Latest / Becker’s Healthcare Podcast / Redefining Orthopedic Care Through Value, Innovation and Better Outcomes with Dr. David Bernstein

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Redefining Orthopedic Care Through Value, Innovation and Better Outcomes with Dr. David Bernstein · Becker’s Healthcare Podcast

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  - So join us November second through the fifth
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  - at the Hyatt Regency in Chicago, and come
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  - Register on our events page at beckershospitalreview.com
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  - by clicking on the events tab in the
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  - upper right.
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  - This is Laura Dirda with the Becker's Healthcare
• 1:00
  - podcast. I'm thrilled today to be joined by
• 1:02
  - doctor David Bernstein, a Harvard trained orthopedic surgeon.
• 1:05
  - David Bernstein, it's a pleasure to have you
• 1:07
  - on the podcast today. Thanks so much for
• 1:09
  - having me. It's a pleasure to be with
• 1:10
  - you. Absolutely. Now I'm excited for our conversation.
• 1:12
  - I know a lot happening in orthopedics right
• 1:15
  - now and in health care, in particular,
• 1:17
  - you know, so many different things looking at
• 1:19
  - the clinical side, looking at the business side,
• 1:21
  - private equity, and more. So I'm excited to
• 1:23
  - dig into these things with you. But before
• 1:25
  - we do, can you tell us a little
• 1:26
  - bit more about yourself and your background?
• 1:28
  - Absolutely.
• 1:29
  - So, as you mentioned, I, am a Harvard
• 1:32
  - trained orthopedic surgeon, finished up orthopedic surgery residency
• 1:35
  - in the Harvard combined orthopedic residency program,
• 1:38
  - last month.
• 1:39
  - But I've had kind of a bit of
• 1:41
  - a, a winding journey from a career standpoint.
• 1:45
  - I I've always been interested in the intersection
• 1:47
  - of the business, politics, and delivery of health
• 1:49
  - care. And part of that stems from, the
• 1:52
  - fact that my dad's a pediatrician.
• 1:54
  - My mom's a pediatric nurse, and I grew
• 1:56
  - up,
• 1:57
  - in a household
• 1:58
  - where my dad loved what he did, and
• 2:01
  - he loved his patients and
• 2:03
  - but just couldn't understand why the health care
• 2:05
  - system didn't work. It just it just didn't
• 2:07
  - seem to work. It was there was always
• 2:08
  - a concern about,
• 2:10
  - something here or something there
• 2:12
  - about why patients were struggling to pay for
• 2:15
  - health care or why health care,
• 2:17
  - didn't seem to deliver the outcomes that that
• 2:20
  - had been promised. And so I was always
• 2:22
  - interested in in why that was the case.
• 2:23
  - It seems to me that health care is
• 2:25
  - the one,
• 2:27
  - area that everybody in the world,
• 2:29
  - could benefit from from having it improved. Yet
• 2:32
  - if you go to anybody on the street,
• 2:34
  - I would suspect that no one would say,
• 2:36
  - oh, the health system is is exceptional and
• 2:38
  - it works well, whether that's in The US
• 2:40
  - or or, frankly, anywhere across the world. And
• 2:42
  - so that always puzzled me.
• 2:43
  - And so that kind of set my my
• 2:45
  - career trajectory.
• 2:47
  - I went,
• 2:48
  - to to Bowdoin College up in Maine,
• 2:51
  - and absolutely loved it. And I actually majored
• 2:52
  - in economics because I wanted to understand incentives
• 2:55
  - and and what drives people to to do
• 2:58
  - certain things and how can we use incentives
• 3:01
  - to fix health care.
• 3:03
  - And so that led me that led me
• 3:05
  - to study economics always with the lens of
• 3:07
  - what does that mean from a health care's
• 3:09
  - perspective.
• 3:10
  - And fast forward,
• 3:12
  - a few years, I I lived in Europe.
• 3:13
  - I tried to understand the the European
• 3:16
  - models of health care. Obviously,
• 3:19
  - being American, trying to understand the American models
• 3:21
  - of health care, and I enrolled in a
• 3:23
  - dual MD MBA program at the University of
• 3:25
  - Rochester,
• 3:26
  - again, with the goal of how do I
• 3:28
  - marry my interest in delivering one on one
• 3:30
  - patient care but making a broader impact,
• 3:34
  - broader positive impact from the health system perspective.
