
  - able to do that. So that's how
• 9:45
  - I'm probably gonna be able to launch that
• 9:47
  - is that I've got a younger partner who
• 9:50
  - will be able to take on those patients
• 9:52
  - who don't
• 9:53
  - wanna opt through that cash fee for service
• 9:55
  - placement. But I think it's inevitable, and I
• 9:58
  - probably have eight to ten years left in
• 9:59
  - my career. And I I don't see how
• 10:01
  - there's a way that I'll make it ten
• 10:03
  - years without going to that fee for service
• 10:06
  - as,
• 10:07
  - plan,
• 10:09
  - how things are the trajectory of where things
• 10:11
  - are heading.
• 10:12
  - Yeah. And, you know, obviously, you know, things
• 10:15
  - are just changing rapidly all the time. I
• 10:17
  - was wondering if you could talk about a
• 10:20
  - recent decision or a pivot that require the
• 10:23
  - most leadership conviction from you?
• 10:26
  - Certainly. Well, we just changed our EMR system,
• 10:30
  - and it was a big decision for us.
• 10:32
  - We went from you know, I don't have
• 10:33
  - to name names, but we went from a
• 10:34
  - system that was fine eight years ago, but
• 10:36
  - now it's missing missing a lot of the
• 10:38
  - bells and whistles.
• 10:39
  - We're going into an EMR system that,
• 10:43
  - has a bunch of bells and whistles,
• 10:45
  - billing side, AI side for documentation,
• 10:49
  - and
• 10:50
  - as well as scheduling. And
• 10:52
  - so the tough decision there with the leadership
• 10:54
  - is that that will result in the,
• 10:57
  - the loss of seven employees.
• 11:00
  - So
• 11:01
  - that changes things and that you have employees
• 11:03
  - that you've been with you for a number
• 11:04
  - of years, but you can then utilize the
• 11:07
  - technology in order to, unfortunately, eliminate those positions
• 11:11
  - and you and and have less of a
• 11:13
  - cost
• 11:14
  - to do that job through AI
• 11:16
  - and through the better documentation of the new
• 11:19
  - EMR system.
• 11:20
  - So that that's,
• 11:22
  - gonna be an interesting summer here as we,
• 11:24
  - roll down that pathway and transition from one
• 11:27
  - EMR to the other and one billing style
• 11:29
  - to the other billing style, and then the
• 11:30
  - loss of about seven employees that'll be replaced
• 11:33
  - with AI.
• 11:35
  - Got it. You know, when it comes to
• 11:37
  - AI, I'd love to hear any other interesting,
• 11:39
  - use cases you have for it, whether it
• 11:42
  - is, you know, replacing,
• 11:44
  - staff or augmenting or just kind of enhancing
• 11:47
  - the folks that you do have.
• 11:49
  - Absolutely. So I use it as part of
• 11:51
  - my program for my perioperative
• 11:53
  - education for my patients.
• 11:54
  - Mhmm. I use an AI chatbot through StreamMD,
• 11:58
  - and it's I program it with my information.
• 12:01
  - Patients receive information and messages starting three weeks
• 12:04
  - before and then, you know, all the way
• 12:05
  - until six weeks after surgery. And it details
• 12:07
  - what they should be doing, what to expect,
• 12:09
  - what's gonna be what where and why they're
• 12:12
  - supposed to be doing, when they're gonna get
• 12:13
  - their medication. It's embedded with videos that I've
• 12:16
  - created that are there, so it creates the
• 12:19
  - contact with the patient.
• 12:21
  - It has significantly
• 12:22
  - reduced the number of phone calls that we
• 12:24
  - get from patients.
• 12:25
  - They can ask questions to the chatbot,
• 12:28
  - and those questions can be answered based on
• 12:30
  - the information that I programmed in through StreamMD
• 12:33
  - so that it's
• 12:35
  - it, they don't have to call somebody. They
• 12:37
  - don't have to plug up phone lines. They
• 12:38
  - don't have to talk to the surgical scheduler,
• 12:40
  - the MA, or myself.
