Latest / Becker’s Healthcare Podcast / Bob Bishop, Chief Designer, JointSpace

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Bob Bishop, Chief Designer, JointSpace · Becker’s Healthcare Podcast

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Hello, and welcome to the Becker's Healthcare podcast
0:37
recorded live at the thirty first annual business
0:39
and operations of ASC's conference.
0:42
I'm joined today by Bob Bishop, chief designer
0:44
at JointSpace.
0:46
Bob, to kick us off, can you share
0:47
a little bit about yourself and your work
0:48
in the ASC space?
0:50
Sure. So,
0:52
Jeremy, this is this is a picture of
0:54
me in, like, 1959.
0:56
This is my my sister and I in
0:58
my grandma's backyard in Jackson, Michigan after she's
1:03
just had
1:04
her hips, which she was born with dislocated,
1:08
reattached to the socket.
1:10
And so
1:11
I've literally been involved with
1:14
ambulation
1:15
and surgery
1:16
for sixty five years now because I was
1:18
about four or five then and we're now
1:20
in 2025.
1:22
So
1:23
I've been
1:24
deeply involved both
1:27
with family results as well as I got
1:30
involved scientifically and
1:32
entrepreneurially
1:34
involved
1:35
in this whole space for a long, long
1:37
time.
1:38
So the ASC market in The US is
1:40
projected to reach, 60,800,000,000.0
1:43
by 2030 and continues to experience strong year
1:45
over year growth. From your perspective,
1:48
what would you say the most significant trends
1:50
and market forces driving this expansion, and how
1:53
should ASC leaders be preparing today?
1:56
So I'm gonna give an answer that is
2:00
very simple on one level and very complex
2:02
on the other, and it's the advancement of
2:05
knowledge.
2:07
And
2:08
by that, what I mean is something very
2:10
specific, which is that we now
2:13
know what we know
2:15
and we know why we know it in
2:17
ways that are exponentially growing.
2:21
And that is the driver
2:23
for why we are
2:25
now labeling what we say as an ASC.
2:29
And in most people here are going to
2:31
think, Oh, that's a separate building,
2:33
not the hospital
2:35
where we do surgery. As far as I'm
2:37
concerned,
2:38
ambulatory
2:39
surgery
2:40
is
2:41
not
2:42
where you walk in or walk out. It's
2:45
to actually change the ambulation of the patient.
2:49
And it's our knowledge about what makes that
2:51
happen and what causes
2:53
good results and bad results that's accelerating
2:57
massively rapidly
2:59
primarily through advanced technologies, but most of which
3:02
are computer related.
3:04
So from AI and robotic surgeries to advanced
3:07
EHR systems,
3:08
technology remains both a make or break factor
3:11
and critical driver of ASC operations at scale.
3:15
How do you see deeper tech integration shaping
3:17
the way ASCs deliver care and manage their
3:19
businesses over the next few years?
3:21
So
3:22
the distribution
3:24
of
3:26
incredibly
3:27
powerful technology
3:28
has gotten to the point where we all
3:30
have it in our side pockets.
3:32
And
3:34
the availability
3:35
of
3:36
networks
3:37
that can connect
3:39
those devices.
3:40
And
3:42
regardless of where you are in space and
3:44
time
3:45
has just
3:47
incredibly
3:48
become ubiquitous with
3:51
Musk putting up
3:53
satellite systems that create
3:56
a internet
3:57
from the sky. This device I have in
3:59
my pocket will connect to that satellite.
4:02
Not all do, but this one does and
4:04
all future ones will. So
4:07
the connectivity
4:09
of
4:10
the power of Silicon
4:12
calculations,
4:14
which is incredibly
4:16
powerful
4:17
is
4:18
everywhere all the time now. And
4:21
that's the primary driver
4:23
of what is
4:25
changing things so quickly. And we're adjusting to
4:28
all of the ramifications
4:31
of how that
4:32
was originally delivered and how it's evolving.
4:36
So is there one particular
4:38
technology or innovation that stands out to you
4:41
as especially transformative?
