This is Alan Condon with the Becker's Healthcare
Podcast, and I'm thrilled to be joined today
by doctor Michael Ast, a fantastic leader who
wears many different hats at Hospital for Special
Surgery,
including chief of the knee service,
chief medical innovation officer,
and director of ambulatory surgery center strategy.
Doctor Ast, a pleasure to have you back
on the Beckers podcast with us today. For
those who mightn't be as well acquainted with
you or Hospital for Special Surgery, do you
mind taking a moment to give us a
little bit more about your role and your
background at HSS?
Sure. And thanks so much for having me
back. Always appreciate the invitation.
So as you said, my name is Mike
Ast. I'm a hip and knee replacement surgeon
at HSS. HSS
is a large orthopedic specialty hospital in New
York City. It is the oldest orthopedic specialty
hospital in the world. We've been around for
a hundred and sixty years,
and specialize entirely in musculoskeletal
care.
Myself, personally, I I trained at HSS,
and have been in attending there now for
the last eight years.
And as you noted, I also hold a
couple of other roles, including,
partnering with,
our chief innovation officer to run our innovation
institute as well as, a role as a
director of our ASC strategy. All that on
top of what I do on a day
to day basis, like I said, which is
just hip and knee replacements.
Fantastic. I don't know where you find the
time to do it all, but, excited
to dive right in and hear a little
bit more about that, Mike.
So to kick it off, I think, obviously,
a couple weeks into 2025
here.
What are the the two or three trends
that you're really focused on this year, whether
as it relates to orthopedics or the ASC
field,
more broadly?
Yeah. Well, I think in orthopedics, we're gonna
see another year of growth. I just think
as
the population
continues to age a bit and try to
be more active, certainly, I still think we're
coming out of the pandemic, although we're pretty
far out. I think volumes will continue to
increase. So that's the positive side of it.
The negative side of it, of course, we're
always watching that costs also continue to increase.
We're continuing to watch the shift from inpatient
to outpatient having a significant effect on
how patients are treated, on how patients seek
care, and also on the revenues
to whether it's our ambulatory surgery centers or
our hospitals, and some of those are working
in opposite directions. But I think combining that
with the very rapid pace of innovation, I'm
hoping that,
as we start to see interest rates come
down, we'll see some more reinvestment
into innovation. We that was really, really hot
in 2021,
'20 '20 '2, slowed down a bit over
the last couple of years. I think we're
gonna see a big reinvestment
both on the digital side as we start
to talk about lot big data and machine
learning and AI and also on just the
general,
digital health care innovation side. I think there's
a lot of really exciting
tailwinds on that side that may help balance
some of the headwinds everybody in health care
is facing right now, combining, of course, with
the new
incoming,
regulatory changes that we may all be seeing
in the next couple of months.
Absolutely. I think
AI is something
no secret to you, to any of our
listeners here
as popping up everywhere across the health care
space and even outside it. Specifically as it
relates to your practice with HHS,
are there any specific areas within the AI
technological field that you're particularly excited about? Are
there any early, initiatives that you're focused on,
any early results that you can share? I
know it's such a big, big area, but
I'd love to kinda get a specific example
or two that you see a really, potential
big impact.
Yeah. I mean, I can give you three
very concrete examples that we're dealing with, even
today in my practice, and they're very different.
And some of them are very simple, some
a bit more complex. So, obviously,
one very, very simple example that was, talked
about this morning by many of my colleagues
and I is just making basic tasks easier.
So every single,
professional out there has to get their resume
or their CV in place. And it's just
a task you do every once in a
while, certainly when you're, like myself as an
academic surgeon preparing for promotions
within our medical school or things like that.
It's just a tedious task, and we've been
hoping for this AI making tedious tasks easier.
And this morning, we launched,
just internally, but very excited to most of
the doctors,
a way that AI is gonna help us
do all of that. Very simply, it searches
the Internet, brings up all our recent publications,
brings up anywhere we're mentioned in the news,
brings up anywhere that we, have given some
local lectures or invited symposium talks, structures it
for us, puts it all together. We can
simply review it and probably save me ten
to twelve hours of work just when the
next time comes, to apply for another promotion
or send my CV somewhere. So it seems
like such a simple thing, but
such a powerful tool that,
has been unlocked,
with very, very simple machine learning and and
AI type stuff. Take that one step further
on the clinical practice. One of the things
we're most excited about right now is the
development of our
AI powered
postoperative
chatbot.
