BoneChat #125 - Help for spine startups - the NASS Innovation Summit with NASS CEO, Eric Muehlbauer

Welcome to Bon Chat 125. Today we have Eric Mehlbauer, uh, the CEO of NAS. Um, Eric's a Harvard-trained attorney who is a strategic systems thinker, policy operator at NAS. He's also the architect of the upcoming NAS Innovation Summit that we're going to hear about soon. So welcome to BoneChat, Eric. We're going to dive into the kind of the upcoming summit and your vision for, you know, bridging the gap between spine founders and the capital that they need. So handing the mic over to you.

Welcome aboard. Thanks, Tiger. And thanks, Alyssa, for making the introduction. Probably via LinkedIn a while back. So I've been, uh, doing my research. I, I've watched some of your previous, um, Bone Chats. In fact, I was just texting with Mark Visco Gliosi because I was watching some of his earlier ones. So, uh, I'm probably gonna meet up with him next week. So let me, let me just, um, say hi to Andrea and, uh, Raymond, guys I've talked to before. So good to see you guys again.

Hi, Eric.

Hi. So let me just start off with a little bit about where NASA is. So we're in the middle of strategic planning. Actually, we just completed it on Tuesday night. So we came up with a revised mission, vision, and kind of where we're going. And one of the key things that I'm very happy about is that innovation was really just something I was pushing for the last couple of years. And the board's really embracing it. So it's, it's, it's part of one of our top 4 goals is to stimulate innovation. And so to me, that is getting the thumbs up to move forward with— I've got a 5-year strategic plan I've already put in place on how to bring innovation forward with NAS. So I view us as kind of a spine innovation hub going forward. So you'll hear more about that as things, uh, move along. So I'm very excited about that. The other thing that's really significant is we're kind of getting back to basics and focusing on surgeon issues. Um, we've got about 75% of our members are surgeons, about 50% ortho, 25% neuro, and then the rest are PM&R, anesthesia, you name it. But we're We're going back to basics. And when I first started at NASS 3 decades ago, we had a lot of orthopedic surgeons involved in industry. We went into the ethics side of things maybe too far, and a lot of people in industry didn't like that. So they kind of took their ball and went home. But, you know, now we've got all kinds of things going on in innovation and working with companies. So we know that this is also what our members want, and it's what the field needs. So I just want to kind of set the stage on that. And you're getting the first external acknowledgement that we've just revised our mission. I won't show it to you yet because we got some press releases in the works, but it's going to be surgically focused. And Earlier today, so I got a report from OrthoWorld about what's going on in the market. I'm sure you guys have seen that, but you know, the spine market is, was $1.1 billion last year. They predict it's gonna go to $12.5 billion by 2029. So we wanna be a part of where this is going. And I think that we can help with helping with people's ideas in a few different ways. Number one, putting people together. I know that there's a lot of noise in the field. I tease Alyssa that she should come up with like an Alyssa's list, kind of like you find a, you know, somebody to work on your house through another set, Angie's List. Alyssa should come up with a list of good consultants, people she's worked with, people who've worked well. And that's something that we can work on a little bit later. So that's kind of some of the background. And the idea for the Innovation Summit, I've really been trying to get the board to sink their teeth into innovation for 5 or 6 years. And finally, Zoe Gogowalla, 2 years ago, really embraced the idea of let's, let's do something different. Let's do something on innovation. And the idea is to bring together engineers, lawyers, regulatory experts, medtech execs, people with ideas, venture capital folks, FDA experts in one place where we can all talk about where we're going and how do we get there. Andrea actually gave me an idea last year I think it was during the reception and she said, she's like, this is the first meeting I've ever been at where I feel like I belong. I'm like, well, what do you mean? Do you wanna tell me what you said?

Sure. Yeah. I mean, I, I worked in, in spine specifically for 15, 16 years now. I do patent research. I'm not, not an attorney. I'm a patent researcher in analytics and I've always kind of wanted to go to NAS, but it was— I knew it was more for surgeons, and so there wasn't really a place for me. And the Innovation Summit was where I sort of found my people and was very welcoming. It was where I could find clients, where people can find me, where I could see all the tech that I'm working on and new tech that's coming out. So it was fantastic, and it was a smaller conference where it made it, it's really intimate. You really get to talk to people and, and in a sort of less formal way.

