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Hello, and welcome to the Becker's Healthcare podcast.

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My name is Chanel Plunger. And today, I'm

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thrilled to speak with doctor h Curtis Piggs

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of the Joint Replacement Institute

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who joins us today to share insights into

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his background, hip and knee replacement journeys he's

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keeping an eye on, and a lot more.

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Doctor Biggs, thank you so much for joining

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me. Could you start out start us out

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by introducing yourself and telling us a little

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bit about your background and organization?

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Well, thank you for having me. And, yes,

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myself, I'm a a orthopedic surgeon, fellowship trained

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joint replacement.

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I specialize in hip and knee replacement solely

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in my practice.

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I'm located in Naples, Florida,

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and where we have a concentration of patients

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who require,

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my care, fortunately. I'm fortunate to be in

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that marketplace.

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My training, through Cleveland Clinic,

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about 20 I've been in practice now for

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about twenty three years.

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My emphasis at this time is trying to

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specialize in outpatient same day total joints, specifically

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hip and knee replacements,

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and also reducing

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postoperative narcotic usage

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and

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helping to reduce

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the patient's time to return to function.

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So that's that's where I'm at in my

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practice.

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Perfect. Well, to get us started in the

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meat of the podcast a bit, can you

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talk about some trends that you're watching either

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in health care as a whole, hip and

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knee replacement, orthopedic, whatever you'd like to talk

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about?

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Well, some of the trends that we're seeing

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is the the

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I think one of the month the one

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that affects the patients. We're gonna talk about

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a few. One of them medical.

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The next is financially.

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So on the medical side, there's been an

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emphasis by

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orthopedic surgeons led specifically by Andrew Wickline

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to help reduce the the postoperative narcotic usage

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by identifying those patients at risk, also utilizing,

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different postoperative medication

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and treatment protocols

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to reduce amount of narcotics that are used.

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Now the amount of opioids that are used

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following a joint replacement, specifically knee replacement,

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are taking over a 100 oxycodone pills in

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the postoperative period has been something that is

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not unusual

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in the past.

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What we're trying to do now is make

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patients aware

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different protocols that are available to help reduce

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swelling,

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help reduce the need for the narcotics. So

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we have these patients down to maybe taking

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a handful of pills,

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such as anywhere from five to twenty pills,

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which is a significant reduction.

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The narcotics are not without their problems, including

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constipation,

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let alone the addiction issues that go with

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it.

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So by introducing modalities such

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as anti swelling medications,

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elevations,

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light compression sleeves,

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and

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moderate initial

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physical therapy postoperatively

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has led us to

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seeing and identifying patients and ability to reduce

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that.

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So I'm part of an initiative called March

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to a Million, which is we're trying to

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identify a million patients who've had a hip

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or knee replacement that required very minimal narcotic

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usage.

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That and then turn, will they

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learn to presenting

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to this to a larger group

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saying this is how it was done. This

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is how we were able to reduce the

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narcotics so that

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that protocol could be used by more surgeons

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to reduce that.

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So what it does is we identify a

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postoperative patient who required

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very little narcotic usage and then they share

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their information onto a, a website

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that they were part of a recovery process

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that required very little narcotics.

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That way, we can identify them, what that

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surgeon did,

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and then

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finding a group

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protocol

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that can be identified as something that'll be

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optimal

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to reduce in their narcotic usage.

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So I have to commend doctor Wickline who

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is a,

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on the forefront

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of research when it comes to the tsunami

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of swelling postoperatively

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and reducing that through medication and conservative physical

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therapy post op. So he's been able to

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reduce that and share that protocol with others

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that have allowed us to really identify

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and reduce the risk of narcotic usage.

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So that's something that's, helpful for both the

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surgeon who's writing the prescription,

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but it's also helpful for the patient who

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is

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using the medication and the side effects that

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go with it. So that's a trend that's,

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really been brought to the forefront front over

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the last couple of years.