So when our patients call us with very
basic questions of when can I shower, when
can I do this, when should I can
you help me make my appointment, tell me
a little bit more about what I should
be expecting on day one, day two, day
three, as opposed to that having to be
a person
calling back with the use of generative AI?
We've been able to create a tool that
patients can interact with that has seen ex
incredible success in our early pilot data with
our patients. I mean, patients love it, responds
right away, responds with the
with the information that we gave it to
respond, and responds in any language that you
can speak, which gives it a huge advantage
over someone like me who doesn't speak, let's
say, French or Japanese or any language that
a patient might want. So that's a very,
very concrete clinical example that we've had very
early success with, and I'm super excited about
moving forward. The two in development that are
the most exciting obviously are, ambient listening devices
to help us write our notes and get
things done, make our offices more efficient, bring
us up to being able to get back
to face to face conversations with patients without
having to worry about writing my note, getting
through, making all my orders, having ambient listening
devices in all of the rooms that we
do is something that HSS has actually made
a pretty significant investment with. Thanks to a
very generous donation,
from a grateful patient to help us develop
and work with this technology
to bring it to more patients such that
the patient doctor interaction came back to being
just that, not the patient doctor computer interaction.
And then the last thing, of course, is
that the future where we all wanna see
this go in surgery is how can we
make surgery better? How can we make surgery
more predictable? And the combination of advanced
surgical tools like computer navigation and robotics, certainly
in joint replacement and in spine surgery, is
a big topic right now. And combining that
with machine learning algorithms and AI and large
datasets, we could start to help develop decision
support tools that are really gonna help us
bring personalized patient
surgery that hopefully will give us improved patient
outcomes in the future.
I see. Yeah. Mike, I absolutely love those
specific examples and kinda early results as well.
The the ambient listening device is something I
still hear come up time and time again.
But even to your point, some of those
other,
making basic tedious tasks easier. I imagine resumes,
CVs, promotions, getting all that stuff in order.
I I imagine saving ten to twelve hours
for for a busy leader, but a practicing
surgeon like yourself is a huge time saving,
which no doubt you can do a lot
more with that ten, twelve hours,
a week. So really, really fascinating to get
your perspective, your insight on some of those
AI,
solutions and both the boat you're working on
now and also they're eyeballing down the line.
Jumping into our next next question here, it
kinda ties nicely into this, but no doubt
you're excited about AI there. But is there
anything that you're particularly excited about whether it
may be specific to your practice or maybe
in the surgical tech field? What are you
kind of, keeping a close eye on?
Yeah. I think, again, as a hip and
knee replacement surgeon within the technology field, all
of the different robotic and computer based systems
are the things that are the most exciting
to us. Over time, we're just trying to
hone down our ability to personalize and more
exactly perform the procedures that we think help
so many patients. And the way I always
look at that type of technology is it
exist the the growth of it exists in
two ways. Number one, the individual technology gets
better. Number two, the access to that technology
gets more ubiquitous, meaning that more patients
can be helped by that technology,
not just across New York City or The
United States, but even across the world. And
I think it's both of those combined together
as the cost of these technologies comes down,
as they continue to evolve, and just technology
in general continues to move forward. I'm very
excited to see the next generation of our
surgical computers, the next generation of our surgical
robots, the next generation of our three d
printed implants.
But I'm probably more excited to see the
democratization
of access
to that type of technology,
where instead of this type of technology being
used in five, ten, 15, maybe twenty percent
of surgeries, I'm excited for five years down
the road when it's 95, a % of
surgeries and not just in New York and
not just in The United States, but really
everywhere around the world.
Yeah. Absolutely.
And one quick, not to harp too much
on with AI, but I've heard so much
in terms of the integration of AI into
specifically,
hip and knee robotics.
Where do you see the biggest opportunity in
that in that area?
