Hello, and welcome to the Becker's Healthcare podcast.
My name is Chanel Plunger. And today, I'm
thrilled to speak with doctor h Curtis Piggs
of the Joint Replacement Institute
who joins us today to share insights into
his background, hip and knee replacement journeys he's
keeping an eye on, and a lot more.
Doctor Biggs, thank you so much for joining
me. Could you start out start us out
by introducing yourself and telling us a little
bit about your background and organization?
Well, thank you for having me. And, yes,
myself, I'm a a orthopedic surgeon, fellowship trained
joint replacement.
I specialize in hip and knee replacement solely
in my practice.
I'm located in Naples, Florida,
and where we have a concentration of patients
who require,
my care, fortunately. I'm fortunate to be in
that marketplace.
My training, through Cleveland Clinic,
about 20 I've been in practice now for
about twenty three years.
My emphasis at this time is trying to
specialize in outpatient same day total joints, specifically
hip and knee replacements,
and also reducing
postoperative narcotic usage
and
helping to reduce
the patient's time to return to function.
So that's that's where I'm at in my
practice.
Perfect. Well, to get us started in the
meat of the podcast a bit, can you
talk about some trends that you're watching either
in health care as a whole, hip and
knee replacement, orthopedic, whatever you'd like to talk
about?
Well, some of the trends that we're seeing
is the the
I think one of the month the one
that affects the patients. We're gonna talk about
a few. One of them medical.
The next is financially.
So on the medical side, there's been an
emphasis by
orthopedic surgeons led specifically by Andrew Wickline
to help reduce the the postoperative narcotic usage
by identifying those patients at risk, also utilizing,
different postoperative medication
and treatment protocols
to reduce amount of narcotics that are used.
Now the amount of opioids that are used
following a joint replacement, specifically knee replacement,
are taking over a 100 oxycodone pills in
the postoperative period has been something that is
not unusual
in the past.
What we're trying to do now is make
patients aware
different protocols that are available to help reduce
swelling,
help reduce the need for the narcotics. So
we have these patients down to maybe taking
a handful of pills,
such as anywhere from five to twenty pills,
which is a significant reduction.
The narcotics are not without their problems, including
constipation,
let alone the addiction issues that go with
it.
So by introducing modalities such
as anti swelling medications,
elevations,
light compression sleeves,
and
moderate initial
physical therapy postoperatively
has led us to
seeing and identifying patients and ability to reduce
that.
So I'm part of an initiative called March
to a Million, which is we're trying to
identify a million patients who've had a hip
or knee replacement that required very minimal narcotic
usage.
That and then turn, will they
learn to presenting
to this to a larger group
saying this is how it was done. This
is how we were able to reduce the
narcotics so that
that protocol could be used by more surgeons
to reduce that.
So what it does is we identify a
postoperative patient who required
very little narcotic usage and then they share
their information onto a, a website
that they were part of a recovery process
that required very little narcotics.
That way, we can identify them, what that
surgeon did,
and then
finding a group
protocol
that can be identified as something that'll be
optimal
to reduce in their narcotic usage.
So I have to commend doctor Wickline who
is a,
on the forefront
of research when it comes to the tsunami
of swelling postoperatively
and reducing that through medication and conservative physical
therapy post op. So he's been able to
reduce that and share that protocol with others
that have allowed us to really identify
and reduce the risk of narcotic usage.
So that's something that's, helpful for both the
surgeon who's writing the prescription,
but it's also helpful for the patient who
is
using the medication and the side effects that
go with it. So that's a trend that's,
really been brought to the forefront front over
the last couple of years.
Exciting stuff. And now on top of the
opioid sparing initiatives that you guys are currently
doing, can you talk about some more things,
or you can expand more on that, that
you were focused on and excited about going
forward in the rest of 2025?
