This is Alan Gondland with the Becker's Podcast,
and I am delighted to be joined today
by doctor Jason Koh, orthopedic
surgeon at Endeavor Health. Doctor Koh, delighted to
have you back on the podcast with us
today. Before we dive into our discussion, do
you mind taking a moment to give us
a little bit more insight about your role
and your background at Endeavor Health?
Absolutely.
And, Alan, thank you so much for having
me on the podcast. It's always a pleasure
to be back on Becker's.
My role is as the Mark Niemann family
chair at Endeavor Health, which is one of
the largest, health care systems in Illinois,
and I help lead our orthopedic specialty hospital
at Skokie.
I'm a clinical professor at the University of
Chicago and a chief medical officer for the
Chicago Fire
Major League Soccer team.
Clinically, I'm a practicing sports medicine and shoulder
surgeon,
but I also have a administrative role in,
overseeing orthopedic activity across the entire system,
which has been helped by,
you know, obviously, it had benefits, some good
training over the years at Harvard Hopkins Hospital
For Special Surgery and Cleveland Clinic,
and then, also an MBA at Northwestern.
Fantastic. So thanks so much for the the
brief intro, a little bit about your background.
Massive soccer fan, a big Chicago Fire fan,
so I'm delighted to hear that as well.
Doctor Ko, so much going on in the
field of orthopedics at
challenges as well.
What what innovations
or what trends are you most excited by,
in orthopedics today?
Well, I think there's a lot of exciting
work happening around regenerative medicine.
One of the things that has recently been
in the news in Chicago is the return
of Lonzo Ball to the Chicago Bulls
after a cartilage and meniscus transplant.
This is a procedure that's been performed,
over the past several years. And actually, I've
had experience doing this in,
other, collegiate and, semi pro,
basketball players in the past.
But the combination of these
transplantation
activities to help regenerate the knee is actually
an area that's really exciting, and we continue
to make new advances over the past several
years.
I think another area that's increasingly exciting is
the expansion and use of robotic and computer
assisted technology,
around making surgery more precise.
At Skokie Hospital, where our orthopedic hospital is,
over 90% of our total hip and knee
replacements are done with some computer assisted or
robotic technology. And this is now spreading
into other areas such as
spine surgery
and shoulder replacement.
And I think finally, another
really exciting area is what the potential is
for artificial intelligence.
Initially,
we're probably gonna see a lot more uptake
and use of this in helping with the
patient and clinical documentation.
The idea is that also maybe can help
with appropriate,
coding.
I do know that actually insurance companies are
using AI to help,
adjudicate claims.
But I think on the provider side, we
may need to use AI to help us
enhance our ability to appropriately document the work
that we do.
A lot a lot of exciting things there.
No doubt AI, top of mind, robotic surgery,
in terms of total joints, knee, hip replacements.
To follow-up on the first kind that you've
mentioned,
quite an interesting one when we talked about
regenerative medicine and whatnot. Do you mind giving
us a little bit more insight into
recent advancements
in regenerative medicine like cartilage regrowth?
And how do they how do you integrate
procedures like this in terms of meniscus transplants?
Absolutely.
So,
what's happened over the years, and I've been
involved with cartilage
transplantation research for over close to 30 years
at this point in time,
is we're getting more and more different tools.
Historically,
some of the techniques involved
harvesting cells and then placing it under some
sort of periosteal
patch,
which had to be sutured in place. Very
technically tedious and difficult procedures.
And, what things have evolved to is
more of a use of sometimes donated cartilage
tissue
or other systems where there
are scaffolds that help, promote cartilage regrowth
or the use of
transplants that have,
scaffolds now that can be transplanted,
arthroscopically or very minimally invasively.
This has enhanced our ability to,
heal menis
articular cartilage.
With the meniscus cartilage,
we're, I think, getting much more comfortable with
doing meniscus transplantation.
And there are some
different techniques where
we're evolving and testing actually around
partial meniscus transplantation. We've done some,
specific biomechanics work around that, and that might
be able to help restore the meniscus, which
functions at a shock absorber for the knee.
So it's an exciting period of time, and
then there's these augments that we can use
like platelet rich plasma or bone marrow aspirate.
Yeah. Absolutely. I'm sorry to cut across you
there. Well, it was fascinating to hear about
some of those recent advancements and from the
biologics perspective, those regenerative medicine, their procedures,
and how they can, of course, potentially improve
outcomes and recovery for patients in some of
these complex procedures as well.
You also earlier mentioned robotic surgery, AI.
I'm just curious to see, when you look
ahead, what what do you think about the
future of the spine and orthopedics field? When
you see the next 2 or 3 years,
anything else that you see being growing in
prominently among surgeons? Anything else that you're keeping
a close eye on?
Well, I think there's obviously a lot of
technological
advances.
