Hi, everyone. This is Brian Zimmerman with Becker
Healthcare care. Thank you for tuning in into
the Becker Health care Podcast series. We are
thrilled to be joined today by doctor On,
the chief of shoulder and elbow surgery at
Meds star Union Memorial Hospital.
Doctor Murphy, thank you so much for joining
the podcast today. I'm really excited to dive
into your professional journey and hear more about
your surgical techniques.
Excellent. Thank you for the privilege of doing
this. Yeah. Great. So let let's get into
it.
Doctor Murphy to begin, let's just discuss here
a bit about your background
and how you came to specialize in in
in total shoulder art capacity or total shoulder
replacements.
What led you to this area of orthopedic?
Sure. You know, I did traditional training of
medical school,
then
a 5 year residency in orthopedic surgery, and
then a 1 year
specialized fellowship and shoulder surgery
mentors,
or
well known shoulder surgeons. I love the surgery
and the people,
the types of surgery and and giving them
great outcomes. And then over time,
where I trained for my fellowship,
my
attending my my fellowship director was actually designing
a shoulder replacement system at that time, I
got really involved and interested in the design
process, the entrepreneurial process.
And then over time, you know, I've been
really
love the the nuances of shoulder art pla,
the ability to give great outcomes to patients.
Now with the advent,
it's not new anymore, but the advent of
reverse shoulder replacement which is different than ana
atomic shoulder replacement.
We even can help more and more patients
get great function and and pain relief.
In certainly exciting time as well with more
procedures shifting to outpatient settings. So And this,
of course includes shoulder replacement, which cms us
approved for coverage in As as of January
20 24 this year.
Can you walk us through how this is
a has affected your practice in the As?
What impact do you expect it will have
on the overall market? For outpatient total shoulder
replacements?
Sure. We started doing outpatient shoulder surgery or
shoulder replacement surgery
right around the time of Covid where we
really couldn't keep patients in the hospital. We
have proven and published
with research that outpatient,
shoulder Arthur last your replacements is very safe.
And we traditionally did that at the main
hospital we would can discharge them to home,
but now with the,
authorization by most commercial payers and from Medicare
as well,
we have now shifted a significant
population to the outpatient
ambulatory setting
where they get great care,
regional anesthesia,
obviously, it's outpatient and
when we designed our
enhanced system, we had
the As in mind with a lot of
efficiencies,
that we designed into the system.
Exciting. I mean, in your experience then as
an orthopedic surgeon, I mean you're also
Understand an editor for academic journals an act
leader in various fellowship and research
initiatives.
Can you sort of... I wanna just sort
of pull out some best practices here.
That that you can share with our listeners
in terms of driving efficiency and quality for
total shoulder replacements and As c's. What tips
do you have? Pearls of Wisdom, What what
what do you have to to to pass
on to surgeons out there listening to this
who who might be just honestly, starting to
perform this procedure in now outpatient settings.
Well, it's it's a lot of work on
the front end. We actually developed at Meds
story.
Patient access clinical care team. So on the
front end,
the most important things for
outpatient shoulder art classes to make sure that
patients have
a support system at home. So they need
to have help when they get home,
along with being obviously healthy enough to to
undergo the surgery. So Age is really not
a big part of the of the decision
factor because there's a lot of relatively healthy
people even in their seventies and eighties, but
it's it's on the front end, making sure
they have
access to supported homes. We make sure they
have all that,
and that along with... Know, a great anesthesia
team to provide peri,
pain control and anal
has allowed us to have it. And you
know, you know, we do about 90 per...
Sent outpatient both ana atomic and reverse it
at this time, both from the main hospital.
And from... Obviously, our As c's is where
we trying to do more and more
authorized care cases.
And and then can you talk a bit
more too about, I I guess, the techniques
and technologies?
Glad that have really
helped you achieve that level efficiency?
I would say that, you know, when we
designed our...
System. It's really important at an As c
to have an efficient system because you have
multiple cases going on ortho You have to
have them discharge in time. The big part
of our system
are any system when you're doing Art flask
to hit knee shoulders to have an efficient
sterile processing system.
