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Today's clinical providers and healthcare systems

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need a strategic partner that is focused on

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the evolution of healthcare delivery.

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At Surgery Partners, we are redefining the healthcare

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industry

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as a nation's leading independent operator of surgical

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facilities and ancillary services.

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With an extensive presence spanning over 180

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locations nationwide,

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our commitment extends beyond healthcare.

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It's about fostering successful partnerships

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that enhance the quality of care in the

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communities we serve.

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Surgery Partners is more than an operator or

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service provider. We are your strategic ally committed

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to transforming healthcare delivery.

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Learn more at surgerypartners.com.

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Hello. This is Francesca Matthews with the Becker's

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ASC review podcast.

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I am thrilled to be joined today by

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Tammy Smittle, CEO of Stonegate Surgery Center. Tammy,

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Tammy, thank you so much for being here

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today. Thanks for having me.

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Great. Well, just to start off, could you

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please introduce yourself and tell us a little

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bit about your background?

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Yeah. So I'm Tammy Smittle. I've been a

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nurse for almost thirty years.

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I am now a group CEO of a

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surgical hospital here in Austin and then a

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surgery center also in Austin. So I have

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ASD and then, a surgical hospital that's about

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15 miles apart from each other. So

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been in health care for a long time,

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been a surgical nurse my entire career.

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Can't imagine doing anything else except what I

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do.

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Excellent. Well, we'll just, jump right into it

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then. As an ASC leader, what are the

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top three trends you're following in health care

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and ASCs today?

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Yeah. So the top three are obviously the

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same as everybody else's. Watching the higher acuity

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patients and procedures being performed within the ASC

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safely.

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We you know, it started last year with

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or several years ago, we started with the

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total knees and then adding total hips and

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now total shoulders. And there's a lot of

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things that we can do

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better than the hospital systems can, so it's

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exciting to see those patients,

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migrate over

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to the ASC world.

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Second thing would be the employers,

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entering partnerships with ASCs

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to shift procedures out of hospitals

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and,

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and into the ASCs entirely.

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It's often waiving out of pocket cost,

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to the patients, and it's increasing quality and

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and reducing cost to the employer because a

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lot of these employers have set have self

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funded plans.

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So it's been fun to watch the ASCs

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work directly

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with these self funded plan employers

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to get take care of the patients.

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The third thing kind of follows into

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cases moving over to ASD is the the

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amount of hospital investments. And in Austin, it's

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pretty impressive right now.

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Currently, over 70% of health systems plan to

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expand or acquire ASC capacity.

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In Austin, it's it's happening now on a

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daily basis. So it's interesting to see these

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hospital mergers with ASCs.

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It's you know, because it's it it's

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better for patients. Like, it's they can have

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the sicker patients in the hospital and do

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all their surgical cases in the ASC.

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And it's operational efficiencies, and and I think

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the surge the patients are demanding it. Market's

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demanding that these cases move

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to the ASC.

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They don't wanna be around sick patients. So

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those are the trends that I'm currently watching.

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Mhmm. Absolutely. And what are you most excited

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about right now in this space? So last

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week was we all got the email or

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the

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the note from Becker saying that, that CMS

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has proposed this three year phase out of

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the of the inpatient only list.

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Super excited about that.

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It's gonna be 285

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musculoskeletal

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procedures scheduled for 2026

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gonna be released off of the inpatient only

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list.

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We've been performing cases and we can perform

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these cases,

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for commercial plans and we've been doing, you

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know, lumbar fusions and we've been doing the

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reverse total shoulders and,

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even some hip and knee revisions. We've been

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doing these safely

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for a while. It's really great that CMS

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is recognizing it,

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so I'm excited to see that. Another big

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thing that we're excited about is,

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and then Texas is this noncompete

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issue.

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We're being told it's gonna change the five

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mile radius for one year. So that's gonna

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be huge

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in order for

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as an independent a runner a c CEO

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of an independent surgery center, it's interesting to

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get these doctors that are leaving hospital employment.