I think that really comes down to the
concept of this decision support tools. The ability
to say, okay. We see a patient and
they look like this, and they look exactly
like this. Their leg has this angle to
it. Their arthritis has this pattern to it.
And now we're gonna look at how do
we perform their surgery and how did they
do. Because not every knee looks the same,
not every hip looks the same. And for
generations, simply because of the technology we had
available to us, despite them not looking the
same, they were all treated the same. And
I think AI and these large machine learning
algorithms
have this this huge potential
to change that paradigm completely and basically take
this to a point where a patient who
looks like this and walks like this and
has these preoperative functional limitations and has these
postoperative
functional expectations
should be treated with surgery done in this
manner with this implant
and this recovery pathway, and that's gonna lead
them back to the outcome that they were
looking for. And that
really, really honed down level of personalization
is really where I think you can't do
it on your own. I can't look at
my patients, the however many I take care
of each week or each month and be
precise enough to know the differences.
But when you start using things like AI,
all of a sudden you can take very,
very large datasets,
huge amounts of very specific types of data.
And as long as the inputs
are accurate and clean, you might be able
to get that type of, information on the
back end.
Yeah. Absolutely. And kind of fascinating, as a
bit of a self confessed,
gadget and tech tech nerd. It's, fascinating to
hear the evolution of this technology and also
to your point, the the democratization of access
to some of this technology as well.
Mike, last question. I'd love to kinda get
a little bit more insight from you on
before we let you go. HSS,
obviously,
fantastic institution,
ton of growth recently, not just in the
New York area, also expanding their footprint in
Florida,
along with the likes of Rotman, Mount Sinai.
Over the next twelve months or so, where
are the the core areas of growth that
HSS is really looking to focus on?
Yeah. I think we have two sort of
ways that we think about growth. We have
our local growth within what we call our
Tristate area, and the most exciting part of
that in in, again, in very concrete ways
is we're excited to increase our ambulatory surgery
center presence in the Tristate area, hopefully, with
growth within that core market, but providing more
access to more patients closer to home.
And I think that does two things for
us. Number one, obviously, it helps us expand
access to high quality orthopedic care and musculoskeletal
care, and it helps it be easier for
patients to access the system. It also helps
open up space at our main campus where
we can continue to drive the most complex
orthopedic care from around the world. You know,
we take care of, and we're blessed and
and privileged to take care of some of
the most
complex orthopedic problems, not just from New York,
not just from The United States, but truly
from around the globe. And by opening up
more space within our institution itself, we can
continue to increase the access to that super
high quality,
super complex orthopedic care while at the same
time providing every patient who wants it access
to HSS level care. So that's the sort
of local market. Florida, obviously, as you said,
is is an interesting market to a lot
of people.
And we have our West Palm facility, which
has been doing great for several years. And
then, of course, the facility that we opened,
on the E on the West Coast in
in Naples in partnership with Naples Community Hospital
and both of those now up and running.
We're really excited for the opening of the
physical Naples facility. So while the program has
been in place, the physical facility will be
opening q one, q end q one, beginning
of q two this year. And that's super
exciting because it'll have access to outpatient services,
ambulatory surgery, physical therapy, imaging, and all right
there on the North Campus Of NCH. So
very, very exciting. And then, of course, our
recently announced partnership with University of Miami, which
I believe you covered within, within the Becker's
healthcare sphere.
Another very exciting opportunity to increase access to
HSS level care for the rest of,
Southern Florida.
And I think when you combine those two,
those are the things that we're doing homegrown.
Now we will always continue to evaluate other
opportunities whether it's on a national scale or
an international scale, and these are often through
educational partnerships, working partnerships,
or something we haven't even thought of yet
because our goal has always been that as
a leader in musculoskeletal health around the world,
our goal is to increase access to high
quality musculoskeletal care to every patient that wants
it and needs it.
Absolutely. Doctor Ast, fascinating to to have you
back on the podcast with us again. A
ton of growth, not just at at HSS,
but but also your practice as well. Fascinating
to get the inside scoop, and, I really
look forward to connecting with you again down
the line. Thanks so much for having me.
It's always a pleasure.