Yeah, and that's by design. We don't want this to be more than 125 people, and we're at 74 right now. So I think we'll get there. We've got 15 pitches set up. And, and, and we've got roundtable discussions where I really want people to do exactly what you're talking about. Talk to each other, you know, help each other out with ideas. What are some leads? And we, this year, we're building on what we did last year. And again, it's really funny. When I first had the idea, I put together kind of a framework. And within our membership, in our database, we have a group, we call them CBIs, Commercial Business Interest People. So they're not necessarily surgeons, they're not necessarily providers. They're people who are, who come to NAS for the business side of things. So I sent it out to maybe 25 of them. Alyssa sent me back 3 pages of notes. So I was like, hmm, I think you're now on the program committee. So, and she's been invaluable because she really has guided us along with the other folks like Izzy Lieberman, Sogo Kawala, on where we need to go. So again, thank you, Melissa. Do you want to add anything about, you know, how this started and from your perspective?

So I think going back, and this might be a little controversial, but I think, leave it to me to put that right on the table from the get-go. But I think what happens is there's an undercurrent of unsatisfied users within SPINE. About where innovation has gone. And I think when you have big companies that are led by people on the finance side or, or product management side or engineering side, you, you lack people that have worked in the clinic or the OR, you have a significant issue with where innovation can go because The whole point of innovation is solving problems. And if you don't have that, that lens to look from, and your engineers, they don't really have that lens to look from either. So you, you're relying on the surgeons who have only one lens without, but they don't, they have clinic and they have surgery, but they don't have the additional throughput on distribution channels and so forth. So really, I think there's just an undercurrent of information gaps. And this exists in hospital systems too. So physicians don't talk to each other, right? And so I think what this really does is start to pull it back, back into solving problems. Like Eric said, getting back to the basics of solving problems. And when you start solving problems, you pull people together, the experts that are the best the best of each individual problem, and then you cumulatively create innovation. And we will see the ripple effects of this for decades. So this is just the beginning of what we can do. And I think that the Innovation Summit— I, I really— what I like about it is that we're putting issues on the table, but we're also adjusting. Just, we're nimble. The Innovation Summit is nimble based off of what the feedback that we received last year. It's just like a startup, right? We're adjusting to what people want, and it's so cool to watch and, and see how quickly Eric's done a phenomenal job of just of, of pulling in information from all over to, to adjust to the needs of, of the market of attendees that want to attend.

Yeah, well, thanks for that summary. And again, thanks for your guidance. So I just brought up our current attendee list. So you can see we've got member doctors, people who are commercial affiliates, you know, neurosurgeons, orthopedic surgeons. I've got one guy from Israel, Uri Hettelsberg. He's a neurosurgeon. I just met him by email, I don't know, 6 months ago, but I put him on the program committee 'cause he's been involved in development of ideas in Israel. So Carrie Hagan, former, CEO of Intrinsic, and now he's in consulting. Alyssa. But I've got some, some long-standing members here. Um, uh, uh, Anil Sharma, he's a PM&R doc, but he's got a fund. Uh, we've got Kenneth Blank, who's a PhD. Ken Yanomura has been on my ethics committee. So, uh, it's going to be a really interesting group of people, uh, and, and I'm eager to see the kinds of things that they they want to talk about. And, and last year it was really, we just did the basics. This year we're, we're really focusing on, uh, I think as I've studied this, another quick background is I have a book called, I put together called Roadmap to Innovation. And Tiger, you might appreciate this. So I was in the hospital engineering field before I came here, so I studied TQM CQI, that kind of stuff. So all I did was describe the process from idea through exit. You know, each of these different chapters could probably be a book in and of itself. But Jeffrey Donner, who's a NAS member, read the book. He's like, thank you. I wish I'd read this 5 years ago. Because, you know, what I was trying to point out was a lot of where the, where you can trip up. Right? A perfect example is like FDA. People get so excited about FDA, uh, approval, and they think that's the be-all end-all, right? But there's a, a rule within FDA called least burdensome provision. So they're obligated to tell you the lowest level of research that you can do to get over their regulatory hurdle. And keep in mind, law and regulations, they're the lowest— they're the lowest behavior, you know, it's minimally acceptable behavior. What you want is the best, right? Like ethics. So, uh, what I tell people is it's— you're better off doing a better study that people want to see, not just to get over FDA, because what are you after? You're after market acceptance. You want the doctors to read your, um, your articles and your research and say, oh, that's the study I wanted to hear. And payers, that's what they want to see too. So one of the other things that NASS has done fairly well over the last 10 years is we're really involved in the payers. So we have these things, we call them coverage recommendation documents. So we've got about 20 of them right now. And They're on a wide variety of topics. They're on our website. They're free to our members. And what these folks do, or these documents do, they help grease the skids for people who want to get reimbursed. So the Vizcogliosi brothers, I was talking with them a few years ago. They did a study about payment changes in a certain area, and they said the one controlling factor they saw was that we had just done a coverage recommendation document, and that changed the behavior of the payers in the field. Because we've got orthopedic surgeons, neurosurgeons, physiatrists, and very strict ethics rules. So the stuff that we produce is credible. And so there's clinical guidelines, you know what those are. Those are very evidence-driven. Appropriate use criteria, it's a little bit lower. Then we've got these coverage recommendation documents. And the field knows that the payers are going to use whatever they can to deny payment. So these are evidence-informed, I call them, and there's definitely some expert opinion in there. But we want to give our members and the field ways to fight back against denials. And where I see this going with this group is I'm calling them tech assessments. So we're going to have 15 pitches this year. We're not doing Shark Tank because that's really for early stage idea companies. But what we're going to do is we're going to give feedback to those audience, direct feedback, right? Here's what I like about it. Here's what I think, you know, in terms of market access, you know, difficulty, whatever. Whatever the criteria are. But what I could see us doing down the road is, I call it a tech assessment, where we take our members to review the technology and put something together about it with the company's input and put our name on it. Because then what the company is going to be able to do is go out and talk to other potential funders and to talk to, um, payers, say, this is what NAS says about our tech. Right? So, and this is building on what we've done with our coverage recommendation documents. And we worked with the insurers on those, on the process we used to put those documents together. So that's why UnitedHealthcare, Blue Cross Blue Shield, Aetna, Aetna's tougher, but as you guys probably all know, but that's why a lot of them are more accepting of what we've got going on.

