1 00:00:00,080 --> 00:00:02,560 This is Alan Condon with the Becker's Healthcare 2 00:00:02,560 --> 00:00:05,040 Podcast, and I'm thrilled to be joined today 3 00:00:05,040 --> 00:00:08,400 by doctor Michael Ast, a fantastic leader who 4 00:00:08,400 --> 00:00:11,519 wears many different hats at Hospital for Special 5 00:00:11,519 --> 00:00:12,019 Surgery, 6 00:00:12,400 --> 00:00:14,419 including chief of the knee service, 7 00:00:14,734 --> 00:00:16,675 chief medical innovation officer, 8 00:00:16,975 --> 00:00:20,114 and director of ambulatory surgery center strategy. 9 00:00:20,894 --> 00:00:22,574 Doctor Ast, a pleasure to have you back 10 00:00:22,574 --> 00:00:25,214 on the Beckers podcast with us today. For 11 00:00:25,214 --> 00:00:27,294 those who mightn't be as well acquainted with 12 00:00:27,294 --> 00:00:29,535 you or Hospital for Special Surgery, do you 13 00:00:29,535 --> 00:00:30,710 mind taking a moment to give us a 14 00:00:30,710 --> 00:00:32,189 little bit more about your role and your 15 00:00:32,189 --> 00:00:33,250 background at HSS? 16 00:00:34,109 --> 00:00:35,549 Sure. And thanks so much for having me 17 00:00:35,549 --> 00:00:37,329 back. Always appreciate the invitation. 18 00:00:37,710 --> 00:00:38,990 So as you said, my name is Mike 19 00:00:38,990 --> 00:00:40,670 Ast. I'm a hip and knee replacement surgeon 20 00:00:40,670 --> 00:00:41,810 at HSS. HSS 21 00:00:42,429 --> 00:00:45,684 is a large orthopedic specialty hospital in New 22 00:00:45,684 --> 00:00:47,765 York City. It is the oldest orthopedic specialty 23 00:00:47,765 --> 00:00:49,604 hospital in the world. We've been around for 24 00:00:49,604 --> 00:00:50,984 a hundred and sixty years, 25 00:00:51,604 --> 00:00:53,545 and specialize entirely in musculoskeletal 26 00:00:54,085 --> 00:00:54,585 care. 27 00:00:55,445 --> 00:00:58,100 Myself, personally, I I trained at HSS, 28 00:00:58,560 --> 00:01:00,399 and have been in attending there now for 29 00:01:00,399 --> 00:01:01,539 the last eight years. 30 00:01:02,159 --> 00:01:03,760 And as you noted, I also hold a 31 00:01:03,760 --> 00:01:05,219 couple of other roles, including, 32 00:01:05,760 --> 00:01:06,739 partnering with, 33 00:01:07,439 --> 00:01:10,239 our chief innovation officer to run our innovation 34 00:01:10,239 --> 00:01:12,295 institute as well as a role as a 35 00:01:12,295 --> 00:01:14,534 director of our ASC strategy. All that on 36 00:01:14,534 --> 00:01:15,495 top of what I do on a day 37 00:01:15,495 --> 00:01:16,775 to day basis, like I said, which is 38 00:01:16,775 --> 00:01:18,075 just hip and knee replacements. 39 00:01:18,935 --> 00:01:20,454 Fantastic. I don't know where you find the 40 00:01:20,454 --> 00:01:22,395 time to do it all, but, excited 41 00:01:22,935 --> 00:01:24,454 to dive right in and hear a little 42 00:01:24,454 --> 00:01:25,915 bit more about that, Mike. 43 00:01:26,775 --> 00:01:28,950 So to kick it off, I think, obviously, 44 00:01:29,010 --> 00:01:30,849 a couple weeks into 2025 45 00:01:30,849 --> 00:01:31,349 here. 46 00:01:32,049 --> 00:01:33,890 What are the the two or three trends 47 00:01:33,890 --> 00:01:36,049 that you're really focused on this year, whether 48 00:01:36,049 --> 00:01:38,469 as it relates to orthopedics or the ASC 49 00:01:38,689 --> 00:01:39,189 field, 50 00:01:39,810 --> 00:01:40,549 more broadly? 