BoneChat #43 - Random discussion

Yeah, so we didn't have a speaker this week and I thought we would try this. So this is, this is Bone Chat Discussion 43. So we're gonna do a random discussion for the first time. Anything you wanna talk about, just throw out a topic. What's bothering you? What's interesting? Funding, conferences. Friends, and, and if you want to go deep, we— I can certainly turn off the recording anytime you want. We can go dark anytime you want. So let's talk about NAS first. So Alessa threw out the question. She's— it costs $2,000 or $3,000 to speak at NAS, and as a pre-commercial startup, Is it worth it?

That's not NASC. That was the other one that you posted. That was the other conference. It was $2,250, I think. I've gotten to the point of just coming to accept the philosophy that we're going to have to pay to raise money. So it's just the nature of the beast. And so is it worth it for that conference?

What conference is— what funding conference is that?

Let me see. You posted it, I think, last week.

That was the MedTech Strategist, right, Alyssa?

I think that's— thank you. Yes, you have a better brain than I do.

Yeah, the Innovation Summit at the Grand Hotel.

Thank you.

What are your opinions, Barry?

Barry, what do you think? Have you been to that?

I have. I actually did them way back in my younger days when I was at Synectic Product Development and you made the rounds of those pretty when it was IN3. That's dating myself pretty badly. And, but yeah, I find them pretty interesting. And then there's also one here in Philadelphia with PACT where there's about 45 startup companies presenting at various different levels. So if you haven't gotten involved with that here locally in Philadelphia, that's another really good one, the Philadelphia Alliance for Capital and Technology.

So, Alessa, you missed Ted's talk last week, but it was a TED Talk. But anyway, he gave a great presentation on how to get the most out of the conference, and he really talked about funding conferences as much as medical conferences. So what would you do ahead of time to get the most out of it, Ted?

Yeah, I mean, the theme is, is, is Essentially, the conclusion you came up with, Alyssa, is that you, you have to commit to being engaged and, and being there. And, um, you know, ask colleagues and peers and people like this on the, on this call regarding their experiences for these conferences, because some of them can be just a bust even if you prepare as much as possible. But MedTech Strategist, LSI, LSX is going on right now in Boston. They, they are, they've been growing, they've been, they've been growing their attendance, they've been active. And my, my experience with them is, as I prepare and take time to review who's there, match it up with the target list for the client, for my company or the company I'm representing, and, and just maximize the time. I've always come away with, I believe, an ROI that makes sense because at least a handful of good contacts, warm leads that I didn't have, or unexpected encounters and leads. And it just takes the hard work, the preparation, and then when you're there, just like when you're going to a trade show, because I talked about trade shows last week as well, It's similar. You're on. I mean, you're on from 6:00 AM till midnight, you know, days in a row. It's, it's tiring, but it, it's all about the networking and being there and the face-to-face and the combination of the advance work, um, setting up meetings, uh, reaching out to your network, letting people know. And today, doing all the social media posting to say I'm gonna be at this conference, I'm gonna be at this event, meet me there. Or if you're gonna be there, DM me directly. And I, I believe it's worth it. I believe it's worth it. And, you know, I would just ask it, I don't know which, so you're asking about MedTech Strategist. I've not actually been to one of those, but I, I've had a client company go to the most recent one in Dublin. And came back and said, yeah, definitely recommend it, it's good. And it's even a different flavor meeting than LSI because it's a little smaller and it's a little more likely you're going to just interface and interact with investors and other people in our industry. Um, not that you don't at LSI, but you got to really work hard, you know, even harder I think at LSI to get the, the investor connections particularly.

That's what I've heard, particularly for a hardware company, that LSI is not particularly the best because so many technologies are being presented there. Is that your—

would you—

Yeah.

Well, I would just say hardware and spine is difficult in general just because there's a sort of a bad track record of VCs getting burned in spine over the last couple of decades. And so that it's not as in general, just implant, orthopedic implants is, is not as sexy as all the other things. They're really focused in on diagnostics and AI and wearables and cardio, cardio, cardiovascular and stroke and, and, and, um, things like that are, are, are seem to be getting more attention. But, you know, that's part of sort of making your story, crystallizing your message and, and making it really clear that you're not just another implant, you know, you're not just another plate or a screw with a cool way to manufacture it in your favorite color and put your initials and your college logo on it, personalizing it.

Yeah, very good.

On the smaller local kind of events, I went to Project MedTech in the spring and Duane has them in multiple locations. Um, and there were— there was a spine company, there were— there was a couple of ortho and investors, and it, it's smaller. So I think along the same lines, I've never been to NAS, but I think it's the, the investors are much more approachable. Um, and you can network with them.

And I've been— I went to their— one of their first events over in Houston, and Dwayne's just a those guys were just great guys, um, in general. Um, and they have the, uh, startup in mind at a $250, you know, admittance. Um, um, I don't— but the problem is, is because they develop, um, they typically have their company's pitch. And so, uh, it's— you're showing up to hopefully figure out who you're meeting with, um, and Um, and so they have a lot of things right, um, for their clients. Um, and so, so it's good. I think they've done a really nice job.

