Latest / Becker’s Healthcare Podcast / Cory Calendine, MD, Orthopaedic Surgeon at the Bone and Joint Institute of Tennessee

Transcript

Cory Calendine, MD, Orthopaedic Surgeon at the Bone and Joint Institute of Tennessee · Becker’s Healthcare Podcast

• 0:00
  This is Carly Beam with the Becker Spine
• 0:02
  and Orthopedics podcast. And joining me today is
• 0:05
  doctor Corey Kallendine,
• 0:07
  a surgeon with Bone and Joint Institute of
• 0:09
  Tennessee.
• 0:10
  Doctor Kallendine, thank you so much for being
• 0:12
  here today.
• 0:13
  Carly, thanks so much for having me.
• 0:15
  And so before we begin, I'd love if
• 0:17
  you could just introduce yourself and tell us
• 0:19
  a bit more about your background.
• 0:21
  Yeah. Thank thank you for that. My name
• 0:23
  is Corey Kallendine. As as you mentioned, Carly,
• 0:26
  I'm an orthopedic surgeon. I practice with the
• 0:28
  Bone and Joint Institute of Tennessee, just outside
• 0:31
  of Nashville.
• 0:32
  My practice is really focused just on hip
• 0:35
  and knee replacement, so that's kind of the
• 0:36
  world I live in.
• 0:38
  Obviously, I do some
• 0:40
  some work with industry on innovation and robotics
• 0:44
  tech. That's probably why I follow Becker so
• 0:46
  closely. But I do a lot of work
• 0:48
  with AUKUS too, our our hip and knee
• 0:50
  society.
• 0:51
  So I like to be,
• 0:54
  I guess, involved to the point that there's
• 0:56
  always something new. There's always something interesting, and
• 0:58
  I guess that's what really drives me. It's
• 1:01
  that, pursuit of better.
• 1:03
  I I I think you and I have
• 1:04
  connected on social.
• 1:06
  Mhmm. LinkedIn and others. Yeah. That's You know?
• 1:09
  Also, I do some work in patient education.
• 1:11
  So, thank you so much for having me
• 1:13
  on on the podcast. I appreciate the opportunity
• 1:15
  to share and connect.
• 1:17
  Of course. And love to touch back on
• 1:19
  what you're talking about patient education. But first,
• 1:22
  I want to ask you about just when
• 1:24
  it especially comes to hip and knee replacement,
• 1:26
  what kinds of orthopedic innovations
• 1:28
  really excite you the most right now? What
• 1:31
  is what's stirring up the most conversation,
• 1:33
  especially also with,
• 1:35
  with AUKUS. I'm probably pronouncing that acronym wrong.
• 1:38
  But No. No. That's exactly right. AUKUS, and
• 1:40
  that's what we say too. I guess I
• 1:42
  I said hypodesic side. It sounded weird. AUKUS
• 1:45
  is what we call it. But,
• 1:46
  but but, yeah. So so there's always something
• 1:50
  exciting, and I think you have to talk
• 1:51
  about robotics.
• 1:52
  Now robotics is not necessarily new, but I
• 1:55
  was just I was just looking through these
• 1:57
  numbers. If you look at some of the
• 1:59
  early projection numbers for robotics,
• 2:02
  they they they said that by 2025,
• 2:04
  it would be like,
• 2:06
  one in four hips and and two out
• 2:08
  of three knees by 2025. Well, we we
• 2:11
  spoke back that. And if you look at
• 2:13
  AJRR,
• 2:15
  those numbers
• 2:16
  don't really pan out. If you look at
• 2:18
  AJRR, the use of robotics is is well
• 2:21
  below those projected numbers. In fact, like I
• 2:23
  said, I was just looking it up actually
• 2:25
  before
• 2:26
  before this podcast.
• 2:27
  So so for robotic knees, it's about sixteen
• 2:30
  percent. At least that was in 2024.