51 00:01:41,365 --> 00:01:43,125 Yeah. Well, I think in orthopedics, we're gonna 52 00:01:43,125 --> 00:01:45,204 see another year of growth. I just think 53 00:01:45,204 --> 00:01:45,704 as 54 00:01:46,325 --> 00:01:46,984 the population 55 00:01:47,284 --> 00:01:49,685 continues to age a bit and try to 56 00:01:49,685 --> 00:01:52,665 be more active, certainly, I still think we're 57 00:01:52,805 --> 00:01:54,805 coming out of the pandemic, although we're pretty 58 00:01:54,805 --> 00:01:57,159 far out. I think volumes will continue to 59 00:01:57,159 --> 00:01:59,479 increase. So that's the positive side of it. 60 00:01:59,479 --> 00:02:00,760 The negative side of it, of course, we're 61 00:02:00,760 --> 00:02:03,340 always watching that costs also continue to increase. 62 00:02:03,560 --> 00:02:05,979 We're continuing to watch the shift from inpatient 63 00:02:06,280 --> 00:02:09,115 to outpatient having a significant effect on 64 00:02:09,655 --> 00:02:12,534 how patients are treated, on how patients seek 65 00:02:12,534 --> 00:02:14,074 care, and also on the revenues 66 00:02:14,775 --> 00:02:17,094 to whether it's our ambulatory surgery centers or 67 00:02:17,094 --> 00:02:18,694 our hospitals, and some of those are working 68 00:02:18,694 --> 00:02:21,780 in opposite directions. But I think combining that 69 00:02:21,780 --> 00:02:24,099 with the very rapid pace of innovation, I'm 70 00:02:24,099 --> 00:02:24,920 hoping that, 71 00:02:25,460 --> 00:02:27,060 as we start to see interest rates come 72 00:02:27,060 --> 00:02:28,680 down, we'll see some more reinvestment 73 00:02:28,980 --> 00:02:31,379 into innovation. We that was really, really hot 74 00:02:31,379 --> 00:02:32,340 in 2021, 75 00:02:32,340 --> 00:02:34,165 '20 '20 '2, slowed down a bit over 76 00:02:34,165 --> 00:02:35,685 the last couple of years. I think we're 77 00:02:35,685 --> 00:02:36,985 gonna see a big reinvestment 78 00:02:37,365 --> 00:02:39,044 both on the digital side as we start 79 00:02:39,044 --> 00:02:41,284 to talk about lot big data and machine 80 00:02:41,284 --> 00:02:43,444 learning and AI and also on just the 81 00:02:43,444 --> 00:02:43,944 general, 82 00:02:44,405 --> 00:02:46,724 digital health care innovation side. I think there's 83 00:02:46,724 --> 00:02:48,025 a lot of really exciting 84 00:02:48,540 --> 00:02:50,939 tailwinds on that side that may help balance 85 00:02:50,939 --> 00:02:52,699 some of the headwinds everybody in health care 86 00:02:52,699 --> 00:02:55,199 is facing right now, combining, of course, with 87 00:02:55,340 --> 00:02:56,319 the new 88 00:02:56,699 --> 00:02:57,199 incoming, 89 00:02:58,780 --> 00:03:00,699 regulatory changes that we may all be seeing 90 00:03:00,699 --> 00:03:02,080 in the next couple of months. 91 00:03:03,125 --> 00:03:04,344 Absolutely. I think 92 00:03:04,645 --> 00:03:05,544 AI is something 93 00:03:05,925 --> 00:03:07,444 no secret to you, to any of our 94 00:03:07,444 --> 00:03:08,264 listeners here 95 00:03:08,724 --> 00:03:10,805 as popping up everywhere across the health care 96 00:03:10,805 --> 00:03:13,444 space and even outside it. Specifically as it 97 00:03:13,444 --> 00:03:15,864 relates to your practice with HHS, 98 00:03:16,805 --> 00:03:19,930 are there any specific areas within the AI 99 00:03:20,469 --> 00:03:23,270 technological field that you're particularly excited about? Are 100 00:03:23,270 --> 00:03:25,669 there any early, initiatives that you're focused on, 101 00:03:25,669 --> 00:03:27,349 any early results that you can share? I 102 00:03:27,349 --> 00:03:28,789 know it's such a big, big area, but 103 00:03:28,789 --> 00:03:30,469 I'd love to kinda get a specific example 104 00:03:30,469 --> 00:03:32,229 or two that you see a really, potential 105 00:03:32,229 --> 00:03:32,969 big impact. 