Some of the things that,
some of our physicians are looking at are,
for example, endoscopic
spine surgery,
where it's that's becoming even less invasive than
the minimally invasive technologies.
The like we talked about, the use of
increased precision with robotic or computer assisted
planning.
And this can actually potentially incorporate some technologies
such as
augmented or mixed reality where,
a surgeon will be able to see the
actual,
structure of the bones and also
superimpose,
a preoperative
plan and help navigate the instrumentation
as it's being used.
So,
certainly,
I mean, it's, you know, I'm sure many
of us have played with some sort of
augmented or mixed reality,
little things on, your cell phone where you
can superimpose some sort of other
image onto,
the real real world.
But where this is going to become, I
think, easily incorporated
over time next several years is increasingly that
might be used in a orthopedic and clinical
setting.
It's fascinating.
As a bit of a a gadget or
a tech nerd myself,
I got to play with some of these
technologies at the last NAST conference.
But I'm so curious just to hear, your
thoughts on the next generation of spine surgeons
as it relates to these technologies.
Is it a case where,
health systems,
hospitals,
ASCs,
wanting to be competitive
and wanting to recruit the next generation of
talent. Is it a case that these,
spine, orthopedic robots,
AR, VR technologies, is it a case that
these practices, hospitals are going to need, must
have technologies to recruit the latest and greatest
talent coming out of these residency and fellowship
programs for the future?
Well, I would say it's actually in the
early stages.
At the Skokie Hospital in Endeavour,
we actually have a few
of the,
spine robots currently.
It's they're seeing some limited use,
but I think what's gonna happen as time
goes by, it's going to be easier and
to use.
There are some barriers such as need for
registration
and things
of the spine intraoperatively.
So I think this is an area in
evolution, and we're still in the process of
seeing what technologies will end up on top.
And it's, but it is an exciting time,
and I think it's definitely
something to keep an eye on.
Absolutely. Fascinating to hear about all those technologies
in spine, orthopedics as it relates to robots,
AI, some of the regenerative medicine aspects that
you talked about earlier.
Doctor. Koh, turning the turning the page a
little bit, can you give me a bit
of insight into what are the biggest headwinds,
the biggest challenges that you're planning for, in
2025?
Well, in 2025,
I think there's
a couple of issues that, we've been some
of which have been around for a while.
I think everybody in health care is aware
of the fact that there's continues to be
declining reimbursement for the work that we do,
and the cost of delivering care has continued
to increase. So everybody's gonna have to become,
more efficient
in order to survive.
Another area of significant
uncertainty is around,
what health care is gonna look like in
the new administration.
There are,
essentially have been statements that there's things will
be different,
but,
how different, what the pace of change will
be, and what those ultimate differences will be,
remains unknown.
And so,
this is something that I think we're gonna
have to be prepared for,
on,
many fronts.
And I think the other area
that is,
we see,
and I think maybe
have actually experienced this on a personal level
is increasing issues with,
authorization
of services.
You know, there's a recent paper in,
that from the JAMA Network saying that about
a third of patients on Medicare Advantage have
experienced some sort of denial over the past
year. Rates of
continues
to increase
continues to increase. And I think everybody's feeling
that
how,
we can deal with that is going to
be,
an ongoing issue. And I think that's an
area of concern for many patients as well
as providers.
Yeah. I think to your point, consistently
ranked as the number one frustration or challenge
by both providers and patients. So interesting to
see potential to change in administration, whether there
might be any shift or potential changes in
the guide there in the future.
Doctor Koh, last question before I let you
go, kind of ending on a little bit
of a more positive note.
Where do you see the best or the
biggest opportunities for growth in the future, whether
for your own practice or the orthopedic specialty
at Andeavor Health? Where are you, most looking
to grow?
Well, I think it's really interesting. And and
one of the great things that we're seeing
is that there's a lot of patients that
are taking a strong interest in
their,
maintaining a hack healthy active lifestyle.
And, we certainly see that the demographics of
the country are that there's this aging boomer
generation that still wants to stay active and
healthy. And for orthopedics, that's a real opportunity
to try to help patients and meet that
need.
So,
where we are is, the fact that, procedures
continue to get, less invasive,
recovery became continues to get quicker,
but also some of the other areas where
I think there's continued growth is the opportunity
to meet patients where they're at.
One of the things that we've helped innovate
is,
orthopedic
walk in clinics. A number of folks have
done this across the country.
But I really think that expanding this area
allows patients to get the services they need
when they need them,
rather than having to wait a long time.
And this is gonna allow patients to get
the care they need and the treatment they
need quicker and faster and, get back on
the road to recovery,
more quickly.
Absolutely. Doctor Koh, fascinating to hear, about some
of the trends that you're following,
some of those innovations in spine and orthopedics.
Really, really appreciate you taking the time out
of your busy schedule and and great to
hear about all the excellent work about you,
and your providers and your team that have
never helped her do. Thank you so much.
Thank you, Alan.