• 2:32
  In robotic hips, it's about six point five
• 2:34
  percent. So it's talked about a ton, but
• 2:36
  if you look at overall adoption
• 2:38
  now
• 2:39
  AJRR
• 2:40
  obviously isn't capturing everybody in The US, but
• 2:42
  certainly those numbers are different than a a
• 2:45
  60 or 70%
• 2:47
  utilization of robotics. But none the
• 2:49
  nonetheless, it's it's certainly continuing to rise
• 2:53
  year over year. Now I've tried to figure
• 2:55
  out, like, why why that is. You know,
• 2:57
  a huge part of that may be the
• 2:58
  migration to the ASC. Some of these robotic
• 3:01
  platforms
• 3:02
  require large capital investments. That's obviously much more
• 3:05
  difficult for the ASC setting.
• 3:07
  That that may be something that that that
• 3:09
  slowed things down. Also, you know, I mentioned
• 3:12
  the AJRR numbers is like, you know, ground
• 3:14
  truth. But but but in reality,
• 3:17
  there are less
• 3:18
  ASCs in the AJRR than hospital,
• 3:21
  facilities. So they're probably getting some bias there
• 3:23
  too.
• 3:24
  But but nonetheless, robotics is still exciting.
• 3:27
  I I think that's a area ripe for
• 3:29
  innovation.
• 3:30
  There are obviously probably
• 3:33
  well, most companies have a robotic play,
• 3:36
  but the reality is is they continue to
• 3:37
  evolve and change. That's what's really exciting. And
• 3:39
  and how is robotics gonna serve our patients?
• 3:43
  What robotics
• 3:44
  what robotics for me really does, though, is
• 3:46
  give me data, like a ton of data.
• 3:48
  And and AI get talks gets talked about
• 3:51
  all the time. So I guess I guess
• 3:52
  we have to say AI a few times
• 3:53
  in the podcast, make sure we get some
• 3:55
  coverage. But but, you know, as a surgeon,
• 3:57
  the way I talk about that is data's
• 4:00
  great, but as a surgeon, I don't really
• 4:02
  want data. I want insights. And AI will
• 4:05
  be that connection between these huge amounts of
• 4:07
  data that are collected by this robotic platform.
• 4:10
  I want the insight only. And so AI
• 4:13
  can probably help us get there. And then
• 4:15
  personalization
• 4:16
  is a is big talk now, particularly in
• 4:18
  knee replacement. So we used to kinda put
• 4:21
  all the knees, Carly. I don't wanna, like,
• 4:23
  disturb those listening, but we used to put
• 4:25
  all the knees in, you know, what we
• 4:26
  call straight. So mechanical zero. So
• 4:29
  you you you probably know if you walk
• 4:31
  around with your friends, you know, some people
• 4:32
  have a little bow leg, and some people
• 4:34
  are a little knock kneed. And Yeah. You
• 4:35
  know, there's a wide range of normal. But
• 4:37
  when we did knee replacement, we'd always put
• 4:39
  them right down the middle. You know, we
• 4:40
  call that mechanical alignment. But now there's such
• 4:43
  emphasis with this increased data about the patients
• 4:46
  that we can really customize the procedure to
• 4:49
  the patient. So we're just we're just really
• 4:50
  starting that. So I think personalization is, super
• 4:53
  exciting when we talk about innovation in ortho.
• 4:56
  And I'd love to hear your perspective on
• 4:58
  how personalization,
• 5:01
  leveraging data analytics and AI,
• 5:03
  how how been you how have you been
• 5:05
  using that in your practices? Can you talk
• 5:07
  about any,
• 5:09
  recent,
• 5:10
  case examples, you know, without without breaking HIPAA,
• 5:12
  of course, but any case examples where this
• 5:15
  stuff was particularly
• 5:17
  helpful?
• 5:18
  Well, you you the the robotic platform that
• 5:20
  I use, you get a preoperative CT scan.