• 12:41
  - And it's been very, very helpful just to
• 12:44
  - relieve some of the phone calls. We get
• 12:46
  - 15,000 phone calls a month here. Wow. And
• 12:49
  - we're not a and we're not a giant
• 12:50
  - practice. And so Yeah. I can only imagine
• 12:52
  - in bigger facilities how they have to answer
• 12:55
  - that.
• 12:55
  - We had to move,
• 12:57
  - we had to move our call center offshore
• 13:01
  - because we could not employ,
• 13:04
  - local residents at the rate
• 13:07
  - that they required and still make it affordable.
• 13:10
  - So Yeah. The hope is that with AI,
• 13:12
  - we'll be able to bring the bring to
• 13:14
  - lose that cost of shipping these,
• 13:17
  - positions overseas
• 13:18
  - so that we can, you know, maintain much
• 13:20
  - more control of that situation. But,
• 13:23
  - that's that's where things have to happen. And
• 13:25
  - if you're gonna stick with the the archaic,
• 13:29
  - unfortunately,
• 13:30
  - without AI,
• 13:31
  - you're gonna really struggle because you can't handle
• 13:34
  - staffing with the constant,
• 13:35
  - reduction in pay,
• 13:37
  - the elevation of what
• 13:39
  - the,
• 13:40
  - employees are requiring for to work for you,
• 13:44
  - and then trying to maintain their benefits. When
• 13:46
  - we do four zero one k, we do
• 13:47
  - health insurance. 85% of their health insurance is
• 13:49
  - paid by us.
• 13:51
  - We do profit sharing. So in order to
• 13:52
  - maintain those to get your good employees, you've
• 13:54
  - gotta find other ways to cut costs so
• 13:56
  - you can still continue to manage those benefits
• 13:58
  - for them.
• 13:59
  - Yeah. That's, you know, that's really cool you're
• 14:00
  - saying also about the chatbot. So you're able
• 14:03
  - to kind of program in some answers. So
• 14:06
  - it's, you know, it's not just, you know,
• 14:08
  - you're all you're, like, talking to chat CBT.
• 14:10
  - You're actually talking to,
• 14:12
  - your own insights as a physician.
• 14:14
  - Yeah. So it's programmed based on what my
• 14:16
  - protocols are. So it's not just a generic.
• 14:19
  - It's not chat answering you. It's chat reviewing
• 14:22
  - my information and answering it according to my
• 14:24
  - protocols.
• 14:26
  - So it's it's a nice way for them
• 14:27
  - to receive answers of which I approve of.
• 14:30
  - They're not just something random that's coming off
• 14:32
  - of the chat's research.
• 14:34
  - Huge advantage for sure. It has been it
• 14:36
  - has been very, very well received by patients
• 14:38
  - to where they I probably ninety percent of
• 14:41
  - my people come in at four weeks and
• 14:42
  - say, I really love the chat. I knew
• 14:44
  - what was going on. I you know, there
• 14:46
  - was no mystery.
• 14:47
  - And most of the time, they answer questions
• 14:49
  - before I need to even have them. I
• 14:51
  - didn't even know I had that question, but
• 14:52
  - they answered it. So it's very both. It
• 14:54
  - was a very positive thing, and I pay
• 14:56
  - a pay a flat fee on a monthly
• 14:57
  - basis. And no matter how many patients are
• 14:59
  - in the in the queue for surgery, it's
• 15:01
  - it's all covered. So the more patients you
• 15:03
  - have, it's actually more cost effective too.
• 15:06
  - Definitely. And, you know, kind of speaking about
• 15:09
  - technology and,
• 15:11
  - in OR, you know, we have robot assisted
• 15:13
  - joint replacement, and that's become, you know,
• 15:16
  - near standard in a lot of high volume
• 15:19
  - programs. Unfortunately.
• 15:21
  - Unforce yes. Why why do you say that?
• 15:23
  - Let's hear it.
• 15:24
  - Because there's no literature that shows they do
• 15:26
  - any better.
• 15:28
  - Yeah. Let's talk more about that. Yeah. So,
• 15:31
  - even just recently, this two year follow-up on
• 15:33
  - robotic knees versus on, traditional instrumentation, they found
• 15:37
  - that the robotic knees had more incidence of
• 15:39
  - complications at two year follow-up, whether it's fractures
• 15:41
  - or or, wound problems, things like that. So,
• 15:46
  - the robot is a great set of tools.
