1
00:00:00,000 --> 00:00:02,240
Hi, everyone. This is Brian Zimmerman with Becker's

2
00:00:02,240 --> 00:00:04,240
Healthcare. Thank you so much for tuning in

3
00:00:04,240 --> 00:00:05,859
to the Becker's Healthcare podcast.

4
00:00:06,480 --> 00:00:08,900
Today, we're going to talk about clinical excellence,

5
00:00:09,039 --> 00:00:12,259
economic value, and operational support in the ASC.

6
00:00:12,884 --> 00:00:15,205
Joining me for this discussion is doctor Robert

7
00:00:15,205 --> 00:00:15,705
Maley.

8
00:00:16,005 --> 00:00:18,744
Doctor Maley is a fellowship trained, board certified

9
00:00:18,885 --> 00:00:21,925
orthopedic surgeon who specializes in hip and knee

10
00:00:21,925 --> 00:00:24,345
replacement and practices out of California

11
00:00:24,725 --> 00:00:25,785
Pacific Orthopedics.

12
00:00:26,324 --> 00:00:27,765
Doctor Maley, thank you so much for being

13
00:00:27,765 --> 00:00:28,505
here today.

14
00:00:28,920 --> 00:00:29,660
Thanks for having

15
00:00:30,280 --> 00:00:32,679
me. So so let's start by, I guess,

16
00:00:32,679 --> 00:00:33,960
getting to know you a little bit more.

17
00:00:33,960 --> 00:00:35,240
Can you can you share a little bit

18
00:00:35,240 --> 00:00:36,920
more details than what I did there about

19
00:00:36,920 --> 00:00:39,079
about your professional background and the work you're

20
00:00:39,079 --> 00:00:39,579
doing?

21
00:00:39,960 --> 00:00:41,159
Yeah. So I grew up in the Bay

22
00:00:41,159 --> 00:00:42,914
Area and and was fortunate to find a

23
00:00:42,914 --> 00:00:44,134
job in San Francisco

24
00:00:44,674 --> 00:00:46,914
coming out of fellowship. I did my residency

25
00:00:46,914 --> 00:00:47,975
at Stanford and,

26
00:00:48,435 --> 00:00:50,354
fellowship in hip and knee replacement at Rush

27
00:00:50,354 --> 00:00:53,075
in Chicago. And at Rush, in particular, I

28
00:00:53,075 --> 00:00:55,929
learned a lot of then, newer techniques for

29
00:00:55,929 --> 00:00:57,149
less invasive surgery,

30
00:00:58,009 --> 00:01:00,989
outpatient surgery, in addition to revision surgery. So

31
00:01:01,210 --> 00:01:02,489
coming into the Bay Area, I was really

32
00:01:02,489 --> 00:01:04,090
kind of eager to apply what I had

33
00:01:04,090 --> 00:01:04,590
learned

34
00:01:05,530 --> 00:01:06,030
and,

35
00:01:06,649 --> 00:01:09,825
unfortunately, part of a big group. There's about

36
00:01:09,905 --> 00:01:10,805
15 of us.

37
00:01:11,744 --> 00:01:12,484
Great partners,

38
00:01:12,944 --> 00:01:16,004
but total joint replacement in the outpatient setting,

39
00:01:16,224 --> 00:01:17,584
you know, was a new thing in San

40
00:01:17,584 --> 00:01:19,984
Francisco when I came into practice about thirteen

41
00:01:19,984 --> 00:01:20,724
years ago.

42
00:01:21,265 --> 00:01:23,685
So, yeah, I've had a very unique journey,

43
00:01:24,250 --> 00:01:26,569
developing our program at our surgery center. I

44
00:01:26,569 --> 00:01:28,090
feel like I've learned a lot along the

45
00:01:28,090 --> 00:01:28,590
way.

46
00:01:29,209 --> 00:01:31,950
Our group services San Francisco and Marin County,

47
00:01:32,569 --> 00:01:33,769
so we see a lot of patients from

48
00:01:33,769 --> 00:01:36,329
the Bay Area. We see, you know, very

49
00:01:36,329 --> 00:01:36,829
young

50
00:01:37,234 --> 00:01:38,994
active athletic, you know, patients that have worn

51
00:01:38,994 --> 00:01:40,834
out their joints to the middle aged and

52
00:01:40,834 --> 00:01:43,415
even the the older folks. So we practice,

53
00:01:43,795 --> 00:01:45,715
you know, both at a hospital setting as

54
00:01:45,715 --> 00:01:47,254
well as an ASC setting.

