1 00:00:00,119 --> 00:00:02,357 Hi, everyone. This is Brian Zimmerman with Becker 2 00:00:02,517 --> 00:00:04,275 Healthcare care. Thank you for tuning in into 3 00:00:04,275 --> 00:00:06,912 the Becker Health care Podcast series. We are 4 00:00:06,912 --> 00:00:08,990 thrilled to be joined today by doctor On, 5 00:00:09,804 --> 00:00:12,522 the chief of shoulder and elbow surgery at 6 00:00:12,601 --> 00:00:14,519 Meds star Union Memorial Hospital. 7 00:00:15,079 --> 00:00:16,757 Doctor Murphy, thank you so much for joining 8 00:00:16,757 --> 00:00:18,995 the podcast today. I'm really excited to dive 9 00:00:18,995 --> 00:00:21,243 into your professional journey and hear more about 10 00:00:21,243 --> 00:00:22,121 your surgical techniques. 11 00:00:23,396 --> 00:00:25,549 Excellent. Thank you for the privilege of doing 12 00:00:25,549 --> 00:00:27,942 this. Yeah. Great. So let let's get into 13 00:00:27,942 --> 00:00:28,021 it. 14 00:00:28,833 --> 00:00:31,142 Doctor Murphy to begin, let's just discuss here 15 00:00:31,142 --> 00:00:32,199 a bit about your background 16 00:00:32,574 --> 00:00:34,405 and how you came to specialize in in 17 00:00:34,405 --> 00:00:37,748 in total shoulder art capacity or total shoulder 18 00:00:37,748 --> 00:00:38,146 replacements. 19 00:00:38,638 --> 00:00:40,781 What led you to this area of orthopedic? 20 00:00:41,972 --> 00:00:45,067 Sure. You know, I did traditional training of 21 00:00:45,067 --> 00:00:45,782 medical school, 22 00:00:46,655 --> 00:00:47,155 then 23 00:00:47,545 --> 00:00:50,265 a 5 year residency in orthopedic surgery, and 24 00:00:50,265 --> 00:00:51,405 then a 1 year 25 00:00:51,784 --> 00:00:54,204 specialized fellowship and shoulder surgery 26 00:00:54,585 --> 00:00:54,905 mentors, 27 00:00:55,638 --> 00:00:56,116 or 28 00:00:56,752 --> 00:00:58,900 well known shoulder surgeons. I love the surgery 29 00:00:58,900 --> 00:00:59,537 and the people, 30 00:01:00,253 --> 00:01:02,162 the types of surgery and and giving them 31 00:01:02,162 --> 00:01:03,992 great outcomes. And then over time, 32 00:01:04,644 --> 00:01:06,642 where I trained for my fellowship, 33 00:01:07,761 --> 00:01:08,261 my 34 00:01:08,720 --> 00:01:11,597 attending my my fellowship director was actually designing 35 00:01:11,597 --> 00:01:14,008 a shoulder replacement system at that time, I 36 00:01:14,008 --> 00:01:16,959 got really involved and interested in the design 37 00:01:16,959 --> 00:01:19,214 process, the entrepreneurial process. 38 00:01:20,389 --> 00:01:22,223 And then over time, you know, I've been 39 00:01:22,223 --> 00:01:22,723 really 40 00:01:24,234 --> 00:01:27,350 love the the nuances of shoulder art pla, 41 00:01:28,070 --> 00:01:31,106 the ability to give great outcomes to patients. 42 00:01:31,426 --> 00:01:32,385 Now with the advent, 43 00:01:33,198 --> 00:01:35,346 it's not new anymore, but the advent of 44 00:01:35,346 --> 00:01:37,653 reverse shoulder replacement which is different than ana 45 00:01:37,653 --> 00:01:38,925 atomic shoulder replacement. 46 00:01:39,482 --> 00:01:41,392 We even can help more and more patients 47 00:01:41,392 --> 00:01:43,562 get great function and and pain relief. 