WEBVTT 1 00:00:02.000 --> 00:00:04.719 - The strategic agenda facing hospital and health system 2 00:00:04.719 --> 00:00:06.819 - leaders right now is not a short list. 3 00:00:07.200 --> 00:00:09.839 - Growth in a consolidating market, sustainable margins in 4 00:00:09.839 --> 00:00:12.080 - a reimbursement environment that rarely moves in your 5 00:00:12.080 --> 00:00:12.464 - favor, 6 00:00:12.945 --> 00:00:15.445 - a tech investment cycle that demands both urgency 7 00:00:15.585 --> 00:00:16.404 - and discipline, 8 00:00:16.945 --> 00:00:19.344 - and a workforce story that is still being 9 00:00:19.344 --> 00:00:19.844 - written. 10 00:00:20.464 --> 00:00:23.904 - Eker's fourteenth annual CEO CFO roundtable brings together 11 00:00:23.904 --> 00:00:27.265 - more than 1,500 executive level attendees and nearly 12 00:00:27.265 --> 00:00:30.170 - 400 speakers across four days of sessions that 13 00:00:30.170 --> 00:00:32.429 - are designed to help c suite leaders benchmark, 14 00:00:32.649 --> 00:00:34.590 - pressure test, and sharpen their priorities. 15 00:00:35.210 --> 00:00:37.130 - Not in the abstract, but against the real 16 00:00:37.130 --> 00:00:39.390 - decisions they'll face heading into the next year. 17 00:00:39.609 --> 00:00:41.049 - It's the kind of event you leave with 18 00:00:41.049 --> 00:00:42.890 - a clear sense of where you stand and 19 00:00:42.890 --> 00:00:43.814 - what comes next. 20 00:00:44.375 --> 00:00:46.534 - So join us November second through the fifth 21 00:00:46.534 --> 00:00:49.094 - at the Hyatt Regency in Chicago, and come 22 00:00:49.094 --> 00:00:50.475 - ready to do the hard thinking. 23 00:00:50.854 --> 00:00:54.614 - Register on our events page at beckershospitalreview.com 24 00:00:54.614 --> 00:00:56.375 - by clicking on the events tab in the 25 00:00:56.375 --> 00:00:57.195 - upper right. 26 00:00:58.240 --> 00:01:00.399 - This is Laura Dirda with the Becker's Healthcare 27 00:01:00.399 --> 00:01:02.320 - podcast. I'm thrilled today to be joined by 28 00:01:02.320 --> 00:01:05.219 - doctor David Bernstein, a Harvard trained orthopedic surgeon. 29 00:01:05.519 --> 00:01:07.040 - David Bernstein, it's a pleasure to have you 30 00:01:07.040 --> 00:01:09.200 - on the podcast today. Thanks so much for 31 00:01:09.200 --> 00:01:10.479 - having me. It's a pleasure to be with 32 00:01:10.479 --> 00:01:12.965 - you. Absolutely. Now I'm excited for our conversation. 33 00:01:12.965 --> 00:01:15.204 - I know a lot happening in orthopedics right 34 00:01:15.204 --> 00:01:17.465 - now and in health care, in particular, 35 00:01:17.765 --> 00:01:19.524 - you know, so many different things looking at 36 00:01:19.524 --> 00:01:21.364 - the clinical side, looking at the business side, 37 00:01:21.364 --> 00:01:23.444 - private equity, and more. So I'm excited to 38 00:01:23.444 --> 00:01:25.170 - dig into these things with you. But before 39 00:01:25.170 --> 00:01:26.450 - we do, can you tell us a little 40 00:01:26.450 --> 00:01:28.069 - bit more about yourself and your background? 41 00:01:28.689 --> 00:01:29.189 - Absolutely. 42 00:01:29.650 --> 00:01:32.370 - So, as you mentioned, I, am a Harvard 43 00:01:32.370 --> 00:01:35.569 - trained orthopedic surgeon, finished up orthopedic surgery residency 44 00:01:35.569 --> 00:01:38.069 - in the Harvard combined orthopedic residency program, 45 00:01:38.930 --> 00:01:39.584 - last month. 46 00:01:39.984 --> 00:01:41.665 - But I've had kind of a bit of 47 00:01:41.665 --> 00:01:44.724 - a, a winding journey from a career standpoint. 48 00:01:45.504 --> 00:01:47.504 - I I've always been interested in the intersection 49 00:01:47.504 --> 00:01:49.744 - of the business, politics, and delivery of health 50 00:01:49.744 --> 00:01:52.224 - care. And part of that stems from, the 51 00:01:52.224 --> 00:01:54.069 - fact that my dad's a pediatrician. 52 00:01:54.689 --> 00:01:56.370 - My mom's a pediatric nurse, and I grew 53 00:01:56.370 --> 00:01:56.870 - up, 54 00:01:57.409 --> 00:01:58.230 - in a household 55 00:01:58.689 --> 00:02:01.490 - where my dad loved what he did, and 56 00:02:01.490 --> 00:02:03.030 - he loved his patients and 57 00:02:03.329 --> 00:02:05.250 - but just couldn't understand why the health care 58 00:02:05.250 --> 00:02:07.090 - system didn't work. It just it just didn't 59 00:02:07.090 --> 00:02:08.449 - seem to work. It was there was always 60 00:02:08.449 --> 00:02:09.875 - a concern about, 61 00:02:10.655 --> 00:02:12.594 - something here or something there 62 00:02:12.895 --> 00:02:15.455 - about why patients were struggling to pay for 63 00:02:15.455 --> 00:02:17.074 - health care or why health care, 64 00:02:17.775 --> 00:02:20.574 - didn't seem to deliver the outcomes that that 65 00:02:20.574 --> 00:02:22.175 - had been promised. And so I was always 66 00:02:22.175 --> 00:02:23.855 - interested in in why that was the case. 67 00:02:23.855 --> 00:02:25.800 - It seems to me that health care is 68 00:02:25.800 --> 00:02:26.540 - the one, 69 00:02:27.319 --> 00:02:29.420 - area that everybody in the world, 70 00:02:29.960 --> 00:02:32.620 - could benefit from from having it improved. Yet 71 00:02:32.840 --> 00:02:34.520 - if you go to anybody on the street, 72 00:02:34.520 --> 00:02:36.200 - I would suspect that no one would say, 73 00:02:36.200 --> 00:02:38.439 - oh, the health system is is exceptional and 74 00:02:38.439 --> 00:02:40.235 - it works well, whether that's in The US 75 00:02:40.235 --> 00:02:42.235 - or or, frankly, anywhere across the world. And 76 00:02:42.235 --> 00:02:43.694 - so that always puzzled me. 77 00:02:43.995 --> 00:02:45.995 - And so that kind of set my my 78 00:02:45.995 --> 00:02:46.814 - career trajectory. 