55
00:01:48,194 --> 00:01:50,754
Excellent. Appreciate the background. And I'm I'm sitting

56
00:01:50,754 --> 00:01:52,594
in front of a microphone here in Chicago,

57
00:01:52,594 --> 00:01:55,170
so certainly have a bias for for for

58
00:01:55,170 --> 00:01:57,329
your your education that you what you what

59
00:01:57,329 --> 00:01:58,709
you did and what you learned,

60
00:01:59,170 --> 00:02:01,329
at Rush. So appreciate that that piece of

61
00:02:01,329 --> 00:02:02,549
the background as well.

62
00:02:03,170 --> 00:02:03,890
You have,

63
00:02:06,284 --> 00:02:06,784
you

64
00:02:07,645 --> 00:02:08,004
have, a a a reputation, a pension, I'd

65
00:02:08,004 --> 00:02:09,885
say, I guess, for for pioneer pioneering new

66
00:02:09,885 --> 00:02:12,064
technologies within the ASC space.

67
00:02:12,605 --> 00:02:14,605
With so many new technologies hitting the market,

68
00:02:14,605 --> 00:02:16,284
how do you decipher which ones you want

69
00:02:16,284 --> 00:02:16,865
to trial?

70
00:02:17,405 --> 00:02:19,324
That's a great question. You know, whenever something's

71
00:02:19,324 --> 00:02:20,764
presented to you, you have to take into

72
00:02:20,764 --> 00:02:21,264
account,

73
00:02:21,780 --> 00:02:23,300
what could be helpful and what might just

74
00:02:23,300 --> 00:02:25,860
be noise. During my journey of trying to

75
00:02:25,860 --> 00:02:28,099
transition cases to the outpatient setting, I was

76
00:02:28,099 --> 00:02:29,379
trying to look and see what we actually

77
00:02:29,379 --> 00:02:30,120
really needed.

78
00:02:30,819 --> 00:02:33,379
Our surgery center, which is Presidio Surgery Center

79
00:02:33,379 --> 00:02:35,735
in San Francisco, is a multi specialty center.

80
00:02:36,435 --> 00:02:37,254
So you have

81
00:02:37,555 --> 00:02:40,675
general surgeons, ENT, orthopedic surgeons, spine surgeons, all

82
00:02:40,675 --> 00:02:42,135
practicing at one facility.

83
00:02:42,594 --> 00:02:44,355
So when we started our total joint program

84
00:02:44,355 --> 00:02:46,675
about ten years ago, we were looking for

85
00:02:46,675 --> 00:02:48,449
different efficiencies that could help

86
00:02:49,009 --> 00:02:51,090
us not only start the program, you know,

87
00:02:51,090 --> 00:02:53,969
but also save us in terms of trying

88
00:02:53,969 --> 00:02:56,370
to navigate bringing a whole new service line

89
00:02:56,370 --> 00:02:59,409
to an already busy center. So when presented

90
00:02:59,409 --> 00:03:00,229
with new technologies,

91
00:03:00,544 --> 00:03:02,245
oftentimes we're looking to

92
00:03:02,544 --> 00:03:04,544
we were looking to solve a problem and

93
00:03:04,544 --> 00:03:06,944
fortunately somebody came up with one and and

94
00:03:06,944 --> 00:03:09,425
presented it to us. And as as we

95
00:03:09,425 --> 00:03:11,104
began our journey, as we got going, there

96
00:03:11,104 --> 00:03:12,864
were things that that came along the way

97
00:03:12,864 --> 00:03:14,944
that we realized, you know, operating on younger

98
00:03:14,944 --> 00:03:15,444
patients,

99
00:03:16,110 --> 00:03:17,330
with better bone quality

100
00:03:17,709 --> 00:03:18,610
just required

101
00:03:19,150 --> 00:03:21,229
the use of tools that we didn't have.

102
00:03:21,229 --> 00:03:21,889
And so,

103
00:03:22,189 --> 00:03:24,669
as we started to see, tools like Concise

104
00:03:24,669 --> 00:03:27,389
come along, we were introduced to efficiencies and

105
00:03:27,389 --> 00:03:29,275
technologies that were,

106
00:03:29,675 --> 00:03:32,794
greatly needed in our space. So, you know,

107
00:03:32,794 --> 00:03:35,194
anytime a new tech comes up, you know,

108
00:03:35,194 --> 00:03:36,635
I'm eager to at least look at it,

109
00:03:36,635 --> 00:03:38,395
evaluate it, and see if there can be

110
00:03:38,395 --> 00:03:40,314
something that we can apply for usage in

111
00:03:40,314 --> 00:03:40,974
our center.

