1 00:00:00,080 --> 00:00:02,159 This is Alan Gondland with the Becker's Podcast, 2 00:00:02,159 --> 00:00:03,759 and I am delighted to be joined today 3 00:00:03,759 --> 00:00:05,620 by doctor Jason Koh, orthopedic 4 00:00:05,919 --> 00:00:09,199 surgeon at Endeavor Health. Doctor Koh, delighted to 5 00:00:09,199 --> 00:00:10,800 have you back on the podcast with us 6 00:00:10,800 --> 00:00:13,119 today. Before we dive into our discussion, do 7 00:00:13,119 --> 00:00:14,240 you mind taking a moment to give us 8 00:00:14,240 --> 00:00:15,974 a little bit more insight about your role 9 00:00:15,974 --> 00:00:17,515 and your background at Endeavor Health? 10 00:00:18,295 --> 00:00:18,795 Absolutely. 11 00:00:19,574 --> 00:00:21,894 And, Alan, thank you so much for having 12 00:00:21,894 --> 00:00:23,655 me on the podcast. It's always a pleasure 13 00:00:23,655 --> 00:00:24,875 to be back on Becker's. 14 00:00:26,135 --> 00:00:28,375 My role is as the Mark Niemann family 15 00:00:28,375 --> 00:00:30,379 chair at Endeavor Health, which is one of 16 00:00:30,379 --> 00:00:33,280 the largest, health care systems in Illinois, 17 00:00:33,820 --> 00:00:36,559 and I help lead our orthopedic specialty hospital 18 00:00:36,619 --> 00:00:37,359 at Skokie. 19 00:00:38,059 --> 00:00:40,219 I'm a clinical professor at the University of 20 00:00:40,219 --> 00:00:42,219 Chicago and a chief medical officer for the 21 00:00:42,219 --> 00:00:43,119 Chicago Fire 22 00:00:44,075 --> 00:00:45,534 Major League Soccer team. 23 00:00:46,314 --> 00:00:49,114 Clinically, I'm a practicing sports medicine and shoulder 24 00:00:49,114 --> 00:00:49,614 surgeon, 25 00:00:50,155 --> 00:00:52,475 but I also have a administrative role in, 26 00:00:52,715 --> 00:00:55,774 overseeing orthopedic activity across the entire system, 27 00:00:56,780 --> 00:00:58,239 which has been helped by, 28 00:00:58,539 --> 00:01:00,699 you know, obviously, it had benefits, some good 29 00:01:00,699 --> 00:01:03,659 training over the years at Harvard Hopkins Hospital 30 00:01:03,659 --> 00:01:05,519 For Special Surgery and Cleveland Clinic, 31 00:01:05,819 --> 00:01:08,400 and then, also an MBA at Northwestern. 32 00:01:10,314 --> 00:01:11,994 Fantastic. So thanks so much for the the 33 00:01:11,994 --> 00:01:13,594 brief intro, a little bit about your background. 34 00:01:13,594 --> 00:01:16,075 Massive soccer fan, a big Chicago Fire fan, 35 00:01:16,075 --> 00:01:18,015 so I'm delighted to hear that as well. 36 00:01:18,555 --> 00:01:21,034 Doctor Ko, so much going on in the 37 00:01:21,034 --> 00:01:23,049 field of orthopedics at orthopedics at any one 38 00:01:23,049 --> 00:01:24,729 time. A lot of exciting things, no doubt 39 00:01:24,729 --> 00:01:26,349 some of the challenges as well. 40 00:01:27,290 --> 00:01:28,509 What what innovations 41 00:01:28,890 --> 00:01:31,530 or what trends are you most excited by, 42 00:01:31,769 --> 00:01:33,069 in orthopedics today? 43 00:01:34,424 --> 00:01:36,444 Well, I think there's a lot of exciting 44 00:01:36,504 --> 00:01:39,165 work happening around regenerative medicine. 45 00:01:39,784 --> 00:01:42,024 One of the things that has recently been 46 00:01:42,024 --> 00:01:44,284 in the news in Chicago is the return 47 00:01:44,905 --> 00:01:47,484 of Lonzo Ball to the Chicago Bulls 48 00:01:47,810 --> 00:01:50,149 after a cartilage and meniscus transplant. 