4:44
So I think that
4:46
the
4:47
use of blockchain
4:49
in the sense of
4:51
what
4:52
zero knowledge
4:54
as they call it,
4:55
platforms
4:57
is going to drive a massive change.
5:01
I created a company that I sold to
5:03
Zimmer
5:04
that
5:05
collected
5:07
x-ray
5:08
that was originally when I started doing it
5:11
using film and chemicals.
5:13
And I conceived of
5:16
transforming that to a digital acquisition
5:19
and distribution of those x rays for reasons
5:21
that had to do with the fact that
5:23
I owned a distributorship
5:25
in the Detroit area and I hire somebody
5:28
that worked in Traverse City
5:30
four and a half, five hours away in
5:32
good weather.
5:33
And I had
5:35
at that time to buy
5:37
my own implants and instruments,
5:40
which is not the way things work now,
5:42
but I had to make an investment in
5:45
those and then hire people and had to
5:46
have the whole operational environment for it. So
5:50
I
5:52
had seen the digital x-ray systems that were
5:55
in hospitals.
5:57
And the metaphor I use is I sort
5:59
of took what was a
6:02
digital imaging system
6:04
designed as a Peterbilt
6:06
and turned it into a bicycle
6:08
where it could be used by everybody
6:11
and yet still get the most incredible results.
6:15
In fact, I just saw a thing on
6:16
x yesterday showing that humans on a bicycle
6:20
outperform
6:21
every other animal
6:24
in terms
6:26
of the speed
6:27
and distance that they can transport themselves. There
6:30
is no other
6:32
animal
6:33
that we can't ultimately beat on a bicycle
6:35
in terms of the thermodynamic efficiencies. And in
6:38
the way,
6:39
what I just did was take the systems
6:42
that were
6:43
in hospitals and moved it into the regular
6:46
orthopedic office.
6:48
So
6:49
that became
6:51
model
6:52
in which
6:53
while I was doing that, it was the
6:55
eighties and the nineties.
6:57
And we were just breaking into what we
6:58
now call sort of web two. We moved
7:00
to these dynamic web spaces,
7:03
but they were wide open protocols
7:06
that we ultimately then put security on and
7:09
called them
7:10
HTTPS,
7:12
which became secure,
7:15
still breakable.
7:17
And
7:17
what we have now are
7:19
systems that do those computations
7:22
locally
7:24
and distributed
7:26
simultaneously.
7:27
And yet they're on secure protocols that are
7:31
private
7:33
from the beginning to the end where they're
7:35
encrypted
7:36
on device and decrypted
7:38
later. Only if you have public and private
7:40
keys that
7:43
is going to change
7:45
the game
7:46
because the,
7:47
the
7:48
whole
7:49
supply chain of moving all of the people,
7:53
the equipment, the information,
7:55
and the decisions that go into performing
7:59
a, a, an operation
8:00
successfully
8:02
is being
8:03
transformed
8:04
into
8:05
an infrastructure where you can not only collect
8:07
that information,
8:09
but process it
8:11
and then still retain
8:14
the privacy
8:15
of everybody involved
8:17
at their pleasure,
8:18
not at
8:19
the system's pleasure. Right. So I believe what's
8:22
going to happen is that that will transform
8:25
the system
8:27
economically in ways that it will no longer
8:30
be necessary to have
8:32
a monopoly
8:34
directed by
8:36
striker Zimmer Depew
8:39
owning
8:40
a massive portion
8:42
of the production
8:43
in selling
8:44
of total joints
8:46
of spinal implants, etcetera. And there are a
8:48
few other companies that fit into that category,
8:51
but those technologies that they're actually delivering
8:55
turned metal. Right. It's been around
8:58
for
8:59
nearly a hundred years.
9:02
There's nothing very special about that. It's only
9:05
the technology
9:06
of the capture of that operating environment
9:11
and its improvement
9:12
that
9:13
has become difficult.
9:15
This will help resolve that in a massive
9:17
way. So I think that's gonna transform
9:20
the economics massively.