• 3:37
  - Because in my mind, if you can move
• 3:39
  - the needle just a little bit, you could
• 3:41
  - have an impact,
• 3:43
  - across tens of thousands, if not millions of
• 3:45
  - people instantaneously.
• 3:47
  - And so I enrolled in in in that
• 3:49
  - dual MDMBA program,
• 3:51
  - learned, learned a great deal. And as I
• 3:53
  - was nearing the completion
• 3:56
  - of that, I had the remarkable opportunity to,
• 4:00
  - to join Michael Porter and Bob Kaplan at
• 4:02
  - Harvard Business School as their senior researcher in
• 4:04
  - health care and value based health care,
• 4:06
  - to really, again, dig into this question about
• 4:09
  - how do we fix the challenges we're seeing
• 4:11
  - in health care to make a positive difference
• 4:13
  - in the lives of of many.
• 4:15
  - So I worked at Harvard Business School for
• 4:17
  - for,
• 4:18
  - a bit before transitioning to residency,
• 4:22
  - at Harvard
• 4:23
  - and then having just completed it. And so
• 4:25
  - I've always been at this odd intersection of
• 4:27
  - the business, politics,
• 4:29
  - and clinical care delivery side of health care,
• 4:32
  - and that to me is is the most
• 4:34
  - exciting area to be in as we look
• 4:36
  - to solve some of the challenges we face
• 4:38
  - both in orthopedics, but frankly, across health care
• 4:40
  - more broadly.
• 4:42
  - It makes a lot of sense. You know?
• 4:43
  - And it's a really impactful kinda origin story
• 4:46
  - for your passion in health care and how
• 4:48
  - exactly you came to to be in this
• 4:51
  - space, which is really exciting.
• 4:53
  - What's it been like, you know, training as
• 4:55
  - a physician and
• 4:57
  - in such a a a,
• 4:59
  - transformational time in the health care space? What's
• 5:01
  - that been like?
• 5:02
  - Yeah. It's it's it's been it's been exciting,
• 5:05
  - I think. One of the things that's very
• 5:07
  - interesting is when you talk to a lot
• 5:08
  - of people and say, oh, I'm gonna be
• 5:10
  - in health care. There's a lot of physicians
• 5:12
  - out there who say, oh, I don't know
• 5:13
  - if now is the time to to to
• 5:15
  - be in health care. To me, this is
• 5:16
  - actually the most exciting time to be in
• 5:18
  - health care. It's a time of great need
• 5:20
  - and great challenge. And to me, whenever there's
• 5:22
  - a challenge, there's an opportunity, and that opportunity
• 5:25
  - is to help fix some of these some
• 5:27
  - of these issues that we see.
• 5:29
  - It's been challenging, but it's been challenging and
• 5:31
  - exciting at the same time. And so
• 5:33
  - one of the things that's really nice about
• 5:35
  - training,
• 5:36
  - to be clinically,
• 5:38
  - relevant, if you will, and clinically driven is
• 5:40
  - that you see the the challenges that are
• 5:43
  - described at a 30,000 foot view onto on
• 5:46
  - the one to one level. So whether it's
• 5:48
  - price transparency
• 5:50
  - and health care access,
• 5:52
  - which health care access does not equal health,
• 5:54
  - by the way, and we can discuss that
• 5:56
  - a little bit more too.
• 5:57
  - But whether it's health care access, whether it's
• 5:59
  - obtaining and and staying healthy, whether it's health
• 6:02
  - care price transparency,
• 6:03
  - you see that at the ground level on
• 6:05
  - these one to one patient interactions when patients
• 6:07
  - ask ask you questions. And then when you
• 6:09
  - take a 30,000 foot view and you start
• 6:12
  - discussing kind of what are policy changes or
• 6:14
  - health system changes that we can actually implement
• 6:16
  - to drive
• 6:18
  - progress,
• 6:19
  - you can start to marry those two those
• 6:21
  - two realms. And so I've found training clinically
• 6:24
  - to be incredibly,
• 6:26
  - powerful,
• 6:27
  - both as a tool to learn what matters
• 6:30
  - most to patients, but also as a tool
• 6:33
  - to really drive that one to one positive
• 6:35
  - change so that when you see these
• 6:37
  - challenges at a 30,000 foot view, maybe taking
• 6:40
  - longer than you want to actually make progress,
• 6:43
  - you can go back, help patients one on
• 6:46
  - one, and also see see their progress individually.