49 00:01:51,090 --> 00:01:53,269 This is a procedure that's been performed, 50 00:01:54,209 --> 00:01:56,849 over the past several years. And actually, I've 51 00:01:56,849 --> 00:01:58,290 had experience doing this in, 52 00:01:58,930 --> 00:02:01,750 other, collegiate and, semi pro, 53 00:02:02,114 --> 00:02:03,734 basketball players in the past. 54 00:02:04,114 --> 00:02:05,894 But the combination of these 55 00:02:06,194 --> 00:02:06,694 transplantation 56 00:02:07,234 --> 00:02:10,354 activities to help regenerate the knee is actually 57 00:02:10,354 --> 00:02:12,995 an area that's really exciting, and we continue 58 00:02:12,995 --> 00:02:15,395 to make new advances over the past several 59 00:02:15,395 --> 00:02:15,895 years. 60 00:02:16,740 --> 00:02:20,439 I think another area that's increasingly exciting is 61 00:02:20,819 --> 00:02:23,700 the expansion and use of robotic and computer 62 00:02:23,700 --> 00:02:24,760 assisted technology, 63 00:02:26,099 --> 00:02:28,439 around making surgery more precise. 64 00:02:29,544 --> 00:02:33,165 At Skokie Hospital, where our orthopedic hospital is, 65 00:02:33,705 --> 00:02:36,264 over 90% of our total hip and knee 66 00:02:36,264 --> 00:02:38,665 replacements are done with some computer assisted or 67 00:02:38,665 --> 00:02:41,004 robotic technology. And this is now spreading 68 00:02:41,305 --> 00:02:43,405 into other areas such as 69 00:02:44,159 --> 00:02:44,900 spine surgery 70 00:02:45,519 --> 00:02:47,219 and shoulder replacement. 71 00:02:47,840 --> 00:02:49,699 And I think finally, another 72 00:02:50,000 --> 00:02:52,879 really exciting area is what the potential is 73 00:02:52,879 --> 00:02:54,340 for artificial intelligence. 74 00:02:55,599 --> 00:02:56,099 Initially, 75 00:02:57,194 --> 00:02:59,354 we're probably gonna see a lot more uptake 76 00:02:59,354 --> 00:03:01,754 and use of this in helping with the 77 00:03:01,754 --> 00:03:03,614 patient and clinical documentation. 78 00:03:04,474 --> 00:03:06,394 The idea is that also maybe can help 79 00:03:06,394 --> 00:03:07,055 with appropriate, 80 00:03:07,754 --> 00:03:08,254 coding. 81 00:03:08,555 --> 00:03:11,114 I do know that actually insurance companies are 82 00:03:11,114 --> 00:03:12,509 using AI to help, 83 00:03:13,469 --> 00:03:14,530 adjudicate claims. 84 00:03:15,229 --> 00:03:17,150 But I think on the provider side, we 85 00:03:17,150 --> 00:03:18,909 may need to use AI to help us 86 00:03:18,909 --> 00:03:21,709 enhance our ability to appropriately document the work 87 00:03:21,709 --> 00:03:22,530 that we do. 88 00:03:23,709 --> 00:03:25,150 A lot a lot of exciting things there. 89 00:03:25,150 --> 00:03:28,235 No doubt AI, top of mind, robotic surgery, 90 00:03:28,614 --> 00:03:31,275 in terms of total joints, knee, hip replacements. 91 00:03:32,694 --> 00:03:34,375 To follow-up on the first kind that you've 92 00:03:34,375 --> 00:03:34,875 mentioned, 93 00:03:35,495 --> 00:03:37,414 quite an interesting one when we talked about 94 00:03:37,414 --> 00:03:40,215 regenerative medicine and whatnot. Do you mind giving 95 00:03:40,215 --> 00:03:42,074 us a little bit more insight into 96 00:03:42,629 --> 00:03:43,449 recent advancements 97 00:03:43,750 --> 00:03:46,810 in regenerative medicine like cartilage regrowth? 