• 5:22
  You know, we always use to we always
• 5:24
  used to plan total knee, you know, just
• 5:25
  on an X-ray. So but but now we
• 5:27
  plan on three dimensions. We've been doing that
• 5:29
  for a while. But when you think about
• 5:31
  three-dimensional
• 5:32
  planning, you know, I I mentioned earlier, when
• 5:34
  we did a knee replacement, we just made
• 5:35
  them all straight. Right? That's just talking about
• 5:37
  one plane. That's me, like, looking straight at
• 5:39
  the patient and their leg is straight. But,
• 5:41
  really, the knee is quite complex. It it
• 5:43
  not only has some bow. So,
• 5:46
  you know, most people are are are a
• 5:48
  little bit bow legged bow legged. We call
• 5:50
  that varus.
• 5:51
  So so we leave them in a little
• 5:53
  bit of that bow legged posture, but it's
• 5:55
  not just that plane. So their legs a
• 5:57
  little bowed when you look at them, but
• 5:58
  it's also rotation of the femoral component. What
• 6:00
  we're trying to get at is better balance.
• 6:03
  The the the really, the holy grail for
• 6:05
  us is we wanna personalize, like, a knee
• 6:08
  replacement
• 6:09
  to make sure that the patient
• 6:11
  kind of forgets they ever had a knee
• 6:13
  replacement. We want their knee to feel like
• 6:14
  God's knee. Right? The the creator's knee, if
• 6:17
  you will.
• 6:18
  And and so so how are we gonna
• 6:20
  get there? Well, we've gotta make those custom
• 6:22
  changes.
• 6:23
  All I do is hip and knee replacement,
• 6:25
  and I do hundreds and hundreds a year.
• 6:27
  You would think the more I do, the
• 6:29
  more all of them look the same, but,
• 6:31
  Carly, it's it's the exact opposite. So the
• 6:33
  the more I do, the more nuance I
• 6:35
  see in between. So so so how does
• 6:37
  personalization change? It changes everything. If I can
• 6:40
  move the implants with precision to get a
• 6:42
  balanced knee, I don't have to do soft
• 6:43
  tissue releases. That means less pain, faster recovery.
• 6:47
  You know, our population is getting younger and
• 6:48
  younger. They wanna go back to work faster
• 6:50
  and faster. So the demands society is putting
• 6:53
  on the procedure are huge, and I think
• 6:55
  personalization is the key. Now where where AI
• 6:58
  comes in so I just mentioned you kinda,
• 7:00
  like, modify it during the case, and, okay,
• 7:02
  this is your custom plan. But now what
• 7:05
  we have to do is connect that to
• 7:06
  outcomes. Right? What are those intraoperative changes that
• 7:10
  we make that are directly
• 7:12
  going to impact the patient outcome? And that's
• 7:14
  where we're just gonna get so much data,
• 7:16
  so much data, so much data, and we
• 7:18
  really need AI to kinda sort sort through
• 7:20
  it for us.
• 7:21
  Absolutely. And you also mentioned a bit on
• 7:24
  just adoption trends with them,
• 7:27
  orthopedic registries.
• 7:28
  And you said that they were a bit
• 7:30
  below what, I guess, folks have been predicting
• 7:33
  before. But I'm wondering, what does the overall
• 7:36
  trend look like? Is this kind of is
• 7:38
  it still a steady upward curve, or is
• 7:40
  it kinda more like with spine of the
• 7:41
  American Spine Registry where the robotics curve is
• 7:45
  kind of a little more flat now? What
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  is what is the big trend in terms
• 7:49
  of in terms of that? It's it's a
• 7:51
  it's a great question, and I know there
• 7:53
  are a lot of economists probably
• 7:55
  following Becker's that are watching this closer than
• 7:57
  I am. But but there is constant growth.
• 7:59
  I I I don't wanna leave with it
• 8:01
  somehow flattened out in any way. There's there's
• 8:04
  there's growth year over year. I think the,
• 8:07
  increased,
• 8:08
  robotic utilization was up 8% year over year
• 8:11
  in just AJRR alone. So we can pull
• 8:13
  some of those numbers. So I don't I
• 8:15
  don't wanna leave the listeners with, oh, it's
• 8:16
  kinda stalled or sailed out. No. It's definitely
• 8:19
  continuing to grow. But I think the early
• 8:20
  projections we're talking about, like, Campbell Clinic did
• 8:23
  a paper, I wanna say, in, 2018.