So, um, Eric, can you share the 15 pitch companies? Can you share kind of who they are or what stage they are?

Uh, yeah, sure, I could pull that right up. I was just looking at it a minute or two ago. Uh, here we go.

And Eric, actually, I bet you a lot of people on here don't know about Aetna. So, and see, this is, these are the things that they take our blinders off when we talk all together.

Yep. Well, in fact, we have a separate issue. We're working with neurosurgery, orthopedic surgery on an issue with Aetna on Code 22853, I think it was. Anyway, but we're writing letters to get them to change their perspective. Uh, uh, one of the guys who's at our annual— at the Innovation Conference, uh, Chris Kaufman, he's our first vice president. He is a coding and reimbursement expert. He's been, uh, on our coding committee for 20 years. He also is a reviewer for Turning Point. So he does utilization review for them. And he's going to give one of the key talks at the Innovation Summit. And he's also willing to sit down and talk with anybody who wants about their coding strategy going forward. So this is the list of— the current list of— I call them pitchers. I like the White Sox. So, you know, we don't have good pitching. But these are the good pitchers. We've got 3DSK Spine, Rehab Wheel, Spinal Simplicity, Spark Spine, Advita, Amber Implants. One of these guys is from Brazil, I know that. NanoHive. This guy, Daniel Jacobson, is interesting. He's been involved in development of several products, but he just kind of consults on them. So we've got Renovos, Neuroaxis, UTRAC, Lenos, NanoHive, Cutting Edge Spine, Amphix, FoxEyes, and Facet Dynamics. I'd have to pull up the other part of the report I got to show exactly where they are in their development. But that's the names anyway. And again, we're going to do this the end of day 2.. And we're gonna do, you know, audience feedback on their stuff. I'm gonna have Jeffrey Rowe, who's one of the main speakers, spine surgeon. He's been involved in Carlsmed and some other developments. He, Izzy, and probably one other do, you know, Q&A right at the end. You know, a couple of quick questions for each of the presenters. So Raymond.

Thank you. First off, thank you for all your efforts. I really, really appreciate you and this new direction. So is the pitch list closed or is it still open?

It's closed. We sold out.

So again, well, I did notice one thing. You have NanoHive on twice. Oh, did you notice that?

I did not.

So I will— they can see one position for overpurged spine, but I don't know, it's up to y'all. I can go either way. Yeah, I am attending.

Okay, well, let me, let me take a look. I, uh, again, I just had my registrar send that to me about 30 minutes ago, so I didn't really take it.

Yeah, that works. I'm sorry, you can trade an end company with an end company.

There you go, there you go.

Works.

Well, let me bring up the, uh, the program for this year. I mean, it's on our website, but this is my behind-the-scenes one. Um, so again, here's the Innovation Network Summit, and again, I, I credit Alyssa with the work part because where we're going with this is Like, so next year the meeting is going to be in conjunction with our annual meeting in Boston. And what we have talked about is working with people with startup ideas and helping them develop a prototype and maybe even actually print it at the annual meeting. So that's the, the work part.

