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The Becker's team is excited to announce the

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launch of our new CFO and Revenue Cycle

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podcast.

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Tune in for conversations with finance experts from

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the top hospitals and health systems. We'll discuss

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key trends and ideas to drive meaningful change

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in the industry. Look for Becker's CFO and

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Revenue Cycle podcast wherever you listen to episodes.

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This is Carly Beam with the Becker Spine

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and Orthopedics podcast.

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I'm thrilled to be joined today by doctor

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Alok Charan of Spine and Performance Institute.

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Doctor Charan, thank you so much for being

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here today. Thank you, Carly. I'm really looking

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forward to our conversation today.

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Likewise.

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Before we dive into our conversation, could you

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introduce yourself and tell us a bit about

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your background?

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Absolutely. Sure. Well, my name is, as you

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mentioned earlier, is Alok Sharan. I'm an orthopedic

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spine surgeon.

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I have my own solo practice in the

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state of New Jersey, which is called the

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Spine and Performance Institute.

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I've been practicing

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spine surgery now for almost twenty years, and

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I've had a a great career so far

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starting off in,

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a major

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academic medical center. I took a little detour

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and got a health care MBA

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and went into private practice. And, eventually,

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a couple years ago, I started my own

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practice, which is now called the Spine and

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Performance Institute.

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Great.

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And, you know, you said you got a

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health care MBA and that you started your

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own practice. Can you talk about,

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you know,

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what have been the benefits of having this

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this business education,

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and what

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what opportunities and challenges do you see with

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running your own practice in 2025?

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That's a great question.

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I I'll say that it's been very professionally

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fulfilling to start my own practice, but no

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question,

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very challenging.

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We're in a tough environment right now.

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There are a lot of pressures on

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reimbursement,

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for the solo physician, but

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I started my own practice because

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I realized that health care is in a

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very dynamic state now, and I'm sure we'll

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get into it later on in the podcast.

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But health care is in a very dynamic

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state now. It requires a lot of agility,

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a lot of entrepreneurial thinking.

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After I finished up my health care MBA

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at Dartmouth, I realized that I just don't

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wanna be part of just doing the same

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thing.

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And I needed to sort of break away

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from, if you will, like, the ivory towers

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of the academic centers and really start my

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own thing. And I've been really excited to

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sort of execute on what my vision is

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of where health care is going and also

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have the ability to be agile and change

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if I need to.

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Absolutely. And, you know, you're a huge leader

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in awake spine surgery.

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Can you talk about the state of that

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at your practice and then just within the

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spine specialty overall?

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Absolutely. Yeah. So, you know, awake spine surgery

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initially came out of desire of just doing

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spine surgery without general anesthesia.

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That's how it started because I had a

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patient who had actually requested that. This is

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ten plus years ago now.

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At this point now, awake spine surgery has

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really evolved into

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the development of what we call a rapid

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recovery protocol.

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Meaning at this point now, when someone comes

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to me for a spinal fusion,

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we're able to do their surgery in a

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minimally invasive fashion through a small incision

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using local anesthesia and sedation

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and discharge them home on the same day

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on just Motrin and Tylenol.

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So at this point now,

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a week spine surgery for us is an

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opioid free

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same day spine procedure, which has just been

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really exciting to work on over the past

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few years.

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And what and the truth is actually is

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that what's been great is that as

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as we've been able to do more and

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more patients using this rapid recovery at o

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x spine surgery,

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protocol, more patients are coming to us because

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they're appreciating

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the vulnerability

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and sort of, quote, the collateral damage

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of general anesthesia.

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So it's been nice that we've had many

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patients come to us, not just from our

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local region, but also from out of state

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Texas, DC,

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Chicago,

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because they realize that they wanna have spine

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surgery. They need to have spine surgery because

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of the pain,

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but they're slowly beginning to realize that,

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general anesthesia does have some side effects.

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And if it's possible to have a surgery

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without the general anesthesia,

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they're going for it. What's been exciting for

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me to see

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as the field evolves is the number of

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practitioners throughout the country

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who are also observing the same issues and

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reaching out to me and asking me about

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our protocol.

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I think originally you had asked me about,

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the state of oblique spine surgery throughout the

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country.

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What's what I'm really excited about now is

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that,

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my colleague, Mohammed Abdelbar, he's a spine surgeon

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at Duke. He's been spearheading the publication of

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a book. So this fall, we're actually coming

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out with our first book on awake spine

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surgery. It should be published by this fall.