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Exciting stuff. And now on top of the

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opioid sparing initiatives that you guys are currently

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doing, can you talk about some more things,

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or you can expand more on that, that

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you were focused on and excited about going

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forward in the rest of 2025?

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Well, some of the things that we're excited

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about for me personally is, as part of

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twenty plus years of being in this business

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and seeing some of the

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things that work and the things that don't

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work,

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I took it upon myself to

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work through the process of

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designing,

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creating,

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and bringing to market

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a hip replacement

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femoral component

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that optimizes

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installation,

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bone,

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incorporation,

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restructuring the hip back to its normal anatomy

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by using a curved anatomic stem,

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and bringing it to market. We now have

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60 patients who have had the device FDA,

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which is now has been FDA approved

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to utilize for hip replacement that will slowly

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be brought to market across multiple surgeons

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as we try to bring that device into

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the

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into the forefront.

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Now the identifiable benefits of it is that

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it restores the hip center

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back to the natural native place.

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So instead of trying to fit a square

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peg in a round hole, which is much

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like a a traditional hip replacement, which has

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worked well,

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This actually restores the anatomy based on the

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curvature of the femur, and it replaces the

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head back into the normal hip center,

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optimizing the patient's mechanics postoperatively.

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So we've seen results with this so far,

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but, obviously, in the early stages. But as

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that continues to grow, it's very exciting.

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I've been part of a few design teams,

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which I've intended to help

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companies

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develop new hip replacements,

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and I found them to be very less

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than satisfying, so to speak, because the changes

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that you were trying to make were very

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hard and cumbersome to move with so many

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people in the in the process, not only

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surgeons, but engineers

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and financial people at the at the,

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the companies.

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So I sat down one day five years

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ago now and, drew out what I thought

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would be optimum for a replacement,

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worked with some CAD engineers to design a,

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a working model, then

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fortunate enough to find some contractors that could

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help me

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manufacture the device,

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do my functional testing,

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cadaver lab studies,

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and then

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shoot for an FDA approval, which was,

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achieved in July of twenty three

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and then

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contracting with a company to manufacture and bring

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it to market and distribute. So,

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that in itself as a surgeon is very

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unusual

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to be able to go through that process,

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but what we're seeing come out on the

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other side is exciting. We have surgeons that

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are interested in in being part of that,

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development

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of a of a more specific shape to

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match the patient's anatomy.

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It's easier to get in. It's easier

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to balance, and it's,

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in the hopes of having less postoperative recovery

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issues.

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So that's, something personally for me that's been

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exciting and, been fun to be part of

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and bring too with being able to start

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with a napkin drawing,

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get it manufactured,

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FDA approved, implanted in a patient, and actually

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receive a patent for the design has been

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very exciting.

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So I look forward to that and how

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that growth happens in the next couple years.

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Definitely exciting. And then as a kind of

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follow-up to that,

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whenever you're dishing out new and improve or

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innovative

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products like this,

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what does reimbursement look like? Or do you

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guys do completely fee for service? Or how

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do you handle

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all that? Well, that's a nice transition because

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so on the implant side, for me, on

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that implant that it gets implanted, anything that

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I implant, I don't I do not receive

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any,

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financial benefit for any implant that I use

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that I designed.

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I am only receiving payment as far as

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a royalty is concerned when another surgeon uses

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it.

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So that's that financial side. And then as

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far as the reimbursement,

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reimbursement is a great transition of where the

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next big problem is for accessibility to patients.

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So for us as surgeons, what we receive

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from Medicare

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is around $1,300

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for a hip or knee replacement, just an

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average between the two. Then we'll receive another

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20%

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of that fee

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from a supplemental

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or a secondary insurance.

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Because of inflation, which has changed 20% in

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the last three years and the drop in

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reimbursement by 10% in the last three years

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and the increase in overhead in the last

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three years,

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our overhead averages around anywhere from 65 to

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70% of our business in private practice.

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So when you take out the overhead and

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the taxes, what the surgeon goes home with

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is about a $150,

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upwards of a $175

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after all those things are paid.