So they get—

we got to get them with the right engineers, 3D printer people, and, um, and we want people to come to this meeting work with each other too. So that's another part of it. So here's our program committee. Mike Wang, a lot of people know him in Miami. Zori, been involved in NAS for years. Scott Kreiner, just, he would be our past president. I mean, technically he is, but he went to Boston Scientific. He's now their medical director for the neuromodulation division. Michael Phailings in Canada, he's an expert in spinal cord injury issues. Chris Kaufman, I mentioned. Greg Banker is a VC. Mark Viscogliosi, everybody knows him. Alyssa, everybody knows her. Yuri, and, uh, oh, Izzy Lieberman and Zogho Gwala are the co-chairs. So, so we'll do a welcome, then we're going to do a market overview with, uh, SmartTrack. So Aaron Dorgan and company, uh, that should be good. Last year we had, um, The guys from OrthoWorld, Mike Evers do it. And we're kind of working with them because they have OMTEC right up the street that ends at noon and we start at 1:00. So that's on purpose because some other folks are going to come right down the street. And then we'll have a panel discussion on current issues in the medtech innovation system. Let's see here. All right. Then we're going to talk about the hidden truth in funding spine innovation. So Mark and Alyssa are going to tackle that one. Then we've got Zach Noling from K2X Capital, talk about early-stage funding. And then venture capital, private equity funding, where the money— when more money becomes a risk to innovation. So Kerry Hagen, I've known Kerry for a long time. He is actually the inspiration for the Roadmap to Innovation book, because about, I don't know, 8 years ago, uh, Intrinsic, um, not sure exactly what they had, some questions about how to do things at our annual meeting. So I got on the phone with him, with our president at the time, Bill Waters from Texas, and Kerry was lamenting there's no roadmap if you're a startup. Company. There's no guidance, guidance anywhere. So I started doing research then. I was like, you know what, let's, let's try to help figure this out using my TQM brain. And so 8 years later, obviously didn't have a lot of time to work on it, I put this book together. So, and again, it's really short. It's a primer more than anything. Uh, then Jeffrey Rowe, um, Jeffrey used to work, uh, he used to be on our Coding Committee a long time ago, so he and Chris Kaufman are good friends, and he's been, he's been a success story. Uh, last year I tried to get John Kostowick to come and talk about K2M. Uh, Eric Major did a great job describing, uh, that success story because I really want some success stories to, to feed into this system. So, and he's going to talk about what it took for him to build Carlsmed, Amplify, and he's got a group now called Intuitive X. He's also got a fund that he's developing, and he's probably going to be the sponsor of our Spine Venture Village at the annual meeting this year, and he'll probably be co-chair for the innovation track at the annual meeting next year. So Jeff, um, I don't know if a lot of you guys know him, but I got him on the phone one day and talked to him for about 90 minutes. And he's really excited about doing this. So I think he's going to be a great addition to the event. So then we'll have a panel discussion of Michael Phailings and Izzy are going to talk about the clinician innovator trials, tribulations, and triumphs. And then we're going to do a little bit of a kind of go outside a little bit. So we got an email from a member about a year and a half ago about a 13-year-old girl from Uzbekistan born with diastomelia. So it's a congenital disorder where the spinal cord splits. So one of our Board member Stephen Wang worked with Terence Ishmael to help her. So we're going to tell that story, and we're going to have them focus on what some of the innovations were that helped this, this, this girl from Uzbekistan. So, and then we go into— they're going to have a little panel discussion, then we're going to have a reception where Andrea can give me more input. So So that's day 1. Any questions? Again, that's really market overview and funding. That's what we're talking about. So day 2, the theme is really securing IP, monetizing your product, and gaining market access. And again, gaining market access, that's what I've heard from people like Raymond and Alyssa about what's really needed in the field is how do you go from idea to getting the market to accept your stuff. So, so, Andrea, you want to talk about your first part there, patent strategy?

Sure. That is something I'm doing with an attorney, Diane Dobrian. She was, she attended one of the BoneChat, well, my presentation on BoneChat. And we're doing this together both from a sort of patent information aspect. That's going to be my part. How to make sure that someone else has not already had made your invention, gotten a patent on your invention. And then she's going to talk more about actually the drafting applications, what needs to be in them, when to do it. And so we're sort of putting our heads together to, to have, again, a roadmap for someone in the innovation and when, when to do what. In, in IP, from an IP lens.

Great. Thanks again for your help. So it's funny because we had, uh, one of my local friends is an attorney, and, uh, he, he got me a couple of folks. They were okay, but Andrea really knows this stuff, so I'm excited to, to have her, uh, participate. So thanks again.

Andrea was the first person to weed out our design philosophy because we didn't want to infringe upon patents, right? And so that, that's like the very first step a company should go to, um, to protect them for the ripple effects, to protect for protection, um, um, throughout the entire company process formation.

It's chapter 1 of my book also, uh, Andrea, you need to write the next, the next version 2.0, the That's your chapter.

Okay.

All right.

I'll help out.