79 00:02:47.754 --> 00:02:48.415 - I went, 80 00:02:48.715 --> 00:02:50.655 - to to Bowdoin College up in Maine, 81 00:02:51.034 --> 00:02:52.889 - and absolutely loved it. And I actually majored 82 00:02:52.889 --> 00:02:55.370 - in economics because I wanted to understand incentives 83 00:02:55.370 --> 00:02:58.730 - and and what drives people to to do 84 00:02:58.730 --> 00:03:00.830 - certain things and how can we use incentives 85 00:03:01.129 --> 00:03:02.349 - to fix health care. 86 00:03:03.425 --> 00:03:05.264 - And so that led me that led me 87 00:03:05.264 --> 00:03:07.824 - to study economics always with the lens of 88 00:03:07.824 --> 00:03:09.585 - what does that mean from a health care's 89 00:03:09.585 --> 00:03:10.085 - perspective. 90 00:03:10.784 --> 00:03:11.764 - And fast forward, 91 00:03:12.145 --> 00:03:13.985 - a few years, I I lived in Europe. 92 00:03:13.985 --> 00:03:16.245 - I tried to understand the the European 93 00:03:16.544 --> 00:03:18.560 - models of health care. Obviously, 94 00:03:19.099 --> 00:03:21.980 - being American, trying to understand the American models 95 00:03:21.980 --> 00:03:23.420 - of health care, and I enrolled in a 96 00:03:23.420 --> 00:03:25.500 - dual MD MBA program at the University of 97 00:03:25.500 --> 00:03:26.000 - Rochester, 98 00:03:26.939 --> 00:03:28.700 - again, with the goal of how do I 99 00:03:28.700 --> 00:03:30.780 - marry my interest in delivering one on one 100 00:03:30.780 --> 00:03:33.280 - patient care but making a broader impact, 101 00:03:34.664 --> 00:03:37.625 - broader positive impact from the health system perspective. 102 00:03:37.625 --> 00:03:39.144 - Because in my mind, if you can move 103 00:03:39.144 --> 00:03:41.625 - the needle just a little bit, you could 104 00:03:41.625 --> 00:03:42.444 - have an impact, 105 00:03:43.064 --> 00:03:45.224 - across tens of thousands, if not millions of 106 00:03:45.224 --> 00:03:46.205 - people instantaneously. 107 00:03:47.400 --> 00:03:49.319 - And so I enrolled in in in that 108 00:03:49.319 --> 00:03:50.939 - dual MDMBA program, 109 00:03:51.959 --> 00:03:53.959 - learned, learned a great deal. And as I 110 00:03:53.959 --> 00:03:55.419 - was nearing the completion 111 00:03:56.039 --> 00:03:58.520 - of that, I had the remarkable opportunity to, 112 00:04:00.014 --> 00:04:02.414 - to join Michael Porter and Bob Kaplan at 113 00:04:02.414 --> 00:04:04.574 - Harvard Business School as their senior researcher in 114 00:04:04.574 --> 00:04:06.435 - health care and value based health care, 115 00:04:06.974 --> 00:04:09.294 - to really, again, dig into this question about 116 00:04:09.294 --> 00:04:11.454 - how do we fix the challenges we're seeing 117 00:04:11.454 --> 00:04:13.710 - in health care to make a positive difference 118 00:04:13.710 --> 00:04:15.169 - in the lives of of many. 119 00:04:15.469 --> 00:04:17.550 - So I worked at Harvard Business School for 120 00:04:17.550 --> 00:04:18.050 - for, 121 00:04:18.430 --> 00:04:21.730 - a bit before transitioning to residency, 122 00:04:22.430 --> 00:04:23.089 - at Harvard 123 00:04:23.389 --> 00:04:25.230 - and then having just completed it. And so 124 00:04:25.230 --> 00:04:27.470 - I've always been at this odd intersection of 125 00:04:27.470 --> 00:04:28.824 - the business, politics, 126 00:04:29.285 --> 00:04:32.564 - and clinical care delivery side of health care, 127 00:04:32.564 --> 00:04:34.165 - and that to me is is the most 128 00:04:34.165 --> 00:04:36.245 - exciting area to be in as we look 129 00:04:36.245 --> 00:04:38.245 - to solve some of the challenges we face 130 00:04:38.245 --> 00:04:40.485 - both in orthopedics, but frankly, across health care 131 00:04:40.485 --> 00:04:41.225 - more broadly. 132 00:04:42.419 --> 00:04:43.539 - It makes a lot of sense. You know? 133 00:04:43.539 --> 00:04:46.019 - And it's a really impactful kinda origin story 134 00:04:46.019 --> 00:04:48.419 - for your passion in health care and how 135 00:04:48.419 --> 00:04:51.300 - exactly you came to to be in this 136 00:04:51.300 --> 00:04:52.839 - space, which is really exciting. 