• 15:49
  - That's how I describe it to patients. I've
• 15:51
  - done over a thousand robots. They add twenty
• 15:53
  - minutes or so to surgery. No matter how
• 15:55
  - efficient you are, they do add time.
• 15:57
  - They add cost to the case.
• 15:59
  - The machine costs a lot of money.
• 16:01
  - I have very,
• 16:04
  - you know, strong feelings about the robot. I
• 16:06
  - think the robot's great marketing, and that's what
• 16:08
  - it is. When you have giant implant companies
• 16:11
  - whose prices on their implants are going down,
• 16:13
  - they have to find another source of income.
• 16:15
  - And so then robot. Here is the robot.
• 16:17
  - Here's a million dollar robot that you can
• 16:19
  - buy, and then we'll give you a price
• 16:21
  - reduction on all our implants if you become
• 16:23
  - a one or two vendor system. So then
• 16:26
  - they force you to use, you know, all
• 16:27
  - of this one so that they can get
• 16:29
  - a good deal on the robot, then they
• 16:30
  - can market and advertise it. But the proof
• 16:32
  - is in the pudding.
• 16:34
  - The it shows that a good traditional knee
• 16:37
  - versus a PSI knee versus a robot knee,
• 16:41
  - they all do very they all do well.
• 16:43
  - So why are we adding more difficulty to
• 16:45
  - the case,
• 16:46
  - more
• 16:47
  - overhead,
• 16:48
  - more equipment,
• 16:50
  - more things that can go wrong?
• 16:52
  - Because of marketing. Every patient loves to hear
• 16:55
  - robots and lasers.
• 16:56
  - Half the patients don't even know that the
• 16:58
  - robot doesn't even cut
• 16:59
  - them. Yeah. But still, the surgeon has to
• 17:02
  - interpret the results and do the surgery.
• 17:04
  - So it's a
• 17:06
  - I think it's a terrific,
• 17:08
  - angle that the implant companies have come up
• 17:11
  - with.
• 17:11
  - And I think it's fascinating technology,
• 17:14
  - and it works,
• 17:15
  - but at what
• 17:17
  - point?
• 17:19
  - It costs more. It takes longer.
• 17:22
  - So and it doesn't change the long term
• 17:24
  - results.
• 17:26
  - So I know you I know you said
• 17:27
  - you have used,
• 17:28
  - or you've used, you know, multiple multiple cases.
• 17:31
  - How are you deciding
• 17:32
  - when to use it versus
• 17:34
  - when
• 17:35
  - not?
• 17:37
  - At this point, the only time I'd use
• 17:38
  - a robot, if I had a a,
• 17:40
  - short stature,
• 17:44
  - traumatic deformity, post traumatic arthritis, or things like
• 17:47
  - that of which I needed it. And that's
• 17:49
  - on knees. On hips, I have no no,
• 17:52
  - I have no great,
• 17:54
  - use for the robot.
• 17:58
  - And are your helpful.
• 18:00
  - I was gonna say, are are any of
• 18:01
  - the, I guess, younger, earlier career physicians that
• 18:04
  - you practice, are they more keen on the
• 18:06
  - on the robot? Or how are you? Yeah.
• 18:08
  - My partner, that's all he was trained on
• 18:09
  - in his residency. And so he's a big
• 18:11
  - robot user, and I'm a I'm a proponent.
• 18:13
  - And I patients, I give him a choice.
• 18:15
  - If you'd really like the robot,
• 18:17
  - I've got a great surgeon who's who's very
• 18:19
  - well trained and does a wonderful job with
• 18:21
  - robot. That's his set of tools.
• 18:23
  - And
• 18:25
  - that surgeon, whoever's doing it, should be using
• 18:27
  - their set of tools, whether they're mechanical, kinematic,
• 18:30
  - whether they're traditional, they're they're,
• 18:33
  - you know,
• 18:34
  - PSI jigs, whether they're robot. They need to
• 18:36
  - be using what they use the most and
• 18:37
  - what they get the best results with.
• 18:40
  - And that's that matters.
• 18:42
  - Repetition matters. So you need a surgeon who
• 18:43
  - does a lot of that case.
