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forward slash beckerspodcast.
Hello, and welcome to the Becker's Healthcare podcast
recorded live at the thirty first annual business
and operations of ASC's conference.
I'm joined today by Bob Bishop, chief designer
at JointSpace.
Bob, to kick us off, can you share
a little bit about yourself and your work
in the ASC space?
Sure. So,
Jeremy, this is this is a picture of
me in, like, 1959.
This is my my sister and I in
my grandma's backyard in Jackson, Michigan after she's
just had
her hips, which she was born with dislocated,
reattached to the socket.
And so
I've literally been involved with
ambulation
and surgery
for sixty five years now because I was
about four or five then and we're now
in 2025.
So
I've been
deeply involved both
with family results as well as I got
involved scientifically and
entrepreneurially
involved
in this whole space for a long, long
time.
So the ASC market in The US is
projected to reach, 60,800,000,000.0
by 2030 and continues to experience strong year
over year growth. From your perspective,
what would you say the most significant trends
and market forces driving this expansion, and how
should ASC leaders be preparing today?
So I'm gonna give an answer that is
very simple on one level and very complex
on the other, and it's the advancement of
knowledge.
And
by that, what I mean is something very
specific, which is that we now
know what we know
and we know why we know it in
ways that are exponentially growing.
And that is the driver
for why we are
now labeling what we say as an ASC.
And in most people here are going to
think, Oh, that's a separate building,
not the hospital
where we do surgery. As far as I'm
concerned,
ambulatory
surgery
is
not
where you walk in or walk out. It's
to actually change the ambulation of the patient.
And it's our knowledge about what makes that
happen and what causes
good results and bad results that's accelerating
massively rapidly
primarily through advanced technologies, but most of which
are computer related.
So from AI and robotic surgeries to advanced
EHR systems,
technology remains both a make or break factor
and critical driver of ASC operations at scale.
How do you see deeper tech integration shaping
the way ASCs deliver care and manage their
businesses over the next few years?
So
the distribution
of
incredibly
powerful technology
has gotten to the point where we all
have it in our side pockets.
And
the availability
of
networks
that can connect
those devices.
And
regardless of where you are in space and
time
has just
incredibly
become ubiquitous with
Musk putting up
satellite systems that create
a internet
from the sky. This device I have in
my pocket will connect to that satellite.
Not all do, but this one does and
all future ones will. So
the connectivity
of
the power of Silicon
calculations,
which is incredibly
powerful
is
everywhere all the time now. And
that's the primary driver
of what is
changing things so quickly. And we're adjusting to
all of the ramifications
of how that
was originally delivered and how it's evolving.
So is there one particular
technology or innovation that stands out to you
as especially transformative?
So I think that
the
use of blockchain
in the sense of
what
zero knowledge
as they call it,
platforms
is going to drive a massive change.
I created a company that I sold to
Zimmer
that
collected
x-ray
that was originally when I started doing it
using film and chemicals.
And I conceived of
transforming that to a digital acquisition
and distribution of those x rays for reasons
that had to do with the fact that
I owned a distributorship
in the Detroit area and I hire somebody
that worked in Traverse City
four and a half, five hours away in
good weather.
And I had
at that time to buy
my own implants and instruments,
which is not the way things work now,
but I had to make an investment in
those and then hire people and had to
have the whole operational environment for it. So
I
had seen the digital x-ray systems that were
in hospitals.
And the metaphor I use is I sort
of took what was a
digital imaging system
designed as a Peterbilt
and turned it into a bicycle
where it could be used by everybody
and yet still get the most incredible results.
In fact, I just saw a thing on
x yesterday showing that humans on a bicycle
outperform
every other animal
in terms
of the speed
and distance that they can transport themselves. There
is no other
animal
that we can't ultimately beat on a bicycle
in terms of the thermodynamic efficiencies. And in
the way,
what I just did was take the systems
that were
in hospitals and moved it into the regular
orthopedic office.
So
that became
model
in which
while I was doing that, it was the
eighties and the nineties.
And we were just breaking into what we
now call sort of web two. We moved
to these dynamic web spaces,
but they were wide open protocols
that we ultimately then put security on and
called them
HTTPS,
which became secure,
still breakable.
And
what we have now are
systems that do those computations
locally
and distributed
simultaneously.
And yet they're on secure protocols that are
private
from the beginning to the end where they're
encrypted
on device and decrypted
later. Only if you have public and private
keys that
is going to change
the game
because the,
the
whole
supply chain of moving all of the people,
the equipment, the information,
and the decisions that go into performing
a, a, an operation
successfully
is being
transformed
into
an infrastructure where you can not only collect
that information,
but process it
and then still retain
the privacy
of everybody involved
at their pleasure,
not at
the system's pleasure. Right. So I believe what's
going to happen is that that will transform
the system
economically in ways that it will no longer
be necessary to have
a monopoly
directed by
striker Zimmer Depew
owning
a massive portion
of the production
in selling
of total joints
of spinal implants, etcetera. And there are a
few other companies that fit into that category,
but those technologies that they're actually delivering
turned metal. Right. It's been around
for
nearly a hundred years.
There's nothing very special about that. It's only
the technology
of the capture of that operating environment
and its improvement
that
has become difficult.
This will help resolve that in a massive
way. So I think that's gonna transform
the economics massively.