9:22
And I just wanna rewind a little bit
9:24
and
9:25
say so,
9:26
you know, Blockchain, it was the big buzzword
9:29
a few years ago. I think, you know,
9:31
you you hear it a little bit less,
9:32
but I think, you know, maybe a lot
9:34
of people listening to this podcast
9:36
are gonna have kind of, like, well, I've
9:37
heard the term. Yeah. I know it has
9:39
to do with Bitcoin or not Bitcoin, but,
9:42
digital cryptocurrencies in that space. But can you
9:45
give a very kind of high level and
9:47
easy to digest overview of,
9:49
you know, how blockchain works and and,
9:52
just kind of, like, as it pertains to
9:54
what you're talking about? Yeah. So
9:57
you know what? When I was a very
9:59
young kid, I got a
10:02
bank account
10:03
and it only had a couple bucks in
10:05
it, but they gave you that savings account
10:08
booklet that somebody actually wrote in it how
10:12
much was in the bank that I had
10:13
given them. And
10:15
when I went to get money back, they
10:17
would not only give me the money, but
10:18
they would scratch in there on what was
10:20
called a ledger,
10:22
which looks just like a spreadsheet. It's just
10:24
a grid.
10:25
And it would say how much money I
10:28
had, how much I took out, what was
10:30
the net and what date it was. That
10:32
information
10:34
is the essence of
10:36
the currency environment of Bitcoin.
10:39
It's simply a ledger,
10:41
but what's different is that it's digital.
10:45
That's not magical,
10:47
but what gets magical is that it's encrypted,
10:50
meaning that simply that it has a, a
10:54
hash up of the information in such a
10:56
way that if you don't know what the
11:00
key is that unlocks it,
11:02
you can't see what it is. And that
11:04
key system is just like if you go
11:06
to that same bank and you put money
11:08
in the safety deposit box,
11:10
the bank has a key to your box
11:13
and you have a key. Without both of
11:15
them, you can't get in it.
11:18
You can't get in it because you don't
11:19
have the bank's key. They can't get it
11:21
because they don't have your key. That's how
11:24
the encryption works.
11:25
There is a public key that everybody can
11:29
see
11:30
And then there's just your private key. So
11:32
is it like in the movies where there's,
11:33
like, a nuclear launch code and it takes
11:35
two people to turn the key? You got
11:37
it.
11:38
Just like if you were watching
11:41
exactly. Denzel Washington. Right. Right. Right. Right. That's
11:44
what you're thinking, Don. Yep.
11:46
Yep.
11:47
Yeah. Exactly.
11:49
That's it. That's awesome. That complicated
11:51
until you let it be. Mhmm. Otherwise, it's
11:55
just plain old simple easy stuff. Okay.
11:58
Okay.
11:59
Well, with 60% of health systems considering ASC
12:02
joint ventures
12:03
and many ASCs already partnering with systems in
12:06
their communities, what opportunities do you see for
12:09
collaboration
12:09
whether with other providers or vendors to strengthen
12:13
patient care and operational efficiency?
12:16
Okay. So I think that what's happened from
12:19
when I was
12:20
describing to you when I was a little
12:22
kid,
12:23
this
12:25
surgeon
12:26
whose name was doctor Stolberg
12:28
and
12:29
my mom and dad and my sister
12:32
had a deep relationship with. Mhmm. And it
12:34
was
12:36
one of trust. And it was
12:39
one where there were almost, there was almost
12:41
nobody
12:42
between them.
12:44
Today,
12:46
I just had lunch with a surgeon who
12:50
basically started
12:51
the spine business
12:53
with a company called sophomore organic that became
12:56
a Medtronic company
12:58
at Texas back Institute.
12:59
And
13:01
he's 83 I think he told me now.
13:04
And we were talking about this a little
13:05
bit and I said, yeah, what I want
13:07
to do is get all those people out
13:09
from in between
13:10
the surgeon and the patient because that's what's
13:13
changed
13:14
is that at this point
13:16
there are so many players entailed
13:20
in having
13:21
a
13:22
simple conversation.
13:25
Was that going to get repaid?