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That's really exciting. Can you dive in a

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bit deeper into these rapid recovery protocols? So

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any

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specifics and if if you think any of

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these could be applied to

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other types of spine cases, you know, whether

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it's, you know,

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outpatient, minimally invasive, etcetera.

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Yeah. Absolutely. For sure. You know, what's interesting

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for me is this.

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I've I've come to a couple different conclusions

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as we continue to develop our protocol.

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It's pretty clear to me that a patient

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has a problem, a spine problem. They wanna

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come to you and in the least invasive

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fashion, have their problem fixed and be able

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to go to work as soon as possible

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or be independent as soon as possible.

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So initially, when we started doing awake spine

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surgery,

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we noticed that if you go from

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using general anesthesia to just spinal anesthesia,

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that your length of stay goes down by

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50%.

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As we started adding in other items such

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as, like, a regional block and,

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marking that lasts for about twenty four to

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forty eight hours,

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we noticed that patients were mobilizing quicker after

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surgery and requiring less pain meds. And we

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got to a pretty efficient point where we

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were doing spinal fusion surgery,

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and sending them home the same day. So

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once we achieved a same day discharge after

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spinal fusion surgery, we thought, okay. What's the

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next big challenge that we can go after?

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The next big challenge we thought was to

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go after the opioid problems. We all know

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about the problems of opioids and spinal fusion

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surgery.

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And, you know, I've heard about multimodal analgesia

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and different kind of protocols people are using.

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But,

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in speaking to my colleagues who do orthopedic

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sports medicine,

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I appreciated from them the value of nutrition

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and nutritional optimization

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prior to surgery. Now they're doing it for

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their athletes,

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but I thought, how can we transpose that

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knowledge to our spine patients?

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And what we started doing, which has been

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absolutely incredible to work on and and see

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the results of is,

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prior to surgery, we have,

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a protocol where we sort of nutritionally optimize

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the patients

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using an anti inflammatory amino acid along with

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an amino acid supplementation.

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What we're seeing now is that by sort

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of, quote, reducing the inflammation prior to surgery

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and to some degree helping build up their

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muscles,

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the patients require less pain meds after surgery.

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And when we started realizing that, we realized

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that these patients actually don't need opioids.

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So by using knowledge

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of the, the work that my colleagues are

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doing on athletes and bringing it over to

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spine surgery, we saw that, basically, we can

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do opioid free spinal fusion surgery and send

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them home the same day.

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That's really cool. And I imagine, you know,

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this holistic approach, it also

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I imagine it helps with, you know, cost

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for practice,

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the patients, etcetera.

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Absolutely. It's you know, it it's it's very

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satisfying because it kind of opens up

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who you could do spinal surgery on. So

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I'll give you an example. We just operated

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on a gentleman. He's, late seventies, early eighties,

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a physician, A practicing physician who truly I

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mean, at 80 years old, if you're seeing

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patients, I mean, you truly enjoy what you're

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doing.

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He needed a spinal fusion surgery, and our

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goal was basically to figure out how we

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can do the proper surgery for him while

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minimizing any kind of collateral damage.

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He went through our whole protocol, and about

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a week or two after surgery, he's like,

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can I go back to can I go

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back to work now?

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So from my perspective, what I think is

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so interesting about that is, first of all,

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it's obviously gratifying to be able to take

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care of someone, take care of the pain.

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But then the ability to bring them back

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into doing what they enjoy, which is working

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in this situation, or just giving them back

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to society

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is absolutely amazing. Right? We're doing that quicker.

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And so there's a whole sort of class

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of patients so we can sort of offer

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this to who probably would have been, let's

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say,

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rejected from having spine surgery from others. Now

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there's gonna be, a whole class of people

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that it opens up the world to who

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we who we can take care of.

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How much do you see awake spine surgery

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growing in prevalence? You talk about all these

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benefits and, you know, how much do you

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think this will

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expand to just the wider population?

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You know, it's a it's a very patient

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driven, outcomes driven approach.

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And I believe that as more publication

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public education goes on about this, more patients

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will be demanding it. Right? That's why patients

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are coming to me right now. And then

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eventually, they'll be seeking out surgeons who are

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doing this.

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We're seeing in other fields like, the one

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field where I think this has really been

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really interesting is in, hand surgery.

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In hand surgery, they do, what's called Wallant,

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w a l a n t, which is

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wide awake low local incision, no tourniquet hand

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surgery, where patients are literally coming into an

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office, rolling up their sleeves, having hand surgery,

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and and driving home the same day.

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They've been leaders in the field of trying

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to avoid the whole notion of general anesthesia

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and really just using local anesthesia.