• 6:49
  - And, ultimately, at the end of the day,
• 6:50
  - as long as you move the needle for
• 6:52
  - everybody, you're you're improving the health of the
• 6:54
  - population. And so it's been exciting,
• 6:57
  - challenging,
• 6:58
  - and something that gets me up every morning,
• 7:00
  - ready to go to work.
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  - I love that. I think that's such a
• 7:04
  - great mindset and approach when you're thinking about,
• 7:06
  - you know, all the the big challenges within
• 7:09
  - health care and in accessing health care and
• 7:10
  - then boiling into, you know, where the innovation
• 7:13
  - can happen and what makes the biggest difference
• 7:16
  - for the patient population you're working with. I
• 7:18
  - I'm curious. What are some of the the
• 7:20
  - things that you've been most focused on and
• 7:22
  - excited about right now within health care and
• 7:24
  - within orthopedics in particular?
• 7:26
  - Yeah. So I think the future of orthopedics
• 7:28
  - is actually incredibly exciting.
• 7:31
  - It's really undergoing a huge structural shift that's
• 7:34
  - that's been ongoing for a while, but it's
• 7:37
  - it's expedited
• 7:38
  - recently.
• 7:39
  - So kind of how, where, and by whom
• 7:42
  - is care delivered.
• 7:43
  - So historically, orthopedics and many of the surgical
• 7:46
  - subspecialties
• 7:48
  - have been within the four walls of a
• 7:50
  - major traditional
• 7:51
  - hospital,
• 7:52
  - and it's now being decentralized.
• 7:55
  - And they're being it's being moved to ambulatory
• 7:58
  - surgical centers and and different Medicare and Medicaid,
• 8:03
  - interventions are kinda pushing the boundaries of what
• 8:05
  - it means to deliver orthopedic care. And so
• 8:08
  - we're taking this model and flipping it on
• 8:11
  - its head. How do we deliver
• 8:12
  - the best orthopedic care to patients
• 8:16
  - when they need it, where they need it,
• 8:18
  - while being rewarded for delivering the outcomes that
• 8:21
  - actually matter to
• 8:23
  - those patients.
• 8:24
  - And, honestly, it needs to be driven by
• 8:26
  - orthopedic surgeons. If it's driven by those who
• 8:29
  - don't deliver the care, which a lot of
• 8:32
  - health care, frankly, over time has been driven
• 8:34
  - by policymakers and those who don't understand what
• 8:36
  - it means to deliver care,
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  - that's when patients lose, and that's where the
• 8:41
  - that's when the subspecialty
• 8:43
  - fields within orthopedics and orthopedics more broadly lose.
• 8:46
  - And so it really this type of change
• 8:49
  - is coming, and it's coming from regulatory frameworks.
• 8:52
  - It's coming from financial
• 8:54
  - base frankly, requirements in order to be financially
• 8:57
  - sustainable.
• 8:58
  - And so this needs to be driven by
• 9:00
  - orthopedics,
• 9:01
  - and orthopedic surgeons themselves,
• 9:03
  - to deliver this coordinated care.
• 9:06
  - So two
• 9:07
  - well, two or three areas that I kinda
• 9:09
  - think are really, really important today.
• 9:12
  - As I mentioned, a lot of
• 9:14
  - the the traditional thinking of health care and
• 9:16
  - orthopedic surgery being delivered within the four walls
• 9:18
  - of a hospital is just no frankly no
• 9:20
  - longer the case.
• 9:22
  - And so ambulatory surgical centers are super, super
• 9:25
  - exciting. And they're not exciting just because
• 9:28
  - they are,
• 9:31
  - the hot and and and sexy area to
• 9:33
  - receive care, but they're exciting because you can
• 9:35
  - deliver
• 9:36
  - care at a cheaper price that's frankly better
• 9:39
  - in a area that patients
• 9:41
  - live in already.
• 9:42
  - It
• 9:43
  - that has better parking, that has better patient
• 9:46
  - experience,
• 9:47
  - and can
• 9:48
  - really shift
• 9:49
  - the the model of care of care delivery.
• 9:52
  - And we're seeing that actually from a regulatory
• 9:55
  - perspective too as CMS revises or removes many
• 9:58
  - of its inpatient only,
• 10:00
  - list of surgeries
• 10:02
  - to really allow,
• 10:04
  - orthopedic surgeons to deliver care to patients in
• 10:07
  - an area that that is best for them.