98 00:03:47,509 --> 00:03:49,370 And how do they how do you integrate, 99 00:03:49,830 --> 00:03:52,490 procedures like this in terms of meniscus transplants? 100 00:03:53,990 --> 00:03:54,490 Absolutely. 101 00:03:54,870 --> 00:03:55,370 So, 102 00:03:56,235 --> 00:03:57,995 what's happened over the years, and I've been 103 00:03:57,995 --> 00:03:59,135 involved with cartilage 104 00:03:59,995 --> 00:04:03,435 transplantation research for over close to 30 years 105 00:04:03,435 --> 00:04:04,655 at this point in time, 106 00:04:04,955 --> 00:04:07,294 is we're getting more and more different tools. 107 00:04:07,835 --> 00:04:08,335 Historically, 108 00:04:08,794 --> 00:04:10,495 some of the techniques involved 109 00:04:11,040 --> 00:04:13,599 harvesting cells and then placing it under some 110 00:04:13,599 --> 00:04:14,500 sort of periosteal 111 00:04:14,800 --> 00:04:15,300 patch, 112 00:04:15,840 --> 00:04:17,680 which had to be sutured in place. Very 113 00:04:17,680 --> 00:04:20,100 technically tedious and difficult procedures. 114 00:04:20,720 --> 00:04:23,379 And, what things have evolved to is 115 00:04:23,805 --> 00:04:26,545 more of a use of sometimes donated cartilage 116 00:04:26,685 --> 00:04:27,185 tissue 117 00:04:27,564 --> 00:04:30,144 or other systems where there 118 00:04:31,084 --> 00:04:34,464 are scaffolds that help, promote cartilage regrowth 119 00:04:34,925 --> 00:04:36,144 or the use of 120 00:04:36,939 --> 00:04:38,319 transplants that have, 121 00:04:38,860 --> 00:04:40,720 scaffolds now that can be transplanted, 122 00:04:41,259 --> 00:04:43,600 arthroscopically or very minimally invasively. 123 00:04:44,540 --> 00:04:46,639 This has enhanced our ability to, 124 00:04:47,100 --> 00:04:48,079 heal menis 125 00:04:48,540 --> 00:04:49,680 articular cartilage. 126 00:04:50,404 --> 00:04:51,865 With the meniscus cartilage, 127 00:04:52,245 --> 00:04:54,884 we're, I think, getting much more comfortable with 128 00:04:54,884 --> 00:04:56,425 doing meniscus transplantation. 129 00:04:58,004 --> 00:04:59,384 And there are some 130 00:04:59,764 --> 00:05:01,144 different techniques where 131 00:05:02,004 --> 00:05:04,185 we're evolving and testing actually around 132 00:05:04,490 --> 00:05:07,149 partial meniscus transplantation. We've done some, 133 00:05:07,610 --> 00:05:10,810 specific biomechanics work around that, and that might 134 00:05:10,810 --> 00:05:12,970 be able to help restore the meniscus, which 135 00:05:12,970 --> 00:05:15,949 functions at a shock absorber for the knee. 136 00:05:16,250 --> 00:05:17,850 So it's an exciting period of time, and 137 00:05:17,850 --> 00:05:19,850 then there's these augments that we can use 138 00:05:19,850 --> 00:05:22,964 like platelet rich plasma or bone marrow aspirate. 