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So for us as surgeons, it's not a

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very tenable situation, and there has to be

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changes that are made. I personally personally am

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still

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insurance, and I'm on Medicare, and I'm on

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most commercial insurances,

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But looking at other options and how to

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change that,

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whether that's going to be a concierge service

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that's offered to the patients to provide accessibility

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and additional features, including rehab protocols, which are

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really

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specific to the surgeon,

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or they dropping Medicare and going to a

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straight fee for service is what has to

285
00:09:55,615 --> 00:09:56,835
change coming up.

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Because the current situation

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00:09:59,294 --> 00:10:01,615
probably won't last for very much longer before

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people either have to

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retire early,

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become owned by private equity,

291
00:10:07,189 --> 00:10:08,789
or they have to go on to be

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00:10:08,789 --> 00:10:11,189
employed by a hospital system. That way, the

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hospital system can pay the surgeon based off

294
00:10:13,110 --> 00:10:14,089
of their other ancillaries

295
00:10:14,629 --> 00:10:16,069
of which they get paid for at a

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00:10:16,069 --> 00:10:18,009
higher rate than we do in private practice.

297
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So I think that's some of the major

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changes. We've seen patients,

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affected by this.

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They're very understanding of what's when we talk

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00:10:26,195 --> 00:10:28,195
to them about this. But this we have

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00:10:28,195 --> 00:10:30,514
surgeons that are moving to that model, whether

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00:10:30,514 --> 00:10:32,615
it's fee for service after dropping Medicare,

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00:10:33,339 --> 00:10:36,059
or they're going to a concierge type, service

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where they have accessibility

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00:10:37,820 --> 00:10:38,480
to the surgeon

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00:10:39,100 --> 00:10:40,799
for a based on a fee.

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So those changes are coming. They're gonna be

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pretty big in the next two years. I

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think there's a lot of private practitioners who

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have to make that big decision,

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which direction that they wanna head, whether they

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wanna become employed or stay

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open and self employed is all very dependent

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00:10:57,555 --> 00:10:59,555
on how they're gonna handle that. The reduction

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in income, the inflation,

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00:11:02,120 --> 00:11:04,919
and then, obviously, the increase in overhead because

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of our economy. So that is a big

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00:11:07,320 --> 00:11:08,919
one that's gonna affect both the surgeons and

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the patients as far as accessibility.

321
00:11:11,720 --> 00:11:13,639
Absolutely. Thank you so much for walking us

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00:11:13,639 --> 00:11:14,379
through that.

323
00:11:14,774 --> 00:11:16,615
Now you've already mentioned a few things that

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00:11:16,615 --> 00:11:18,855
you should definitely be proud of, but can

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00:11:18,855 --> 00:11:21,434
you talk about an initiative or a project

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00:11:21,495 --> 00:11:23,334
from the past, I don't know, like, year

327
00:11:23,334 --> 00:11:24,855
and a half or so that you're proud

328
00:11:24,855 --> 00:11:25,754
of as well?

329
00:11:26,214 --> 00:11:27,879
Oh, for sure. I I mean, besides the

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00:11:27,879 --> 00:11:29,320
the implant, which was a bit that was

331
00:11:29,320 --> 00:11:32,059
a longer process of over six years now.

332
00:11:33,159 --> 00:11:35,720
The bigger initiative for me is is securing

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00:11:35,720 --> 00:11:36,220
our

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00:11:36,519 --> 00:11:39,320
discharge rate and our infection rate. So same

335
00:11:39,320 --> 00:11:40,059
day discharge

336
00:11:40,440 --> 00:11:42,220
and then infection rate that's

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00:11:42,855 --> 00:11:44,875
significantly lower than the national average.

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00:11:45,495 --> 00:11:47,014
We look at it as the big reason

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00:11:47,014 --> 00:11:48,794
is obviously efficient surgery,

340
00:11:49,495 --> 00:11:49,995
utilizing,

341
00:11:51,014 --> 00:11:52,154
some of the arrogance

342
00:11:52,455 --> 00:11:52,955
irrigation

343
00:11:53,334 --> 00:11:53,834
techniques,

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00:11:54,375 --> 00:11:56,235
and then, of course, getting them home.