137 00:04:53.379 --> 00:04:55.459 - What's it been like, you know, training as 138 00:04:55.459 --> 00:04:56.654 - a physician and 139 00:04:57.134 --> 00:04:58.415 - in such a a a, 140 00:04:59.055 --> 00:05:01.134 - transformational time in the health care space? What's 141 00:05:01.134 --> 00:05:01.954 - that been like? 142 00:05:02.735 --> 00:05:05.555 - Yeah. It's it's it's been it's been exciting, 143 00:05:05.615 --> 00:05:07.134 - I think. One of the things that's very 144 00:05:07.134 --> 00:05:08.654 - interesting is when you talk to a lot 145 00:05:08.654 --> 00:05:10.334 - of people and say, oh, I'm gonna be 146 00:05:10.334 --> 00:05:12.209 - in health care. There's a lot of physicians 147 00:05:12.209 --> 00:05:13.730 - out there who say, oh, I don't know 148 00:05:13.730 --> 00:05:15.250 - if now is the time to to to 149 00:05:15.250 --> 00:05:16.529 - be in health care. To me, this is 150 00:05:16.529 --> 00:05:18.290 - actually the most exciting time to be in 151 00:05:18.290 --> 00:05:20.769 - health care. It's a time of great need 152 00:05:20.769 --> 00:05:22.769 - and great challenge. And to me, whenever there's 153 00:05:22.769 --> 00:05:25.170 - a challenge, there's an opportunity, and that opportunity 154 00:05:25.170 --> 00:05:27.144 - is to help fix some of these some 155 00:05:27.144 --> 00:05:28.685 - of these issues that we see. 156 00:05:29.144 --> 00:05:31.625 - It's been challenging, but it's been challenging and 157 00:05:31.625 --> 00:05:33.564 - exciting at the same time. And so 158 00:05:33.865 --> 00:05:35.625 - one of the things that's really nice about 159 00:05:35.625 --> 00:05:36.125 - training, 160 00:05:36.504 --> 00:05:37.324 - to be clinically, 161 00:05:38.024 --> 00:05:40.420 - relevant, if you will, and clinically driven is 162 00:05:40.420 --> 00:05:43.300 - that you see the the challenges that are 163 00:05:43.300 --> 00:05:46.339 - described at a 30,000 foot view onto on 164 00:05:46.339 --> 00:05:48.680 - the one to one level. So whether it's 165 00:05:48.819 --> 00:05:49.720 - price transparency 166 00:05:50.180 --> 00:05:51.560 - and health care access, 167 00:05:52.350 --> 00:05:54.525 - which health care access does not equal health, 168 00:05:54.525 --> 00:05:56.045 - by the way, and we can discuss that 169 00:05:56.045 --> 00:05:57.185 - a little bit more too. 170 00:05:57.564 --> 00:05:59.645 - But whether it's health care access, whether it's 171 00:05:59.645 --> 00:06:02.285 - obtaining and and staying healthy, whether it's health 172 00:06:02.285 --> 00:06:03.264 - care price transparency, 173 00:06:03.964 --> 00:06:05.725 - you see that at the ground level on 174 00:06:05.725 --> 00:06:07.884 - these one to one patient interactions when patients 175 00:06:07.884 --> 00:06:09.759 - ask ask you questions. And then when you 176 00:06:09.759 --> 00:06:12.319 - take a 30,000 foot view and you start 177 00:06:12.319 --> 00:06:14.560 - discussing kind of what are policy changes or 178 00:06:14.560 --> 00:06:16.959 - health system changes that we can actually implement 179 00:06:16.959 --> 00:06:17.699 - to drive 180 00:06:18.080 --> 00:06:18.580 - progress, 181 00:06:19.040 --> 00:06:21.360 - you can start to marry those two those 182 00:06:21.360 --> 00:06:24.165 - two realms. And so I've found training clinically 183 00:06:24.225 --> 00:06:25.204 - to be incredibly, 184 00:06:26.384 --> 00:06:26.884 - powerful, 185 00:06:27.425 --> 00:06:30.464 - both as a tool to learn what matters 186 00:06:30.464 --> 00:06:32.884 - most to patients, but also as a tool 187 00:06:33.104 --> 00:06:35.584 - to really drive that one to one positive 188 00:06:35.584 --> 00:06:37.524 - change so that when you see these 189 00:06:37.919 --> 00:06:40.720 - challenges at a 30,000 foot view, maybe taking 190 00:06:40.720 --> 00:06:43.379 - longer than you want to actually make progress, 191 00:06:43.759 --> 00:06:46.079 - you can go back, help patients one on 192 00:06:46.079 --> 00:06:49.060 - one, and also see see their progress individually. 193 00:06:49.519 --> 00:06:50.959 - And, ultimately, at the end of the day, 194 00:06:50.959 --> 00:06:52.240 - as long as you move the needle for 195 00:06:52.240 --> 00:06:54.634 - everybody, you're you're improving the health of the 196 00:06:54.634 --> 00:06:57.375 - population. And so it's been exciting, 197 00:06:57.834 --> 00:06:58.334 - challenging, 198 00:06:58.634 --> 00:07:00.574 - and something that gets me up every morning, 199 00:07:00.875 --> 00:07:02.014 - ready to go to work. 200 00:07:02.875 --> 00:07:04.235 - I love that. I think that's such a 201 00:07:04.235 --> 00:07:06.475 - great mindset and approach when you're thinking about, 202 00:07:06.475 --> 00:07:09.060 - you know, all the the big challenges within 203 00:07:09.060 --> 00:07:10.899 - health care and in accessing health care and 204 00:07:10.899 --> 00:07:13.879 - then boiling into, you know, where the innovation 205 00:07:13.939 --> 00:07:16.019 - can happen and what makes the biggest difference 206 00:07:16.019 --> 00:07:18.419 - for the patient population you're working with. I 207 00:07:18.500 --> 00:07:20.180 - I'm curious. What are some of the the 208 00:07:20.180 --> 00:07:22.185 - things that you've been most focused on and 209 00:07:22.185 --> 00:07:24.344 - excited about right now within health care and 210 00:07:24.344 --> 00:07:25.884 - within orthopedics in particular? 