48 00:01:45,081 --> 00:01:47,798 In certainly exciting time as well with more 49 00:01:47,798 --> 00:01:51,009 procedures shifting to outpatient settings. So And this, 50 00:01:51,089 --> 00:01:53,965 of course includes shoulder replacement, which cms us 51 00:01:53,965 --> 00:01:56,282 approved for coverage in As as of January 52 00:01:56,282 --> 00:01:57,320 20 24 this year. 53 00:01:57,974 --> 00:01:59,490 Can you walk us through how this is 54 00:01:59,490 --> 00:02:02,043 a has affected your practice in the As? 55 00:02:02,841 --> 00:02:04,437 What impact do you expect it will have 56 00:02:04,437 --> 00:02:07,579 on the overall market? For outpatient total shoulder 57 00:02:07,635 --> 00:02:07,953 replacements? 58 00:02:08,986 --> 00:02:12,483 Sure. We started doing outpatient shoulder surgery or 59 00:02:12,483 --> 00:02:14,016 shoulder replacement surgery 60 00:02:14,644 --> 00:02:16,317 right around the time of Covid where we 61 00:02:16,317 --> 00:02:18,310 really couldn't keep patients in the hospital. We 62 00:02:18,310 --> 00:02:19,686 have proven and published 63 00:02:20,222 --> 00:02:21,816 with research that outpatient, 64 00:02:22,549 --> 00:02:24,866 shoulder Arthur last your replacements is very safe. 65 00:02:25,266 --> 00:02:27,903 And we traditionally did that at the main 66 00:02:27,903 --> 00:02:30,220 hospital we would can discharge them to home, 67 00:02:30,380 --> 00:02:31,192 but now with the, 68 00:02:32,150 --> 00:02:35,659 authorization by most commercial payers and from Medicare 69 00:02:35,659 --> 00:02:36,217 as well, 70 00:02:36,855 --> 00:02:38,711 we have now shifted a significant 71 00:02:39,089 --> 00:02:40,500 population to the outpatient 72 00:02:41,415 --> 00:02:42,314 ambulatory setting 73 00:02:43,407 --> 00:02:44,841 where they get great care, 74 00:02:45,876 --> 00:02:46,991 regional anesthesia, 75 00:02:47,389 --> 00:02:49,323 obviously, it's outpatient and 76 00:02:49,874 --> 00:02:51,408 when we designed our 77 00:02:52,262 --> 00:02:53,956 enhanced system, we had 78 00:02:54,411 --> 00:02:56,800 the As in mind with a lot of 79 00:02:56,800 --> 00:02:57,300 efficiencies, 80 00:02:58,169 --> 00:02:59,685 that we designed into the system. 81 00:03:02,558 --> 00:03:04,554 Exciting. I mean, in your experience then as 82 00:03:04,554 --> 00:03:06,284 an orthopedic surgeon, I mean you're also 83 00:03:06,721 --> 00:03:09,740 Understand an editor for academic journals an act 84 00:03:09,740 --> 00:03:11,749 leader in various fellowship and research 85 00:03:12,123 --> 00:03:12,362 initiatives. 86 00:03:13,235 --> 00:03:15,240 Can you sort of... I wanna just sort 87 00:03:15,240 --> 00:03:17,080 of pull out some best practices here. 88 00:03:17,800 --> 00:03:19,400 That that you can share with our listeners 89 00:03:19,400 --> 00:03:22,120 in terms of driving efficiency and quality for 90 00:03:22,120 --> 00:03:25,008 total shoulder replacements and As c's. What tips 91 00:03:25,008 --> 00:03:27,069 do you have? Pearls of Wisdom, What what 92 00:03:27,069 --> 00:03:28,654 what do you have to to to pass 93 00:03:28,654 --> 00:03:30,398 on to surgeons out there listening to this 94 00:03:30,398 --> 00:03:32,792 who who might be just honestly, starting to 95 00:03:32,792 --> 00:03:34,777 perform this procedure in now outpatient settings. 