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This is Alan Condon back on the Becker's

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Healthcare podcast.

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And today, I'm thrilled to be joined by

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doctor Craig McMains, a fellowship trained spine surgeon

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who specializes in minimally invasive

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and complex spine surgery at OrthoIndy.

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Doctor Maines, a pleasure to have you back

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on the podcast with us today.

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Before we dive into some questions that I'd

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love to get to, I'd love to hand

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the floor over to you just to tell

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us a little bit more about your role

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and your background at OrthoIndy.

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Absolutely. Thanks for having me on, Alan. Appreciate

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the time today.

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As you've said, I'm, Craig McMains. I am

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a orthopedic spine surgeon. I've been in practice,

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close to a decade now. I'm currently

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a partner at OrthoIndy,

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specializing in minimally invasive and complex spinal procedures.

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So,

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OrthoIndy,

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is a, Indiana's

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first physician owned, like, orthopedic hospital. We founded

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the hospital in, I think, I think it

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was around 02/2005. The group's been together for

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about fifty years.

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And so that kind of,

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innovative approach has been part of the DNA

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of the group, and that's what attracted me

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to joining the the group. And so,

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for my individual practice,

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kinda leveraging that, you know, physician ownership and

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kinda top down control,

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into my,

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care for my spine patients and incorporating

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kind of forward thinking technologies to get better

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outcomes at a,

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at a good value.

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Alright. So we're excited to to dive in

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and kinda learn a little bit more about

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your practice, kinda where you're headed, what you're

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planning for this year, doctor McMaes. I think,

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certainly,

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no secret to you, to me, to many

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of our audience, the the big headwinds that

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health care across the board is facing. But

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I guess specific to your practice, specific to

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spine surgery and orthoIndy,

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what are the the big headwinds that you're

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really planning for this year?

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Yeah. So,

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you know, that that's a great question, and

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I think I'm gonna sound like a broken

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record for everybody else, you know, in terms

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of the

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kinda group level headwinds. I'll I'll talk about

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my individual practice first, though.

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You know, I I'm we we started a

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a little over a year, year and a

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half ago, an endoscopic spine program at OrthoIndy,

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And that's been something that's really kind

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of caused me to see a paradigm shift

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in how I view patients. Right? Historically,

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you know, the foundations of spine surgery are

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stabilized,

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you know, decompress,

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correct. And now,

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you know, I don't have to approach that

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with a kind of

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anatomy altering approach anymore. Right? I don't have

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to do a a spinal fusion to get

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an adequate decompression

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or,

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to preserve,

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you know, integrity. And so being able to

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have these ultra minimally invasive approaches to the

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spine where we can

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decompress,

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the neuroelements and kind of preserve anatomy has

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been kind of a real boon in my

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practice. Patients love it. They're they're getting back

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to activity faster,

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and, just really having good great recoveries.

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The the analogy I I kinda

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always bring up is,

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you know, my orthopedic background is look at

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the where shoulder,

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arthroscopy went and and the treatment for rotator

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cuffs. Right? We used to do these open

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approaches historically.

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They were highly disfiguring and highly,

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you know,

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morbid for patients to undergo.

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Well, we got better. We we developed these

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less invasive or you call minimally invasive techniques

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of many open deltoid sparing you know, deltoid

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splitting approach.

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We got some good visualization with that. Some

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people would advocate it was superior for a

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long time even

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after arthroscopy got introduced. Right? Because historically, arthroscopy

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is really challenging, cumbersome, and expensive for shoulders.

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But now if you look at the current

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landscape, that's the gold standard. Nobody would tell

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you that you should go backwards and have

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these open approaches even in a less invasive

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fashion. So I think spine's gonna go through

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that paradigm shift as a field, and,

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we're gonna do better of preserving,

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normal anatomy while alleviating

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pathology. So that's kind of

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my big headwind is just, the kinda change

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I see in my practice individually is, like,

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how do I keep leveraging that? How do

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I get that to go forward?

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From a a group standpoint, you know, we're

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we're facing these, you know, as always, kind

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of

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regulatory

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and financial,

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headwinds. Right?

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We we have

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trouble

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with our payers, you know, giving,

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surgeons and individual physicians

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an appropriate compared to, say, like, a big

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hospital system. Right? And there's all kinds of

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data out there showing that the reimbursement for

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facilities is going up or was physician rates

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are flat, if not dropping.