211 00:07:26.824 --> 00:07:28.604 - Yeah. So I think the future of orthopedics 212 00:07:28.824 --> 00:07:30.685 - is actually incredibly exciting. 213 00:07:31.064 --> 00:07:34.664 - It's really undergoing a huge structural shift that's 214 00:07:34.664 --> 00:07:36.959 - that's been ongoing for a while, but it's 215 00:07:37.439 --> 00:07:38.100 - it's expedited 216 00:07:38.639 --> 00:07:39.139 - recently. 217 00:07:39.839 --> 00:07:42.319 - So kind of how, where, and by whom 218 00:07:42.319 --> 00:07:43.379 - is care delivered. 219 00:07:43.839 --> 00:07:46.720 - So historically, orthopedics and many of the surgical 220 00:07:46.720 --> 00:07:47.220 - subspecialties 221 00:07:48.000 --> 00:07:50.079 - have been within the four walls of a 222 00:07:50.079 --> 00:07:51.300 - major traditional 223 00:07:51.680 --> 00:07:52.180 - hospital, 224 00:07:52.915 --> 00:07:54.694 - and it's now being decentralized. 225 00:07:55.475 --> 00:07:58.055 - And they're being it's being moved to ambulatory 226 00:07:58.355 --> 00:08:02.215 - surgical centers and and different Medicare and Medicaid, 227 00:08:03.235 --> 00:08:05.795 - interventions are kinda pushing the boundaries of what 228 00:08:05.795 --> 00:08:08.689 - it means to deliver orthopedic care. And so 229 00:08:08.689 --> 00:08:11.090 - we're taking this model and flipping it on 230 00:08:11.090 --> 00:08:12.629 - its head. How do we deliver 231 00:08:12.930 --> 00:08:15.750 - the best orthopedic care to patients 232 00:08:16.210 --> 00:08:18.470 - when they need it, where they need it, 233 00:08:18.610 --> 00:08:21.330 - while being rewarded for delivering the outcomes that 234 00:08:21.330 --> 00:08:23.110 - actually matter to 235 00:08:23.665 --> 00:08:24.485 - those patients. 236 00:08:24.865 --> 00:08:26.944 - And, honestly, it needs to be driven by 237 00:08:26.944 --> 00:08:29.985 - orthopedic surgeons. If it's driven by those who 238 00:08:29.985 --> 00:08:32.304 - don't deliver the care, which a lot of 239 00:08:32.304 --> 00:08:34.465 - health care, frankly, over time has been driven 240 00:08:34.465 --> 00:08:36.865 - by policymakers and those who don't understand what 241 00:08:36.865 --> 00:08:38.245 - it means to deliver care, 242 00:08:38.639 --> 00:08:41.040 - that's when patients lose, and that's where the 243 00:08:41.040 --> 00:08:42.340 - that's when the subspecialty 244 00:08:43.040 --> 00:08:46.019 - fields within orthopedics and orthopedics more broadly lose. 245 00:08:46.399 --> 00:08:49.300 - And so it really this type of change 246 00:08:49.440 --> 00:08:52.340 - is coming, and it's coming from regulatory frameworks. 247 00:08:52.399 --> 00:08:53.779 - It's coming from financial 248 00:08:54.514 --> 00:08:57.014 - base frankly, requirements in order to be financially 249 00:08:57.154 --> 00:08:57.654 - sustainable. 250 00:08:58.115 --> 00:09:00.355 - And so this needs to be driven by 251 00:09:00.355 --> 00:09:00.855 - orthopedics, 252 00:09:01.475 --> 00:09:03.335 - and orthopedic surgeons themselves, 253 00:09:03.715 --> 00:09:05.975 - to deliver this coordinated care. 254 00:09:06.595 --> 00:09:07.075 - So two 255 00:09:07.715 --> 00:09:09.575 - well, two or three areas that I kinda 256 00:09:09.710 --> 00:09:11.490 - think are really, really important today. 257 00:09:12.110 --> 00:09:13.889 - As I mentioned, a lot of 258 00:09:14.350 --> 00:09:16.590 - the the traditional thinking of health care and 259 00:09:16.590 --> 00:09:18.910 - orthopedic surgery being delivered within the four walls 260 00:09:18.910 --> 00:09:20.830 - of a hospital is just no frankly no 261 00:09:20.830 --> 00:09:21.730 - longer the case. 262 00:09:22.054 --> 00:09:25.095 - And so ambulatory surgical centers are super, super 263 00:09:25.095 --> 00:09:27.595 - exciting. And they're not exciting just because 264 00:09:28.134 --> 00:09:28.534 - they are, 265 00:09:31.174 --> 00:09:33.254 - the hot and and and sexy area to 266 00:09:33.254 --> 00:09:35.735 - receive care, but they're exciting because you can 267 00:09:35.735 --> 00:09:36.235 - deliver 268 00:09:36.750 --> 00:09:39.389 - care at a cheaper price that's frankly better 269 00:09:39.389 --> 00:09:41.090 - in a area that patients 270 00:09:41.470 --> 00:09:42.370 - live in already. 271 00:09:42.830 --> 00:09:43.070 - It 272 00:09:43.710 --> 00:09:46.190 - that has better parking, that has better patient 273 00:09:46.190 --> 00:09:46.690 - experience, 274 00:09:47.309 --> 00:09:48.049 - and can 275 00:09:48.429 --> 00:09:49.410 - really shift 276 00:09:49.754 --> 00:09:52.095 - the the model of care of care delivery. 