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As more and more public education,

279
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happens around this whole notion of avoiding general

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anesthesia,

281
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you're gonna see, patients demanding it. I think

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in your parts of the world in Chicago,

283
00:10:02,245 --> 00:10:04,664
I believe they just did a kidney transplant

284
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or a kidney harvest

285
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using spinal anesthesia. And so we're seeing it

286
00:10:09,089 --> 00:10:10,929
in other fields of medicine. People are realizing

287
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that. So then I think when patients begin

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to understand that this is a very safe

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and reasonable option,

290
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that demand will force, more and more providers

291
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to change the way they do spine surgery.

292
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But then in addition, I think what's gonna

293
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be really interesting and really where I'm really

294
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excited about

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is, being able to educate the insurance companies

296
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on this. So we're in the process of

297
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pulling our data together and looking at it

298
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from a cost effective point of view, and

299
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there's no question, as you can imagine, that

300
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it's very cost effective.

301
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And so in due time, it'll be interesting

302
00:10:40,420 --> 00:10:42,679
to see how the insurance companies engage us

303
00:10:42,980 --> 00:10:44,519
and perhaps even incentivize,

304
00:10:44,980 --> 00:10:46,279
doing awake spine surgery.

305
00:10:47,139 --> 00:10:47,800
Are you

306
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optimistic about the the payer reception to this?

307
00:10:50,664 --> 00:10:52,584
Because I know, like, disc replacement, for instance,

308
00:10:52,584 --> 00:10:55,304
it's been proven to be safe and effective

309
00:10:55,304 --> 00:10:57,565
for, you know, decades before

310
00:10:58,184 --> 00:11:00,584
the some of the big private insurers, you

311
00:11:00,584 --> 00:11:03,404
know, became keen on covering it.

312
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I think so. You know, these things are

313
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very complicated.

314
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It's,

315
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you know, perhaps we need to study the

316
00:11:10,320 --> 00:11:12,240
the disc replacement world a little bit to

317
00:11:12,240 --> 00:11:14,399
understand what worked and didn't work in terms

318
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of their discussions with insurance companies.

319
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But, you know, my belief has always been

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is that if you can truly show with

321
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data

322
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that what you're doing is better and meaningful,

323
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it's not gonna happen overnight. It's gonna be

324
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a series of conversations.

325
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But over time, I am hopeful

326
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that the insurance companies will realize that this

327
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is this is a very good, predictable,

328
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avenue

329
00:11:35,589 --> 00:11:36,730
for rapid recovery.

330
00:11:38,710 --> 00:11:40,970
And, you know, what other spine innovations

331
00:11:41,269 --> 00:11:42,490
excite you besides

332
00:11:42,950 --> 00:11:44,089
awake spine surgery?

333
00:11:44,574 --> 00:11:46,574
Yeah. I mean, you know, the what I

334
00:11:46,574 --> 00:11:48,495
think is really exciting, and I think it's

335
00:11:48,495 --> 00:11:50,735
maybe the sort of standard, but everyone's probably

336
00:11:50,735 --> 00:11:52,735
seeing this as a the notion of artificial

337
00:11:52,735 --> 00:11:54,034
intelligence right now.

338
00:11:54,574 --> 00:11:57,294
AI is is prevalent in so many different

339
00:11:57,294 --> 00:11:59,470
aspects of what we do. But what I'm

340
00:11:59,470 --> 00:12:02,850
really excited about is the integration of AI.

341
00:12:03,230 --> 00:12:05,470
And just our really common workflows. Now I

342
00:12:05,470 --> 00:12:08,029
I know that's not maybe the most catchy

343
00:12:08,029 --> 00:12:09,470
thing out there, but the reason why I'm

344
00:12:09,470 --> 00:12:11,950
so excited about it is because it's gonna

345
00:12:11,950 --> 00:12:12,690
help us

346
00:12:13,065 --> 00:12:16,504
collect data, process data really quickly, and then

347
00:12:16,504 --> 00:12:19,004
be able to improve our ability to predict

348
00:12:19,304 --> 00:12:21,144
what needs to be. What I mean by

349
00:12:21,144 --> 00:12:23,325
that is this. You know, many patients

350
00:12:23,705 --> 00:12:26,179
right now, I'm I'm lucky that patients, they

351
00:12:26,179 --> 00:12:27,079
seek me out,

352
00:12:27,539 --> 00:12:29,059
because they want a weak spline surgery. Right?