• 18:47
  - That's also very important. So, I think there's
• 18:50
  - we have great surgeons,
• 18:51
  - and they all can use different techniques
• 18:54
  - to get a great result. So I will
• 18:56
  - never fault someone for using a robot or
• 18:58
  - a PSI or traditional instruments. If that's what
• 19:00
  - it is for you to get your best,
• 19:02
  - result for that patient, that's what we should
• 19:04
  - be using.
• 19:05
  - But to say one is substantially better than
• 19:07
  - the other, I'm I'm
• 19:08
  - I think that jury is in, and there
• 19:11
  - isn't one that's necessarily better than than the
• 19:14
  - other.
• 19:15
  - So what kind of orthopedic technologies
• 19:18
  - really do get you jumping out of your
• 19:20
  - seat with excitement? I know the robots, they
• 19:22
  - have you kind of watching you or enjoying
• 19:24
  - them, but what kind of what really excites
• 19:26
  - you then when it comes to orthopedic tech,
• 19:29
  - whether in your implant or anything like that?
• 19:33
  - Boy,
• 19:36
  - I think the the bearing surfaces are gonna
• 19:38
  - be,
• 19:39
  - something that's interesting. I think three d printing
• 19:42
  - in the
• 19:44
  - in the ASC, which is coming down the
• 19:46
  - line
• 19:47
  - where they'll,
• 19:48
  - be able to three d print your if
• 19:50
  - you're gonna do a PSI jig, they'll be
• 19:51
  - able to print that right in your center.
• 19:53
  - So they take the MRI scan, and then
• 19:55
  - there's no shipping, and then you can sterilize
• 19:57
  - it locally.
• 19:58
  - Also, I'd I'd be interested to see what's
• 20:00
  - gonna happen with peak if there's gonna be
• 20:02
  - an opportunity for a peak,
• 20:04
  - bearing surface for knee replacement because that would
• 20:07
  - be something that could also be printed on-site.
• 20:09
  - So then there's no inventory.
• 20:11
  - It's just done.
• 20:13
  - But those things are very science fiction at
• 20:15
  - this point.
• 20:16
  - There's people talking about it, and I think
• 20:18
  - there's people that are, like, doing it, modeling
• 20:20
  - it. But I'm not sure if that's,
• 20:23
  - like, in the near future or the far
• 20:24
  - future, to be honest with you.
• 20:26
  - Yeah. Yeah. I I personally have created my
• 20:29
  - own
• 20:31
  - hip femoral implant.
• 20:33
  - Mhmm.
• 20:34
  - I created it from a starting with a
• 20:36
  - napkin,
• 20:37
  - drew it on a napkin, then contract kinda
• 20:40
  - made a contracted a, with an engineer to
• 20:44
  - help me change it to a into a
• 20:46
  - CAD model.
• 20:48
  - I then worked with Signature Orthopedics out of
• 20:51
  - Australia to do all my testing for
• 20:54
  - strength testing,
• 20:55
  - functional testings to make sure everything lines up
• 20:58
  - the way it's supposed to.
• 21:00
  - I received my five ten k on the
• 21:03
  - device in,
• 21:04
  - '24,
• 21:06
  - and we started putting devices in in September
• 21:09
  - '24. And we have over a 110 of
• 21:11
  - those
• 21:12
  - those hip replacements that are in place now
• 21:15
  - at a a year and a half out.
• 21:17
  - So that's Incredible.
• 21:18
  - Going from a napkin going from a napkin
• 21:21
  - into a a person. Do you so do
• 21:23
  - you, like, have that napkin just kinda, like,
• 21:25
  - fridge this memorabilia that's
• 21:27
  - Yeah. It's still we've got it. You know?
• 21:30
  - Because it was a it was a big
• 21:31
  - decision because I was I'm self funded. And
• 21:33
  - so,
• 21:34
  - for me, it was
• 21:35
  - every every little turn, whether it was a
• 21:38
  - patent,
• 21:39
  - application,
• 21:41
  - you know,
• 21:42
  - you know, paying for the testing to be
• 21:44
  - done,
• 21:45
  - those are all comes out of my pocket
• 21:47
  - and, very grateful to have a an awesome
• 21:50
  - spouse. And she's understands that this is an
• 21:52
  - investment potentially of something, and it leaves a
• 21:55
  - legacy of something that could be a a
• 21:57
  - game changer
• 21:58
  - in what,
• 22:00
  - in my field, which is kinda cool.