112
00:03:41,810 --> 00:03:44,129
Yeah. And it sounds like based on your

113
00:03:44,129 --> 00:03:45,030
response there,

114
00:03:45,330 --> 00:03:47,250
the the technology has to be solving for

115
00:03:47,250 --> 00:03:49,590
something. Correct? There's gotta be a problem present.

116
00:03:50,449 --> 00:03:52,310
Exactly. Yeah. Yeah.

117
00:03:53,409 --> 00:03:54,849
I wanna get to sort of a quote

118
00:03:54,849 --> 00:03:56,324
that we hear from time to time when

119
00:03:56,405 --> 00:03:58,104
talking to to leaders in this space is,

120
00:03:58,485 --> 00:04:00,084
you know, if you can't measure it, then

121
00:04:00,084 --> 00:04:02,724
you can't manage it. How does this, I

122
00:04:02,724 --> 00:04:04,405
I guess, relate to you? Are there any

123
00:04:04,405 --> 00:04:06,805
particular technologies that that come to mind that

124
00:04:06,805 --> 00:04:08,564
you and your center are currently using to

125
00:04:08,564 --> 00:04:09,864
to measure and manage?

126
00:04:10,990 --> 00:04:13,069
Yes. So the we're doing total hip and

127
00:04:13,069 --> 00:04:13,969
total knee replacements.

128
00:04:14,270 --> 00:04:15,870
When we started our total joint program, you

129
00:04:15,870 --> 00:04:17,389
know, ten years ago, now we do shoulders

130
00:04:17,389 --> 00:04:19,470
and elbows. I have partners that do shoulders

131
00:04:19,470 --> 00:04:21,709
and elbows. But in the very beginning, one

132
00:04:21,709 --> 00:04:24,910
of our struggles was inventory. So we were

133
00:04:24,910 --> 00:04:26,935
having a conflict of

134
00:04:27,314 --> 00:04:28,935
booking six cases, trying

135
00:04:29,474 --> 00:04:31,414
to manage the inventory for those cases,

136
00:04:31,954 --> 00:04:34,115
and the reps were bringing in, you know,

137
00:04:34,115 --> 00:04:37,235
six trays, you know, actually more than six

138
00:04:37,235 --> 00:04:38,759
sets of trays for every case because we

139
00:04:38,759 --> 00:04:40,839
were at that time, this is before Actus

140
00:04:40,839 --> 00:04:41,899
came out. So we

141
00:04:42,279 --> 00:04:44,360
were ordering Karai, but then we'd have a

142
00:04:44,360 --> 00:04:47,259
Summit on backup. And so the inventory grew

143
00:04:47,319 --> 00:04:49,160
exponentially. And in San Francisco, we don't have

144
00:04:49,160 --> 00:04:50,600
a lot of real estate and we were

145
00:04:50,600 --> 00:04:53,185
trying to manage all this inventory. So,

146
00:04:53,524 --> 00:04:55,285
one of the original technologies that I was

147
00:04:55,285 --> 00:04:57,225
introduced was advanced case management.

148
00:04:57,685 --> 00:05:00,004
It's a partnership between DoxSpera and J and

149
00:05:00,004 --> 00:05:00,664
J Medtech.

150
00:05:00,964 --> 00:05:02,084
And one of the things that they were

151
00:05:02,084 --> 00:05:04,669
able to measure was on the preoperative templating

152
00:05:04,669 --> 00:05:06,889
side, you know, to get an idea of,

153
00:05:06,949 --> 00:05:08,490
you know, the patient's age

154
00:05:09,029 --> 00:05:10,330
and the, templated

155
00:05:11,029 --> 00:05:12,629
side so that we had a better idea

156
00:05:12,629 --> 00:05:13,830
of what to expect.

157
00:05:14,310 --> 00:05:15,430
That was the first time that we were

158
00:05:15,430 --> 00:05:16,490
able to really truly

159
00:05:16,824 --> 00:05:17,324
quantitate

160
00:05:17,785 --> 00:05:19,785
our needs in terms of what sizes are

161
00:05:19,785 --> 00:05:21,625
we going to need, what inventory do we

162
00:05:21,625 --> 00:05:22,125
need.

163
00:05:22,425 --> 00:05:24,524
That was roughly around 2018

164
00:05:24,585 --> 00:05:27,064
and soon thereafter we started using Actus. So

165
00:05:27,064 --> 00:05:29,725
the combination of both ACM and Actus

166
00:05:30,105 --> 00:05:32,860
cut back dramatically on the number of boxes

167
00:05:32,860 --> 00:05:35,500
of stems and cups that were sent, to

168
00:05:35,500 --> 00:05:37,600
the center, you know, for a surgical day.