353
00:12:29,059 --> 00:12:30,419
So we just had a guy from Texas

354
00:12:30,419 --> 00:12:32,100
fly up. He did his research and came

355
00:12:32,100 --> 00:12:34,179
to see me. Okay. So that's fine. He

356
00:12:34,179 --> 00:12:35,940
was a pretty healthy guy. Didn't really have

357
00:12:35,940 --> 00:12:36,919
any medical problems.

358
00:12:37,779 --> 00:12:40,245
During his surgery, it was great. Opioid free.

359
00:12:40,245 --> 00:12:42,404
Flew back to Texas the following week. But

360
00:12:42,404 --> 00:12:43,924
let's say you had a patient like the

361
00:12:43,924 --> 00:12:45,444
80 year old gentleman who I just operated

362
00:12:45,444 --> 00:12:47,384
on who wasn't as,

363
00:12:48,004 --> 00:12:50,024
optimized, if you will, prior to surgery.

364
00:12:50,485 --> 00:12:52,324
Mhmm. Now if you had the ability to

365
00:12:52,324 --> 00:12:54,664
sort of collect data on him,

366
00:12:55,740 --> 00:12:58,779
not just medical data, but but even nutritional

367
00:12:58,779 --> 00:13:01,820
data and even psychological data, what I'm excited

368
00:13:01,820 --> 00:13:03,899
about is the ability to collect the data

369
00:13:03,899 --> 00:13:05,279
and perhaps use AI

370
00:13:05,660 --> 00:13:08,139
to come up with a personalized algorithm to

371
00:13:08,139 --> 00:13:10,160
optimize him prior to surgery.

372
00:13:10,674 --> 00:13:12,514
So for right now, like, we're using a

373
00:13:12,514 --> 00:13:14,674
weak spine surgery and discharging people home same

374
00:13:14,674 --> 00:13:17,475
day for fairly healthy people. But let's say

375
00:13:17,475 --> 00:13:18,995
they're not so healthy. Let's say they're sort

376
00:13:18,995 --> 00:13:20,375
of class two or class three.

377
00:13:20,835 --> 00:13:22,595
Then AI is gonna be great because it

378
00:13:22,595 --> 00:13:24,595
will since it'll be so integrated into our

379
00:13:24,595 --> 00:13:25,095
workflows,

380
00:13:25,720 --> 00:13:27,799
gathering the data and analyzing and then predicting

381
00:13:27,799 --> 00:13:30,200
will become even easier. So that's what really

382
00:13:30,200 --> 00:13:32,519
excites me about, the use of AI in

383
00:13:32,519 --> 00:13:33,340
spine surgery.

384
00:13:33,799 --> 00:13:35,399
Yeah. So it sounds like AI could be

385
00:13:35,399 --> 00:13:38,120
a real a real tool in just kind

386
00:13:38,120 --> 00:13:38,779
of widening

387
00:13:39,080 --> 00:13:40,860
accessibility to health care.

388
00:13:41,495 --> 00:13:44,075
Absolutely. Absolutely. And we're in the process now

389
00:13:44,534 --> 00:13:46,315
of, collecting step data

390
00:13:46,774 --> 00:13:48,214
on our patients. And I think there's a

391
00:13:48,214 --> 00:13:50,294
lot to be said about your sort of,

392
00:13:50,695 --> 00:13:53,654
gate signature. I think that, soon enough, we'll

393
00:13:53,654 --> 00:13:56,269
have good data about how your gait has

394
00:13:56,269 --> 00:13:57,870
a particular signature, and it could tell us

395
00:13:57,870 --> 00:13:59,629
a lot. They already know that, you know,

396
00:13:59,629 --> 00:14:01,549
they can predict the progression of Parkinson's, for

397
00:14:01,549 --> 00:14:04,269
example, based off of your gait data. So

398
00:14:04,269 --> 00:14:07,089
in due time, as we study this more,

399
00:14:07,309 --> 00:14:08,850
we'll be able to use your,

400
00:14:09,389 --> 00:14:10,129
gait data

401
00:14:10,554 --> 00:14:12,795
as a predictor for disease and then being

402
00:14:12,795 --> 00:14:14,795
able to monitor treatment. So that's what we're

403
00:14:14,795 --> 00:14:16,075
working on right now, and I'm really excited

404
00:14:16,075 --> 00:14:16,735
about that.

405
00:14:17,195 --> 00:14:18,735
That's really that's really fascinating.

406
00:14:19,274 --> 00:14:21,934
And my last question for you, doctor Sharron,

407
00:14:22,394 --> 00:14:24,715
what are some other health care trends that

408
00:14:24,715 --> 00:14:27,740
you're following closely today, whether it's in spine

409
00:14:27,799 --> 00:14:30,059
or just in health care overall?