So you actually have cost savings with regards
to time. So Td,
time driven
cost initiatives.
They're based on time.
So you can actually... With 2 trays. Our
system has 2 trays where many systems have
you know, 09:10
trays that they use. And by only having
2 trays,
we're able to increase our efficiency and sterile
processing. So
you know, if processing is 500 to 700
dollars an hour, and you only have 2
trays
or any
pace
then you're obviously gonna drive your cost down.
So time driven, you activity based costing or
Td a
for a stem shoulder replacement,
has shown to be the most cost effective
As c type of procedure to do, and
that's that's what we had in mind.
I appreciate you getting into those details and
And we've talked so far about some of
the things that excites you today? III wanna
look forward here a little bit. What what
developments and future opportunities? Or do you really
see on the horizon? In for for total
shoulder replacements in the As. What what what...
What's really exciting to you when you think
about the future here?
Well, I think we're gonna be doing more
and more reverse as well as ana atomic
shoulder replacement as an patient. In the next
year, so we're gonna be starting some
investigation device exemption studies to do a stem
reverse shoulder replacement
as an outpatient, And all of these in
the 1 system
are gonna enable us to do any type
of shoulder replacement system
at an As.
So
that's what I'm excited about. I think the
future is and it's it's obvious is moving
towards more and more outpatient and As c
types of surgeries and having the the right
equipment
and
implant design and efficiencies
are gonna be important to to maintain what
we're doing right now are and improving.
Mh. They and could you say even more
about sort of what
the the ability to do more reverse gold
art pla?
In in the outpatient setting, What would that
mean? I, I guess for your your practice
in patients too?
So traditionally, reversed shoulder replace... Is for older
patients, more complex cases,
and we traditionally have done those at the
hospital over the last 15 years because
there were issues with potential blood loss or
or complexity of the surgery. But, you know,
doing a reverse shoulder replacement now at an
As
means
First of all, patients just love having outpatient
surgery. They, you know,
the biggest issues people have or get sick
is staying in the hospital too long.
So, you know, they love having outpatient surgery,
going to an ambulatory care center, you know,
ease of use, ease of
getting in and out in great anesthesia. So
reverse where it used to be more complex
and,
you know, hundred percent of those cases we
would do as an inpatient at the main
hospital,
now with the types of devices I use
and the d enhanced system, you know, you
can do a reverse
as an outpatient,
no matter what complexity it is. And it's
given those patients the ability to do all
their to get out and have the surgery
done at the As and have a great
outcome and easy day at
easy day at work for me too.
Well, that, you know, I'm sure that's welcome.
And and 1 final very important question for
me. Sometimes, dr Murphy, my my shoulder clicks
when I exercise. That's not good. Is it?
Clicking is okay unless it hurts when it
clicks.
So if it hurts when it clicks, then
then you... And it doesn't go away you
know, with some time and then you need
to get a looked at. Well, well, thank
you for ind me, and giving me a
little bit,
you know, the pro work there. I appreciate
it.
Is there anything we didn't cover today that
you'd like to share with listeners, anything you
maybe wanna re emphasize?
The 1 the 1 thing I like to
emphasize whenever I do these types of talks
are or conversations is that, you know, shoulder
art pla d,
you know, years ago, was very
novel to many areas in many centers and,
and and wasn't known as having great outcomes.
I just want the... I want the patient
population to know that if you seek out
a well trained... Experience fellowship trained shoulder surgeon
in shoulder, Art pla
is gonna give you a great result. And
there's no reason to
live with pain and dysfunction, when we have
these capabilities, this knowledge, this technology now. So
We're still trying to, you know, to get
get the word out as it is and,
and let, you know, let our patients know
that there's an option for those who have
really bad our t shoulders or bad rotator
cuff tears and and doing shoulder replacement for
those reasons can give you a great result.
Well, doctor Murphy. Thank you so much for
for joining me on the podcast today and
and walking me through your professional journey and
and and some of your your surgical techniques
and your hopes for the future. I appreciate
the time. It's been my pleasure. Appreciate it.
I'd also like to thank our podcast sponsor,
D Sent, the orthopedic company of Johnson and
Johnson.
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