277 00:09:52.394 --> 00:09:55.054 - And we're seeing that actually from a regulatory 278 00:09:55.195 --> 00:09:58.554 - perspective too as CMS revises or removes many 279 00:09:58.554 --> 00:10:00.095 - of its inpatient only, 280 00:10:00.795 --> 00:10:01.774 - list of surgeries 281 00:10:02.315 --> 00:10:03.615 - to really allow, 282 00:10:04.779 --> 00:10:07.340 - orthopedic surgeons to deliver care to patients in 283 00:10:07.340 --> 00:10:10.080 - an area that that is best for them. 284 00:10:10.540 --> 00:10:11.679 - We're also seeing 285 00:10:12.059 --> 00:10:15.259 - increased in artificial intelligence and virtual physical therapy 286 00:10:15.259 --> 00:10:16.639 - and digital health platforms 287 00:10:17.095 --> 00:10:19.274 - that really allow patients to engage 288 00:10:19.735 --> 00:10:22.054 - with their orthopedic surgeons and their orthopedic care 289 00:10:22.054 --> 00:10:24.855 - teams in a more meaningful way than has 290 00:10:24.855 --> 00:10:27.195 - historically been done. And this allows 291 00:10:27.575 --> 00:10:28.554 - patients to 292 00:10:29.029 --> 00:10:29.690 - to frankly 293 00:10:30.070 --> 00:10:32.570 - receive better care and and hopefully improve clinical 294 00:10:32.629 --> 00:10:33.129 - outcomes. 295 00:10:33.750 --> 00:10:35.450 - And the last thing I'll say is 296 00:10:35.830 --> 00:10:37.290 - we're also seeing changes, 297 00:10:38.309 --> 00:10:39.610 - in in measurement 298 00:10:39.990 --> 00:10:41.450 - in measurement of prices, 299 00:10:41.875 --> 00:10:44.115 - in measurement of the of the cost of 300 00:10:44.115 --> 00:10:48.115 - care, and how those direct bundle payments and 301 00:10:48.115 --> 00:10:50.514 - measurement of patient reported outcome measures that are 302 00:10:50.514 --> 00:10:52.215 - now included in many of the CMS, 303 00:10:52.915 --> 00:10:53.654 - and CMMI 304 00:10:54.035 --> 00:10:54.535 - models 305 00:10:54.870 --> 00:10:57.690 - are playing into how we better understand, 306 00:10:58.629 --> 00:11:01.129 - how our care is being received by patients 307 00:11:01.429 --> 00:11:03.269 - and how that leads to the outcomes that 308 00:11:03.269 --> 00:11:04.870 - matter most to them and how do we 309 00:11:04.870 --> 00:11:06.250 - optimize those outcomes 310 00:11:06.710 --> 00:11:08.970 - for them. And so all of these things 311 00:11:09.190 --> 00:11:12.465 - that have kind of been historically written in 312 00:11:12.465 --> 00:11:14.884 - this paper or that paper as a theoretical 313 00:11:15.345 --> 00:11:17.684 - are now becoming the reality on the ground. 314 00:11:18.625 --> 00:11:20.465 - Well, that's so exciting to hear. And and 315 00:11:20.465 --> 00:11:23.745 - certainly thinking about that patient experience and then 316 00:11:23.745 --> 00:11:26.059 - marrying the technology along with, 317 00:11:27.000 --> 00:11:29.079 - access to care and in connection with the 318 00:11:29.079 --> 00:11:32.120 - specialists that are are, all working together to 319 00:11:32.120 --> 00:11:34.839 - help the patients in along their care journey 320 00:11:34.839 --> 00:11:35.659 - is so critical. 321 00:11:36.039 --> 00:11:38.220 - And then thinking through the value piece too, 322 00:11:38.615 --> 00:11:40.134 - I know there's been a lot of fits 323 00:11:40.134 --> 00:11:42.134 - and starts over the last few decades when 324 00:11:42.134 --> 00:11:44.454 - you think about value based care in particular 325 00:11:44.454 --> 00:11:46.074 - in orthopedics. And so, 326 00:11:46.855 --> 00:11:49.115 - what makes this different? Where do you see 327 00:11:49.414 --> 00:11:52.134 - as being, the the the elements of all 328 00:11:52.134 --> 00:11:54.214 - of this that are are going to help 329 00:11:54.214 --> 00:11:56.029 - it stick and and really make sure that 330 00:11:56.029 --> 00:11:58.290 - the orthopedic patient population is, 331 00:11:58.830 --> 00:12:01.870 - not only having everything available, but adopting it 332 00:12:01.870 --> 00:12:03.250 - and really optimizing 333 00:12:03.629 --> 00:12:05.790 - what they have in order to achieve the 334 00:12:05.790 --> 00:12:08.634 - outcomes they want? It's a great question. 335 00:12:09.095 --> 00:12:10.134 - And I think there's, 336 00:12:11.095 --> 00:12:13.115 - what's really gonna make this stick today 337 00:12:13.654 --> 00:12:16.794 - is there's political, financial, and operational challenges 338 00:12:17.174 --> 00:12:19.574 - that require it to stick today. And the 339 00:12:19.574 --> 00:12:22.360 - thing that I think is most important to 340 00:12:22.360 --> 00:12:24.840 - touch upon is the term value based health 341 00:12:24.840 --> 00:12:27.100 - care often gets one of two responses. 342 00:12:27.720 --> 00:12:30.120 - One is you get an eye roll. You 343 00:12:30.120 --> 00:12:32.279 - get this eye roll of, oh, this is 344 00:12:32.279 --> 00:12:35.019 - a this is this is simply cost cutting. 