13:27
Is it my deductible met yet? Because
13:30
on January 3, I'm going to have to
13:32
start all over again. But on December 28,
13:35
if I can get in,
13:36
it's free. Right, right. How does that make?
13:40
I want to know is, is it okay
13:43
for me to play tennis? Right. Right. Right.
13:46
Right. What the hell? And so
13:48
we need to find ways to remove
13:51
all of those
13:53
intermediaries. And Mhmm. That's what I think the
13:57
massive opportunity
13:58
of the technology change that's beginning to happen
14:00
is we're going back to that possibility again
14:03
where
14:04
we can reinitiate a relationship
14:07
between the patient and the doctor.
14:11
Those same doctors don't want all those people
14:14
in between,
14:15
come to the Becker meeting and come to
14:17
any others. You will hear them all
14:21
say things like that over and over again.
14:23
And when you talk to the patients,
14:25
they're so frustrated. They don't know what's up
14:27
and what's down. A 100%. And it's primarily
14:30
because they can't go talk to a trusted
14:34
doctor Mhmm.
14:36
And have a conversation
14:37
without a whole bunch of people being in
14:39
between for reasons that seem
14:42
unexplainable
14:44
other than for the fact that that's how
14:46
it accidentally
14:47
evolved over the period of the last
14:49
two or three decades.
14:51
Right. It hadn't been that way before
14:54
then, but it was the initiation of this
14:55
web two world
14:57
where we had these
15:00
expectations.
15:01
You may not be old enough to remember,
15:03
but we were told the electronic medical record
15:06
is going to revolutionize
15:09
and make so efficient. And all it has
15:11
done is resulted in the exact opposite of
15:14
that for most people who are in the
15:16
system.
15:16
It's web three or blockchain
15:19
sort of reinitiating
15:21
that opportunity,
15:24
but changing the inertia of the culture, right?
15:27
Getting all of those systems back into place
15:31
where I literally can communicate directly with my
15:34
doctor and not have to tell anybody else.
15:36
There are some people who want to say,
15:38
you know, you shouldn't be able to do
15:39
that. Right. And I say,
15:42
well, exactly who the hell do you think
15:43
you are? Right. That you should tell me
15:46
what I can do with my life. And
15:48
I think we just went through a whole
15:49
transition
15:52
of my body,
15:53
my decision.
15:56
And I think that's the essence of this
15:58
is that we all have
16:01
a responsibility to ourselves to take care of
16:03
ourselves. Mhmm. And if we need help, we
16:05
should find somebody who we trust, and nobody
16:08
else should be a part of that. Right.
16:09
Right. Right. Well, Bob, you know, this has
16:12
been a great conversation.
16:13
Is there anything we didn't touch on or
16:15
any final thoughts you'd like to leave with
16:16
our audience today?
16:18
Well,
16:19
I like to say that
16:21
the
16:22
opportunity for
16:24
the progression and innovation
16:27
is infinite.
16:30
And that's not to say
16:32
that what will happen will be good. Mhmm.
16:35
But
16:36
my perspective is that the growth of knowledge
16:40
is unstoppable.
16:41
Mhmm. And that
16:43
can also mean
16:45
that people with bad intentions
16:48
can capture that knowledge
16:50
and do things. So that's not to say
16:53
that everything will turn out well, but it
16:56
can. It is possible.
16:58
And that to me
17:00
is why I'm optimistic.
17:02
It's not that it is certain,
17:05
it's that I can decide
17:09
to have an impact in a positive way.
17:11
And when I see things that aren't right,
17:14
I can speak about
17:16
it and I can change it. And that's
17:18
kinda where I'm at with this is
17:20
I would like to see the reconnection
17:23
of
17:24
a doctor and a patient in a trusted
17:26
relationship
17:27
in which there are not impediments
17:29
that are artificial
17:31
Mhmm. To people being able to take care
17:33
of themselves
17:34
with a trusted adviser. Mhmm. Mhmm.
17:37
Well, Bob, thank you again for the great
17:39
conversation today. And, again, thank you for joining
17:41
us, and I hope you have a lovely
17:42
rest of your day. Thanks, sir.