96 00:03:35,730 --> 00:03:37,636 Well, it's it's a lot of work on 97 00:03:37,636 --> 00:03:40,495 the front end. We actually developed at Meds 98 00:03:40,495 --> 00:03:40,733 story. 99 00:03:41,543 --> 00:03:44,096 Patient access clinical care team. So on the 100 00:03:44,096 --> 00:03:44,654 front end, 101 00:03:45,292 --> 00:03:46,989 the most important things for 102 00:03:47,844 --> 00:03:50,477 outpatient shoulder art classes to make sure that 103 00:03:50,477 --> 00:03:51,169 patients have 104 00:03:51,689 --> 00:03:53,767 a support system at home. So they need 105 00:03:53,767 --> 00:03:55,285 to have help when they get home, 106 00:03:55,925 --> 00:03:58,562 along with being obviously healthy enough to to 107 00:03:58,562 --> 00:04:00,740 undergo the surgery. So Age is really not 108 00:04:01,612 --> 00:04:03,918 a big part of the of the decision 109 00:04:03,918 --> 00:04:05,827 factor because there's a lot of relatively healthy 110 00:04:05,827 --> 00:04:07,657 people even in their seventies and eighties, but 111 00:04:07,657 --> 00:04:10,215 it's it's on the front end, making sure 112 00:04:10,215 --> 00:04:10,953 they have 113 00:04:11,565 --> 00:04:13,551 access to supported homes. We make sure they 114 00:04:13,551 --> 00:04:14,187 have all that, 115 00:04:15,219 --> 00:04:18,181 and that along with... Know, a great anesthesia 116 00:04:18,181 --> 00:04:19,719 team to provide peri, 117 00:04:20,736 --> 00:04:22,274 pain control and anal 118 00:04:23,131 --> 00:04:24,408 has allowed us to have it. And you 119 00:04:24,408 --> 00:04:25,925 know, you know, we do about 90 per... 120 00:04:26,178 --> 00:04:28,883 Sent outpatient both ana atomic and reverse it 121 00:04:28,883 --> 00:04:30,315 at this time, both from the main hospital. 122 00:04:30,474 --> 00:04:32,542 And from... Obviously, our As c's is where 123 00:04:32,542 --> 00:04:34,415 we trying to do more and more 124 00:04:34,954 --> 00:04:36,074 authorized care cases. 125 00:04:37,754 --> 00:04:39,035 And and then can you talk a bit 126 00:04:39,035 --> 00:04:41,115 more too about, I I guess, the techniques 127 00:04:41,115 --> 00:04:42,074 and technologies? 128 00:04:42,807 --> 00:04:44,260 Glad that have really 129 00:04:44,634 --> 00:04:47,095 helped you achieve that level efficiency? 130 00:04:48,445 --> 00:04:50,033 I would say that, you know, when we 131 00:04:50,033 --> 00:04:50,430 designed our... 132 00:04:51,322 --> 00:04:54,430 System. It's really important at an As c 133 00:04:54,430 --> 00:04:56,502 to have an efficient system because you have 134 00:04:56,502 --> 00:04:59,069 multiple cases going on ortho You have to 135 00:04:59,069 --> 00:05:01,626 have them discharge in time. The big part 136 00:05:01,626 --> 00:05:02,525 of our system 137 00:05:03,144 --> 00:05:05,302 are any system when you're doing Art flask 138 00:05:05,302 --> 00:05:08,272 to hit knee shoulders to have an efficient 139 00:05:08,272 --> 00:05:09,787 sterile processing system. 140 00:05:10,266 --> 00:05:13,536 So you actually have cost savings with regards 141 00:05:13,536 --> 00:05:15,551 to time. So Td, 142 00:05:16,168 --> 00:05:16,987 time driven 143 00:05:17,459 --> 00:05:18,493 cost initiatives. 