169
00:05:38,060 --> 00:05:40,540
Fast forward to, you know, ten years later,

170
00:05:40,540 --> 00:05:42,620
you know, now we are, like most centers,

171
00:05:42,620 --> 00:05:45,100
obsessed with time and efficiency in trying to

172
00:05:45,100 --> 00:05:46,699
manage, you know, the different,

173
00:05:47,180 --> 00:05:48,754
throughputs of the center.

174
00:05:50,254 --> 00:05:52,334
And constantly, we're looking at different types of

175
00:05:52,334 --> 00:05:52,834
technologies

176
00:05:53,935 --> 00:05:55,954
to record our day and to see

177
00:05:56,334 --> 00:05:57,935
where we are efficient and where we could

178
00:05:57,935 --> 00:06:00,675
be more efficient. Another technology that was presented

179
00:06:00,939 --> 00:06:03,980
by my DePuy sales representative was the DEO

180
00:06:03,980 --> 00:06:04,480
solution.

181
00:06:05,100 --> 00:06:06,459
And I'm not sure if you're familiar with

182
00:06:06,459 --> 00:06:07,920
that one, but that's one where

183
00:06:08,540 --> 00:06:10,779
a cell phone is anchored in the corner

184
00:06:10,779 --> 00:06:11,439
of the room.

185
00:06:11,899 --> 00:06:12,399
And

186
00:06:13,100 --> 00:06:16,079
through their proprietary technology, they're able to record

187
00:06:16,300 --> 00:06:18,274
the work flow during a surgery and in

188
00:06:18,274 --> 00:06:19,095
between turnover.

189
00:06:19,555 --> 00:06:20,834
And what they can do is they can,

190
00:06:21,314 --> 00:06:23,154
this is video recording and then they translate

191
00:06:23,154 --> 00:06:25,154
to, you know, a table that actually graphs

192
00:06:25,154 --> 00:06:27,634
time. So you can track what different team

193
00:06:27,634 --> 00:06:28,615
members are doing

194
00:06:28,939 --> 00:06:30,539
and what the surgeon is or is not

195
00:06:30,539 --> 00:06:32,860
doing during a case and in between cases.

196
00:06:32,860 --> 00:06:33,819
So we were able to see what our

197
00:06:33,819 --> 00:06:36,860
turnover time was, what our time efficiency was

198
00:06:36,860 --> 00:06:39,819
from wheels in to cut, to close, to

199
00:06:39,819 --> 00:06:40,639
wheels out.

200
00:06:41,074 --> 00:06:42,915
And so I think that technology gave us

201
00:06:42,915 --> 00:06:44,834
great insight into where we could be more

202
00:06:44,834 --> 00:06:46,375
efficient. And they were able to identify

203
00:06:47,235 --> 00:06:50,194
things as granular as this one assistant tends

204
00:06:50,194 --> 00:06:51,415
to take a lot longer

205
00:06:51,875 --> 00:06:53,014
in closing the wound.

206
00:06:53,634 --> 00:06:54,979
So we were able to then help you

207
00:06:54,979 --> 00:06:55,800
know, our teammates,

208
00:06:56,100 --> 00:06:57,300
you know, point out where we could be

209
00:06:57,300 --> 00:06:59,300
more efficient. And by doing that, you know,

210
00:06:59,300 --> 00:07:01,699
now you see your case numbers improve because

211
00:07:01,699 --> 00:07:03,459
you're able to do more cases in in,

212
00:07:03,459 --> 00:07:05,079
you know, the same amount of time.

213
00:07:06,180 --> 00:07:08,740
That that that's really fascinating. Appreciate the background

214
00:07:08,740 --> 00:07:10,259
on the technology. Can you share a little

215
00:07:10,259 --> 00:07:12,394
bit I mean, because that's just gotta I

216
00:07:12,394 --> 00:07:15,194
I would imagine for for for someone who's

217
00:07:15,194 --> 00:07:16,875
been doing this a while, that's just gotta

218
00:07:16,875 --> 00:07:19,194
be such a new unlocking some new potentials

219
00:07:19,194 --> 00:07:21,675
there. Can you just share, I guess, personally,

220
00:07:21,675 --> 00:07:23,274
what that experience has been like for you

221
00:07:23,274 --> 00:07:25,290
in terms of the time savings? And also,

222
00:07:25,770 --> 00:07:27,790
any tips in terms of how you communicate,

223
00:07:28,730 --> 00:07:31,210
you you know, like, using this data, putting

224
00:07:31,210 --> 00:07:33,050
it into play? Because I imagine there there

225
00:07:33,050 --> 00:07:33,949
could be some hesitancy.