106 00:03:33,594 --> 00:03:35,134 Yeah. I mean, I can give you three 107 00:03:35,594 --> 00:03:38,314 very concrete examples that we're dealing with, even 108 00:03:38,314 --> 00:03:41,354 today in my practice, and they're very different. 109 00:03:41,354 --> 00:03:42,715 And some of them are very simple, some 110 00:03:42,715 --> 00:03:44,574 a bit more complex. So, obviously, 111 00:03:45,034 --> 00:03:47,759 one very, very simple example that was, talked 112 00:03:47,759 --> 00:03:49,439 about this morning by many of my colleagues 113 00:03:49,439 --> 00:03:52,800 and I is just making basic tasks easier. 114 00:03:52,800 --> 00:03:53,860 So every single, 115 00:03:54,639 --> 00:03:56,479 professional out there has to get their resume 116 00:03:56,479 --> 00:03:58,240 or their CV in place. And it's just 117 00:03:58,240 --> 00:03:59,439 a task you do every once in a 118 00:03:59,439 --> 00:04:01,840 while, certainly when you're, like myself as an 119 00:04:01,840 --> 00:04:04,064 academic surgeon preparing for promotions 120 00:04:04,525 --> 00:04:06,525 within our medical school or things like that. 121 00:04:06,525 --> 00:04:08,685 It's just a tedious task, and we've been 122 00:04:08,685 --> 00:04:11,805 hoping for this AI making tedious tasks easier. 123 00:04:11,805 --> 00:04:13,104 And this morning, we launched, 124 00:04:13,564 --> 00:04:15,885 just internally, but very excited to most of 125 00:04:15,885 --> 00:04:16,545 the doctors, 126 00:04:17,165 --> 00:04:19,110 a way that AI is gonna help us 127 00:04:19,110 --> 00:04:20,790 do all of that. Very simply, it searches 128 00:04:20,790 --> 00:04:22,810 the Internet, brings up all our recent publications, 129 00:04:22,870 --> 00:04:24,709 brings up anywhere we're mentioned in the news, 130 00:04:24,709 --> 00:04:26,870 brings up anywhere that we, have given some 131 00:04:26,870 --> 00:04:29,670 local lectures or invited symposium talks, structures it 132 00:04:29,670 --> 00:04:31,125 for us, puts it all together. We can 133 00:04:31,125 --> 00:04:33,524 simply review it and probably save me ten 134 00:04:33,524 --> 00:04:35,764 to twelve hours of work just when the 135 00:04:35,764 --> 00:04:38,245 next time comes, to apply for another promotion 136 00:04:38,245 --> 00:04:40,084 or send my CV somewhere. So it seems 137 00:04:40,084 --> 00:04:41,704 like such a simple thing, but 138 00:04:42,310 --> 00:04:44,149 such a powerful tool that, 139 00:04:44,790 --> 00:04:45,769 has been unlocked, 140 00:04:46,310 --> 00:04:48,389 with very, very simple machine learning and and 141 00:04:48,389 --> 00:04:50,709 AI type stuff. Take that one step further 142 00:04:50,709 --> 00:04:52,389 on the clinical practice. One of the things 143 00:04:52,389 --> 00:04:54,470 we're most excited about right now is the 144 00:04:54,470 --> 00:04:55,930 development of our 145 00:04:56,470 --> 00:04:57,209 AI powered 146 00:04:58,144 --> 00:04:58,644 postoperative 147 00:04:59,185 --> 00:04:59,685 chatbot. 148 00:05:00,064 --> 00:05:01,904 So when our patients call us with very 149 00:05:01,904 --> 00:05:04,305 basic questions of when can I shower, when 150 00:05:04,305 --> 00:05:05,745 can I do this, when should I can 151 00:05:05,745 --> 00:05:07,664 you help me make my appointment, tell me 152 00:05:07,664 --> 00:05:09,264 a little bit more about what I should 153 00:05:09,264 --> 00:05:10,944 be expecting on day one, day two, day 154 00:05:10,944 --> 00:05:13,240 three, as opposed to that having to be 155 00:05:13,379 --> 00:05:14,039 a person 156 00:05:14,339 --> 00:05:16,740 calling back with the use of generative AI? 157 00:05:16,740 --> 00:05:18,180 We've