139 00:05:24,145 --> 00:05:25,824 Yeah. Absolutely. I'm sorry to cut across you 140 00:05:25,824 --> 00:05:27,345 there. Well, it was fascinating to hear about 141 00:05:27,345 --> 00:05:29,264 some of those recent advancements and from the 142 00:05:29,264 --> 00:05:32,564 biologics perspective, those regenerative medicine, their procedures, 143 00:05:33,019 --> 00:05:35,180 and how they can, of course, potentially improve 144 00:05:35,180 --> 00:05:37,100 outcomes and recovery for patients in some of 145 00:05:37,100 --> 00:05:38,959 these complex procedures as well. 146 00:05:39,500 --> 00:05:42,720 You also earlier mentioned robotic surgery, AI. 147 00:05:43,819 --> 00:05:45,500 I'm just curious to see, when you look 148 00:05:45,500 --> 00:05:47,774 ahead, what what do you think about the 149 00:05:47,774 --> 00:05:50,495 future of the spine and orthopedics field? When 150 00:05:50,495 --> 00:05:52,514 you see the next 2 or 3 years, 151 00:05:53,055 --> 00:05:55,295 anything else that you see being growing in 152 00:05:55,295 --> 00:05:57,694 prominently among surgeons? Anything else that you're keeping 153 00:05:57,694 --> 00:05:58,754 a close eye on? 154 00:06:00,060 --> 00:06:02,060 Well, I think there's obviously a lot of 155 00:06:02,060 --> 00:06:02,560 technological 156 00:06:03,019 --> 00:06:03,519 advances. 157 00:06:03,899 --> 00:06:05,279 Some of the things that, 158 00:06:06,060 --> 00:06:08,560 some of our physicians are looking at are, 159 00:06:08,620 --> 00:06:09,839 for example, endoscopic 160 00:06:10,219 --> 00:06:10,959 spine surgery, 161 00:06:11,659 --> 00:06:14,814 where it's that's becoming even less invasive than 162 00:06:14,814 --> 00:06:16,514 the minimally invasive technologies. 163 00:06:17,294 --> 00:06:19,615 The like we talked about, the use of 164 00:06:19,615 --> 00:06:22,834 increased precision with robotic or computer assisted 165 00:06:23,694 --> 00:06:24,194 planning. 166 00:06:24,974 --> 00:06:28,115 And this can actually potentially incorporate some technologies 167 00:06:28,414 --> 00:06:29,074 such as 168 00:06:29,730 --> 00:06:31,750 augmented or mixed reality where, 169 00:06:32,449 --> 00:06:35,410 a surgeon will be able to see the 170 00:06:35,410 --> 00:06:35,910 actual, 171 00:06:36,689 --> 00:06:38,870 structure of the bones and also 172 00:06:39,170 --> 00:06:39,670 superimpose, 173 00:06:41,250 --> 00:06:41,910 a preoperative 174 00:06:42,345 --> 00:06:45,165 plan and help navigate the instrumentation 175 00:06:45,545 --> 00:06:46,685 as it's being used. 176 00:06:47,865 --> 00:06:48,365 So, 177 00:06:48,985 --> 00:06:49,485 certainly, 178 00:06:49,865 --> 00:06:52,264 I mean, it's, you know, I'm sure many 179 00:06:52,264 --> 00:06:53,944 of us have played with some sort of 180 00:06:53,944 --> 00:06:55,404 augmented or mixed reality, 181 00:06:56,379 --> 00:06:59,180 little things on, your cell phone where you 182 00:06:59,180 --> 00:07:01,279 can superimpose some sort of other 183 00:07:02,139 --> 00:07:02,960 image onto, 184 00:07:03,339 --> 00:07:04,639 the real real world. 185 00:07:05,180 --> 00:07:06,779 But where this is going to become, I 186 00:07:06,779 --> 00:07:08,240 think, easily incorporated 187 00:07:08,685 --> 00:07:11,564 over time next several years is increasingly that 188 00:07:11,564 --> 00:07:14,305 might be used in a orthopedic and clinical 189 00:07:14,365 --> 00:07:14,865 setting. 190 00:07:16,365 --> 00:07:17,185 It's fascinating. 191 00:07:17,645 --> 00:07:18,965 As a bit of a a gadget or 192 00:07:18,965 --> 00:07:20,225 a tech nerd myself, 193 00:07:20,605 --> 00:07:22,305 I got to play with some of these 194 00:07:23,009 --> 00:07:24,949 technologies at the last NAST conference. 