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  And and they're the ones that were showing
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  that, like, 70%, you know, adoption, in a
• 8:30
  very short period of time. We're we're not
• 8:32
  seeing those, but I think they were looking
• 8:34
  at that early adoption, you know, that really,
• 8:36
  you know, catch fire adoption. And now as
• 8:39
  more and more companies are coming into space,
• 8:41
  they're they're they're they're changing the platforms as
• 8:43
  we go, and there's been a little bit
• 8:45
  more may maybe thoughtful adoption or gradual adoption.
• 8:48
  And, again, I think we've run into some
• 8:50
  of these limitations we were talking about too
• 8:51
  about capital investment. I think that's still a
• 8:53
  challenge.
• 8:54
  Yeah. And when you think about,
• 8:56
  just all these different med tech companies
• 8:59
  in general, not just one specifically, what do
• 9:01
  you need to see
• 9:03
  from them maybe to help practices meet in
• 9:06
  the middle when it terms when it comes
• 9:08
  to,
• 9:09
  costs and
• 9:10
  adoption because, you know, obviously, surgeons
• 9:13
  might be open to using these products, but
• 9:15
  then, of course but then the cost, you
• 9:17
  know
• 9:18
  No. You're you're you're you're you're exactly right.
• 9:20
  And that and that's kind of the pivotal
• 9:22
  role, and I do think it's up to
• 9:23
  industry, by the way. I'll I'll I'll, throw
• 9:26
  all of industry under the bus. I think
• 9:28
  it's up to industry to figure out how
• 9:30
  to get these tools,
• 9:31
  you know, into the into the hands of
• 9:33
  the surgeons, I guess, is is really what
• 9:35
  I mean to say, but but but the
• 9:36
  focus should be on the patient. So so
• 9:38
  if you really do have a good implant
• 9:39
  that,
• 9:40
  that that is delivered with technology, how are
• 9:42
  you gonna get that to the ultimate patient?
• 9:44
  Isn't that what we're all here for? We're
• 9:45
  trying to, you know, make health care better.
• 9:47
  We're trying to have a a better better
• 9:49
  care for the patient.
• 9:51
  How how do they do that? I mean,
• 9:52
  they've gotten pretty creative with financing models, you
• 9:54
  know, lease models, rental models, of course. You
• 9:56
  know, we mentioned the ASC. They they don't
• 9:58
  really have the same capital budgets as some
• 10:00
  of the hospitals. So there are same things
• 10:02
  like joint value where essentially,
• 10:05
  you know, we'll give you a discount for
• 10:08
  the amount of products you use over a
• 10:10
  wide service line, those those kind of things.
• 10:12
  They're getting really creative to figure out how.
• 10:15
  Maybe they
• 10:17
  pay per case instead of a large capital
• 10:19
  call at the front. There there are more
• 10:21
  and more interesting ways. There are newer,
• 10:24
  platforms out there, newer robotic platforms that are
• 10:26
  coming on that are cheaper as well.
• 10:28
  And so that's kind of interesting. You know?
• 10:31
  I I think given enough time,
• 10:33
  most things become a commodity. So,
• 10:36
  you know, oh, I just want a robot,
• 10:37
  and you start to look around for robots
• 10:39
  and you kinda go to the cheaper one.
• 10:40
  You know? I don't know that that's always
• 10:42
  the best play because all these robotic systems
• 10:44
  are are so unique.
• 10:46
  But I I think competition in the market
• 10:48
  helps. I think unique
• 10:50
  capital call strategies, so, you know, rental agreements,
• 10:54
  leasing agreements,
• 10:56
  I I think are helping get access,
• 10:59
  for the patients.