Well, some of the things that we're excited
about for me personally is, as part of
twenty plus years of being in this business
and seeing some of the
things that work and the things that don't
work,
I took it upon myself to
work through the process of
designing,
creating,
and bringing to market
a hip replacement
femoral component
that optimizes
installation,
bone,
incorporation,
restructuring the hip back to its normal anatomy
by using a curved anatomic stem,
and bringing it to market. We now have
60 patients who have had the device FDA,
which is now has been FDA approved
to utilize for hip replacement that will slowly
be brought to market across multiple surgeons
as we try to bring that device into
the
into the forefront.
Now the identifiable benefits of it is that
it restores the hip center
back to the natural native place.
So instead of trying to fit a square
peg in a round hole, which is much
like a a traditional hip replacement, which has
worked well,
This actually restores the anatomy based on the
curvature of the femur, and it replaces the
head back into the normal hip center,
optimizing the patient's mechanics postoperatively.
So we've seen results with this so far,
but, obviously, in the early stages. But as
that continues to grow, it's very exciting.
I've been part of a few design teams,
which I've intended to help
companies
develop new hip replacements,
and I found them to be very less
than satisfying, so to speak, because the changes
that you were trying to make were very
hard and cumbersome to move with so many
people in the in the process, not only
surgeons, but engineers
and financial people at the at the,
the companies.
So I sat down one day five years
ago now and, drew out what I thought
would be optimum for a replacement,
worked with some CAD engineers to design a,
a working model, then
fortunate enough to find some contractors that could
help me
manufacture the device,
do my functional testing,
cadaver lab studies,
and then
shoot for an FDA approval, which was,
achieved in July of twenty three
and then
contracting with a company to manufacture and bring
it to market and distribute. So,
that in itself as a surgeon is very
unusual
to be able to go through that process,
but what we're seeing come out on the
other side is exciting. We have surgeons that
are interested in in being part of that,
development
of a of a more specific shape to
match the patient's anatomy.
It's easier to get in. It's easier
to balance, and it's,
in the hopes of having less postoperative recovery
issues.
So that's, something personally for me that's been
exciting and, been fun to be part of
and bring too with being able to start
with a napkin drawing,
get it manufactured,
FDA approved, implanted in a patient, and actually
receive a patent for the design has been
very exciting.
So I look forward to that and how
that growth happens in the next couple years.
Definitely exciting. And then as a kind of
follow-up to that,
whenever you're dishing out new and improve or
innovative
products like this,
what does reimbursement look like? Or do you
guys do completely fee for service? Or how
do you handle
all that? Well, that's a nice transition because
so on the implant side, for me, on
that implant that it gets implanted, anything that
I implant, I don't I do not receive
any,
financial benefit for any implant that I use
that I designed.
I am only receiving payment as far as
a royalty is concerned when another surgeon uses
it.
So that's that financial side. And then as
far as the reimbursement,
reimbursement is a great transition of where the
next big problem is for accessibility to patients.
So for us as surgeons, what we receive
from Medicare
is around $1,300
for a hip or knee replacement, just an
average between the two. Then we'll receive another
20%
of that fee
from a supplemental
or a secondary insurance.
Because of inflation, which has changed 20% in
the last three years and the drop in
reimbursement by 10% in the last three years
and the increase in overhead in the last
three years,
our overhead averages around anywhere from 65 to
70% of our business in private practice.
So when you take out the overhead and
the taxes, what the surgeon goes home with
is about a $150,
upwards of a $175
after all those things are paid.
So for us as surgeons, it's not a
very tenable situation, and there has to be
changes that are made. I personally personally am
still
insurance, and I'm on Medicare, and I'm on
most commercial insurances,
But looking at other options and how to
change that,
whether that's going to be a concierge service
that's offered to the patients to provide accessibility
and additional features, including rehab protocols, which are
really
specific to the surgeon,
or they dropping Medicare and going to a
straight fee for service is what has to
change coming up.
Because the current situation
probably won't last for very much longer before
people either have to
retire early,
become owned by private equity,
or they have to go on to be
employed by a hospital system. That way, the
hospital system can pay the surgeon based off
of their other ancillaries
of which they get paid for at a
higher rate than we do in private practice.
So I think that's some of the major
changes. We've seen patients,
affected by this.