• 10:10
  - We're also seeing
• 10:12
  - increased in artificial intelligence and virtual physical therapy
• 10:15
  - and digital health platforms
• 10:17
  - that really allow patients to engage
• 10:19
  - with their orthopedic surgeons and their orthopedic care
• 10:22
  - teams in a more meaningful way than has
• 10:24
  - historically been done. And this allows
• 10:27
  - patients to
• 10:29
  - to frankly
• 10:30
  - receive better care and and hopefully improve clinical
• 10:32
  - outcomes.
• 10:33
  - And the last thing I'll say is
• 10:35
  - we're also seeing changes,
• 10:38
  - in in measurement
• 10:39
  - in measurement of prices,
• 10:41
  - in measurement of the of the cost of
• 10:44
  - care, and how those direct bundle payments and
• 10:48
  - measurement of patient reported outcome measures that are
• 10:50
  - now included in many of the CMS,
• 10:52
  - and CMMI
• 10:54
  - models
• 10:54
  - are playing into how we better understand,
• 10:58
  - how our care is being received by patients
• 11:01
  - and how that leads to the outcomes that
• 11:03
  - matter most to them and how do we
• 11:04
  - optimize those outcomes
• 11:06
  - for them. And so all of these things
• 11:09
  - that have kind of been historically written in
• 11:12
  - this paper or that paper as a theoretical
• 11:15
  - are now becoming the reality on the ground.
• 11:18
  - Well, that's so exciting to hear. And and
• 11:20
  - certainly thinking about that patient experience and then
• 11:23
  - marrying the technology along with,
• 11:27
  - access to care and in connection with the
• 11:29
  - specialists that are are, all working together to
• 11:32
  - help the patients in along their care journey
• 11:34
  - is so critical.
• 11:36
  - And then thinking through the value piece too,
• 11:38
  - I know there's been a lot of fits
• 11:40
  - and starts over the last few decades when
• 11:42
  - you think about value based care in particular
• 11:44
  - in orthopedics. And so,
• 11:46
  - what makes this different? Where do you see
• 11:49
  - as being, the the the elements of all
• 11:52
  - of this that are are going to help
• 11:54
  - it stick and and really make sure that
• 11:56
  - the orthopedic patient population is,
• 11:58
  - not only having everything available, but adopting it
• 12:01
  - and really optimizing
• 12:03
  - what they have in order to achieve the
• 12:05
  - outcomes they want? It's a great question.
• 12:09
  - And I think there's,
• 12:11
  - what's really gonna make this stick today
• 12:13
  - is there's political, financial, and operational challenges
• 12:17
  - that require it to stick today. And the
• 12:19
  - thing that I think is most important to
• 12:22
  - touch upon is the term value based health
• 12:24
  - care often gets one of two responses.
• 12:27
  - One is you get an eye roll. You
• 12:30
  - get this eye roll of, oh, this is
• 12:32
  - a this is this is simply cost cutting.
• 12:35
  - Or you get this
• 12:36
  - response of, oh, this is gonna save health
• 12:38
  - care. And I think what the reality is
• 12:41
  - is we need to understand what value based
• 12:44
  - health care actually means,
• 12:46
  - and then we can start to implement it.
• 12:48
  - And that the reason I say that is
• 12:50
  - there are a lot of things out there
• 12:51
  - that are called, quote, unquote, value based health
• 12:53
  - care that are not value based health care.
• 12:56
  - And and so for example,
• 12:59
  - we use the term bundle payments
• 13:02
  - to,
• 13:03
  - to talk about how we deliver care,
• 13:06
  - over
• 13:08
  - a set good a set a set of
• 13:10
  - services, for example. But actual bundle payments should
• 13:14
  - be
• 13:15
  - cover a
• 13:16
  - condition, not the delivery of a total joint
• 13:18
  - replacement.
• 13:19
  - If you give a bundle payment just for
• 13:22
  - joint replacement, for example, that's really just fee
• 13:24
  - for sale service on steroids, and you're just
• 13:26
  - expanding
• 13:28
  - the the
• 13:29
  - the fee and you're expanding the number of
• 13:31
  - services, but it's not actually taking care of
• 13:33
  - a patient's condition. And it doesn't actually incentivize
• 13:36
  - you necessarily
• 13:38
  - to deliver care long term,
• 13:41
  - at at the outcomes that matter most to
• 13:43
  - patients.
• 13:44
  - And so I think we need to be
• 13:45
  - careful a lot of times when we talk
• 13:47
  - about value based health care and the terms
• 13:48
  - within value based health care to make sure
• 13:51
  - that we're not just using a term
• 13:53
  - that
• 13:54
  - sounds sexy, but then actually not
• 13:57
  - implementing it in a way that's that's true
• 14:00
  - to to the value based health care ethos.