144 00:05:19,050 --> 00:05:20,164 They're based on time. 145 00:05:20,880 --> 00:05:23,665 So you can actually... With 2 trays. Our 146 00:05:23,665 --> 00:05:26,154 system has 2 trays where many systems have 147 00:05:26,544 --> 00:05:27,823 you know, 09:10 148 00:05:27,823 --> 00:05:30,460 trays that they use. And by only having 149 00:05:30,460 --> 00:05:31,100 2 trays, 150 00:05:31,579 --> 00:05:34,776 we're able to increase our efficiency and sterile 151 00:05:34,776 --> 00:05:35,995 processing. So 152 00:05:36,470 --> 00:05:38,790 you know, if processing is 500 to 700 153 00:05:38,790 --> 00:05:39,990 dollars an hour, and you only have 2 154 00:05:39,990 --> 00:05:40,490 trays 155 00:05:40,870 --> 00:05:41,689 or any 156 00:05:41,990 --> 00:05:42,490 pace 157 00:05:42,949 --> 00:05:44,470 then you're obviously gonna drive your cost down. 158 00:05:44,709 --> 00:05:48,082 So time driven, you activity based costing or 159 00:05:48,242 --> 00:05:48,982 Td a 160 00:05:49,601 --> 00:05:51,918 for a stem shoulder replacement, 161 00:05:53,197 --> 00:05:55,295 has shown to be the most cost effective 162 00:05:55,848 --> 00:05:57,837 As c type of procedure to do, and 163 00:05:57,837 --> 00:05:59,030 that's that's what we had in mind. 164 00:06:00,382 --> 00:06:02,584 I appreciate you getting into those details and 165 00:06:02,704 --> 00:06:04,060 And we've talked so far about some of 166 00:06:04,060 --> 00:06:06,612 the things that excites you today? III wanna 167 00:06:06,612 --> 00:06:08,765 look forward here a little bit. What what 168 00:06:08,765 --> 00:06:11,237 developments and future opportunities? Or do you really 169 00:06:11,237 --> 00:06:13,509 see on the horizon? In for for total 170 00:06:13,569 --> 00:06:15,730 shoulder replacements in the As. What what what... 171 00:06:15,889 --> 00:06:17,329 What's really exciting to you when you think 172 00:06:17,329 --> 00:06:17,970 about the future here? 173 00:06:18,689 --> 00:06:20,129 Well, I think we're gonna be doing more 174 00:06:20,129 --> 00:06:23,645 and more reverse as well as ana atomic 175 00:06:23,645 --> 00:06:26,735 shoulder replacement as an patient. In the next 176 00:06:26,735 --> 00:06:28,661 year, so we're gonna be starting some 177 00:06:29,687 --> 00:06:32,899 investigation device exemption studies to do a stem 178 00:06:33,276 --> 00:06:34,574 reverse shoulder replacement 179 00:06:34,951 --> 00:06:37,344 as an outpatient, And all of these in 180 00:06:37,344 --> 00:06:38,322 the 1 system 181 00:06:38,954 --> 00:06:40,790 are gonna enable us to do any type 182 00:06:40,790 --> 00:06:42,408 of shoulder replacement system 183 00:06:42,786 --> 00:06:43,605 at an As. 184 00:06:44,223 --> 00:06:44,723 So 185 00:06:45,181 --> 00:06:47,336 that's what I'm excited about. I think the 186 00:06:47,336 --> 00:06:49,575 future is and it's it's obvious is moving 187 00:06:49,575 --> 00:06:52,033 towards more and more outpatient and As c 188 00:06:52,033 --> 00:06:55,205 types of surgeries and having the the right 189 00:06:55,205 --> 00:06:55,705 equipment 190 00:06:56,093 --> 00:06:56,593 and 191 00:06:57,045 --> 00:06:58,974 implant design and efficiencies 192 00:06:59,585 --> 00:07:02,124 are gonna be important to to maintain what 193 00:07:02,124 --> 00:07:03,711 we're doing right now are and improving. 