• 22:03
  - Obviously, we have a lot of, invested in
• 22:05
  - it, both financially and emotionally at this point,
• 22:08
  - having been working on it for six years.
• 22:10
  - And to see the people that are a
• 22:12
  - year and a half out and they're doing
• 22:14
  - great, it's very satisfying.
• 22:16
  - I I worked in with a company as
• 22:18
  - a design surgeon on a group project,
• 22:20
  - and it wasn't very satisfying in the end.
• 22:23
  - I don't think any of us were really
• 22:24
  - happy with the process. And afterwards, I said,
• 22:26
  - you know, why can't I just do this
• 22:27
  - myself? Because it's less chefs in the kitchen,
• 22:29
  - and we'll take what I know after doing,
• 22:32
  - you know, four or 5,000 direct to anterior
• 22:34
  - hips.
• 22:34
  - You have to have some, you know, preferences
• 22:37
  - of what you've seen and what would work.
• 22:38
  - And so that's where it started on, and
• 22:40
  - and then it became to its own device
• 22:42
  - at this point. So we're just building inventory,
• 22:45
  - trying to get to 200 in, and then
• 22:47
  - we'll, reach out to,
• 22:50
  - to surgeons for their input into implantation.
• 22:54
  - And, actually, this morning, I just filed a
• 22:56
  - new patent design application for the collared version
• 22:58
  - of that stem. So so it's exciting. Those
• 23:00
  - are the things that I get excited about
• 23:02
  - because it's,
• 23:03
  - that's something that, you know, you learn from
• 23:05
  - your your twenty years of doing this. And,
• 23:07
  - okay, let's apply it. What can I do
• 23:09
  - to make
• 23:10
  - orthopedics
• 23:11
  - and total joint surgery better when you're gone?
• 23:14
  - Did you do something that made it better?
• 23:16
  - And, working on that. And then I'm very
• 23:18
  - also involved with,
• 23:20
  - going to a non opioid,
• 23:22
  - recovery process. I haven't written for an opioid
• 23:24
  - since last July.
• 23:26
  - Wow.
• 23:27
  - So I have a very specific protocol.
• 23:29
  - Yeah. Let's talk about those. Yeah. It's actually
• 23:32
  - very cool. And, I have to credit, doctor
• 23:35
  - Andrew Wickline in Utica.
• 23:37
  - He's phenomenal
• 23:39
  - as far as pushing this type of
• 23:41
  - changes across the board. His study in swelling,
• 23:45
  - and the elimination of opioids and the and
• 23:47
  - limiting how much activity and,
• 23:51
  - step counts, things like that have made a
• 23:53
  - big difference. And so
• 23:56
  - there's a group of us, March to a
• 23:57
  - Million. That group is trying to
• 24:00
  - encourage everybody to get to total joints that
• 24:02
  - are less than 10 per episode.
• 24:06
  - In the state of Florida,
• 24:07
  - the average oxycodone count for a total knee
• 24:10
  - post op is a 120
• 24:11
  - oxycodones.
• 24:13
  - That's incredible.
• 24:14
  - That's so high. It's crazy.
• 24:17
  - And so considering that eighty thousand people die
• 24:19
  - from narcotic,
• 24:21
  - overdoses
• 24:22
  - from abuse
• 24:23
  - every year, we've gotta find a way to
• 24:25
  - reduce that. And if we can, as orthopods,
• 24:27
  - not give somebody an,
• 24:29
  - an opioid, then we're part of the solution,
• 24:32
  - not part of the problem.
• 24:33
  - So I've taken some of these things from
• 24:36
  - preoperative icing,
• 24:39
  - to Iovera preoperatively
• 24:40
  - two weeks prior,
• 24:42
  - to different blocks intraoperatively, different medications that I've
• 24:44
  - used now that I didn't use, you know,
• 24:47
  - a year ago,
• 24:48
  - postoperatively
• 24:49
  - using compression sleeves, using
• 24:52
  - ice machines, using supplements, including protein supplements, amino
• 24:55
  - acids,
• 24:57
  - biologics such as bone marrow aspiration concentrations,
• 25:00
  - and utilizing,
• 25:01
  - also
• 25:02
  - hesperidin and dicemone.