• 11:00
  Yeah. Thank you for breaking that down. I
• 11:03
  wanna pivot a bit. How are you thinking
• 11:05
  about
• 11:06
  growth in your practice over the next twelve
• 11:08
  to twenty four months? Yeah. I mean, Carly,
• 11:11
  my goodness. I'm busy. I'm I'm kinda tired.
• 11:14
  Yeah.
• 11:15
  No. Listen. There there's incredible things in health
• 11:17
  care. The the this this really tailwind of
• 11:20
  hip and knee replacement. You know, I I
• 11:22
  was kind
• 11:23
  of, critical of some of the projection robotic
• 11:26
  data that's lagged behind. But the but the
• 11:28
  projections on the joint growth as as far
• 11:30
  as number of hip and knee cases to
• 11:33
  be done continue to to to grow. You
• 11:36
  know, that that the the paper that always
• 11:37
  gets talked about is, like,
• 11:40
  71%
• 11:41
  growth by 2030
• 11:43
  and wrote it down here. 85% growth in
• 11:45
  total knees by 2030.
• 11:47
  So so we're we're we're continuing to see
• 11:49
  massive volumes. In fact, I think that's why
• 11:52
  these robotics or tech platforms are so are
• 11:55
  so important for us. I mean, we need
• 11:56
  to get better at what we're doing for
• 11:58
  sure, but we also need to get more
• 12:00
  efficient. It can't slow us down. It can't
• 12:02
  cost more. You really need that trifecta. We
• 12:04
  need to do,
• 12:05
  more cases,
• 12:07
  more efficiently
• 12:08
  with less cost. So that that intersection is
• 12:11
  what I think we're really trying to trying
• 12:12
  to figure out. But growth,
• 12:15
  other than just procedural volume, obviously, the ASCs
• 12:18
  are pushing that. You know, a lot of
• 12:19
  physicians are are,
• 12:21
  JVing on those facilities, which again is, is
• 12:24
  a beautiful thing to see efficiency and and
• 12:26
  and care and being careful with the health
• 12:30
  care dollar. I think that's important.
• 12:33
  Growth,
• 12:34
  you know, we mentioned earlier a little bit
• 12:36
  about patient education.
• 12:37
  I I do a lot online to to
• 12:39
  educate patients, and I think if you I
• 12:41
  think more and more patients are are obviously
• 12:43
  getting
• 12:44
  information from online.
• 12:46
  There's always the battle of,
• 12:49
  well, you know, it's it's, you know, salesy
• 12:52
  or these social platforms, you know, are not
• 12:54
  where it's at. But the reality is is
• 12:55
  the patient's gonna get information online from somebody,
• 12:58
  so it might as well be us. I
• 12:59
  think there's a huge positive push for surgeons
• 13:02
  and clinical practices to be more present online.
• 13:06
  And and I think that's going to,
• 13:09
  you know, obviously, get and grow their individual
• 13:11
  practices, but hopefully, also grow the overall education
• 13:14
  of the patient. You know, I think that's
• 13:16
  what we should be after.
• 13:17
  And and certainly year over year, every year,
• 13:20
  there's a publication showing that I think I
• 13:22
  mentioned this earlier that patients are getting younger
• 13:24
  and younger,
• 13:25
  every year,
• 13:27
  requesting or demanding, if you will, hip and
• 13:30
  knee replacement. So I I think that's a
• 13:32
  good thing too,
• 13:33
  be be because
• 13:35
  we're able to deliver better product with better
• 13:37
  parts that are gonna last longer. We feel
• 13:39
  more confident. You know?
• 13:41
  Hip and knee replacement's not that old as
• 13:43
  far as a procedure. I mean, it was
• 13:44
  really what the seventies or eighties, nineteen seventies
• 13:48
  or eighties that it really became,
• 13:50
  something that was available to most people here
• 13:52
  in The US. So, we're pretty young in
• 13:54
  the discipline, but we're continuing to get better
• 13:56
  and better and better. It's bringing to us
• 13:58
  younger, more demanding patients, which is kinda awesome.