been able to create a tool that 158 00:05:18,180 --> 00:05:20,979 patients can interact with that has seen ex 159 00:05:21,139 --> 00:05:23,699 incredible success in our early pilot data with 160 00:05:23,699 --> 00:05:25,620 our patients. I mean, patients love it, responds 161 00:05:25,620 --> 00:05:27,435 right away, responds with the 162 00:05:28,235 --> 00:05:30,634 with the information that we gave it to 163 00:05:30,634 --> 00:05:33,035 respond, and responds in any language that you 164 00:05:33,035 --> 00:05:34,954 can speak, which gives it a huge advantage 165 00:05:34,954 --> 00:05:36,875 over someone like me who doesn't speak, let's 166 00:05:36,875 --> 00:05:38,625 say, French or Japanese or any language that 167 00:05:38,625 --> 00:05:40,410 a patient might want. So that's a very, 168 00:05:40,410 --> 00:05:42,650 very concrete clinical example that we've had very 169 00:05:42,650 --> 00:05:44,810 early success with, and I'm super excited about 170 00:05:44,810 --> 00:05:46,970 moving forward. The two in development that are 171 00:05:46,970 --> 00:05:50,250 the most exciting obviously are, ambient listening devices 172 00:05:50,250 --> 00:05:51,770 to help us write our notes and get 173 00:05:51,770 --> 00:05:54,224 things done, make our offices more efficient, bring 174 00:05:54,224 --> 00:05:55,824 us up to being able to get back 175 00:05:55,824 --> 00:05:58,384 to face to face conversations with patients without 176 00:05:58,384 --> 00:06:00,464 having to worry about writing my note, getting 177 00:06:00,464 --> 00:06:02,865 through, making all my orders, having ambient listening 178 00:06:02,865 --> 00:06:04,384 devices in all of the rooms that we 179 00:06:04,384 --> 00:06:06,384 do is something that HSS has actually made 180 00:06:06,384 --> 00:06:09,125 a pretty significant investment with. Thanks to a 181 00:06:09,830 --> 00:06:11,370 very generous donation, 182 00:06:12,069 --> 00:06:14,629 from a grateful patient to help us develop 183 00:06:14,629 --> 00:06:16,250 and work with this technology 184 00:06:16,550 --> 00:06:18,310 to bring it to more patients such that 185 00:06:18,310 --> 00:06:21,029 the patient doctor interaction came back to being 186 00:06:21,029 --> 00:06:23,904 just that, not the patient doctor computer interaction. 187 00:06:24,125 --> 00:06:25,485 And then the last thing, of course, is 188 00:06:25,485 --> 00:06:27,564 that the future where we all wanna see 189 00:06:27,564 --> 00:06:29,564 this go in surgery is how can we 190 00:06:29,564 --> 00:06:31,485 make surgery better? How can we make surgery 191 00:06:31,485 --> 00:06:33,824 more predictable? And the combination of advanced 192 00:06:34,160 --> 00:06:37,040 surgical tools like computer navigation and robotics, certainly 193 00:06:37,040 --> 00:06:39,079 in joint replacement and in spine surgery, is 194 00:06:39,079 --> 00:06:41,120 a big topic right now. And combining that 195 00:06:41,120 --> 00:06:43,600 with machine learning algorithms and AI and large 196 00:06:43,600 --> 00:06:46,079 datasets, we could start to help develop decision 197 00:06:46,079 --> 00:06:48,160 support tools that are really gonna help us 198 00:06:48,160 --> 00:06:50,014 bring personalized patient 199 00:06:50,475 --> 00:06:52,714 surgery that hopefully will give us improved patient 200 00:06:52,714 --> 00:06:53,694 outcomes in the future. 201 00:06:54,555 --> 00:06:56,475 I see. Yeah. Mike, I absolutely love those 202 00:06:56,475 --> 00:06:59,274 specific examples and kinda early results as well. 203 00:06:59,675 --> 00:07:01,435 The the ambient listening device is something I 204 00:07:01,435 --> 00:07:03,035 still hear come up time and time again. 