Eric, I would, you know, I would encourage if people have ideas on this too, these are really, really smart individuals with lengthy tenures. So if there's something that we're missing the mark on or that can be improved upon this, please let us know. Because we want to make this as powerful and impactful as possible, even if we can't do it even if it's an idea for actual NAS itself, please share with us. We're stronger together.

Yeah, and I have a mind for this stuff. So if you give me the idea now, it doesn't work now, we'll plug it in for next year.

So like Eric said, there's a 5-year map that's being rolled out. So to make this extraordinary and what's being discussed here is just 5% of really what's being discussed in a broader context.

Yep.

Yeah.

And then we're going to go into FDA approval, securing breakthrough device designation. So a lot of you know Lisa Ferrara. I've known Lisa for literally 30 years. We go way, way back. In fact, Lisa and I think Alisa, you're going to join us for— we've got a a town hall with the FDA coming up through the Alliance of Specialty Medicine. So, and then we're going to have Jeff Ziegler talk about what he's done through SI-BONE and Zohri talk about Therapeutics a little bit. So, then do some case discussions. Then here we go, Chris Kaufman. He gave a talk last year, I think it was really well received, Coding for New Tech: Impact on Mergers and Acquisitions. This is the stuff you guys want to know. Yeah. How do you position yourself to, the right way so that you're going to be more attractive?

Raymond. Interesting. Well, I'm kind of taking away from your momentum, but going back to— do you want me to interrupt and go back to one other comment that may be useful for you or Andrea as far as IP from concept to market? I would say even post-market, and what comes to mind is companies that have a philosophy of violating patents and saying, well, just sue me, and how a startup company without those kind of resources can navigate in a proactive way, or at least reactive way, those kinds of situations. So that would be not necessarily for next month, but at some point I think would be useful.

Yeah, I'm sure we'll touch on that. That's part of the freedom to operate sort of due diligence part, but it is something that maybe we can have a separate—

I'm talking about people violating startups' patents because they know startups don't have the money to than the patent.

Got it.

Got it.

That's a really good point. Very good point. And yeah, we'll take that into consideration. Make me— whether it— like Eric said, whether it's this year or next.

Yeah. Well, Raymond, you nailed it. Because in fact, Jeffrey Donner, the guy I mentioned— I've known Jeffrey for years. He's a spine doc in Colorado. And he's facing that right now. You might be aware. And I talked to him about it, um, and he says it's $2 million to fight something like this. And I'm, I'm like, wow, that seems like a lot of money. But when you add engineer time, everything else, it makes sense. So I, I was actually thinking about having him be part of a discussion maybe at the annual meeting on this. And if Andrea, if you're going to be there, you could probably help out.

But, um, yeah, I'll make—

yeah, but definitely following up because there's a when I get to the Spine Venture Village, we'll talk a little bit more about that. But either way, I wanna do this for next year's annual meeting. It's like, I wrote an article, I don't know if some of you were around during the pedicle screw wars back in the late '90s. Yeah, Tiger?

'93, I was there.

Yeah, I was, I had just started at NASS in '94, and in January of '95, we got sued 522 times. As part of a, a multi-district litigation. So I hadn't gone to law school yet at that point, so I got an honorary degree with, uh, the, the legal issues and, um, got a separate education on how insurance really works when you get sued, because we had to sue our insurance company to cover our costs. And wrote an article for the Association Management Field on how insurance works when you really get sued. So anyway, so the insurance side of it to me and how litigation works. Yeah, Raymond, you're spot on. If you're not careful, I'm going to put you on the program committee too. So for next year. All right. So back to this. So FDA. So Lisa Ferrara, an expert on this. Again, if you guys have other names, please send them my way. I'm happy to see, you know, check them out and see if there was a plug them in. Chris Kaufman, Coding for New Tech, How to Position Yourself, The Payer Perspective on New Tech. So Robert Westigan, MD, was involved in the AAOS for a long time. He was at Evacor and Cigna, and now he's the medical director for Hinge Health. So in some ways, he's a little more free to talk about what things were like at Evacor before. So I think he's going to be a real good addition. And then we're going to have a roundtable discussion with those folks. And April Spillane from Intrinsic is going to join them. So then how healthcare systems really decide. So again, Alyssa and I have talked quite a bit over the years about Some of the issues that startups have is they can't get into health systems because of, uh, contracts that already exist, et cetera. So this is a friend of Zogo Gowalla's who's a chief medical officer for BayCare Health System, and he's in charge of, um, the value committee. So we're gonna learn from him what they look for. And be able to ask questions. And then this is, so we have some folks from HealthSouth who we were trying to get involved, but due to the fact that they have to manage too many robots right now, they couldn't participate. But they gave us this guy from LifePoint Health. So Greg May's gonna talk about the spine surgeon's role in adoption. And you know, that's evolving. When the, physician fee schedule came out, um, in January, one of the things that was, uh, in the new reimbursement system is site-neutral payments. So one of the problems we've had over the years is that the influence of spine surgeons has been lessened because a lot of them are working for hospitals or health systems. And so if they're influential, they gotta work internally to get that influence. Now there's more ASCs starting up again, so people are getting back into private practice. And I think that will help, you know, kind of balance the playing field a little bit more. So, but in the meantime, we wanna talk about how the surgeon's role has evolved in these times. So then the roundtable discussion about What do companies get wrong about hospitals, health systems, and payers? What can they do better? Then we'll get into here. Oh yeah, then we get into our— okay, yeah, the payer perspective on new technologies. I mentioned how health systems really decide, and then we're going to get into our pitches after the roundtable discussions. So the roundtables, protecting your IP, coding reimbursement and working with payers, how to integrate with health systems, FDA compliance matters, and then venture capital. Each of those is going to get 5 minutes to report on what their roundtable came up with. I did have to cut that back a little because we had so much interest in the pitches. So then we go through our pitches. Til the end of the day, and then we'll do a, we'll do a wrap-up. So, so we've got 6 exhibitors. We only had 1 last year, so it's growing. I think we only had 12 pitches and we've got 15. So it'll be interesting to see how we work this into the annual meeting for next year.