They're very understanding of what's when we talk
to them about this. But this we have
surgeons that are moving to that model, whether
it's fee for service after dropping Medicare,
or they're going to a concierge type, service
where they have accessibility
to the surgeon
for a based on a fee.
So those changes are coming. They're gonna be
pretty big in the next two years. I
think there's a lot of private practitioners who
have to make that big decision,
which direction that they wanna head, whether they
wanna become employed or stay
open and self employed is all very dependent
on how they're gonna handle that. The reduction
in income, the inflation,
and then, obviously, the increase in overhead because
of our economy. So that is a big
one that's gonna affect both the surgeons and
the patients as far as accessibility.
Absolutely. Thank you so much for walking us
through that.
Now you've already mentioned a few things that
you should definitely be proud of, but can
you talk about an initiative or a project
from the past, I don't know, like, year
and a half or so that you're proud
of as well?
Oh, for sure. I I mean, besides the
the implant, which was a bit that was
a longer process of over six years now.
The bigger initiative for me is is securing
our
discharge rate and our infection rate. So same
day discharge
and then infection rate that's
significantly lower than the national average.
We look at it as the big reason
is obviously efficient surgery,
utilizing,
some of the arrogance
irrigation
techniques,
and then, of course, getting them home.
So we don't optimally have the perfect patient
every time, but optimizing the recovery process by
getting them up, mobilizing them, and most importantly,
getting them home to their own germs have
really significantly reduced that infection rate across the
board for most surgeons.
So I think optimizing that, making it aware
in the community and the public that that's
what's the best situation for them recovery wise,
and that it's, after doing same day total
joints now for ten years, it's become the
standard of care. And people actually question whether
they when you say, well, you might need
to stay in the hospital overnight,
they really don't want to. And it's not
even a question what it was ten years
ago where they said, really? I can go
home? And then you have to convince them
that they're okay.
Now it's they're assuming they're gonna go home
in a few hours and move on. So
I think that's some of the major accomplishments
and that as one of the people in
my area to do that, to have now
where it's the standard of other surgeons in
our area to get everybody home the same
day is is very,
fulfilling for
sure. Absolutely. And now with your twenty three
years in practice, I think you're the perfect
person to ask this question.
What advice would you give to evolving leaders
maybe looking to have the same success or
impact in their careers as you have?
Look at the past to avoid
the same mistakes,
being understanding of the business
aspect of this as a private practitioner.
Now for those on the the employed side,
they're working for hospital systems.
Always look at everything,
twice,
you know, even on the private practice side.
You you make sure that you're staying,
with integrity to your treatment protocol,
that your the patient's outcome always comes
before making business decisions. But, ultimately, you've gotta
find the right pathway
that makes the right sense for what you're
trying to accomplish with your career,
what it allows you to do with with
your personal life, and that doesn't get overrun.
So it's a very delicate balance. Medicine's changed
dramatically
in the last ten years, and we have
only more dramatic changes to come when it
comes to reimbursement
and, how these businesses are gonna be run.
So it used to be private practice was
was a a nice
option.
Now private practice is becoming
very difficult to manage,
staying up on your business skills,
and paying attention more to that side through
your training and early experiences so that you
can help manage that in the future because
it can become daunting
and quickly become a problem.
Excellent advice. Well, doctor Biggs, I've enjoyed your
time today. But before I let you go,
is there anything else that listeners should know?
You don't always need surgery.
Surgery is not always
the right fit, and so
working with patients as a team is very
important. It's one of the aspects that I
key in on when I'm when I'm meeting
with them and going over consultation is that
this is not an Us, me, and versus
you. This is us together, and that we're
in the same canoe, we're on the boat
the same direction. And surgery, while it's a
great option for some, it's not the only
option, and you have to think and talk
about
what the patient wants,
what they're looking for so that you can
create realistic expectations
and have the best possible outcome.
That's a great note to end on, doctor
Biggs. I wanna thank you once again for
your time today and for sharing your insights
on the Becker's healthcare podcast. Thank you. Thank
you.