410
00:14:30,519 --> 00:14:32,120
Yeah. I think that's a great question. Well,

411
00:14:32,120 --> 00:14:34,120
there's two there's two main trends that I'm

412
00:14:34,120 --> 00:14:34,620
really,

413
00:14:35,320 --> 00:14:37,100
curious about, if you will.

414
00:14:37,415 --> 00:14:39,654
One is that I'm seeing a greater move

415
00:14:39,654 --> 00:14:41,835
towards, independent spine practitioners.

416
00:14:42,455 --> 00:14:44,455
I think that there was this pinnacle that

417
00:14:44,455 --> 00:14:45,434
we reached where,

418
00:14:47,415 --> 00:14:49,654
spine doctors or spine surgeons were joining health

419
00:14:49,654 --> 00:14:51,274
care systems or large groups.

420
00:14:51,975 --> 00:14:52,295
And,

421
00:14:53,360 --> 00:14:55,519
for a variety of different reasons, they're perhaps

422
00:14:55,519 --> 00:14:56,580
you're getting a little frustrated

423
00:14:57,120 --> 00:14:58,639
and they're breaking away. And the reason why

424
00:14:58,639 --> 00:15:00,080
I hear about it is because many people

425
00:15:00,080 --> 00:15:02,399
are beginning to call me asking me about

426
00:15:02,399 --> 00:15:03,759
how to set up your own practice and

427
00:15:03,759 --> 00:15:04,899
the challenges. So

428
00:15:05,279 --> 00:15:06,705
I'm curious to see if this is just

429
00:15:06,705 --> 00:15:07,985
sort of a blip right now or if

430
00:15:07,985 --> 00:15:09,524
this is truly a trend

431
00:15:10,304 --> 00:15:12,065
away where we've reached the pinnacle of these

432
00:15:12,065 --> 00:15:14,565
large groups and now towards the independent groups.

433
00:15:15,264 --> 00:15:16,545
And then the other trend, which I think

434
00:15:16,545 --> 00:15:18,404
is gonna be really interesting, is this.

435
00:15:18,945 --> 00:15:20,945
You know, as the as you know, president

436
00:15:20,945 --> 00:15:21,764
Trump just

437
00:15:22,409 --> 00:15:24,209
nominated and confirmed the new secretary of health

438
00:15:24,209 --> 00:15:25,070
and human services.

439
00:15:25,529 --> 00:15:27,789
Mhmm. And there's this huge effort,

440
00:15:28,409 --> 00:15:30,889
to look for inefficiencies and payments at both

441
00:15:30,889 --> 00:15:33,690
the Medicaid level and perhaps not Medicare, but

442
00:15:33,690 --> 00:15:34,750
I'm sure there is.

443
00:15:35,225 --> 00:15:37,384
And so so much so many of the

444
00:15:37,384 --> 00:15:40,524
hospitals in this country depend upon government funding.

445
00:15:41,225 --> 00:15:43,065
If they truly start to pull back on

446
00:15:43,065 --> 00:15:43,804
that funding,

447
00:15:44,264 --> 00:15:46,345
it's gonna cause a really like, a a

448
00:15:46,345 --> 00:15:47,485
seismic shift

449
00:15:47,940 --> 00:15:50,419
in the way hospitals behave. Right? And so

450
00:15:50,419 --> 00:15:51,860
the trend that I'm really curious to see

451
00:15:51,860 --> 00:15:54,360
is that what I I know that president

452
00:15:54,419 --> 00:15:56,840
Trump wants to be a transformer of president,

453
00:15:57,460 --> 00:15:59,460
and so we're gonna see over time over

454
00:15:59,460 --> 00:16:01,465
these next four years how much of health

455
00:16:01,465 --> 00:16:03,804
care you can truly transform and fund and

456
00:16:04,024 --> 00:16:05,705
the change in funding, of course, will lead

457
00:16:05,705 --> 00:16:08,024
to that major transformation. So it's gonna be

458
00:16:08,024 --> 00:16:09,884
really interesting to see what happens there.

459
00:16:10,264 --> 00:16:12,904
Well, this has been a great conversation, doctor

460
00:16:12,904 --> 00:16:14,985
Charon. Thank you for joining us on the

461
00:16:14,985 --> 00:16:17,540
podcast today. It's been a pleasure talking, and

462
00:16:17,540 --> 00:16:19,379
I look forward to connecting again down the

463
00:16:19,379 --> 00:16:21,460
line. Absolutely. Thank you again. It's always a

464
00:16:21,460 --> 00:16:21,960
pleasure.