Eric, are you specifically talking about the Value Analysis Committees, VACs? Yep.

Anywhere.

Okay, that's, that's, that's Timothy Leising right now because it's, it delays their cash flow. If the surgeon says, I want to use your device, and then you got to wait 12 months, it's killing, it's killing startups' cash flow.

Yeah, that's the Timothy Leising, uh, section. So that's, that's, that's the value committee. Got it. And then, um, I, I know we're running, running close on time here, but so the Spine Venture Village, again, this is another I guess, of my brainchild's brainchildren. So we're gonna set the hall, the exhibit hall, up with regular exhibitors, and then we're going to have a startup area. I'm calling it Spy Venture Village. I toyed with the idea of Innovation Island, but because of Epstein, I don't want to use the word island anywhere. So we're doing Spy Venture Village. Jeffrey Rose, Intuix, might, might be the sponsor for it. I'm going to talk with VB Brothers also about it, but we want this to be kind of like an incubator setup where we've got 25 to 30 incubator or new companies together. It's not going to be a 10 by 10 booth, it's going to be what we're calling a pod, and we're going to set up some roundtable discussions just within that group. Now, if other folks from the exhibits or from the meeting itself, they want to sit down, great. But I want this to be productive for this group. So, as we were talking about, Raymond and Andrea, defending your IP in the real world, what actually happens when your idea is challenged? It's here. I'm going to get Jeffrey Donner to talk about this if he's willing to come. If not, we'll get other people who've got experience with this. And that's just going to be a roundtable discussion. I don't think we need— we talked about putting together, you know, presentations, but I think having an area where this group can get together and talk about it will be really valuable to them. And here's part 2, Tiger, winning over the value analysis committee. What have you done that works? I know April Spillane's been pretty good about that, Jeff Ziegler. So I'm going to get them involved. Coding, you know, the hidden levers of success. How does— you've got to start with the right code. You've also got to be really careful that your code doesn't negatively affect what's already out there, because part of what we do with our coding committee is we play defense. If there's a new technology that comes along and it takes 45 minutes and it's similar our members are getting paid for an hour and a half. So if CMS gets ahold of the fact that it's only 45 minutes now, they're going to cut the reimbursement. So we got to be really careful how all that stuff works. So, and then reimbursement reality check, thinking like a payer, and then raising capital without losing control. So those are just the ideas. So again, there's a lot of business-to-business stuff that happens at the NAS annual meeting. I'm sure you all know. So we want to kind of lean into that. So everybody will get 2 badges. If they bring their VC, I'm going to give them an extra badge for free. So, and it's cheaper than, than doing the booth at NAS. So that's what we're doing this year.

So.

Excellent.

Isn't that— that's what I think is special about this, is the problems are being addressed in real time. We know that capital has never been less available in the spine market, and that's because we've had a historically commoditized industry. And so the only ones that can survive right now are the ones that are doing extraordinary things and are making changes and just like this program, it's one of those— it's a way to leverage our understanding and figure out how to solve these problems and these mistakes that have historically held back innovation. I think it's really— join together as a collective and make these changes. And so what we see right now is going to be completely different in 5 years because the momentum is gaining strongly.