345
00:11:56,660 --> 00:11:58,980
So we don't optimally have the perfect patient

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00:11:58,980 --> 00:12:02,600
every time, but optimizing the recovery process by

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00:12:02,899 --> 00:12:05,379
getting them up, mobilizing them, and most importantly,

348
00:12:05,379 --> 00:12:08,180
getting them home to their own germs have

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00:12:08,180 --> 00:12:10,899
really significantly reduced that infection rate across the

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00:12:10,899 --> 00:12:12,040
board for most surgeons.

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00:12:12,535 --> 00:12:14,855
So I think optimizing that, making it aware

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00:12:14,855 --> 00:12:16,455
in the community and the public that that's

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00:12:16,455 --> 00:12:18,875
what's the best situation for them recovery wise,

354
00:12:19,254 --> 00:12:21,894
and that it's, after doing same day total

355
00:12:21,894 --> 00:12:24,294
joints now for ten years, it's become the

356
00:12:24,294 --> 00:12:27,360
standard of care. And people actually question whether

357
00:12:27,360 --> 00:12:29,200
they when you say, well, you might need

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00:12:29,200 --> 00:12:30,500
to stay in the hospital overnight,

359
00:12:31,039 --> 00:12:32,799
they really don't want to. And it's not

360
00:12:32,799 --> 00:12:34,320
even a question what it was ten years

361
00:12:34,320 --> 00:12:35,759
ago where they said, really? I can go

362
00:12:35,759 --> 00:12:37,840
home? And then you have to convince them

363
00:12:37,840 --> 00:12:38,659
that they're okay.

364
00:12:38,985 --> 00:12:40,745
Now it's they're assuming they're gonna go home

365
00:12:40,745 --> 00:12:42,745
in a few hours and move on. So

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00:12:42,745 --> 00:12:44,605
I think that's some of the major accomplishments

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00:12:44,745 --> 00:12:46,664
and that as one of the people in

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00:12:46,664 --> 00:12:48,664
my area to do that, to have now

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00:12:48,664 --> 00:12:50,264
where it's the standard of other surgeons in

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00:12:50,264 --> 00:12:52,105
our area to get everybody home the same

371
00:12:52,105 --> 00:12:53,225
day is is very,

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00:12:54,039 --> 00:12:54,860
fulfilling for

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00:12:55,480 --> 00:12:58,279
sure. Absolutely. And now with your twenty three

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years in practice, I think you're the perfect

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00:13:00,440 --> 00:13:01,820
person to ask this question.

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00:13:02,279 --> 00:13:04,440
What advice would you give to evolving leaders

377
00:13:04,440 --> 00:13:06,940
maybe looking to have the same success or

378
00:13:07,559 --> 00:13:09,419
impact in their careers as you have?

379
00:13:10,334 --> 00:13:12,514
Look at the past to avoid

380
00:13:12,815 --> 00:13:13,794
the same mistakes,

381
00:13:14,574 --> 00:13:16,674
being understanding of the business

382
00:13:17,214 --> 00:13:19,154
aspect of this as a private practitioner.

383
00:13:19,774 --> 00:13:22,095
Now for those on the the employed side,

384
00:13:22,095 --> 00:13:23,794
they're working for hospital systems.

385
00:13:24,419 --> 00:13:25,639
Always look at everything,

386
00:13:26,100 --> 00:13:26,600
twice,

387
00:13:27,059 --> 00:13:29,159
you know, even on the private practice side.