194 00:07:04,917 --> 00:07:07,383 Mh. They and could you say even more 195 00:07:07,383 --> 00:07:08,440 about sort of what 196 00:07:09,292 --> 00:07:11,996 the the ability to do more reverse gold 197 00:07:11,996 --> 00:07:12,871 art pla? 198 00:07:13,760 --> 00:07:15,746 In in the outpatient setting, What would that 199 00:07:15,746 --> 00:07:17,653 mean? I, I guess for your your practice 200 00:07:17,653 --> 00:07:18,447 in patients too? 201 00:07:19,321 --> 00:07:23,175 So traditionally, reversed shoulder replace... Is for older 202 00:07:23,312 --> 00:07:25,463 patients, more complex cases, 203 00:07:25,941 --> 00:07:28,091 and we traditionally have done those at the 204 00:07:28,091 --> 00:07:30,662 hospital over the last 15 years because 205 00:07:31,054 --> 00:07:33,606 there were issues with potential blood loss or 206 00:07:33,606 --> 00:07:35,999 or complexity of the surgery. But, you know, 207 00:07:36,159 --> 00:07:39,030 doing a reverse shoulder replacement now at an 208 00:07:39,189 --> 00:07:39,689 As 209 00:07:40,067 --> 00:07:40,567 means 210 00:07:40,959 --> 00:07:43,024 First of all, patients just love having outpatient 211 00:07:43,024 --> 00:07:43,977 surgery. They, you know, 212 00:07:44,692 --> 00:07:46,996 the biggest issues people have or get sick 213 00:07:46,996 --> 00:07:48,823 is staying in the hospital too long. 214 00:07:50,034 --> 00:07:52,511 So, you know, they love having outpatient surgery, 215 00:07:52,910 --> 00:07:55,627 going to an ambulatory care center, you know, 216 00:07:55,866 --> 00:07:57,360 ease of use, ease of 217 00:07:58,037 --> 00:08:00,269 getting in and out in great anesthesia. So 218 00:08:00,269 --> 00:08:02,102 reverse where it used to be more complex 219 00:08:02,102 --> 00:08:02,602 and, 220 00:08:03,058 --> 00:08:04,891 you know, hundred percent of those cases we 221 00:08:04,891 --> 00:08:06,901 would do as an inpatient at the main 222 00:08:06,901 --> 00:08:07,380 hospital, 223 00:08:08,178 --> 00:08:10,493 now with the types of devices I use 224 00:08:10,493 --> 00:08:13,048 and the d enhanced system, you know, you 225 00:08:13,048 --> 00:08:14,186 can do a reverse 226 00:08:15,055 --> 00:08:16,005 as an outpatient, 227 00:08:16,639 --> 00:08:19,333 no matter what complexity it is. And it's 228 00:08:19,333 --> 00:08:21,155 given those patients the ability to do all 229 00:08:21,155 --> 00:08:23,154 their to get out and have the surgery 230 00:08:23,154 --> 00:08:25,298 done at the As and have a great 231 00:08:25,298 --> 00:08:26,886 outcome and easy day at 232 00:08:27,442 --> 00:08:28,713 easy day at work for me too. 233 00:08:30,000 --> 00:08:32,159 Well, that, you know, I'm sure that's welcome. 234 00:08:32,399 --> 00:08:34,799 And and 1 final very important question for 235 00:08:34,799 --> 00:08:38,245 me. Sometimes, dr Murphy, my my shoulder clicks 236 00:08:38,245 --> 00:08:40,071 when I exercise. That's not good. Is it? 237 00:08:41,183 --> 00:08:44,041 Clicking is okay unless it hurts when it 238 00:08:44,041 --> 00:08:44,279 clicks. 