• 14:01
  And you mentioned about, you know, your social
• 14:03
  media presence. Obviously, you mentioned, you know, we've
• 14:05
  obviously been connecting on LinkedIn. And I'm wondering
• 14:08
  how has when it comes to patient front,
• 14:11
  how has your
• 14:13
  online strategy
• 14:14
  evolved? Are you using are you turning mostly
• 14:17
  to LinkedIn? Are you doing dances on TikTok
• 14:19
  to teach people about these?
• 14:22
  Yes. You don't follow me, Carly, on on
• 14:24
  TikTok? You should know this answer. I'm not
• 14:26
  on TikTok. Yeah. Yeah. Well, that's good for
• 14:28
  you. Let's get that on the record. Becky,
• 14:30
  she is not on TikTok.
• 14:32
  No. It it it does vary by platform.
• 14:34
  I think you have to be very thoughtful
• 14:35
  about that. So,
• 14:37
  LinkedIn, obviously, is a professional voice. I mean,
• 14:39
  the the the the things that you and
• 14:41
  I have connected on, Carly, are are meaningful
• 14:43
  things about what's changing and moving,
• 14:46
  the ASC space in orthopedics. These these are
• 14:48
  big issues
• 14:50
  that that,
• 14:51
  that that need to be talked about. And
• 14:52
  we we need people like you to report
• 14:54
  on them, and we need people like surgeons
• 14:56
  to come in, and we need industry comments.
• 14:58
  So LinkedIn is great for that type of
• 15:01
  conversation. But the patient education piece really for
• 15:04
  me happens more on Facebook and Instagram.
• 15:07
  Unfortunately, I I,
• 15:09
  I I do not dance on any platform.
• 15:12
  So so so my my content's probably very
• 15:15
  bland.
• 15:16
  But just simple explainer videos about, you know,
• 15:18
  what a carpal tunnel release is or, you
• 15:21
  know, what a what a you know, is
• 15:22
  it broken or fractured? You know, just simple
• 15:25
  questions that people Google all the time. So
• 15:27
  so I do more patient education, not not
• 15:30
  not viral trends. I mean, I guess you
• 15:32
  could do that for clicks or likes. But,
• 15:35
  people ask me a lot, though, you know,
• 15:36
  why am I gonna do that? What you
• 15:37
  know, why am I spending time with that?
• 15:40
  Well, the reality is is kinda what I
• 15:42
  mentioned earlier. If if we're not giving patients
• 15:45
  good information,
• 15:46
  they're gonna get information. It's just not gonna
• 15:48
  be good. So I can we can either
• 15:50
  educate them on the front end or we
• 15:51
  can, you know,
• 15:53
  unteach them on the back end, I guess.
• 15:55
  And so so I think it's important that
• 15:57
  our voice be present. With regard to what
• 15:59
  does it do for me, I you know,
• 16:00
  if it were not for the pandemic,
• 16:02
  I don't know if you remember, Carly, but
• 16:04
  there was this virus that, shut down the
• 16:06
  world for a bit.
• 16:08
  And and in in my world in my
• 16:10
  world, in or in orthopedic surgery, there was,
• 16:12
  I think it was fifty seven days no
• 16:13
  elective surgery, so I was stuck at home.
• 16:15
  That's when I started that's when I started
• 16:17
  patient education online. I mean, were it not
• 16:19
  for that, I would have never you know,
• 16:21
  I was bored, quite frankly. I I would
• 16:22
  have never turned to it. But but now
• 16:24
  that I'm in it, I think there's real
• 16:25
  value. I think I think the value is
• 16:27
  to help patients, obviously. That's why I'm there.
• 16:29
  But what it does for me in my
• 16:31
  clinical practice is it builds trust. Every day
• 16:33
  in clinic, Carly, patients walk walk in and
• 16:36
  they say, you know, I'll just meet him.
• 16:38
  Hey. My name is Corey Calendine. And and
• 16:40
  they say, I feel like I already know
• 16:42
  you. You know? And and building trust with
• 16:44
  patients is powerful. We know patients do better
• 16:47
  if they believe and have confidence in their
• 16:49
  care. So I think it's really a way
• 16:51
  that that more of us,
• 16:53
  could could serve. And I'm here to tell
• 16:55
  you, no dance required.