And I just wanna rewind a little bit
and
say so,
you know, Blockchain, it was the big buzzword
a few years ago. I think, you know,
you you hear it a little bit less,
but I think, you know, maybe a lot
of people listening to this podcast
are gonna have kind of, like, well, I've
heard the term. Yeah. I know it has
to do with Bitcoin or not Bitcoin, but,
digital cryptocurrencies in that space. But can you
give a very kind of high level and
easy to digest overview of,
you know, how blockchain works and and,
just kind of, like, as it pertains to
what you're talking about? Yeah. So
you know what? When I was a very
young kid, I got a
bank account
and it only had a couple bucks in
it, but they gave you that savings account
booklet that somebody actually wrote in it how
much was in the bank that I had
given them. And
when I went to get money back, they
would not only give me the money, but
they would scratch in there on what was
called a ledger,
which looks just like a spreadsheet. It's just
a grid.
And it would say how much money I
had, how much I took out, what was
the net and what date it was. That
information
is the essence of
the currency environment of Bitcoin.
It's simply a ledger,
but what's different is that it's digital.
That's not magical,
but what gets magical is that it's encrypted,
meaning that simply that it has a, a
hash up of the information in such a
way that if you don't know what the
key is that unlocks it,
you can't see what it is. And that
key system is just like if you go
to that same bank and you put money
in the safety deposit box,
the bank has a key to your box
and you have a key. Without both of
them, you can't get in it.
You can't get in it because you don't
have the bank's key. They can't get it
because they don't have your key. That's how
the encryption works.
There is a public key that everybody can
see
And then there's just your private key. So
is it like in the movies where there's,
like, a nuclear launch code and it takes
two people to turn the key? You got
it.
Just like if you were watching
exactly. Denzel Washington. Right. Right. Right. Right. That's
what you're thinking, Don. Yep.
Yep.
Yeah. Exactly.
That's it. That's awesome. That complicated
until you let it be. Mhmm. Otherwise, it's
just plain old simple easy stuff. Okay.
Okay.
Well, with 60% of health systems considering ASC
joint ventures
and many ASCs already partnering with systems in
their communities, what opportunities do you see for
collaboration
whether with other providers or vendors to strengthen
patient care and operational efficiency?
Okay. So I think that what's happened from
when I was
describing to you when I was a little
kid,
this
surgeon
whose name was doctor Stolberg
and
my mom and dad and my sister
had a deep relationship with. Mhmm. And it
was
one of trust. And it was
one where there were almost, there was almost
nobody
between them.
Today,
I just had lunch with a surgeon who
basically started
the spine business
with a company called sophomore organic that became
a Medtronic company
at Texas back Institute.
And
he's 83 I think he told me now.
And we were talking about this a little
bit and I said, yeah, what I want
to do is get all those people out
from in between
the surgeon and the patient because that's what's
changed
is that at this point
there are so many players entailed
in having
a
simple conversation.
Was that going to get repaid?
Is it my deductible met yet? Because
on January 3, I'm going to have to
start all over again. But on December 28,
if I can get in,
it's free. Right, right. How does that make?
I want to know is, is it okay
for me to play tennis? Right. Right. Right.
Right. What the hell? And so
we need to find ways to remove
all of those
intermediaries. And Mhmm. That's what I think the
massive opportunity
of the technology change that's beginning to happen
is we're going back to that possibility again
where
we can reinitiate a relationship
between the patient and the doctor.
Those same doctors don't want all those people
in between,
come to the Becker meeting and come to
any others. You will hear them all
say things like that over and over again.
And when you talk to the patients,
they're so frustrated. They don't know what's up
and what's down. A 100%. And it's primarily
because they can't go talk to a trusted
doctor Mhmm.
And have a conversation
without a whole bunch of people being in
between for reasons that seem
unexplainable
other than for the fact that that's how
it accidentally
evolved over the period of the last
two or three decades.
Right. It hadn't been that way before
then, but it was the initiation of this
web two world
where we had these
expectations.
You may not be old enough to remember,
but we were told the electronic medical record
is going to revolutionize
and make so efficient. And all it has
done is resulted in the exact opposite of
that for most people who are in the
system.
It's web three or blockchain
sort of reinitiating
that opportunity,
but changing the inertia of the culture, right?
Getting all of those systems back into place
where I literally can communicate directly with my
doctor and not have to tell anybody else.
There are some people who want to say,
you know, you shouldn't be able to do
that. Right. And I say,
well, exactly who the hell do you think
you are? Right. That you should tell me
what I can do with my life. And
I think we just went through a whole
transition
of my body,
my decision.
And I think that's the essence of this
is that we all have
a responsibility to ourselves to take care of
ourselves. Mhmm. And if we need help, we
should find somebody who we trust, and nobody
else should be a part of that. Right.
Right. Right. Well, Bob, you know, this has
been a great conversation.
Is there anything we didn't touch on or
any final thoughts you'd like to leave with
our audience today?
Well,
I like to say that
the
opportunity for
the progression and innovation
is infinite.
And that's not to say
that what will happen will be good. Mhmm.
But
my perspective is that the growth of knowledge
is unstoppable.
Mhmm. And that
can also mean
that people with bad intentions
can capture that knowledge
and do things. So that's not to say
that everything will turn out well, but it
can. It is possible.
And that to me
is why I'm optimistic.
It's not that it is certain,
it's that I can decide
to have an impact in a positive way.
And when I see things that aren't right,
I can speak about
it and I can change it. And that's
kinda where I'm at with this is
I would like to see the reconnection
of
a doctor and a patient in a trusted
relationship
in which there are not impediments
that are artificial
Mhmm. To people being able to take care
of themselves
with a trusted adviser. Mhmm. Mhmm.
Well, Bob, thank you again for the great
conversation today. And, again, thank you for joining
us, and I hope you have a lovely
rest of your day. Thanks, sir.