226
00:07:34,330 --> 00:07:35,770
Did that come up at all? Anything you

227
00:07:35,770 --> 00:07:36,589
can share there?

228
00:07:37,210 --> 00:07:40,495
Yeah. Absolutely. I think the open collaboration with

229
00:07:40,495 --> 00:07:42,975
everybody in your facility, whether it's a hospital

230
00:07:42,975 --> 00:07:43,955
or an ASC,

231
00:07:44,415 --> 00:07:46,335
is crucial. So, we one of the first

232
00:07:46,335 --> 00:07:47,855
things that we did was we created a

233
00:07:47,855 --> 00:07:50,495
total joints team, and that consisted of our

234
00:07:50,495 --> 00:07:50,995
administrator,

235
00:07:52,039 --> 00:07:53,819
our Medical Director who is an anesthesiologist,

236
00:07:54,439 --> 00:07:54,939
myself

237
00:07:55,560 --> 00:07:58,120
and then a data collections person as well

238
00:07:58,120 --> 00:07:59,100
as our

239
00:07:59,479 --> 00:08:01,879
lead nurse on the Total Joint team. And

240
00:08:01,879 --> 00:08:04,039
we meet monthly. We have met monthly for

241
00:08:04,039 --> 00:08:06,585
ten years, you know, and at each meeting

242
00:08:06,585 --> 00:08:08,764
try to be open and honest with our

243
00:08:08,904 --> 00:08:10,425
feedback on what's going right and what's going

244
00:08:10,425 --> 00:08:11,884
wrong with the program. We review

245
00:08:12,264 --> 00:08:14,045
outcomes data, we review complications,

246
00:08:14,665 --> 00:08:15,964
we review new technologies,

247
00:08:16,745 --> 00:08:18,585
and see or try to see where we

248
00:08:18,585 --> 00:08:19,805
could become more efficient,

249
00:08:20,430 --> 00:08:21,870
and what we can do to optimize the

250
00:08:21,870 --> 00:08:22,370
program.

251
00:08:22,830 --> 00:08:25,069
I think the the biggest thing there is

252
00:08:25,069 --> 00:08:25,810
to have

253
00:08:26,110 --> 00:08:28,750
a team that feels that they can speak

254
00:08:28,750 --> 00:08:29,250
honestly,

255
00:08:30,110 --> 00:08:30,930
that can,

256
00:08:31,470 --> 00:08:32,929
present constructive criticism

257
00:08:33,470 --> 00:08:34,289
to the anesthesiologist.

258
00:08:34,669 --> 00:08:37,044
You're taking too long on doing spinals or

259
00:08:37,044 --> 00:08:39,365
blocks. To the surgeon, you're taking too long

260
00:08:39,365 --> 00:08:41,284
to, you know, do this. Is there something

261
00:08:41,284 --> 00:08:42,985
that you could do quicker because doctor

262
00:08:43,365 --> 00:08:45,324
a does it faster than you do? So

263
00:08:45,324 --> 00:08:48,424
I think open communication is is the key

264
00:08:48,485 --> 00:08:48,985
to

265
00:08:49,629 --> 00:08:51,870
having the honest dialogues that will improve your

266
00:08:51,870 --> 00:08:52,370
efficiencies

267
00:08:52,990 --> 00:08:54,750
along the way. But you're right, I mean,

268
00:08:54,750 --> 00:08:57,009
having these technologies that come up and

269
00:08:57,309 --> 00:08:58,449
being able to see

270
00:08:59,309 --> 00:09:01,549
what your day looks like on a step

271
00:09:01,549 --> 00:09:04,289
by step printout is very impressive.

272
00:09:06,004 --> 00:09:08,004
I imagine so. And struck by your comments

273
00:09:08,004 --> 00:09:09,384
there too around like sort of,

274
00:09:09,845 --> 00:09:11,924
you know, really maximizing the use of the

275
00:09:11,924 --> 00:09:15,125
technology requires this culture of transparency that you've

276
00:09:15,125 --> 00:09:16,184
built over time.

277
00:09:16,884 --> 00:09:19,045
Thinking about that, that culture of transparency, it

278
00:09:19,045 --> 00:09:20,220
seems like your team is

279
00:09:21,179 --> 00:09:23,439
very well positioned to adapt new technologies.

280
00:09:23,819 --> 00:09:25,740
Are there anything else that that that you're

281
00:09:25,740 --> 00:09:27,179
working on in this space in terms of

282
00:09:27,179 --> 00:09:28,879
bringing in technologies to,

283
00:09:29,179 --> 00:09:31,179
to to support different things in the ASC?

284
00:09:31,179 --> 00:09:32,939
Are are you what what else are you

285
00:09:32,939 --> 00:09:34,079
finding value in?