• 14:03
  - A couple things that I think, are are
• 14:06
  - really are really important as well.
• 14:09
  - One is
• 14:10
  - value based health care is simply a strategy.
• 14:14
  - It's not a payment model. It's not just
• 14:17
  - measuring outcomes.
• 14:18
  - It is the idea of how do we
• 14:21
  - deliver and
• 14:22
  - and by measuring those outcomes that matter most
• 14:24
  - to patients, how do we deliver the best
• 14:27
  - outcomes
• 14:28
  - for patients?
• 14:29
  - And then once we understand that, how do
• 14:32
  - we do so efficiently to reduce cost?
• 14:35
  - And so if you think of this, the
• 14:37
  - quote unquote,
• 14:39
  - famous formula, it's not really a formula, the
• 14:42
  - outcomes per dollar spent. It's really a relationship.
• 14:45
  - And if you understand that relationship, you then
• 14:48
  - understand a strategy
• 14:50
  - In the sense that if something increases
• 14:53
  - the outcomes or improves the outcomes,
• 14:56
  - but does not change
• 14:58
  - the cost, you do that every time. If
• 15:01
  - something doesn't change the outcomes, but it reduces
• 15:03
  - the denominator or reduces cost, you also do
• 15:06
  - that every time. What the challenge we face
• 15:09
  - today is what happens if something increases the
• 15:12
  - outcomes or improves the outcomes and increases the
• 15:15
  - cost? Do we do that? Or what if
• 15:17
  - something decreases the outcomes
• 15:19
  - or reduces the outcomes and decrease the cost?
• 15:22
  - Do we do that as well? And that's
• 15:24
  - why orthopedic surgeons need to be leading this
• 15:27
  - because those nuanced decisions
• 15:29
  - require their insight into what matters
• 15:33
  - clinically, what are we measuring, and is what
• 15:35
  - we are measuring really what's most important to
• 15:38
  - patients. And if we don't have orthopedic surgeons
• 15:40
  - at the table, that's when we get into
• 15:42
  - trouble.
• 15:43
  - That's such an excellent point. And, you know,
• 15:45
  - it's so critical when you strip down whether
• 15:47
  - it's body based care or anything else, having
• 15:49
  - that kind of understanding of the patient and
• 15:51
  - knowing what moves the needle for them and
• 15:53
  - and then being able to truly design that
• 15:55
  - into,
• 15:56
  - the health care delivery system on both the
• 15:59
  - clinical as well as financial side,
• 16:01
  - makes a huge difference. And so I I
• 16:03
  - can certainly appreciate that. And I think especially
• 16:05
  - for surgeons like yourself at the beginning of
• 16:07
  - their careers, you know, what do you as
• 16:09
  - you're looking onto the orthopedic field and, you
• 16:12
  - know, thinking about the future, where do you
• 16:13
  - see the biggest areas for growth? What is
• 16:15
  - kind of the the spaces where it makes
• 16:18
  - the most sense to attack and and tackle
• 16:20
  - first? And then looking at true transformation and
• 16:22
  - what's gonna be possible in the next couple
• 16:24
  - decades.
• 16:25
  - How do you think about all of these
• 16:26
  - things and then,
• 16:28
  - incorporate it into the career and practice that
• 16:30
  - you're building?
• 16:32
  - Yeah. It's a it's a really,
• 16:34
  - it's a really, really
• 16:35
  - good question, and it's a big question. So
• 16:37
  - I think,
• 16:38
  - it's no secret that the population is aging.
• 16:42
  - And it is no secret that technology
• 16:45
  - and,
• 16:46
  - including digital health tools and AI
• 16:49
  - is booming and only gonna grow. And so
• 16:51
  - as I think about the start of my
• 16:53
  - career,
• 16:54
  - I think about how do I integrate
• 16:57
  - these tools and instruments
• 17:00
  - to deliver on that strategic goal of value
• 17:03
  - for patients, of improving outcomes
• 17:06
  - while while making it efficient and keeping costs
• 17:09
  - the same or reducing cost. And so one
• 17:11
  - of the challenges is there's so many interesting
• 17:14
  - and cool gizmos and gadgets and tools and
• 17:17
  - instruments
• 17:18
  - out there.