195 00:07:26,129 --> 00:07:28,610 But I'm so curious just to hear, your 196 00:07:28,610 --> 00:07:30,930 thoughts on the next generation of spine surgeons 197 00:07:30,930 --> 00:07:32,470 as it relates to these technologies. 198 00:07:32,930 --> 00:07:34,389 Is it a case where, 199 00:07:35,169 --> 00:07:35,909 health systems, 200 00:07:36,289 --> 00:07:36,789 hospitals, 201 00:07:38,025 --> 00:07:38,525 ASCs, 202 00:07:38,985 --> 00:07:40,285 wanting to be competitive 203 00:07:40,745 --> 00:07:43,145 and wanting to recruit the next generation of 204 00:07:43,145 --> 00:07:44,985 talent. Is it a case that these, 205 00:07:45,384 --> 00:07:46,845 spine, orthopedic robots, 206 00:07:47,625 --> 00:07:50,264 AR, VR technologies, is it a case that 207 00:07:50,264 --> 00:07:53,129 these practices, hospitals are going to need, must 208 00:07:53,129 --> 00:07:55,209 have technologies to recruit the latest and greatest 209 00:07:55,209 --> 00:07:57,209 talent coming out of these residency and fellowship 210 00:07:57,209 --> 00:07:58,269 programs for the future? 211 00:07:59,449 --> 00:08:01,370 Well, I would say it's actually in the 212 00:08:01,370 --> 00:08:02,189 early stages. 213 00:08:03,129 --> 00:08:05,389 At the Skokie Hospital in Endeavour, 214 00:08:06,089 --> 00:08:07,470 we actually have a few 215 00:08:07,884 --> 00:08:08,625 of the, 216 00:08:08,925 --> 00:08:10,305 spine robots currently. 217 00:08:10,845 --> 00:08:13,185 It's they're seeing some limited use, 218 00:08:13,645 --> 00:08:15,805 but I think what's gonna happen as time 219 00:08:15,805 --> 00:08:18,785 goes by, it's going to be easier and 220 00:08:19,004 --> 00:08:19,745 to use. 221 00:08:20,720 --> 00:08:23,379 There are some barriers such as need for 222 00:08:23,519 --> 00:08:24,019 registration 223 00:08:24,319 --> 00:08:24,980 and things 224 00:08:25,439 --> 00:08:27,459 of the spine intraoperatively. 225 00:08:28,800 --> 00:08:30,720 So I think this is an area in 226 00:08:30,720 --> 00:08:33,360 evolution, and we're still in the process of 227 00:08:33,360 --> 00:08:36,285 seeing what technologies will end up on top. 228 00:08:36,904 --> 00:08:39,625 And it's, but it is an exciting time, 229 00:08:39,625 --> 00:08:40,845 and I think it's definitely 230 00:08:41,225 --> 00:08:42,764 something to keep an eye on. 231 00:08:43,945 --> 00:08:46,440 Absolutely. Fascinating to hear about all those technologies 232 00:08:46,440 --> 00:08:48,700 in spine, orthopedics as it relates to robots, 233 00:08:48,920 --> 00:08:51,320 AI, some of the regenerative medicine aspects that 234 00:08:51,320 --> 00:08:52,620 you talked about earlier. 235 00:08:53,240 --> 00:08:55,559 Doctor. Koh, turning the turning the page a 236 00:08:55,559 --> 00:08:57,399 little bit, can you give me a bit 237 00:08:57,399 --> 00:08:59,660 of insight into what are the biggest headwinds, 238 00:08:59,879 --> 00:09:02,444 the biggest challenges that you're planning for, in 239 00:09:02,444 --> 00:09:02,944 2025? 240 00:09:05,245 --> 00:09:06,384 Well, in 2025, 241 00:09:06,684 --> 00:09:07,584 I think there's 242 00:09:08,444 --> 00:09:11,164 a couple of issues that, we've been some 243 00:09:11,164 --> 00:09:13,024 of which have been around for a while. 