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And, you know, if you look at it

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from, like, comparing it to, like, inflationary data,

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you know,

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physicians have not kept up from a pay

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standpoint,

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and a pay quality standpoint versus,

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kind of what these large health care systems

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do. So

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just trying to make sure that we remain

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patient focused. Right? We wanna get good outcomes

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because,

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you know, it's kinda like a field of

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dreams thing. If you if you build it

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if you build it, they will come. Like,

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if we're doing good work, patients will come

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see us.

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But we have to we have to be

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leaned. We have to make sure that we're

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not,

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you know, becoming bloated with,

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you know,

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excessive cost.

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We try to be, you know, conscientious on

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our implants that we're using, making sure that,

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we're doing things that,

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don't add significant

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delays in care or cost to the system.

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So,

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I mean, that that's a complicated

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answer, but that's kind of the thousand foot

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view of our practice level.

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Yeah. Absolutely. And it kinda ties kind of

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into the the next question that I wanted

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to to pick your brains on. I think

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in terms of what we're seeing across the

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board in spine and orthopedics, some of the

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key trends that kinda play into that,

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we're seeing a a sharp rise in, it

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seems like, orthopedic,

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MSOs,

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management services organizations,

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increased private equity investment coming into the field.

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On the other hand, increased consolidation.

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Also, a ton of excitement in terms of

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what we see in spine technology, orthopedic technology,

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some of the key trends across the board

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here on on a broad level.

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But with some of these in mind, how

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do you see spine, orthopedics?

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How do you see the field evolving over

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the next two to three years? I'm curious

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to kinda get your thoughts there as of

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how you're looking at the future.

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Yeah.

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But the way I I, you know, in

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my perspective is it's it's like this pendulum

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swinging back and forth. Right? We used to

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have all these private practices, and then,

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basically,

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you know, the Affordable Care Act came in

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and,

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changed the landscape. Physician ownership became much increasingly

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rare from a hospital standpoint.

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And

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with insurances putting downward pressure on physician pay,

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you know, the and the the regulatory burden

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of, you know, documentation

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and

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everything else that was required kind of increasing,

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it, you know, it became overwhelming for physicians

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to manage all this. Right? We were trained

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to do

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patient care, to do medicine.

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Our our experience in business is lacking in

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that regard. And so you saw this pendulum

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swing where physicians were becoming hospital employed, like,

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we're joining large groups. Mhmm.

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I think what we have seen now decade

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plus into that kind of change

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is that these large groups have realized they're

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not great at managing subspecialists like spine surgeons.

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Right? And so

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I get the sense that we're kinda getting

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and and the surgeons are getting really frustrated.

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And and we have at the end of

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the day,

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we have the biggest

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card to play in this at this table,

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which is the power of the pen. Right?

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Nothing goes through the health care system pretty

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much without a physician order. And I think

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physicians forget that kind of power they wield

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in this

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in these,

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discussions, we'll call it.

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And so physicians are starting to increasingly pull

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away from these large health care, organizations.

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And,

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you know, right now, we're seeing this trend

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towards, as an alternative, you know, private equity

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involvement and maybe MSOs to try to diminish

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cost,

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with an economy of scale. At OrthoIndy, we're

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we're expanding. We're trying to we we think

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we have a good solution independently of those

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two options, and we're trying to become a

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larger brand around the state. But it's the

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same thing. We're trying to everybody's trying to

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increase economy of scale. So

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I I think that you're gonna kinda continue

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to see the pendulum swing in that direction.

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I I don't foresee private equity.

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I'd like to be wrong on this. I

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don't see them being a long term solution.

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I maybe I'm I'm gonna be proven wrong,

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but,

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you know, at the end of the day,

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those groups are primarily focused with,

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profitability.

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And I think the historic,

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perception of them is that they're gonna come

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in, they're gonna

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make an organization lean, and then the minute

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it's hitting its profit margins, they're gonna try

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to flip it and sell it. So,

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that might, I guess, benefit a group if

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they can buy it off the private equity

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firm maybe. But, I think for physicians,

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those are gonna be the trends we see

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moving forward over the next, you know,

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several years, five years plus.

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And I think that in that regard,

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if you can get and as a subspecialist,

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if you can get in control

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of your facility. Right? Because we we just

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talked about it a second ago. The facility

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reimbursements are doing well.

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Spine surgery getting pushed in the way that

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joints was before. It's it there we wanna

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ratchet down implant cost. You know, we're gonna

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push everybody to outpatient surgery. We wanna leverage

273
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things like

274
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minimally invasive endoscopy to get people

275
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kind of up and back to life faster.