345 00:12:35.240 --> 00:12:36.379 - Or you get this 346 00:12:36.735 --> 00:12:38.815 - response of, oh, this is gonna save health 347 00:12:38.815 --> 00:12:41.455 - care. And I think what the reality is 348 00:12:41.455 --> 00:12:44.174 - is we need to understand what value based 349 00:12:44.174 --> 00:12:45.714 - health care actually means, 350 00:12:46.174 --> 00:12:48.509 - and then we can start to implement it. 351 00:12:48.590 --> 00:12:50.190 - And that the reason I say that is 352 00:12:50.190 --> 00:12:51.790 - there are a lot of things out there 353 00:12:51.790 --> 00:12:53.950 - that are called, quote, unquote, value based health 354 00:12:53.950 --> 00:12:56.450 - care that are not value based health care. 355 00:12:56.750 --> 00:12:58.529 - And and so for example, 356 00:12:59.309 --> 00:13:01.169 - we use the term bundle payments 357 00:13:02.095 --> 00:13:02.595 - to, 358 00:13:03.535 --> 00:13:05.875 - to talk about how we deliver care, 359 00:13:06.975 --> 00:13:07.475 - over 360 00:13:08.335 --> 00:13:10.495 - a set good a set a set of 361 00:13:10.495 --> 00:13:14.254 - services, for example. But actual bundle payments should 362 00:13:14.254 --> 00:13:14.754 - be 363 00:13:15.179 --> 00:13:15.919 - cover a 364 00:13:16.539 --> 00:13:18.860 - condition, not the delivery of a total joint 365 00:13:18.860 --> 00:13:19.360 - replacement. 366 00:13:19.820 --> 00:13:22.139 - If you give a bundle payment just for 367 00:13:22.139 --> 00:13:24.940 - joint replacement, for example, that's really just fee 368 00:13:24.940 --> 00:13:26.940 - for sale service on steroids, and you're just 369 00:13:26.940 --> 00:13:27.440 - expanding 370 00:13:28.059 --> 00:13:28.799 - the the 371 00:13:29.235 --> 00:13:31.714 - the fee and you're expanding the number of 372 00:13:31.714 --> 00:13:33.875 - services, but it's not actually taking care of 373 00:13:33.875 --> 00:13:36.695 - a patient's condition. And it doesn't actually incentivize 374 00:13:36.835 --> 00:13:38.134 - you necessarily 375 00:13:38.674 --> 00:13:40.534 - to deliver care long term, 376 00:13:41.554 --> 00:13:43.315 - at at the outcomes that matter most to 377 00:13:43.315 --> 00:13:43.815 - patients. 378 00:13:44.179 --> 00:13:45.620 - And so I think we need to be 379 00:13:45.620 --> 00:13:47.299 - careful a lot of times when we talk 380 00:13:47.299 --> 00:13:48.899 - about value based health care and the terms 381 00:13:48.899 --> 00:13:51.139 - within value based health care to make sure 382 00:13:51.139 --> 00:13:53.159 - that we're not just using a term 383 00:13:53.539 --> 00:13:54.039 - that 384 00:13:54.500 --> 00:13:57.159 - sounds sexy, but then actually not 385 00:13:57.794 --> 00:14:00.195 - implementing it in a way that's that's true 386 00:14:00.195 --> 00:14:02.375 - to to the value based health care ethos. 387 00:14:03.715 --> 00:14:06.115 - A couple things that I think, are are 388 00:14:06.115 --> 00:14:08.695 - really are really important as well. 389 00:14:09.235 --> 00:14:09.975 - One is 390 00:14:10.480 --> 00:14:13.940 - value based health care is simply a strategy. 391 00:14:14.720 --> 00:14:17.360 - It's not a payment model. It's not just 392 00:14:17.360 --> 00:14:18.340 - measuring outcomes. 393 00:14:18.799 --> 00:14:21.120 - It is the idea of how do we 394 00:14:21.120 --> 00:14:22.179 - deliver and 395 00:14:22.495 --> 00:14:24.975 - and by measuring those outcomes that matter most 396 00:14:24.975 --> 00:14:27.295 - to patients, how do we deliver the best 397 00:14:27.295 --> 00:14:27.795 - outcomes 398 00:14:28.335 --> 00:14:28.995 - for patients? 399 00:14:29.375 --> 00:14:32.095 - And then once we understand that, how do 400 00:14:32.095 --> 00:14:34.835 - we do so efficiently to reduce cost? 401 00:14:35.215 --> 00:14:37.134 - And so if you think of this, the 402 00:14:37.134 --> 00:14:38.035 - quote unquote, 403 00:14:39.509 --> 00:14:42.389 - famous formula, it's not really a formula, the 404 00:14:42.389 --> 00:14:45.210 - outcomes per dollar spent. It's really a relationship. 405 00:14:45.830 --> 00:14:48.629 - And if you understand that relationship, you then 406 00:14:48.629 --> 00:14:50.090 - understand a strategy 407 00:14:50.524 --> 00:14:52.945 - In the sense that if something increases 408 00:14:53.325 --> 00:14:55.664 - the outcomes or improves the outcomes, 409 00:14:56.684 --> 00:14:57.985 - but does not change 410 00:14:58.445 --> 00:15:01.164 - the cost, you do that every time. If 411 00:15:01.164 --> 00:15:03.904 - something doesn't change the outcomes, but it reduces 412 00:15:03.965 --> 00:15:06.839 - the denominator or reduces cost, you also do 413 00:15:06.839 --> 00:15:09.720 - that every time. What the challenge we face 414 00:15:09.720 --> 00:15:12.519 - today is what happens if something increases the 415 00:15:12.519 --> 00:15:15.320 - outcomes or improves the outcomes and increases the 416 00:15:15.320 --> 00:15:17.559 - cost? Do we do that? Or what if 417 00:15:17.559 --> 00:15:19.179 - something decreases the outcomes 418 00:15:19.565 --> 00:15:22.704 - or reduces the outcomes and decrease the cost? 419 00:15:22.764 --> 00:15:24.605 - Do we do that as well? And that's 420 00:15:24.605 --> 00:15:27.084 - why orthopedic surgeons need to be leading this 421 00:15:27.084 --> 00:15:28.945 - because those nuanced decisions 422 00:15:29.485 --> 00:15:32.480 - require their insight into what matters 423 00:15:33.100 --> 00:15:35.580 - clinically, what are we measuring, and is what 424 00:15:35.580 --> 00:15:38.139 - we are measuring really what's most important to 425 00:15:38.139 --> 00:15:40.700 - patients. And if we don't have orthopedic surgeons 426 00:15:40.700 --> 00:15:42.220 - at the table, that's when we get into 427 00:15:42.220 --> 00:15:42.720 - trouble. 