239 00:08:45,169 --> 00:08:47,083 So if it hurts when it clicks, then 240 00:08:47,083 --> 00:08:48,758 then you... And it doesn't go away you 241 00:08:48,758 --> 00:08:50,353 know, with some time and then you need 242 00:08:50,353 --> 00:08:52,507 to get a looked at. Well, well, thank 243 00:08:52,507 --> 00:08:54,581 you for ind me, and giving me a 244 00:08:54,581 --> 00:08:54,955 little bit, 245 00:08:55,630 --> 00:08:57,697 you know, the pro work there. I appreciate 246 00:08:57,697 --> 00:08:57,856 it. 247 00:08:58,730 --> 00:09:00,558 Is there anything we didn't cover today that 248 00:09:00,558 --> 00:09:02,227 you'd like to share with listeners, anything you 249 00:09:02,227 --> 00:09:03,340 maybe wanna re emphasize? 250 00:09:04,708 --> 00:09:06,063 The 1 the 1 thing I like to 251 00:09:06,063 --> 00:09:08,216 emphasize whenever I do these types of talks 252 00:09:08,216 --> 00:09:11,325 are or conversations is that, you know, shoulder 253 00:09:11,325 --> 00:09:12,282 art pla d, 254 00:09:13,094 --> 00:09:15,980 you know, years ago, was very 255 00:09:16,832 --> 00:09:19,719 novel to many areas in many centers and, 256 00:09:20,110 --> 00:09:22,190 and and wasn't known as having great outcomes. 257 00:09:22,350 --> 00:09:24,209 I just want the... I want the patient 258 00:09:24,429 --> 00:09:26,370 population to know that if you seek out 259 00:09:26,830 --> 00:09:29,965 a well trained... Experience fellowship trained shoulder surgeon 260 00:09:29,965 --> 00:09:31,425 in shoulder, Art pla 261 00:09:31,804 --> 00:09:33,884 is gonna give you a great result. And 262 00:09:33,884 --> 00:09:35,504 there's no reason to 263 00:09:35,977 --> 00:09:39,334 live with pain and dysfunction, when we have 264 00:09:39,389 --> 00:09:42,984 these capabilities, this knowledge, this technology now. So 265 00:09:43,134 --> 00:09:44,889 We're still trying to, you know, to get 266 00:09:44,889 --> 00:09:46,404 get the word out as it is and, 267 00:09:46,963 --> 00:09:48,717 and let, you know, let our patients know 268 00:09:48,717 --> 00:09:50,951 that there's an option for those who have 269 00:09:50,951 --> 00:09:54,075 really bad our t shoulders or bad rotator 270 00:09:54,075 --> 00:09:57,341 cuff tears and and doing shoulder replacement for 271 00:09:57,341 --> 00:09:58,934 those reasons can give you a great result. 272 00:09:59,810 --> 00:10:01,721 Well, doctor Murphy. Thank you so much for 273 00:10:01,721 --> 00:10:04,301 for joining me on the podcast today and 274 00:10:04,357 --> 00:10:06,420 and walking me through your professional journey and 275 00:10:06,420 --> 00:10:08,404 and and some of your your surgical techniques 276 00:10:08,404 --> 00:10:10,229 and your hopes for the future. I appreciate 277 00:10:10,229 --> 00:10:12,879 the time. It's been my pleasure. Appreciate it. 278 00:10:13,519 --> 00:10:15,759 I'd also like to thank our podcast sponsor, 279 00:10:15,920 --> 00:10:18,800 D Sent, the orthopedic company of Johnson and 280 00:10:18,960 --> 00:10:19,279 Johnson. 281 00:10:19,774 --> 00:10:22,156 You continue a more podcast from Becker Healthcare 282 00:10:22,156 --> 00:10:25,014 by visiting our podcast page at Becker Hospital 283 00:10:25,014 --> 00:10:25,649 review Duct.