276
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And so if you can get in on

277
00:10:01,705 --> 00:10:03,785
an, you know, a a you know, a

278
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an ASC,

279
00:10:05,465 --> 00:10:07,884
that's gonna be huge because there's a

280
00:10:08,470 --> 00:10:11,910
strong push from all sides, both physician, you

281
00:10:11,910 --> 00:10:13,049
know, large organizations

282
00:10:13,350 --> 00:10:13,850
to

283
00:10:14,230 --> 00:10:16,309
move spine surgery in that direction. The days

284
00:10:16,309 --> 00:10:17,910
of having a a surgery and staying a

285
00:10:17,910 --> 00:10:19,910
week in the hospital are gonna become increasingly

286
00:10:19,910 --> 00:10:22,490
rare outside of a really few special tertiary

287
00:10:22,629 --> 00:10:24,009
facilities in my opinion.

288
00:10:24,764 --> 00:10:27,245
Yeah. It's certainly interesting to see that trend

289
00:10:27,245 --> 00:10:29,325
developed. To your point earlier when we talked

290
00:10:29,325 --> 00:10:32,044
about the traditional spine surgery and how kind

291
00:10:32,044 --> 00:10:34,125
of morbid it used to be, what also

292
00:10:34,125 --> 00:10:36,225
wasn't that long ago when,

293
00:10:37,325 --> 00:10:39,725
spine patients or even total knee, total hip

294
00:10:39,725 --> 00:10:41,779
patients are staying two, three, four days in

295
00:10:41,779 --> 00:10:44,179
the hospital. Now to your point with the

296
00:10:44,179 --> 00:10:47,379
help of these minimally invasive surgical techniques, open

297
00:10:47,379 --> 00:10:49,940
ambulated, out the door in an hour, two

298
00:10:49,940 --> 00:10:52,259
hours. So currently, certainly interesting to see what

299
00:10:52,259 --> 00:10:54,500
happens to the traditional inpatient environment as it

300
00:10:54,500 --> 00:10:57,225
relates to spine surgery, orthopedic surgery, and some

301
00:10:57,225 --> 00:10:59,325
of those territory environments like you had mentioned.

302
00:11:00,585 --> 00:11:02,585
Doctor McBain, last question I have for you,

303
00:11:02,585 --> 00:11:04,205
and you kind of alluded to it earlier.

304
00:11:05,065 --> 00:11:07,544
Certainly interesting to see the the growth of

305
00:11:07,544 --> 00:11:11,139
OrthoIndy over the years. Really fascinating, interesting, it

306
00:11:11,139 --> 00:11:13,320
seems, maybe hub and spoke model there.

307
00:11:14,339 --> 00:11:15,639
Where are OrthoIndy's

308
00:11:16,179 --> 00:11:17,079
best opportunities

309
00:11:17,379 --> 00:11:20,039
for growth? To your point, is it, acquiring

310
00:11:20,100 --> 00:11:21,559
ASCs, building ASCs,

311
00:11:22,285 --> 00:11:24,924
partnering with more referrals, kind of, really expanding

312
00:11:24,924 --> 00:11:27,325
your footprint at that area, new physicians in

313
00:11:27,325 --> 00:11:29,165
the group? Kinda love to get your kinda

314
00:11:29,245 --> 00:11:31,004
the group's game plan and kinda how you're

315
00:11:31,004 --> 00:11:32,304
thinking about growth there.

316
00:11:32,684 --> 00:11:33,184
Sure.

317
00:11:34,365 --> 00:11:36,709
So like you said, we we, you know,

318
00:11:37,009 --> 00:11:38,449
individually, and I I would say to some

319
00:11:38,449 --> 00:11:39,889
degree as a group, I I'm not speaking

320
00:11:39,889 --> 00:11:40,769
for the group here, but,

321
00:11:41,569 --> 00:11:43,970
you know, we we recognize the value of

322
00:11:43,970 --> 00:11:46,529
ASCs and the expansion of ASCs, right, for

323
00:11:46,529 --> 00:11:48,629
all of orthopedics, not just spine surgery.