286
00:09:34,699 --> 00:09:35,985
I I mean, several things. So,

287
00:09:36,625 --> 00:09:37,985
I don't want to get into the weeds

288
00:09:37,985 --> 00:09:40,384
of some of the other stuff that we

289
00:09:40,384 --> 00:09:42,464
do in orthopedics because we have partners that

290
00:09:42,464 --> 00:09:44,944
are great in total shoulders and spine and

291
00:09:44,944 --> 00:09:47,365
whatnot. So focusing mostly on hip and knee,

292
00:09:47,960 --> 00:09:50,200
anytime a new tech comes in, especially being

293
00:09:50,200 --> 00:09:53,080
in San Francisco where technology is very common

294
00:09:53,080 --> 00:09:56,279
and patients have a patients are well read,

295
00:09:56,279 --> 00:09:57,899
they are well informed, they understand

296
00:09:58,279 --> 00:10:00,039
what's in the marketplace and what the marketplace

297
00:10:00,039 --> 00:10:02,415
has to offer. So I think us being

298
00:10:02,715 --> 00:10:03,695
willing to

299
00:10:04,154 --> 00:10:05,754
at least evaluate something to see if it's

300
00:10:05,754 --> 00:10:06,735
going to be a potential

301
00:10:07,115 --> 00:10:09,754
benefit to our practice, our center, our patients

302
00:10:09,754 --> 00:10:11,215
is very important.

303
00:10:12,634 --> 00:10:13,535
And I think

304
00:10:14,154 --> 00:10:15,455
our most recent

305
00:10:15,915 --> 00:10:18,090
focus has been our expansion.

306
00:10:18,950 --> 00:10:20,230
I mentioned that we were, you know, a

307
00:10:20,230 --> 00:10:22,549
multi specialty center. We had five we have

308
00:10:22,549 --> 00:10:24,710
five operating rooms, but we found that as

309
00:10:24,710 --> 00:10:26,789
our total joint program grew, we were running

310
00:10:26,789 --> 00:10:28,230
out of space. So we opened up two

311
00:10:28,230 --> 00:10:29,210
brand new ORs

312
00:10:29,750 --> 00:10:32,409
on another floor in our surgery center.

313
00:10:33,144 --> 00:10:35,464
So our current, you know, project is trying

314
00:10:35,464 --> 00:10:36,445
to manage

315
00:10:37,065 --> 00:10:39,865
manage this and trying to truly become a

316
00:10:39,865 --> 00:10:40,605
high efficiency,

317
00:10:41,784 --> 00:10:43,565
center for total joint replacement.

318
00:10:44,424 --> 00:10:46,184
So one of the most recent projects that

319
00:10:46,184 --> 00:10:48,759
we're taking on is is tracking, you know,

320
00:10:48,759 --> 00:10:50,620
tracking where people are in the workflow

321
00:10:51,080 --> 00:10:53,000
of a day of surgery. So where the

322
00:10:53,000 --> 00:10:54,600
patient is, how much time they're spending in

323
00:10:54,600 --> 00:10:55,960
pre op, how much time they're in the

324
00:10:55,960 --> 00:10:58,040
Operating Room, how much time they're in PACU

325
00:10:58,040 --> 00:10:58,779
before discharge.

326
00:10:59,559 --> 00:11:02,315
Same thing goes for anesthesia and the surgeon

327
00:11:02,315 --> 00:11:03,534
and the surgical team,

328
00:11:04,154 --> 00:11:04,815
and then

329
00:11:05,195 --> 00:11:06,414
our turnover teams.

330
00:11:06,794 --> 00:11:08,254
That's our current focus.

331
00:11:09,115 --> 00:11:11,595
Excellent. I appreciate that background. You've shared so

332
00:11:11,595 --> 00:11:12,629
many sort of really,

333
00:11:13,110 --> 00:11:15,669
you know, tangible details about how you're how

334
00:11:15,669 --> 00:11:17,990
you're operating with this technology in your practice,

335
00:11:17,990 --> 00:11:20,070
but zooming out here. And I don't know

336
00:11:20,070 --> 00:11:21,509
if this is news to you. You you're

337
00:11:21,509 --> 00:11:23,929
probably aware, but, you do have a reputation

338
00:11:23,990 --> 00:11:25,365
as a as a thought thought leader in

339
00:11:25,365 --> 00:11:26,105
this industry.