Well, there's, there's one other really interesting thing that we're talking about internally, and that's NAS starting up its own fund. So getting $25K from 200 members, $5 million fund, not huge, but then our members can help direct where some of those funds go. And we've talked with some other folks in the field about taking that to scale, you know, working with venture capitalists to, to bring more money to the field. There's a lot of ideas, not a lot of funding because there's a lack of understanding and appreciation for how spine works. You know what these folks want? They want to invest in Ollie, the dog food company, and have a 40% return in 3 years. Spine takes 7, 8, sometimes even longer. So you gotta have people who understand that and are willing to invest that time and energy. 'Cause as, as the market predicted, you know, it's gonna grow hopefully to $12.5 billion globally. By 2029. So there's room for both.

Yeah, it's a great— I mean, this is, you know, Warren Buffett's theory personified: get greedy while everybody's getting out. There's no better time to be in spine, and because we are taking initiatives and not allowing— not relying on the big companies who are risk-averse to true innovation, the surgeons as a collective and NAS as a society collective They're taking it upon themselves to go, you know what, we're tired. We're tired of having the same things for 20 years. It's time to, I think, revolutionize the industry. And that might be investing in telomere lengthening. You know, we know we can do it. We can stop the age progression. And this is outside of Illuminate, but there's so much innovation out there that has not been funded and will change the world. And it's about time that we stop looking at little microchanges on topography and look really more at the disease states that cause the failures in spine.

Yep, here, here. So, Eric, part of my environment is I have surgeons that come to me with ideas because they get frustrated. They can't work with the big companies any longer. You've heard that before. The big companies don't innovate, they just stiff arm the surgeon. They just want their business. They don't want their new product ideas and they don't know how to raise money. And I mean, this is great. Tell me more about the fund you're raising and what would be the criteria for a company to tap into that? That, that's really interesting.

Well, again, it's, it's still in the idea phase, so it doesn't exist yet. There are some other— NAS is part of something called the Council of Medical Specialty Societies. So it's 50 medical societies, all specialties, dermatology, urology, you name it, whatever the -ology is. But some of them have already done this. So there's examples where it works. So, and I've chatted with CEOs of these other companies who've done it. So the idea would be, again, limiting it to $25K buy-in, 200 people, $5 million. We go higher, great. But then giving these folks, maybe once a month, you line them up with some pitches and then say, okay, what do you think? Are these things we want to get behind? Haven't figured that part out because the board still hasn't said let's do it. But again, if we, if we can do this, then we're involved, right? We're going to learn even more. And that, that's what excites me as I love learning this stuff.

Yeah, I think the startups need seed money. They don't need, they don't need $5 million. They just need $500,000, $1 million to, to hit early milestones and then to earn the, to earn the Series A later on.

Yep. Yeah. And the thing is, you know, we've got folks who I think would be helpful to them on the reimbursement side. That's kind of our forte, is looking at things. And we work with the insurance companies all the time. We've got something called a payer policy review committee. So we look at their policies, we give them input on it. That's why we decided to write our own coverage recommendations, because there was you know, there's 150+ payers out there and they give us 3 days to look at their policy. So I said, let's turn it on their head. Let's, if we were an insurance company, what would reasonable policies be? And that's where they, those things started. Raymond.

So thanks, Eric. I, what I didn't hear is, and I think we, this has been talked about, is NAS doing something associated with endorsing a technology that might help a small company in their back application? Is that off the table, or did I miss it, or is that still being thought about?

Well, our board to endorse a technology would be tough.

Okay.

Because, you know, For just today, for example, we have a coverage recommendation document coming out on annular closure device, right? That's Barricade. But the board doesn't want to use the name Barricade in it. So they didn't know what to do. So I said, well, here, here's the way we finesse this. We say there's one FDA-approved device on the market for this. And then put a link to the FDA's safety and effectiveness document. So we're not mentioning it, but people know they can get to it real quickly. So, but like I said, if we do tech assessments, right, where we've got, you know, 3 people work on it together because one's an expert, might be a KOL for a company, and then we run it through our executive committee and board. We've got a tech assessment on a new tech. Here's what we like about it. Here's where there are some questions that would be fair to put out. And if it's got NASA's name on it, then you guys can use it to go to the next VC and say, here's what NASA said about my, my product.

So, okay, good.

So it's not an endorsement, but it's a, it's a review. And again, that is not something the board has agreed to do yet. This is just in my plan. So, but if they want to, if they want to go forward with innovation, frankly, they got to listen to me because I'm listening to you.

Terrific.

I appreciate that.

Yeah. So, so I know the Innovation Summit is mostly an in-person thing, but I noticed on the website you can, there's a, there's a remote, uh, access. So that's cheaper, and for people who travel a lot, maybe easier. What do they get access to if they do the remote, the virtual thing?