324
00:11:49,125 --> 00:11:51,205
And, you know, there's a there's a strong

325
00:11:51,205 --> 00:11:53,044
current out there, like I said, of these

326
00:11:53,044 --> 00:11:54,024
smaller practices

327
00:11:54,485 --> 00:11:57,285
feeling pressure, not being happy, or able to

328
00:11:57,285 --> 00:11:58,585
maybe manage the

329
00:11:59,044 --> 00:12:01,924
modern pressures of management. And we think that

330
00:12:01,924 --> 00:12:04,570
we've kind of developed a pretty good model

331
00:12:04,570 --> 00:12:07,769
in in Indianapolis here. And so the the

332
00:12:07,769 --> 00:12:09,389
idea is that maybe we're an alternative

333
00:12:09,850 --> 00:12:10,350
to

334
00:12:10,970 --> 00:12:13,049
all three of those previous options, right, to

335
00:12:13,049 --> 00:12:15,769
big health care organizations like, you know, the

336
00:12:15,769 --> 00:12:18,605
big, you you know, hospital chains that were

337
00:12:18,605 --> 00:12:20,704
were an alternative to MSOs or an alternative

338
00:12:20,764 --> 00:12:23,004
to PE. We can we can provide those

339
00:12:23,004 --> 00:12:27,084
services, but allow surgeons to maintain control and

340
00:12:27,084 --> 00:12:28,784
to guide the patient experience

341
00:12:29,500 --> 00:12:31,820
on a on a on a individual kinda

342
00:12:31,820 --> 00:12:33,120
hands on practice level.

343
00:12:33,820 --> 00:12:36,220
But we can also kinda, by pulling our

344
00:12:36,220 --> 00:12:38,700
resources, generate that economy of scale that lets

345
00:12:38,700 --> 00:12:39,360
us then,

346
00:12:39,740 --> 00:12:40,399
you know,

347
00:12:41,180 --> 00:12:43,840
manage these in rising costs and and,

348
00:12:44,315 --> 00:12:45,995
you know, manage these,

349
00:12:46,554 --> 00:12:48,475
overhead issues that we're all having. Because that's,

350
00:12:48,475 --> 00:12:49,214
like, the biggest

351
00:12:49,595 --> 00:12:51,514
barrier to growth. So, like, you know, you

352
00:12:51,514 --> 00:12:53,674
can try to expand, but, you know, we

353
00:12:53,674 --> 00:12:55,355
we don't want people to we don't want

354
00:12:55,355 --> 00:12:56,794
patients to go out there and have more

355
00:12:56,794 --> 00:12:59,250
problems to some degree. Right? Like, we don't

356
00:12:59,250 --> 00:13:00,370
want we don't want there to be more

357
00:13:00,370 --> 00:13:02,209
business. Instead, the the way that we can

358
00:13:02,209 --> 00:13:04,209
get growth is by diminishing our overhead and

359
00:13:04,209 --> 00:13:04,949
our cost.

360
00:13:05,329 --> 00:13:07,029
I I think that the way that

361
00:13:07,490 --> 00:13:07,990
OrthoIndy

362
00:13:08,370 --> 00:13:10,769
and other practices should look at this the

363
00:13:10,769 --> 00:13:13,350
most is the best opportunity for

364
00:13:13,914 --> 00:13:14,414
growth

365
00:13:15,115 --> 00:13:18,315
is data monetization. Right? So, like, we're all

366
00:13:18,315 --> 00:13:19,294
generating this

367
00:13:19,595 --> 00:13:21,134
impressive data. And

368
00:13:23,195 --> 00:13:23,695
with

369
00:13:24,315 --> 00:13:26,235
some of these AI tools that are available,

370
00:13:26,235 --> 00:13:27,855
we finally have a way of processing

371
00:13:28,235 --> 00:13:29,535
big data, right,

372
00:13:30,389 --> 00:13:32,789
which we never had, you know, ten plus

373
00:13:32,789 --> 00:13:33,509
years ago.

374
00:13:33,909 --> 00:13:36,070
And so if if you as a if

375
00:13:36,070 --> 00:13:38,470
we can, as a practice, figure out, okay,

376
00:13:38,470 --> 00:13:40,629
what's the most efficient pathway through our system

377
00:13:40,629 --> 00:13:42,629
that generates the best outcome for a patient?