205 00:07:03,035 --> 00:07:04,990 But even to your point, some of those 206 00:07:04,990 --> 00:07:05,310 other, 207 00:07:06,350 --> 00:07:09,410 making basic tedious tasks easier. I imagine resumes, 208 00:07:09,470 --> 00:07:12,029 CVs, promotions, getting all that stuff in order. 209 00:07:12,029 --> 00:07:14,270 I I imagine saving ten to twelve hours 210 00:07:14,270 --> 00:07:16,209 for for a busy leader, but a practicing 211 00:07:16,270 --> 00:07:18,824 surgeon like yourself is a huge time saving, 212 00:07:18,824 --> 00:07:20,105 which no doubt you can do a lot 213 00:07:20,105 --> 00:07:21,964 more with that ten, twelve hours, 214 00:07:22,345 --> 00:07:24,504 a week. So really, really fascinating to get 215 00:07:24,504 --> 00:07:26,685 your perspective, your insight on some of those 216 00:07:26,985 --> 00:07:27,305 AI, 217 00:07:27,785 --> 00:07:29,865 solutions and both the boat you're working on 218 00:07:29,865 --> 00:07:32,045 now and also they're eyeballing down the line. 219 00:07:32,504 --> 00:07:34,300 Jumping into our next next question here, it 220 00:07:34,300 --> 00:07:36,860 kinda ties nicely into this, but no doubt 221 00:07:36,860 --> 00:07:38,779 you're excited about AI there. But is there 222 00:07:38,779 --> 00:07:40,939 anything that you're particularly excited about whether it 223 00:07:40,939 --> 00:07:43,340 may be specific to your practice or maybe 224 00:07:43,340 --> 00:07:45,340 in the surgical tech field? What are you 225 00:07:45,340 --> 00:07:47,279 kind of, keeping a close eye on? 226 00:07:47,824 --> 00:07:49,425 Yeah. I think, again, as a hip and 227 00:07:49,425 --> 00:07:52,785 knee replacement surgeon within the technology field, all 228 00:07:52,785 --> 00:07:55,024 of the different robotic and computer based systems 229 00:07:55,024 --> 00:07:56,625 are the things that are the most exciting 230 00:07:56,625 --> 00:07:58,865 to us. Over time, we're just trying to 231 00:07:58,865 --> 00:08:01,860 hone down our ability to personalize and more 232 00:08:01,860 --> 00:08:05,139 exactly perform the procedures that we think help 233 00:08:05,139 --> 00:08:07,139 so many patients. And the way I always 234 00:08:07,139 --> 00:08:09,139 look at that type of technology is it 235 00:08:09,139 --> 00:08:10,979 exist the the growth of it exists in 236 00:08:10,979 --> 00:08:13,459 two ways. Number one, the individual technology gets 237 00:08:13,459 --> 00:08:16,694 better. Number two, the access to that technology 238 00:08:16,754 --> 00:08:19,175 gets more ubiquitous, meaning that more patients 239 00:08:19,555 --> 00:08:21,014 can be helped by that technology, 240 00:08:21,314 --> 00:08:24,035 not just across New York City or The 241 00:08:24,035 --> 00:08:26,035 United States, but even across the world. And 242 00:08:26,035 --> 00:08:28,454 I think it's both of those combined together 243 00:08:28,639 --> 00:08:30,800 as the cost of these technologies comes down, 244 00:08:30,800 --> 00:08:33,620 as they continue to evolve, and just technology 245 00:08:33,679 --> 00:08:36,000 in general continues to move forward. I'm very 246 00:08:36,000 --> 00:08:38,000 excited to see the next generation of our 247 00:08:38,000 --> 00:08:40,480 surgical computers, the next generation of our surgical 248 00:08:40,480 --> 00:08:42,399 robots, the next generation of our three d 249 00:08:42,399 --> 00:08:43,220 printed implants. 