388
00:13:29,620 --> 00:13:31,240
You you make sure that you're staying,

389
00:13:31,779 --> 00:13:34,039
with integrity to your treatment protocol,

390
00:13:34,580 --> 00:13:36,820
that your the patient's outcome always comes

391
00:13:37,975 --> 00:13:41,014
before making business decisions. But, ultimately, you've gotta

392
00:13:41,014 --> 00:13:42,235
find the right pathway

393
00:13:42,695 --> 00:13:44,934
that makes the right sense for what you're

394
00:13:44,934 --> 00:13:46,554
trying to accomplish with your career,

395
00:13:47,014 --> 00:13:49,095
what it allows you to do with with

396
00:13:49,095 --> 00:13:51,274
your personal life, and that doesn't get overrun.

397
00:13:52,159 --> 00:13:55,279
So it's a very delicate balance. Medicine's changed

398
00:13:55,279 --> 00:13:55,779
dramatically

399
00:13:56,159 --> 00:13:57,839
in the last ten years, and we have

400
00:13:57,839 --> 00:14:00,000
only more dramatic changes to come when it

401
00:14:00,000 --> 00:14:00,819
comes to reimbursement

402
00:14:02,159 --> 00:14:04,819
and, how these businesses are gonna be run.

403
00:14:05,075 --> 00:14:07,254
So it used to be private practice was

404
00:14:07,554 --> 00:14:09,014
was a a nice

405
00:14:09,875 --> 00:14:10,375
option.

406
00:14:11,154 --> 00:14:12,774
Now private practice is becoming

407
00:14:13,394 --> 00:14:14,855
very difficult to manage,

408
00:14:15,634 --> 00:14:17,414
staying up on your business skills,

409
00:14:18,220 --> 00:14:20,059
and paying attention more to that side through

410
00:14:20,059 --> 00:14:21,980
your training and early experiences so that you

411
00:14:21,980 --> 00:14:23,580
can help manage that in the future because

412
00:14:23,580 --> 00:14:24,799
it can become daunting

413
00:14:25,179 --> 00:14:26,960
and quickly become a problem.

414
00:14:27,740 --> 00:14:30,220
Excellent advice. Well, doctor Biggs, I've enjoyed your

415
00:14:30,220 --> 00:14:32,240
time today. But before I let you go,

416
00:14:32,345 --> 00:14:34,445
is there anything else that listeners should know?

417
00:14:35,144 --> 00:14:36,605
You don't always need surgery.

418
00:14:37,384 --> 00:14:38,764
Surgery is not always

419
00:14:39,144 --> 00:14:40,845
the right fit, and so

420
00:14:41,225 --> 00:14:43,065
working with patients as a team is very

421
00:14:43,065 --> 00:14:44,825
important. It's one of the aspects that I

422
00:14:44,825 --> 00:14:46,738
key in on when I'm when I'm meeting

423
00:14:46,738 --> 00:14:49,053
with them and going over consultation is that

424
00:14:49,053 --> 00:14:51,369
this is not an Us, me, and versus

425
00:14:51,369 --> 00:14:53,684
you. This is us together, and that we're

426
00:14:53,684 --> 00:14:56,000
in the same canoe, we're on the boat

427
00:14:56,000 --> 00:14:58,315
the same direction. And surgery, while it's a

428
00:14:58,315 --> 00:15:01,004
great option for some, it's not the only

429
00:15:01,004 --> 00:15:03,084
option, and you have to think and talk

430
00:15:03,084 --> 00:15:03,584
about

431
00:15:03,964 --> 00:15:05,105
what the patient wants,

432
00:15:05,804 --> 00:15:07,404
what they're looking for so that you can

433
00:15:07,404 --> 00:15:08,704
create realistic expectations

434
00:15:09,245 --> 00:15:10,945
and have the best possible outcome.

435
00:15:11,740 --> 00:15:13,419
That's a great note to end on, doctor

436
00:15:13,419 --> 00:15:14,940
Biggs. I wanna thank you once again for

437
00:15:14,940 --> 00:15:16,620
your time today and for sharing your insights

438
00:15:16,620 --> 00:15:19,339
on the Becker's healthcare podcast. Thank you. Thank

439
00:15:19,339 --> 00:15:19,839
you.