340
00:11:26,565 --> 00:11:28,884
So curious to close out here. I would

341
00:11:28,884 --> 00:11:30,404
I would love to you just, I guess,

342
00:11:30,404 --> 00:11:32,085
hear your reactions to that. How do you

343
00:11:32,085 --> 00:11:33,845
take that? Or or what ways, I guess,

344
00:11:33,845 --> 00:11:35,285
do you try to lean into that, give

345
00:11:35,285 --> 00:11:36,264
back to the community,

346
00:11:36,725 --> 00:11:39,285
or or share your your expertise with other

347
00:11:39,285 --> 00:11:39,785
colleagues?

348
00:11:41,000 --> 00:11:43,259
I mean, I'm very flattered by that statement.

349
00:11:43,799 --> 00:11:45,480
You know, you come into practice and you

350
00:11:45,480 --> 00:11:45,980
think

351
00:11:46,279 --> 00:11:48,360
you're trying to basically stand on the shoulders

352
00:11:48,360 --> 00:11:50,440
of giants so that trained you, right, and

353
00:11:50,440 --> 00:11:52,360
trying to apply what they have taught you

354
00:11:52,360 --> 00:11:54,759
and then bring it into practice. And outpatient

355
00:11:54,759 --> 00:11:56,059
surgery is not new.

356
00:11:56,465 --> 00:11:58,465
We've learned from doctor Berger, you know, how

357
00:11:58,465 --> 00:12:00,544
to how to successfully do a total joint

358
00:12:00,544 --> 00:12:02,065
replacement and send a patient home the same

359
00:12:02,065 --> 00:12:04,384
day. But it was coming into practice into

360
00:12:04,384 --> 00:12:06,225
an area that was not doing that, that

361
00:12:06,225 --> 00:12:07,445
was eye opening because,

362
00:12:08,225 --> 00:12:10,384
again, I have fantastic partners that are that

363
00:12:10,384 --> 00:12:12,870
are excellent surgeons. But, patients were staying in

364
00:12:12,870 --> 00:12:14,070
the hospital for two to three days and

365
00:12:14,070 --> 00:12:15,909
then being sent to skilled nursing sixty percent

366
00:12:15,909 --> 00:12:18,470
of the time. And so trying to change

367
00:12:18,470 --> 00:12:19,209
that needle,

368
00:12:19,829 --> 00:12:22,149
that's where it was a bit of a

369
00:12:22,149 --> 00:12:24,345
struggle in the beginning. And I think being

370
00:12:24,345 --> 00:12:25,664
one of the first ones at our center

371
00:12:25,664 --> 00:12:28,225
to do outpatient joints with the support of

372
00:12:28,225 --> 00:12:30,485
the administrator and our hospital partner

373
00:12:30,865 --> 00:12:33,584
was critical because that really enabled and empowered

374
00:12:33,584 --> 00:12:35,504
me to try to look for the things

375
00:12:35,504 --> 00:12:38,245
that can help us move our needle. And

376
00:12:38,740 --> 00:12:40,660
to be honest, we started off small. And

377
00:12:40,660 --> 00:12:42,660
if you look at our ten year track

378
00:12:42,660 --> 00:12:44,120
record, you'll see that it's an exponential

379
00:12:44,660 --> 00:12:46,500
improvement in terms of numbers of cases done

380
00:12:46,500 --> 00:12:49,080
per year. And it's because at each

381
00:12:49,779 --> 00:12:51,779
point over the years, we were able to

382
00:12:51,779 --> 00:12:53,044
get become better. We

383
00:12:53,345 --> 00:12:54,404
were able to,

384
00:12:54,865 --> 00:12:56,625
A, prove that it worked, B, show that

385
00:12:56,625 --> 00:12:57,524
it was safe

386
00:12:58,304 --> 00:12:59,044
and then

387
00:12:59,345 --> 00:13:00,245
work on

388
00:13:00,945 --> 00:13:03,184
with industry and our industry partners on the

389
00:13:03,184 --> 00:13:04,784
different technologies. I mean, I can tell you

390
00:13:04,784 --> 00:13:06,839
2018 was a major inflection point in the

391
00:13:06,839 --> 00:13:08,519
number of cases that we were able to

392
00:13:08,519 --> 00:13:09,019
do

393
00:13:09,480 --> 00:13:11,899
because we had three technologies that came in

394
00:13:12,279 --> 00:13:13,879
all at once. We had ACM that was

395
00:13:13,879 --> 00:13:16,940
helping us plan and stock our inventory. We

396
00:13:17,480 --> 00:13:18,539
adapted Concise

397
00:13:18,919 --> 00:13:20,220
during that time and envelosibnab.

398
00:13:21,324 --> 00:13:23,324
And so in the ASC patients, as you

399
00:13:23,324 --> 00:13:24,684
are probably well aware, these are going to

400
00:13:24,684 --> 00:13:26,784
be your younger patients for the most part

401
00:13:27,084 --> 00:13:29,404
that are going to have increased expectations, higher

402
00:13:29,404 --> 00:13:30,865
demands, better bone quality.