• 16:57
  No dance required. There you go.
• 17:00
  And then I'm wondering, you know, of everything
• 17:02
  that we talked about so far, maybe something
• 17:04
  we haven't touched on yet, what do you
• 17:06
  say will be the biggest
• 17:08
  orthopedic disruptors in the next five years?
• 17:11
  Well,
• 17:12
  I mean, GLP ones. I mean, I think
• 17:15
  I think we gotta figure out, like, what
• 17:17
  what they're gonna do to ortho.
• 17:19
  There there's some, publications that show that if
• 17:22
  you're on a GLP one, you're less likely
• 17:24
  to need a revision after hip and knee
• 17:26
  replacement. That's incredible. Carly, you should highlight that
• 17:28
  on Becker's. I'll send it to you. But
• 17:30
  Yes. Absolutely. But but but but the thought
• 17:32
  process that these drugs right? Oh, you think
• 17:34
  they're weight loss drugs or vanity drugs or,
• 17:37
  you you know, it seems like everybody's on
• 17:39
  them. I I just read a statistic, that
• 17:41
  said one in eight
• 17:42
  US one of one in eight people adults
• 17:45
  in The US have tried a GLP one.
• 17:47
  That's an it's an incredible number. And and
• 17:49
  so what effect is that happening? Well, if
• 17:51
  it if it reduces
• 17:53
  revision rates, isn't that incredible?
• 17:55
  Another study out of the Journal of Sports
• 17:57
  Medicine I was looking at just before our
• 17:59
  podcast too,
• 18:01
  show showed that actually there's a lower rate
• 18:03
  that you ever have surgery in the first
• 18:04
  place. You know, a lot of people were
• 18:06
  worried that these patients that have arthritis
• 18:09
  are gonna lose weight. Their arthritis is less
• 18:11
  symptomatic. So the demand for hip and knee
• 18:13
  replacement
• 18:14
  goes goes down. I understand that logic. You're
• 18:17
  probably putting it off. But the reality is
• 18:19
  is once you're bone on bone, no GLP
• 18:22
  one is gonna take away your near hip
• 18:24
  arthritis. So those patients are coming, but they
• 18:26
  come later. So just like those patients
• 18:29
  maybe, perhaps, are waiting longer because they're getting
• 18:32
  some symptomatic relief from weight loss. For every
• 18:35
  pound you lose, it's four pounds of force
• 18:37
  off your off your joints. So maybe those
• 18:39
  patients are able to wait longer on their
• 18:41
  hip and knee replacement, but there's a whole
• 18:42
  another selection of patients that were high risk
• 18:45
  surgical candidates due to obesity
• 18:47
  that are now able to have their surgery
• 18:49
  and have their surgery safer. So so that's
• 18:52
  obviously an increase in in people requiring hip
• 18:55
  and knee replacement. So disruptors, I think the
• 18:57
  GLP ones are kinda jumping, you know, bumbling
• 18:59
  people around. They're they're delaying surgery for some.
• 19:03
  They're making it possible for others, which I
• 19:05
  think is is is incredible.
• 19:07
  The the the ASC continues to be a
• 19:10
  disruptor. We're still trying to figure out that
• 19:11
  space. How do we get more efficient there?