• 17:19
  - But does it do they
• 17:22
  - achieve
• 17:23
  - the the strategy that has been laid out?
• 17:26
  - So as I think about my
• 17:28
  - career trajectory and career
• 17:30
  - aspirations,
• 17:31
  - I wanna make sure that I implement and
• 17:33
  - utilize tools that allow me
• 17:36
  - to improve clinical outcomes. But what does that
• 17:38
  - mean? That means that I have to actually
• 17:40
  - measure those outcomes. And I think measuring those
• 17:42
  - outcomes that matter most to patients should be
• 17:45
  - as routine
• 17:46
  - as taking up someone's blood pressure and their
• 17:48
  - vital signs.
• 17:50
  - As orthopedic surgeons, I wouldn't operate
• 17:53
  - on someone without an x-ray. So why would
• 17:56
  - I
• 17:57
  - deliver a care
• 17:59
  - journey,
• 18:00
  - expectation
• 18:01
  - without understanding their goals, without understanding
• 18:04
  - what their functional status is, without understanding what
• 18:07
  - their pain level is in a way that's
• 18:09
  - actually tangible and and real and not just,
• 18:12
  - oh, I have pain today. Oh, I'm not
• 18:14
  - functioning at the ability I want to, but
• 18:16
  - really digging into
• 18:18
  - validated ways of measuring that.
• 18:20
  - And so I'm super excited about these technologies,
• 18:24
  - but I also wanna take those technologies,
• 18:26
  - implement them in in a learning health system
• 18:29
  - type model, in a quality improvement rapid cycle,
• 18:32
  - and say, yes. This works. This doesn't. And
• 18:35
  - I want the flexibility in order to do
• 18:37
  - that. And that requires
• 18:39
  - a health system that understands
• 18:41
  - that the changes and challenges of tomorrow can't
• 18:45
  - be solved with the instruments and tools of
• 18:47
  - yesterday.
• 18:48
  - And so that's what I'm super, super excited
• 18:50
  - about. That includes those AI tools, as I
• 18:53
  - mentioned, robotics,
• 18:56
  - orthobiologics,
• 18:57
  - smart implants. All of these things have remarkable
• 19:01
  - potential,
• 19:02
  - but we have to make sure we're not
• 19:03
  - just using them because they're the sexy thing
• 19:05
  - to do in today's world, but that they
• 19:07
  - actually
• 19:08
  - improve patient outcomes that matter most to patients.
• 19:12
  - That's amazing to hear. I I love that
• 19:14
  - and truly inspirational about what the future may
• 19:16
  - hold.
• 19:17
  - Thank you so much, doctor Bernstein, for being
• 19:19
  - here on the podcast today. Is there anything
• 19:20
  - you want to leave our listeners with?
• 19:23
  - Thank you,
• 19:24
  - for having me. It's it's truly been a
• 19:26
  - pleasure talking with you,
• 19:28
  - and, I'm just excited. I'm excited about the
• 19:30
  - future of health care. Most people, as I
• 19:33
  - mentioned,
• 19:34
  - today are
• 19:38
  - care is broken. I don't think you'll find
• 19:39
  - a single person in this country or frankly
• 19:41
  - around the world, as I mentioned, who would
• 19:43
  - say health care,
• 19:44
  - is fantastic.
• 19:46
  - But what's exciting about is that we have
• 19:47
  - an opportunity to chart the the next
• 19:51
  - twenty, thirty, forty, fifty, a hundred years of
• 19:53
  - health
• 19:54
  - care. And by doing so, we can make
• 19:56
  - the changes
• 19:57
  - that align the incentives,
• 19:59
  - that
• 20:00
  - reward delivery of exceptional patient care,
• 20:03
  - and that ultimately leads to a healthier population
• 20:07
  - that can,
• 20:08
  - play with their families, deliver economic prosperity,
• 20:11
  - and can really make a difference in the
• 20:13
  - world. And so to me, this is the
• 20:15
  - most exciting time to be in health care.
• 20:17
  - And that's, I think, the that's
• 20:19
  - why I wake up every day excited,
• 20:22
  - for the day and and what I do.
• 20:25
  - Excellent.
• 20:26
  - Thank you so much again for your time
• 20:28
  - today. This has been a really fun conversation,
• 20:30
  - and I look forward to keeping it going.
• 20:33
  - I know, you know, a lot coming up
• 20:34
  - ahead, so we'll definitely have to stay in
• 20:36
  - touch.
• 20:37
  - Fantastic. Looking forward to that.