403
00:13:31,245 --> 00:13:33,404
And so being able to template and to

404
00:13:33,404 --> 00:13:35,584
accurately execute your plan

405
00:13:36,204 --> 00:13:36,704
without

406
00:13:37,210 --> 00:13:38,669
destroying your body trying

407
00:13:39,129 --> 00:13:41,309
to broach the femur and pack the socket,

408
00:13:41,529 --> 00:13:44,250
you know, became very important for us. You

409
00:13:44,250 --> 00:13:46,409
know, now as the programs have matured, you

410
00:13:46,409 --> 00:13:48,409
know, we lean on technology once again. We're

411
00:13:48,409 --> 00:13:51,335
using the Velas robot for total knee replacements.

412
00:13:51,335 --> 00:13:53,735
We're seeing our COO scores jump up five

413
00:13:53,735 --> 00:13:55,414
points compared to where they were prior to

414
00:13:55,414 --> 00:13:56,475
the use of the robot.

415
00:13:56,855 --> 00:13:58,855
It is driving patients to us. We don't

416
00:13:58,855 --> 00:14:00,714
advertise that we have a robot. We don't

417
00:14:00,855 --> 00:14:03,009
try to to sell anything on that. Right?

418
00:14:03,009 --> 00:14:03,669
We just

419
00:14:04,049 --> 00:14:06,449
try to execute the appropriate surgical plan for

420
00:14:06,449 --> 00:14:08,470
a patient and provide them the best outcome.

421
00:14:08,610 --> 00:14:10,049
If we can do that, then patients are

422
00:14:10,049 --> 00:14:12,289
going to be your microphone. They're going to

423
00:14:12,289 --> 00:14:14,769
drive patients to you because their outcomes are

424
00:14:14,769 --> 00:14:15,409
better. So,

425
00:14:16,504 --> 00:14:18,184
I think it's been an evolution to your

426
00:14:18,184 --> 00:14:20,584
point. It's been ten years and that we've

427
00:14:20,584 --> 00:14:22,524
been doing it specifically there and

428
00:14:22,904 --> 00:14:24,024
I'd like to think we were kind of

429
00:14:24,024 --> 00:14:25,325
on the front end of the curve.

430
00:14:26,105 --> 00:14:28,504
And maybe that's why I get to have

431
00:14:28,504 --> 00:14:30,105
these conversations with people like you, right, where

432
00:14:30,105 --> 00:14:31,909
we're talking about you know, the different things

433
00:14:31,909 --> 00:14:33,110
of the AC. I've been on the journey.

434
00:14:33,110 --> 00:14:35,110
I've seen the complications. I've seen the struggles

435
00:14:35,110 --> 00:14:37,210
that that can happen and can occur.

436
00:14:38,230 --> 00:14:40,549
And, you know, I I do like to

437
00:14:40,549 --> 00:14:41,750
talk about it. I do like to share

438
00:14:41,750 --> 00:14:44,504
the experience with others because, you know, I'd

439
00:14:44,565 --> 00:14:47,524
rather see somebody be able to improve their

440
00:14:47,524 --> 00:14:49,845
learning curve, you know, in a much quicker

441
00:14:49,845 --> 00:14:51,924
fashion than have to go through all the

442
00:14:51,924 --> 00:14:53,705
trials and tribulations that we went through.

443
00:14:54,085 --> 00:14:56,565
You know, I think, sharing knowledge is how

444
00:14:56,565 --> 00:14:57,845
we all learn and how we all get

445
00:14:57,845 --> 00:14:58,345
better.

446
00:14:59,360 --> 00:15:01,440
Doctor Meili, I think that's that's a wonderful

447
00:15:01,440 --> 00:15:03,759
place to end. Appreciate the the generosity with

448
00:15:03,759 --> 00:15:05,860
your time and coming on the podcast to

449
00:15:06,159 --> 00:15:08,399
to share, your wisdom and insights with folks

450
00:15:08,399 --> 00:15:10,019
today. Truly appreciate it.

451
00:15:10,480 --> 00:15:12,100
Great. Thank you for having me.

452
00:15:12,565 --> 00:15:15,044
Also wanna thank our podcast sponsor, J and

453
00:15:15,044 --> 00:15:16,964
J MedTech. You can tune in to more

454
00:15:16,964 --> 00:15:19,684
podcasts from Becker's Healthcare by visiting our podcast

455
00:15:19,684 --> 00:15:22,584
page at beckerspodcast.com.