• 19:14
  Our payer's gonna figure it out. And then,
• 19:16
  you know, those rates are gonna go down,
• 19:18
  down, down, and then everybody goes back to
• 19:20
  the hospital in seven to ten years. I
• 19:22
  I don't know. But that's that's interesting. But
• 19:24
  the ASC, I think, you have to see
• 19:26
  is still a significant disruption. That that that
• 19:28
  that is not a that is not a
• 19:30
  settled thing. It's continuing to disrupt. And then
• 19:33
  there's this this incredible,
• 19:35
  you know, continued reduction in reimbursement, not not
• 19:38
  not just for facilities, but for physicians as
• 19:40
  well. I think we've at some there's there's
• 19:43
  gonna be a breaking point at some at
• 19:45
  some point. The the decrease in reimbursement, the
• 19:47
  rising
• 19:48
  labor cost,
• 19:50
  it there's an intersection at some point where
• 19:54
  we could potentially have serious
• 19:56
  access to care
• 19:58
  problems. And and and, hopefully, we figure out
• 20:01
  the efficiency model and some of these payment
• 20:03
  models in time that it doesn't just,
• 20:06
  completely collapse. I I I don't wanna be
• 20:08
  the guy that that, sounds the alarm, but
• 20:11
  when you have continuing declining re reimbursement,
• 20:14
  rising
• 20:15
  staff and,
• 20:16
  you know, labor cost and equipment cost,
• 20:20
  rising inflation,
• 20:22
  that that something has to give. So ho
• 20:24
  hopefully, we'll figure those things out with regard
• 20:26
  to efficiency and optimal site of care before
• 20:29
  the whole thing collapses.
• 20:31
  Of course. And I'd love to, you know,
• 20:33
  just kind of close on, you know, how
• 20:35
  are you
• 20:37
  approaching these headwinds? Were you because, you know,
• 20:39
  your your your practice, your work is still
• 20:42
  standing very strong. I'd love to hear,
• 20:45
  you know, any
• 20:47
  tips, tricks, advice, strategies
• 20:50
  that have helped you weather these reimbursements and
• 20:53
  payer hurdles.
• 20:54
  Yeah. I mean, I I you know, there's
• 20:56
  there's it's still a volume play. I mean,
• 20:58
  we need practices to be busy and efficient.
• 21:01
  And so we mentioned earlier about the digital
• 21:04
  presence. I think there's a lot that you
• 21:06
  can do with absolutely no money to share,
• 21:09
  to raise patient education, to raise awareness for
• 21:12
  what you can contribute,
• 21:14
  to make sure that the patients get to
• 21:15
  the right place at the right time.
• 21:18
  You don't wanna see a surgeon before you
• 21:20
  need to. You don't wanna see
• 21:22
  a a a primary care guy when you
• 21:23
  need surgery. Right? So so I think there's
• 21:26
  a lot we can do to make health
• 21:27
  care more efficient through that digital space that
• 21:29
  we're talking about.
• 21:31
  You know, I I have not,
• 21:33
  done this, but a really interesting trend maybe
• 21:36
  that we'll end on, Carly, is this concept
• 21:38
  that more and more people are, like,
• 21:41
  brand naming
• 21:43
  a procedure
• 21:44
  in order to to raise
• 21:46
  patient volume. You know? You you you you
• 21:49
  see these pharmacy style direct to consumer marketing
• 21:53
  campaigns.
• 21:54
  That's certainly not what I'm recommending. I I
• 21:56
  I think education directly to patients
• 21:59
  to empower them to make the right decision
• 22:01
  for their health in the right time, I
• 22:03
  think that's what's really exciting in health care.
• 22:05
  And I I think Becker's is trying to
• 22:08
  do that by making it available to so
• 22:10
  many, by continuing this conversation, by, you know,
• 22:13
  having a simple bone doc like me on
• 22:14
  your podcast. I think that's amazing.
• 22:17
  Carlyn, I appreciate your leadership in that. But
• 22:19
  but but, really, it's about how we're gonna
• 22:21
  figure out health care, how we're gonna do
• 22:23
  it together.
• 22:24
  Great. Great. Thank you for all of the
• 22:27
  all of the praise, Rebecca. It's obviously a
• 22:29
  huge pleasure to be a part of this
• 22:32
  platform and have these conversations with, folks like
• 22:35
  you. So, doctor Kallendine, thank you so much
• 22:37
  for joining us on the podcast.
• 22:39
  Great conversation,
• 22:40
  and,
• 22:41
  look forward to connecting again in the future.
• 22:44
  Awesome. We'll stay in touch.