250 00:08:43,519 --> 00:08:46,375 But I'm probably more excited to see the 251 00:08:46,375 --> 00:08:46,875 democratization 252 00:08:47,334 --> 00:08:48,075 of access 253 00:08:48,534 --> 00:08:49,834 to that type of technology, 254 00:08:50,214 --> 00:08:52,054 where instead of this type of technology being 255 00:08:52,054 --> 00:08:54,615 used in five, ten, 15, maybe twenty percent 256 00:08:54,615 --> 00:08:56,934 of surgeries, I'm excited for five years down 257 00:08:56,934 --> 00:08:59,660 the road when it's 95, a % of 258 00:08:59,660 --> 00:09:01,340 surgeries and not just in New York and 259 00:09:01,340 --> 00:09:03,500 not just in The United States, but really 260 00:09:03,500 --> 00:09:04,720 everywhere around the world. 261 00:09:05,580 --> 00:09:06,320 Yeah. Absolutely. 262 00:09:06,700 --> 00:09:08,379 And one quick, not to harp too much 263 00:09:08,379 --> 00:09:10,240 on with AI, but I've heard so much 264 00:09:10,415 --> 00:09:12,654 in terms of the integration of AI into 265 00:09:12,654 --> 00:09:13,154 specifically, 266 00:09:13,855 --> 00:09:14,995 hip and knee robotics. 267 00:09:15,615 --> 00:09:17,134 Where do you see the biggest opportunity in 268 00:09:17,134 --> 00:09:18,035 that in that area? 269 00:09:18,654 --> 00:09:20,415 I think that really comes down to the 270 00:09:20,415 --> 00:09:23,509 concept of this decision support tools. The ability 271 00:09:23,509 --> 00:09:25,509 to say, okay. We see a patient and 272 00:09:25,509 --> 00:09:27,850 they look like this, and they look exactly 273 00:09:27,990 --> 00:09:29,830 like this. Their leg has this angle to 274 00:09:29,830 --> 00:09:32,809 it. Their arthritis has this pattern to it. 275 00:09:32,870 --> 00:09:35,125 And now we're gonna look at how do 276 00:09:35,125 --> 00:09:37,204 we perform their surgery and how did they 277 00:09:37,204 --> 00:09:39,605 do. Because not every knee looks the same, 278 00:09:39,605 --> 00:09:41,605 not every hip looks the same. And for 279 00:09:41,605 --> 00:09:44,004 generations, simply because of the technology we had 280 00:09:44,004 --> 00:09:46,644 available to us, despite them not looking the 281 00:09:46,644 --> 00:09:48,919 same, they were all treated the same. And 282 00:09:48,919 --> 00:09:51,819 I think AI and these large machine learning 283 00:09:51,879 --> 00:09:52,379 algorithms 284 00:09:52,919 --> 00:09:54,779 have this this huge potential 285 00:09:55,399 --> 00:09:58,519 to change that paradigm completely and basically take 286 00:09:58,519 --> 00:10:00,600 this to a point where a patient who 287 00:10:00,600 --> 00:10:03,054 looks like this and walks like this and 288 00:10:03,054 --> 00:10:06,595 has these preoperative functional limitations and has these 289 00:10:06,735 --> 00:10:07,235 postoperative 290 00:10:07,615 --> 00:10:08,835 functional expectations 291 00:10:09,615 --> 00:10:12,415 should be treated with surgery done in this 292 00:10:12,415 --> 00:10:14,035 manner with this implant 293 00:10:14,379 --> 00:10:17,339 and this recovery pathway, and that's gonna lead 294 00:10:17,339 --> 00:10:18,699 them back to the outcome that they were 295 00:10:18,699 --> 00:10:20,079 looking for. And that 296 00:10:20,620 --> 00:10:22,799 really, really honed down level of personalization 297 00:10:23,179 --> 00:10:25,100 is really where I think you can't do 298 00:10:25,100 --> 00:10:27,199 it on your own. I can't look at 299 00:10:27,339 --> 00:10:30,585 my patients, the however many I take care 300 00:10:30,585 --> 00:10:32,745 of each week or each month and be 301 00:10:32,745 --> 00:10:34,685 precise enough to know the differences. 