244 00:09:13,084 --> 00:09:15,440 I think everybody in health care is aware 245 00:09:15,440 --> 00:09:17,759 of the fact that there's continues to be 246 00:09:17,759 --> 00:09:20,420 declining reimbursement for the work that we do, 247 00:09:20,879 --> 00:09:23,600 and the cost of delivering care has continued 248 00:09:23,600 --> 00:09:26,639 to increase. So everybody's gonna have to become, 249 00:09:27,040 --> 00:09:27,860 more efficient 250 00:09:28,799 --> 00:09:29,940 in order to survive. 251 00:09:31,404 --> 00:09:33,504 Another area of significant 252 00:09:35,245 --> 00:09:36,524 uncertainty is around, 253 00:09:36,925 --> 00:09:39,165 what health care is gonna look like in 254 00:09:39,165 --> 00:09:40,225 the new administration. 255 00:09:41,485 --> 00:09:42,384 There are, 256 00:09:43,269 --> 00:09:45,830 essentially have been statements that there's things will 257 00:09:45,830 --> 00:09:46,570 be different, 258 00:09:47,110 --> 00:09:47,509 but, 259 00:09:47,990 --> 00:09:49,990 how different, what the pace of change will 260 00:09:49,990 --> 00:09:52,889 be, and what those ultimate differences will be, 261 00:09:53,269 --> 00:09:54,250 remains unknown. 262 00:09:54,804 --> 00:09:55,605 And so, 263 00:09:56,085 --> 00:09:57,845 this is something that I think we're gonna 264 00:09:57,845 --> 00:09:59,304 have to be prepared for, 265 00:10:00,404 --> 00:10:00,725 on, 266 00:10:01,285 --> 00:10:02,184 many fronts. 267 00:10:02,644 --> 00:10:04,024 And I think the other area 268 00:10:04,404 --> 00:10:05,225 that is, 269 00:10:06,165 --> 00:10:06,904 we see, 270 00:10:07,684 --> 00:10:08,904 and I think maybe 271 00:10:09,819 --> 00:10:12,220 I've actually experienced this on a personal level 272 00:10:12,220 --> 00:10:14,079 is increasing issues with, 273 00:10:14,699 --> 00:10:15,199 authorization 274 00:10:15,899 --> 00:10:16,720 of services. 275 00:10:17,419 --> 00:10:20,139 You know, there's a recent paper in, 276 00:10:20,699 --> 00:10:23,179 that from the JAMA Network saying that about 277 00:10:23,179 --> 00:10:24,527 a third of patients on Medicare Advantage have 278 00:10:24,527 --> 00:10:24,921 experienced some sort of denial over the past 279 00:10:24,921 --> 00:10:25,634 year. Rates of 280 00:10:34,915 --> 00:10:35,415 continues 281 00:10:37,075 --> 00:10:37,825 to increase 282 00:10:38,230 --> 00:10:41,670 continues to increase. And I think everybody's feeling 283 00:10:41,670 --> 00:10:42,170 that 284 00:10:43,110 --> 00:10:43,610 how, 285 00:10:44,149 --> 00:10:45,830 we can deal with that is going to 286 00:10:45,830 --> 00:10:46,330 be, 287 00:10:47,190 --> 00:10:49,509 an ongoing issue. And I think that's an 288 00:10:49,509 --> 00:10:52,389 area of concern for many patients as well 289 00:10:52,389 --> 00:10:53,129 as providers. 290 00:10:54,445 --> 00:10:56,144 Yeah. I think to your point, consistently 291 00:10:56,845 --> 00:10:59,585 ranked as the number one frustration or challenge 292 00:10:59,725 --> 00:11:02,284 by both providers and patients. So interesting to 293 00:11:02,284 --> 00:11:05,004 see potential to change in administration, whether there 294 00:11:05,004 --> 00:11:06,764 might be any shift or potential changes in 295 00:11:06,764 --> 00:11:08,225 the guide there in the future. 