• 25:04
  - With doctor Weklein's research on that, it really
• 25:06
  - helps reduce the swelling and inflammation. We give
• 25:08
  - patients a step count,
• 25:10
  - device such as a Fitbit so they can
• 25:12
  - monitor how many steps they're taking,
• 25:15
  - direct communication with the chatbot.
• 25:17
  - We utilize some, you know, unusual things like
• 25:20
  - CBD for topical usage as well as under
• 25:22
  - the tongue to help with sleeping. Mhmm. All
• 25:24
  - these things are a way to try to
• 25:25
  - help reduce it. And, of course, Jernavix
• 25:28
  - is a terrific medication.
• 25:30
  - It has been a game changer,
• 25:32
  - for reducing and almost eliminating for most surgeons
• 25:35
  - using it, the amount of opioids that they're
• 25:36
  - giving their patients.
• 25:38
  - That's wonderful. That's wonderful. And, I mean, I
• 25:40
  - imagine, like,
• 25:41
  - all of that. Sometimes I'm just gonna think
• 25:43
  - about the ripple effect and impact on not
• 25:46
  - having to, you know, write up these opioid
• 25:49
  - prescriptions, you know, for you said first since
• 25:51
  - last July. That's almost a year. Yeah. And
• 25:53
  - we don't get calls because I I have
• 25:55
  - all their medicines sent to them
• 25:57
  - and for in the mail. They get all
• 25:59
  - of their non controlled substance. That's because Jynavix
• 26:02
  - isn't controlled.
• 26:03
  - We use a combination of dexamethasone,
• 26:05
  - tranexamic acid,
• 26:07
  - Tylenol, and the Jynavix,
• 26:09
  - and we're able to control that that pain.
• 26:11
  - And then you combine it with the modification
• 26:13
  - of activities, the the edema control,
• 26:16
  - medications, the nutritional supplements, the compression in the
• 26:18
  - ice, and it's a game changer. I wear
• 26:21
  - rarely have a patient above three of pain
• 26:23
  - on a knee replacement for their entire recovery
• 26:26
  - process, and that's that's
• 26:28
  - been great for both them and us as
• 26:29
  - practitioners.
• 26:31
  - Less phone calls, less problems. It's been fantastic.
• 26:34
  - Now, doctor Biggs, I want to close out
• 26:36
  - our conversation. I wanna and I know you've
• 26:39
  - you've probably meant you've touched on this some,
• 26:41
  - but, you know, I'd love to just
• 26:43
  - hear about the leadership habit or mindset that's
• 26:46
  - been the most critical
• 26:48
  - in
• 26:48
  - moving forward both, you know, user organization and,
• 26:52
  - you know, the people.
• 26:54
  - You have I know it sounds corny, but
• 26:56
  - you have to listen.
• 26:57
  - Yeah. You have to listen to your employees.
• 26:59
  - You have to listen to your partners,
• 27:02
  - and you have to to,
• 27:04
  - take it on yourself to get educated
• 27:07
  - about what's happening.
• 27:09
  - Colleagues are by far
• 27:11
  - the best source of information,
• 27:15
  - forums that you can talk and communicate on.
• 27:18
  - And
• 27:19
  - we're all in this together, especially on the
• 27:21
  - private practice side. Mhmm. It's what works for
• 27:24
  - you? How did that happen?
• 27:26
  - It is so important that we kind of
• 27:28
  - put down the the wall of, well, that's
• 27:31
  - your practice over there, and we're us.
• 27:34
  - It's we've gotta kinda be in this thing
• 27:36
  - together as a private practice
• 27:38
  - to share information so that we can all,
• 27:41
  - you know, be successful and stay here.
• 27:44
  - Very well said. Well, doctor Biggs, thank you
• 27:46
  - so much for joining us on the podcast
• 27:48
  - today. It's been a great conversation,
• 27:51
  - and I hope you enjoy the rest of
• 27:52
  - your day.
• 27:53
  - Thank you. You as well. I appreciate your
• 27:55
  - time.