428 00:15:43.914 --> 00:15:45.595 - That's such an excellent point. And, you know, 429 00:15:45.595 --> 00:15:47.914 - it's so critical when you strip down whether 430 00:15:47.914 --> 00:15:49.754 - it's body based care or anything else, having 431 00:15:49.754 --> 00:15:51.835 - that kind of understanding of the patient and 432 00:15:51.835 --> 00:15:53.674 - knowing what moves the needle for them and 433 00:15:53.674 --> 00:15:55.595 - and then being able to truly design that 434 00:15:55.595 --> 00:15:55.835 - into, 435 00:15:56.680 --> 00:15:59.160 - the health care delivery system on both the 436 00:15:59.160 --> 00:16:01.019 - clinical as well as financial side, 437 00:16:01.800 --> 00:16:03.480 - makes a huge difference. And so I I 438 00:16:03.480 --> 00:16:05.560 - can certainly appreciate that. And I think especially 439 00:16:05.560 --> 00:16:07.800 - for surgeons like yourself at the beginning of 440 00:16:07.800 --> 00:16:09.399 - their careers, you know, what do you as 441 00:16:09.399 --> 00:16:12.095 - you're looking onto the orthopedic field and, you 442 00:16:12.095 --> 00:16:13.774 - know, thinking about the future, where do you 443 00:16:13.774 --> 00:16:15.875 - see the biggest areas for growth? What is 444 00:16:15.934 --> 00:16:18.095 - kind of the the spaces where it makes 445 00:16:18.095 --> 00:16:20.174 - the most sense to attack and and tackle 446 00:16:20.174 --> 00:16:22.574 - first? And then looking at true transformation and 447 00:16:22.574 --> 00:16:24.659 - what's gonna be possible in the next couple 448 00:16:24.659 --> 00:16:25.159 - decades. 449 00:16:25.620 --> 00:16:26.980 - How do you think about all of these 450 00:16:26.980 --> 00:16:27.879 - things and then, 451 00:16:28.259 --> 00:16:30.740 - incorporate it into the career and practice that 452 00:16:30.740 --> 00:16:31.480 - you're building? 453 00:16:32.339 --> 00:16:33.799 - Yeah. It's a it's a really, 454 00:16:34.179 --> 00:16:35.480 - it's a really, really 455 00:16:35.940 --> 00:16:37.940 - good question, and it's a big question. So 456 00:16:37.940 --> 00:16:38.519 - I think, 457 00:16:38.975 --> 00:16:41.795 - it's no secret that the population is aging. 458 00:16:42.415 --> 00:16:44.675 - And it is no secret that technology 459 00:16:45.215 --> 00:16:45.715 - and, 460 00:16:46.175 --> 00:16:48.514 - including digital health tools and AI 461 00:16:49.055 --> 00:16:51.615 - is booming and only gonna grow. And so 462 00:16:51.615 --> 00:16:53.615 - as I think about the start of my 463 00:16:53.615 --> 00:16:54.115 - career, 464 00:16:54.610 --> 00:16:56.790 - I think about how do I integrate 465 00:16:57.889 --> 00:16:59.910 - these tools and instruments 466 00:17:00.529 --> 00:17:03.330 - to deliver on that strategic goal of value 467 00:17:03.330 --> 00:17:05.509 - for patients, of improving outcomes 468 00:17:06.289 --> 00:17:09.484 - while while making it efficient and keeping costs 469 00:17:09.484 --> 00:17:11.884 - the same or reducing cost. And so one 470 00:17:11.884 --> 00:17:14.765 - of the challenges is there's so many interesting 471 00:17:14.765 --> 00:17:17.404 - and cool gizmos and gadgets and tools and 472 00:17:17.404 --> 00:17:17.904 - instruments 473 00:17:18.444 --> 00:17:19.105 - out there. 474 00:17:19.980 --> 00:17:21.839 - But does it do they 475 00:17:22.299 --> 00:17:22.799 - achieve 476 00:17:23.420 --> 00:17:26.140 - the the strategy that has been laid out? 477 00:17:26.140 --> 00:17:27.839 - So as I think about my 478 00:17:28.220 --> 00:17:29.920 - career trajectory and career 479 00:17:30.539 --> 00:17:31.039 - aspirations, 480 00:17:31.744 --> 00:17:33.744 - I wanna make sure that I implement and 481 00:17:33.744 --> 00:17:35.924 - utilize tools that allow me 482 00:17:36.384 --> 00:17:38.705 - to improve clinical outcomes. But what does that 483 00:17:38.705 --> 00:17:40.384 - mean? That means that I have to actually 484 00:17:40.384 --> 00:17:42.625 - measure those outcomes. And I think measuring those 485 00:17:42.625 --> 00:17:45.025 - outcomes that matter most to patients should be 486 00:17:45.025 --> 00:17:45.845 - as routine 487 00:17:46.650 --> 00:17:48.970 - as taking up someone's blood pressure and their 488 00:17:48.970 --> 00:17:49.869 - vital signs. 