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They'll be able to join my

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my ASC at a timelier basis in five

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mile Nanga Peak. That's not bad. So excited

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about that.

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Absolutely. Yeah. Definitely. I've been speaking to a

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lot of leaders about that inpatient only list

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announcement, and I think a lot of folks

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are are looking forward to see how that

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changes things.

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We can do it. I mean, we've been

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doing taking care of it's a fine line.

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You know, it's a tight group of making

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sure that the doctors and anesthesiologists

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work well together as far as getting the

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patient selection right. Because you don't wanna take

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patients that aren't gonna do well in the

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ASC because if something goes wrong, it's we

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have to transfer the patient. Right?

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So I think that that's gonna be a

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learning curve. It's just for surgeons to work

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with anesthesia

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to make sure that our patient selection's

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spot on.

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Absolutely.

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And how are you thinking about growth over

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the next twelve months? So So I think

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that's two phases. And like I said, I've

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been doing this for almost thirty years, and

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I I like to think as the the

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team mom for orthopedic surgeons here in Austin.

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So it's crucial to to manage it

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bringing a new business while maintaining healthy relationships

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with the business you already have. So

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I think that

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I'm always recruiting. I'm always looking for new

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doctors, but I'm at a lucky spot

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with my current surgery center at Stonegate that

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we can kinda pick and choose who comes

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to Stonegate.

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You know, when you're hungry, you pick where

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you work with everybody. But now you can

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you pick the doctors that fit

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what's going on in your surgery center so

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I can I can pick the right doctors

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with the right procedures with the right attitude

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and the right patient care?

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And so we're that we're getting that so

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we can recruit,

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smartly,

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this in the orthopedic world.

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Another thing is, like, with your current doctors,

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there's not a better marketer for you than

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a happy surgeon that's getting distributions.

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So if you just keep your current business

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happy,

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then they're gonna be out there hitting the

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streets telling everybody that this is the center

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to go to because they've had they get

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taken care of. They're getting distributions.

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You know?

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It's a happy place to work,

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and and that's that's huge, and I want

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my surgeons happy. And so we work really

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hard on that.

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Another aspect that I focus on with my

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current doctors and even with new doctors is

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bringing new procedures

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that they may not know about. And my

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surgery center was the first surgery center in

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Texas for an orthopedic surgeon to

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to do a peripheral nerve stem, and now

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I have six orthopedic surgeons that are doing

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peripheral nerve stems. So they're excellent for for

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patients.

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It's a well reimbursed procedure. It reimburses kinda

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similar to a spinal cord stimulator.

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My orthopedist are doing it for rotator cuff,

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pain after rotator cuff, residual pain after total

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joints, or even ankle or wrist pain. So

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this gives the surgeons a new avenue to

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take care of their patients that before they

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would look for pain prescription to to

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to take care of them with. So

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growth is it's on my mind on a

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daily basis, but it's a you have to

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do you have to keep the what you

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got happy and and recruit new over at

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the same time.

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Mhmm.

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Absolutely. And I I like what you said

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there about that that kind of word-of-mouth factor,

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I think, especially just

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given, you know, the way technology is today.

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It's almost like the old fashioned way. It

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can kinda cut through the noise a little

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bit when you've got people just in the

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community talking about their experience.

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You can't really trust you can't Google like

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you used to. Right? You can't really trust

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that as as

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as factual. So I'm telling you, like, the

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the best marketer I've ever had is a

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happy surgeon.

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Even even doctors that are not invested, they'll

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go and say, hey, man. I can I

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I'm efficient? They have quick turnovers.

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I can do eight cases before noon. There's

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there's nothing better than hearing that from another

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surgeon to get a phone call. So we're

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we're really blessed.

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I have a great team that works their

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buns off to make sure everything goes great

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and patient care is good. So,

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I know they work hard, but we feel

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lucky at the same time.

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Absolutely.

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And that sounds like a a good place

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to end things here. It's all I have

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for you today, Tammy.

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And thank you so much for joining us.

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It's been a pleasure speaking with you, and

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I look forward to connecting with you again

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in the future.

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You as well. Thank you so much.