You know what, let me pull that up because this is through— so number one, you get last year's material. You get access to that. Oh, sorry, I don't even know my own website. INS. There we go. Let me pull this up for everybody. So I know you're almost out of time, so I don't want to—

Yeah, I dropped in the chat the link for everybody.

Yep. So here's the registration details. So there's in-person. Let me see here. Where's the other one? Register now. It's probably where you do this. So, but yeah, so I don't, we're going to have some parts of it live. And you can, you can get it live, but it also gives you, we have something called NAS Anytime. It's our, it's our video library basically. And so you get access to that as well. You know, let me send you those details. I just don't have them on this sheet right now. So yeah, we'll make that available to this group.

Eric, what do you think about the concept of of the societies gathering together to create their own GPO for innovative products, considering there's so much reimbursement opportunity with NAS. What would you think? I think that pricing and strategy and alignment— I think it would bring in revenue to NAS instead of just this one random entity that typically has no knowledge or awareness of spine. It brings it back to the physicians having power of access. Access is the most fundamentally critical issue with innovation getting into hospitals. And as we start to solve those issues, we start to solve innovation coming in.

Yeah. So that's also part of the 5-year plan. And again, you and I have talked about this more than once. I guess the question is how to make that work. As, as a nonprofit organization, we would have to do a for-profit subsidiary, which we've done that before, so that's not difficult to do. And then frankly, I think I would rely on the startup community to help run that. You know, what we could do is kind of organize the disorganized. And so like, let's say, Alyssa, you're going to, you know, Jefferson University to talk about Illuminate. Well, you could also bring along some of the other tech that you know. So maybe be the rep for the GPO. I don't know how it would work, but I kind of think of a sweat equity kind of program like that. So Obviously, it's, it's not, there's not been a lot of thought about this, but definitely is on the radar.

I think that's the way that we get put the power back into the surgeon's hands again, is, and then it also gives credibility to the companies that meet certain criteria to be part of that GPO. So it's, it's an exclusive innovation design GPO that physicians trust the infrastructure, trust the reason, the solution, because it's all— and it takes the— it's— if a physician that's like an ophthalmologist is clearing a device into a hospital because they're sitting on the value analysis committee, it takes that responsibility for them to have a judgment call and when they have no idea what a spine, you know, biologic actually is or it needs to be. It's just a guessing game and we're putting that back into the physician's hands. So yeah, Eric, I love— I wanted to highlight that this is what we're going to see. So yes, it may seem small now, but the ripple effects of what is being done are going to change the ecosystem as we know it.

Yeah, that, that's part of the, the 5-year, we call it BHAG, Big Hairy Audacious Goal. So. Love it. Yep.

That's a big idea. That certainly is. All right, 2 more minutes. Any last comments or questions? Everybody's pretty quiet.

We must have answered all their questions before they had them. Question?

Just to comment, if I can, maybe a post-Innovation Summit communication out to the broader NAS community. It might additionally benefit both the attendees and the reg— the reg— or the membership at large, if maybe you have already given that thought or maybe not.

Yeah.

Oh yeah, yeah. I mean, we, we, we do kind of, we call it a post-event review internally. We do it with the board and we do send out that information to our membership. But let's take it a step further. What about a quarterly newsletter on innovation written by the people on this, in this group and others to help guide the field further, taking excerpts from the roundtable discussions and building on them.

You know, so—

I love it. I think that's also in the cards. We have several different sections within NASS, 13 of them. We got, you know, tumors, spinal cord injury, you name it. I could see us developing a Section 9 innovation, and part of our responsibility is a quarterly newsletter of some sort that gets into some of these things. So good.

So Alyssa, from her Lyft car, has asked— sent a note to— any suggestions after the bone chat's over with, just send it to her or Eric. Um, keep the conversation going.

All right, well, Tiger, thanks for having me on. I appreciate, uh, the opportunity to talk about this. I'm pretty passionate about it, as you might be able to tell, uh, and I, I really think that we're going to be able to make some headway.

So it's much needed. I'm glad to see you're doing way more than the academy, the AAOS. So glad, great to see it. Yeah. Thanks for your time, Erica. You're a busy guy.

I would love it if we partnered with them eventually on the GPO stuff. I think it would be really powerful.

Yeah, I met some of the people who do their work, trying to bring them along, but you know, sometimes you're that one duck that's way out in front of the pack. You gotta wait for them to catch up. Absolutely. Or the flock, not the pack. So sorry.

Well, keep flying. Thanks. Thanks, Eric. Thanks for your time. This is eye-opening. Yeah, a lot of people will be there in Chicago, I'm sure.

Great.

Yeah, thanks, guys.

See you all in June.

Appreciate it.

See you soon.

Thank you all.

Bye.