302 00:10:35,384 --> 00:10:37,404 But when you start using things like AI, 303 00:10:37,625 --> 00:10:39,305 all of a sudden you can take very, 304 00:10:39,305 --> 00:10:40,365 very large datasets, 305 00:10:40,904 --> 00:10:43,399 huge amounts of very specific types of data. 306 00:10:43,399 --> 00:10:45,019 And as long as the inputs 307 00:10:45,399 --> 00:10:47,720 are accurate and clean, you might be able 308 00:10:47,720 --> 00:10:49,639 to get that type of, information on the 309 00:10:49,639 --> 00:10:50,299 back end. 310 00:10:50,919 --> 00:10:53,159 Yeah. Absolutely. And kind of fascinating, as a 311 00:10:53,159 --> 00:10:54,379 bit of a self confessed, 312 00:10:54,759 --> 00:10:57,294 gadget and tech tech nerd. It's, fascinating to 313 00:10:57,294 --> 00:10:59,715 hear the evolution of this technology and also 314 00:10:59,774 --> 00:11:02,335 to your point, the the democratization of access 315 00:11:02,335 --> 00:11:04,355 to some of this technology as well. 316 00:11:05,134 --> 00:11:06,894 Mike, last question. I'd love to kinda get 317 00:11:06,894 --> 00:11:08,414 a little bit more insight from you on 318 00:11:08,414 --> 00:11:10,230 before we let you go. HSS, 319 00:11:10,870 --> 00:11:11,370 obviously, 320 00:11:11,750 --> 00:11:12,970 fantastic institution, 321 00:11:14,070 --> 00:11:16,309 ton of growth recently, not just in the 322 00:11:16,309 --> 00:11:19,269 New York area, also expanding their footprint in 323 00:11:19,269 --> 00:11:19,769 Florida, 324 00:11:20,549 --> 00:11:23,049 along with the likes of Rotman, Mount Sinai. 325 00:11:23,825 --> 00:11:25,904 Over the next twelve months or so, where 326 00:11:25,904 --> 00:11:27,985 are the the core areas of growth that 327 00:11:27,985 --> 00:11:30,085 HSS is really looking to focus on? 328 00:11:30,545 --> 00:11:32,384 Yeah. I think we have two sort of 329 00:11:32,384 --> 00:11:33,985 ways that we think about growth. We have 330 00:11:33,985 --> 00:11:35,669 our local growth within what we call our 331 00:11:35,669 --> 00:11:38,470 Tristate area, and the most exciting part of 332 00:11:38,470 --> 00:11:40,709 that in in, again, in very concrete ways 333 00:11:40,709 --> 00:11:44,309 is we're excited to increase our ambulatory surgery 334 00:11:44,309 --> 00:11:46,870 center presence in the Tristate area, hopefully, with 335 00:11:46,870 --> 00:11:50,495 growth within that core market, but providing more 336 00:11:50,495 --> 00:11:52,595 access to more patients closer to home. 337 00:11:53,054 --> 00:11:54,894 And I think that does two things for 338 00:11:54,894 --> 00:11:57,634 us. Number one, obviously, it helps us expand 339 00:11:58,095 --> 00:12:00,835 access to high quality orthopedic care and musculoskeletal 340 00:12:01,294 --> 00:12:03,215 care, and it helps it be easier for 341 00:12:03,215 --> 00:12:05,840 patients to access the system. It also helps 342 00:12:05,840 --> 00:12:08,160 open up space at our main campus where 343 00:12:08,160 --> 00:12:11,200 we can continue to drive the most complex 344 00:12:11,200 --> 00:12:13,360 orthopedic care from around the world. You know, 345 00:12:13,360 --> 00:12:15,680 we take care of, and we're blessed and 346 00:12:15,680 --> 00:12:17,279 and privileged to take care of some of 347 00:12:17,279 --> 00:12:17,860 the most 348 00:12:18,164 --> 00:12:20,565 complex orthopedic problems, not just from New York, 349 00:12:20,565 --> 00:12:22,164 not just from The United States, but truly 350 00:12:22,164 --> 00:12:24,084 from around the globe. And by opening up 351 00:12:24,084 --> 00:12:27,044 more space within our institution itself, we can 352 00:12:27,044 --> 00:12:30,345 continue to increase the access to that super 353 00:12:30,404 --> 00:12:31,144 high quality, 354 00:12:31,639 --> 00:12:33,879 super complex orthopedic care while at the same 355 00:12:33,879 --> 00:12:37,399 time providing every patient who wants it access 356 00:12:37,399 --> 00:12:39,160 to HSS level care. So that's the sort 357 00:12:39,160 --> 00:12:42,120 of local market. Florida, obviously, as you said, 358 00:12:42,120 --> 00:12:43,799 is is an interesting market to a lot 359 00:12:43,799 --> 00:12:44,460 of people. 