378
00:13:42,629 --> 00:13:43,129
And,

379
00:13:43,544 --> 00:13:46,345
you know, with the implants that we're using

380
00:13:46,345 --> 00:13:48,424
and our utilization, you know, what what's the

381
00:13:48,424 --> 00:13:48,924
optimal

382
00:13:49,304 --> 00:13:51,784
construct or, you know, what's the optimal surgery

383
00:13:51,784 --> 00:13:53,704
to get the best outcome? Like, those are

384
00:13:53,704 --> 00:13:56,184
those data monetization questions that if we can

385
00:13:56,184 --> 00:13:57,004
start to

386
00:13:57,610 --> 00:14:00,009
capture that and act on it, that's gonna

387
00:14:00,009 --> 00:14:01,690
lead to the biggest growth changes. And I

388
00:14:01,690 --> 00:14:03,450
and I think, you know, we're doing that.

389
00:14:03,450 --> 00:14:05,450
We're we're we're we're working with, you know,

390
00:14:05,450 --> 00:14:07,769
an AI driven, basically, call center that kinda

391
00:14:07,769 --> 00:14:10,009
manages all of our scheduling now, and that's

392
00:14:10,009 --> 00:14:11,610
that's gonna make a boom. And we're starting

393
00:14:11,610 --> 00:14:12,990
to do that with some of our

394
00:14:13,304 --> 00:14:15,865
PRO data, like our outcomes data. We we

395
00:14:15,865 --> 00:14:17,245
have our own research foundation.

396
00:14:17,784 --> 00:14:20,044
We're gonna we're gonna turn this, you know,

397
00:14:20,985 --> 00:14:23,325
lens to implants here.

398
00:14:24,664 --> 00:14:26,985
And so I think that, as we figure

399
00:14:26,985 --> 00:14:28,205
out how we can

400
00:14:28,759 --> 00:14:30,460
diminish our costs going forward,

401
00:14:32,120 --> 00:14:34,360
that's how we can drive more volume towards

402
00:14:34,360 --> 00:14:37,820
us because patients will and the patients, payers,

403
00:14:38,440 --> 00:14:41,164
employers, right, direct employers, a whole another discussion

404
00:14:41,164 --> 00:14:42,865
we can go in a rabbit hole with.

405
00:14:43,004 --> 00:14:45,264
They'll all start to realize that, hey. OrthoIndy's,

406
00:14:46,204 --> 00:14:48,144
you know, approaching this from a patient

407
00:14:48,605 --> 00:14:51,024
centric, patient versus standpoint, and

408
00:14:51,404 --> 00:14:53,804
they're also forward thinking enough that they're trying

409
00:14:53,804 --> 00:14:55,904
to get ahead of these challenges. And,

410
00:14:56,370 --> 00:14:59,269
I I think we're we're that perfect size

411
00:14:59,970 --> 00:15:03,009
of mass, but nimbleness that we can make

412
00:15:03,009 --> 00:15:05,889
these changes rapidly, and, we're not burdened by

413
00:15:05,889 --> 00:15:06,389
bureaucracy.

414
00:15:07,649 --> 00:15:09,330
Yeah. No. And I and I guess I

415
00:15:09,330 --> 00:15:10,727
told a lie because you did bring up

416
00:15:10,727 --> 00:15:12,924
such an interesting point there as it relates

417
00:15:12,924 --> 00:15:13,824
to potential

418
00:15:14,444 --> 00:15:16,464
direct to employer contracting and whatnot.

419
00:15:16,845 --> 00:15:19,884
In my recent conversations with orthopedic groups across

420
00:15:19,884 --> 00:15:22,684
the country, it seems like, particularly around the

421
00:15:22,684 --> 00:15:24,865
size and scope of ortho window OrthoIndy,

422
00:15:25,309 --> 00:15:28,350
it seems like more independent orthopedic groups like

423
00:15:28,350 --> 00:15:31,250
yours are taking a harder look at potentially

424
00:15:31,309 --> 00:15:31,870
some of these,

425
00:15:32,589 --> 00:15:35,149
direct employer contracts. Is that something that's top

426
00:15:35,149 --> 00:15:36,209
of mind for Orthoindo,

427
00:15:37,070 --> 00:15:37,889
as you consider

428
00:15:38,254 --> 00:15:40,014
or tackle some of these headwinds? I'd love

429
00:15:40,014 --> 00:15:41,695
to kinda get your perspective there before I

430
00:15:41,695 --> 00:15:42,434
wrap up.

431
00:15:42,975 --> 00:15:43,475
Yeah.

432
00:15:44,174 --> 00:15:45,774
Dan, once again, this is like an individual

433
00:15:45,774 --> 00:15:46,274
perspective.