489 00:17:50.490 --> 00:17:53.230 - As orthopedic surgeons, I wouldn't operate 490 00:17:53.529 --> 00:17:56.410 - on someone without an x-ray. So why would 491 00:17:56.410 --> 00:17:56.910 - I 492 00:17:57.289 --> 00:17:58.509 - deliver a care 493 00:17:59.105 --> 00:17:59.605 - journey, 494 00:18:00.465 --> 00:18:00.965 - expectation 495 00:18:01.424 --> 00:18:04.085 - without understanding their goals, without understanding 496 00:18:04.785 --> 00:18:07.585 - what their functional status is, without understanding what 497 00:18:07.585 --> 00:18:09.664 - their pain level is in a way that's 498 00:18:09.664 --> 00:18:12.945 - actually tangible and and real and not just, 499 00:18:12.945 --> 00:18:14.950 - oh, I have pain today. Oh, I'm not 500 00:18:14.950 --> 00:18:16.950 - functioning at the ability I want to, but 501 00:18:16.950 --> 00:18:18.090 - really digging into 502 00:18:18.470 --> 00:18:20.410 - validated ways of measuring that. 503 00:18:20.710 --> 00:18:23.930 - And so I'm super excited about these technologies, 504 00:18:24.470 --> 00:18:26.490 - but I also wanna take those technologies, 505 00:18:26.870 --> 00:18:29.795 - implement them in in a learning health system 506 00:18:29.795 --> 00:18:32.855 - type model, in a quality improvement rapid cycle, 507 00:18:32.914 --> 00:18:35.075 - and say, yes. This works. This doesn't. And 508 00:18:35.075 --> 00:18:37.315 - I want the flexibility in order to do 509 00:18:37.315 --> 00:18:38.775 - that. And that requires 510 00:18:39.154 --> 00:18:40.775 - a health system that understands 511 00:18:41.609 --> 00:18:45.369 - that the changes and challenges of tomorrow can't 512 00:18:45.369 --> 00:18:47.609 - be solved with the instruments and tools of 513 00:18:47.609 --> 00:18:48.109 - yesterday. 514 00:18:48.809 --> 00:18:50.970 - And so that's what I'm super, super excited 515 00:18:50.970 --> 00:18:53.369 - about. That includes those AI tools, as I 516 00:18:53.369 --> 00:18:54.349 - mentioned, robotics, 517 00:18:56.335 --> 00:18:56.835 - orthobiologics, 518 00:18:57.934 --> 00:19:00.914 - smart implants. All of these things have remarkable 519 00:19:01.134 --> 00:19:01.634 - potential, 520 00:19:02.015 --> 00:19:03.615 - but we have to make sure we're not 521 00:19:03.615 --> 00:19:05.694 - just using them because they're the sexy thing 522 00:19:05.694 --> 00:19:07.839 - to do in today's world, but that they 523 00:19:07.839 --> 00:19:08.339 - actually 524 00:19:08.880 --> 00:19:11.539 - improve patient outcomes that matter most to patients. 525 00:19:12.559 --> 00:19:14.319 - That's amazing to hear. I I love that 526 00:19:14.319 --> 00:19:16.720 - and truly inspirational about what the future may 527 00:19:16.720 --> 00:19:17.220 - hold. 528 00:19:17.599 --> 00:19:19.200 - Thank you so much, doctor Bernstein, for being 529 00:19:19.200 --> 00:19:20.880 - here on the podcast today. Is there anything 530 00:19:20.880 --> 00:19:22.515 - you want to leave our listeners with? 531 00:19:23.474 --> 00:19:24.035 - Thank you, 532 00:19:24.515 --> 00:19:26.275 - for having me. It's it's truly been a 533 00:19:26.275 --> 00:19:27.654 - pleasure talking with you, 534 00:19:28.115 --> 00:19:30.914 - and, I'm just excited. I'm excited about the 535 00:19:30.914 --> 00:19:33.394 - future of health care. Most people, as I 536 00:19:33.394 --> 00:19:33.894 - mentioned, 537 00:19:34.275 --> 00:19:35.174 - today are 538 00:19:38.049 --> 00:19:39.490 - care is broken. I don't think you'll find 539 00:19:39.490 --> 00:19:41.569 - a single person in this country or frankly 540 00:19:41.569 --> 00:19:43.009 - around the world, as I mentioned, who would 541 00:19:43.009 --> 00:19:43.990 - say health care, 542 00:19:44.769 --> 00:19:45.509 - is fantastic. 543 00:19:46.289 --> 00:19:47.890 - But what's exciting about is that we have 544 00:19:47.890 --> 00:19:50.789 - an opportunity to chart the the next 545 00:19:51.274 --> 00:19:53.595 - twenty, thirty, forty, fifty, a hundred years of 546 00:19:53.595 --> 00:19:54.095 - health 547 00:19:54.474 --> 00:19:56.234 - care. And by doing so, we can make 548 00:19:56.234 --> 00:19:56.894 - the changes 549 00:19:57.595 --> 00:19:58.894 - that align the incentives, 550 00:19:59.514 --> 00:20:00.014 - that 551 00:20:00.634 --> 00:20:03.375 - reward delivery of exceptional patient care, 552 00:20:03.755 --> 00:20:06.815 - and that ultimately leads to a healthier population 553 00:20:07.250 --> 00:20:07.970 - that can, 554 00:20:08.289 --> 00:20:11.029 - play with their families, deliver economic prosperity, 555 00:20:11.570 --> 00:20:13.250 - and can really make a difference in the 556 00:20:13.250 --> 00:20:15.250 - world. And so to me, this is the 557 00:20:15.250 --> 00:20:17.250 - most exciting time to be in health care. 558 00:20:17.250 --> 00:20:19.109 - And that's, I think, the that's 559 00:20:19.835 --> 00:20:21.755 - why I wake up every day excited, 560 00:20:22.315 --> 00:20:24.174 - for the day and and what I do. 561 00:20:25.914 --> 00:20:26.414 - Excellent. 562 00:20:26.954 --> 00:20:28.315 - Thank you so much again for your time 563 00:20:28.315 --> 00:20:30.575 - today. This has been a really fun conversation, 564 00:20:30.714 --> 00:20:33.031 - and I look forward to keeping it going. 565 00:20:33.031 --> 00:20:34.551 - I know, you know, a lot coming up 566 00:20:34.551 --> 00:20:36.151 - ahead, so we'll definitely have to stay in 567 00:20:36.151 --> 00:20:36.651 - touch. 568 00:20:37.191 --> 00:20:39.051 - Fantastic. Looking forward to that.