360 00:12:45,075 --> 00:12:46,995 And we have our West Palm facility, which 361 00:12:46,995 --> 00:12:48,915 has been doing great for several years. And 362 00:12:48,915 --> 00:12:51,014 then, of course, the facility that we opened, 363 00:12:51,394 --> 00:12:53,075 on the E on the West Coast in 364 00:12:53,075 --> 00:12:55,634 in Naples in partnership with Naples Community Hospital 365 00:12:55,634 --> 00:12:57,235 and both of those now up and running. 366 00:12:57,235 --> 00:12:59,340 We're really excited for the opening of the 367 00:12:59,580 --> 00:13:01,740 physical Naples facility. So while the program has 368 00:13:01,740 --> 00:13:03,820 been in place, the physical facility will be 369 00:13:03,820 --> 00:13:06,220 opening q one, q end q one, beginning 370 00:13:06,220 --> 00:13:08,139 of q two this year. And that's super 371 00:13:08,139 --> 00:13:10,480 exciting because it'll have access to outpatient services, 372 00:13:10,620 --> 00:13:13,915 ambulatory surgery, physical therapy, imaging, and all right 373 00:13:13,915 --> 00:13:16,154 there on the North Campus Of NCH. So 374 00:13:16,154 --> 00:13:17,675 very, very exciting. And then, of course, our 375 00:13:17,675 --> 00:13:20,394 recently announced partnership with University of Miami, which 376 00:13:20,394 --> 00:13:23,274 I believe you covered within, within the Becker's 377 00:13:23,274 --> 00:13:24,254 healthcare sphere. 378 00:13:24,850 --> 00:13:27,410 Another very exciting opportunity to increase access to 379 00:13:27,410 --> 00:13:30,070 HSS level care for the rest of, 380 00:13:30,529 --> 00:13:31,750 Southern Florida. 381 00:13:32,129 --> 00:13:34,129 And I think when you combine those two, 382 00:13:34,129 --> 00:13:36,309 those are the things that we're doing homegrown. 383 00:13:36,529 --> 00:13:39,090 Now we will always continue to evaluate other 384 00:13:39,090 --> 00:13:40,904 opportunities whether it's on a national scale or 385 00:13:40,904 --> 00:13:42,985 an international scale, and these are often through 386 00:13:42,985 --> 00:13:45,084 educational partnerships, working partnerships, 387 00:13:45,705 --> 00:13:48,024 or something we haven't even thought of yet 388 00:13:48,024 --> 00:13:50,345 because our goal has always been that as 389 00:13:50,345 --> 00:13:52,584 a leader in musculoskeletal health around the world, 390 00:13:52,584 --> 00:13:54,629 our goal is to increase access to high 391 00:13:54,629 --> 00:13:57,110 quality musculoskeletal care to every patient that wants 392 00:13:57,110 --> 00:13:58,090 it and needs it. 393 00:13:58,790 --> 00:14:01,269 Absolutely. Doctor Ast, fascinating to to have you 394 00:14:01,269 --> 00:14:02,950 back on the podcast with us again. A 395 00:14:02,950 --> 00:14:05,509 ton of growth, not just at at HSS, 396 00:14:05,509 --> 00:14:07,757 but but also your practice as well. Fascinating 397 00:14:07,757 --> 00:14:09,597 to get the inside scoop, and, I really 398 00:14:09,597 --> 00:14:10,957 look forward to connecting with you again down 399 00:14:10,957 --> 00:14:12,877 the line. Thanks so much for having me. 400 00:14:12,877 --> 00:14:13,777 It's always a pleasure.