434
00:15:46,654 --> 00:15:48,334
I I don't speak for the group in

435
00:15:48,334 --> 00:15:50,014
this regard, but, you know, I I think

436
00:15:50,014 --> 00:15:52,975
it's it's one of those scenarios where, you

437
00:15:52,975 --> 00:15:55,200
know, if you're a large enough group that

438
00:15:55,200 --> 00:15:57,379
you can handle a large influx of volume

439
00:15:58,000 --> 00:16:00,639
and you have a geographic footprint that, you

440
00:16:00,639 --> 00:16:02,879
know, an employer with, you know, a bit

441
00:16:02,879 --> 00:16:05,540
of a geographic spread needs you know, has

442
00:16:05,920 --> 00:16:08,259
maybe, employees all over the place.

443
00:16:08,894 --> 00:16:09,875
And, you know,

444
00:16:10,415 --> 00:16:13,375
insurance companies are becoming you know, they're they're

445
00:16:13,375 --> 00:16:15,795
combative. They're they're they're challenging to,

446
00:16:16,175 --> 00:16:18,754
work with from as an individual physician standpoint.

447
00:16:18,894 --> 00:16:21,455
Right? They they cave to these big groups

448
00:16:21,455 --> 00:16:24,190
because of that old economy of scale discussion.

449
00:16:24,649 --> 00:16:26,730
Well, if you can offer a superior outcome

450
00:16:26,730 --> 00:16:27,789
and a, you know,

451
00:16:28,649 --> 00:16:30,269
a a superior patient experience,

452
00:16:31,610 --> 00:16:33,610
why can't you go to that employer and

453
00:16:33,610 --> 00:16:36,329
and, you know, maybe pass along some kind

454
00:16:36,329 --> 00:16:38,835
of savings to them, by offering that kind

455
00:16:38,835 --> 00:16:40,054
of direct employer

456
00:16:40,434 --> 00:16:40,934
negotiation

457
00:16:41,475 --> 00:16:42,934
for their for their employees.

458
00:16:43,554 --> 00:16:45,315
I mean, everybody wins then. Right? They're the

459
00:16:45,315 --> 00:16:47,235
the employer is saving money. The patients get

460
00:16:47,235 --> 00:16:48,134
a better experience.

461
00:16:49,875 --> 00:16:52,190
And, you know, the the reason why we're

462
00:16:52,190 --> 00:16:54,190
pushing that is because, hey, we don't have

463
00:16:54,190 --> 00:16:54,690
the

464
00:16:55,710 --> 00:16:58,610
the the the mass of of, negotiators to

465
00:16:58,909 --> 00:17:01,009
chase after, you know, a big,

466
00:17:01,629 --> 00:17:04,049
you know, national insurance company with. So,

467
00:17:04,589 --> 00:17:06,315
I I think that's something that, like, you

468
00:17:06,315 --> 00:17:07,534
know, is gonna become

469
00:17:08,634 --> 00:17:10,554
it's not something maybe as a solution for

470
00:17:10,554 --> 00:17:13,274
every group to pull off. But if you

471
00:17:13,274 --> 00:17:15,034
have a group that is of a certain

472
00:17:15,034 --> 00:17:15,534
size,

473
00:17:16,154 --> 00:17:17,914
you know, it's something that we can it

474
00:17:17,914 --> 00:17:20,359
definitely would be it's definitely on our radar,

475
00:17:20,359 --> 00:17:22,119
and I think it's becoming something that we're

476
00:17:22,119 --> 00:17:23,179
hearing this discussion

477
00:17:23,799 --> 00:17:26,299
occur around the country more and more frequently.

478
00:17:27,159 --> 00:17:29,480
Yeah. No. Fascinating to get your perspectives there.

479
00:17:29,480 --> 00:17:31,399
And I know indeed speaking from for yourself,

480
00:17:31,399 --> 00:17:33,079
a member member of the group, but not

481
00:17:33,079 --> 00:17:33,720
for the group, I really appreciate your perspectives.

482
00:17:35,215 --> 00:17:35,615
Perspectives.

483
00:17:36,095 --> 00:17:38,174
Doctor McMains, so great to have you back

484
00:17:38,174 --> 00:17:38,914
on the podcast.

485
00:17:39,455 --> 00:17:41,855
Really, really enjoyed this conversation, and I look

486
00:17:41,855 --> 00:17:43,215
forward to speaking with you again down the

487
00:17:43,215 --> 00:17:43,715
line.

488
00:17:44,255 --> 00:17:46,035
Really appreciate it. Thank you so much.