296 00:11:09,029 --> 00:11:11,509 Doctor Koh, last question before I let you 297 00:11:11,509 --> 00:11:12,709 go, kind of ending on a little bit 298 00:11:12,709 --> 00:11:14,009 of a more positive note. 299 00:11:15,029 --> 00:11:16,789 Where do you see the best or the 300 00:11:16,789 --> 00:11:19,669 biggest opportunities for growth in the future, whether 301 00:11:19,669 --> 00:11:22,475 for your own practice or the orthopedic specialty 302 00:11:22,475 --> 00:11:24,795 at Andeavor Health? Where are you, most looking 303 00:11:24,795 --> 00:11:25,455 to grow? 304 00:11:26,715 --> 00:11:29,754 Well, I think it's really interesting. And and 305 00:11:29,754 --> 00:11:31,514 one of the great things that we're seeing 306 00:11:31,514 --> 00:11:33,915 is that there's a lot of patients that 307 00:11:33,915 --> 00:11:36,174 are taking a strong interest in 308 00:11:36,659 --> 00:11:37,100 their, 309 00:11:37,539 --> 00:11:40,120 maintaining a hack healthy active lifestyle. 310 00:11:40,740 --> 00:11:44,419 And, we certainly see that the demographics of 311 00:11:44,419 --> 00:11:47,299 the country are that there's this aging boomer 312 00:11:47,299 --> 00:11:50,475 generation that still wants to stay active and 313 00:11:50,475 --> 00:11:54,095 healthy. And for orthopedics, that's a real opportunity 314 00:11:54,235 --> 00:11:56,315 to try to help patients and meet that 315 00:11:56,315 --> 00:11:56,815 need. 316 00:11:57,195 --> 00:11:57,695 So, 317 00:11:58,315 --> 00:12:01,134 where we are is, the fact that, procedures 318 00:12:01,274 --> 00:12:03,214 continue to get, less invasive, 319 00:12:03,674 --> 00:12:06,230 recovery became continues to get quicker, 320 00:12:06,929 --> 00:12:09,009 but also some of the other areas where 321 00:12:09,009 --> 00:12:11,750 I think there's continued growth is the opportunity 322 00:12:11,809 --> 00:12:13,509 to meet patients where they're at. 323 00:12:14,450 --> 00:12:16,710 One of the things that we've helped innovate 324 00:12:17,024 --> 00:12:17,524 is, 325 00:12:17,904 --> 00:12:18,404 orthopedic 326 00:12:18,784 --> 00:12:20,944 walk in clinics. A number of folks have 327 00:12:20,944 --> 00:12:22,324 done this across the country. 328 00:12:22,865 --> 00:12:25,764 But I really think that expanding this area 329 00:12:26,065 --> 00:12:28,304 allows patients to get the services they need 330 00:12:28,304 --> 00:12:29,365 when they need them, 331 00:12:29,950 --> 00:12:32,370 rather than having to wait a long time. 332 00:12:33,070 --> 00:12:35,490 And this is gonna allow patients to get 333 00:12:35,549 --> 00:12:36,990 the care they need and the treatment they 334 00:12:36,990 --> 00:12:39,389 need quicker and faster and, get back on 335 00:12:39,389 --> 00:12:40,450 the road to recovery, 336 00:12:41,230 --> 00:12:41,889 more quickly. 337 00:12:43,225 --> 00:12:47,144 Absolutely. Doctor Koh, fascinating to hear, about some 338 00:12:47,144 --> 00:12:48,605 of the trends that you're following, 339 00:12:48,985 --> 00:12:51,404 some of those innovations in spine and orthopedics. 340 00:12:52,184 --> 00:12:53,865 Really, really appreciate you taking the time out 341 00:12:53,865 --> 00:12:55,384 of your busy schedule and and great to 342 00:12:55,384 --> 00:12:57,404 hear about all the excellent work about you, 343 00:12:57,800 --> 00:12:59,240 and your providers and your team that have 344 00:12:59,240 --> 00:13:01,020 never helped her do. Thank you so much. 345 00:13:01,400 --> 00:13:02,380 Thank you, Alan.