Interesting.

Yeah.

As a, as a just someone who's showing up and doesn't have that insight of who is their client and who isn't, that, that wasn't visible.

So yeah. And they, they did give me a list beforehand, um, to connect with people. Um, But, and again, this was last year or 2 years ago, several of their meetings ago. So I'm sure it's evolved as well. But they did a very nice job, especially for such a quick collaboration.

Another one that is good and it's focused on musculoskeletal is an annual meeting in Memphis every fall. It's run by Gary Stevenson and it's called the MNVC, Musculoskeletal New Ventures Conference.. And it's just orthopedics, musculoskeletal. So it's a day and a half of, of 30 to 36 companies presenting, but also because of the smaller size and everybody's there. Or of course Memphis is, you've got a lot of strategics already there, like Medtronic and Smith Nephew and, right, used to be right now Stryker and, and then others like Healthpoint Capital. That is who Gary works for now. And, and ventures. Service, you know, folks have been to. I don't know if anyone else here has been to that, that meeting, but I always, if I have a, even if I don't have a company that is, you know, look fundraising or in the space, I've gone just to go to the meeting and just because I spent 14 years of my life in Memphis and have a lot of friends there and family. But it's a good meeting. I highly recommend it. It's only $400, $450.

That's so smart. That's so smart to do it that way.

I mean, Memphis meeting is good. It's, it's small and intimate and it's all about orthopedics, which is, which is nice.

Yeah, that, that is really nice because, you know, to be honest with you, I look at it if I were an investor now, granted, I'm clouded with my own judgment here, but if I were an investor and I really focused on Warren Buffett, His philosophy is getting in while everybody's getting out. Everybody's been out of spine for a long time. They've been in extremities. And now that's dwindling away. So I can see— I've actually had meetings with funds that reached out to me as this tiny little company looking to have some kind of information about us. I think there might be a trend that's coming up with that mindset.

Yeah, I'm getting the sense that it's definitely getting better. And it'd be interesting to hear from my contacts that are LSX this week, yesterday and today, and LSI next week in Europe. That one's going to be much more European-focused just because of the location. It's in Portugal. The US one is every March in Southern California in Dana Point. More, more US-focused, but global really in nature to see. But the discussion points that we're hearing, that I'm hearing, is that I think it's warming up. Deals are warming up because capital's been sitting on the sideline. These funds, they have to deploy that capital, you know, they've got to do something with it. They've only got a timeline, a fuse on that capital, and they've been sitting on it for a couple of years. And Now they've got to put it to work.

Darn. And Barry, Barry, were you saying something?

You're on mute.

Yeah, typically they've got like a 7-year window to deploy and get a return on that capital.

Yeah.

Thank you, guys. Thank you. Ted, would you mind introducing me to Gary?

I think—

Mike Sherman tried to introduce me, but I don't know what happened there.

So, no, I know he still has 6 slots left. I'm trying to get 2 of them. So I'm competing against myself now.

Okay. Well, thank you.

Thank you, Ted.

No, because he's looking for 510. My 2 projects are Class 3, and he's also trying not to— he tries to balance out the program. So it's not all spine, or it's not all sports medicine, or all extremities. So he does a good job with that.

That's awesome.

Happy to do it. He's got a big program tomorrow at the OSET, the Ortho Summit. Yeah, in Vegas, where he's doing this HealthPoint Capital Day, and they've got a nice lineup of companies presenting, um, tomorrow, including, um, Aldo Denti from J&J and Ivan Torinos from Zimmer, kind of doing a cage fight or some kind of debate. I don't know, they're gonna put on their karate clothes and fight each other. We'll see. That would be interesting.

So on the, you know, for those of us who are not startups, more on the service provider side, are any of these better than others? Because I have been so tempted to go to NAS, like so many of my sort of like end clients are there. But I don't know if there would be anyone that would actually be in the position to talk to service providers.

Yeah, nice, Andrea. Yeah, that's, I, you know, from a service provider standpoint, I think everybody is, at least in the spine world, is going to be their decision makers. I mean, a lot of companies are, and we talked about this in my talk last week, adjusting their, their budget and their spend and not spending it on a booth anymore. You know, there's even some pretty decent-sized companies that aren't having a booth at NASR, but they're there. They're having a hotel suite nearby, or I just got an email this morning from a CEO saying, "Yep, we're gonna be there, but we're gonna be in a suite at the Ritz-Carlton in downtown Chicago. Pick a time, let's get together on Wednesday." And just because the booth costs so much, even though a suite at the Ritz-Carlton's not inexpensive either, But they, they're all there. So it, it comes back to Andrea, just, just, you know, getting that target list together and say, who, who do I really want to do business with? Or who's a good fit for me? And look at your LinkedIn connections and just start reaching out and post something on LinkedIn saying, I'm going to NAS.

And, you know, yeah, I mean, that's why it's That's why it's tempting, because a lot of my LinkedIn connections are going, right? And they are posting. But yeah, I don't know if they would want to— if that's the best time for them. Like, are they there to meet with surgeons and other kind of providers versus someone like me?

That's the priority from a company standpoint, for sure. And so, you know, push comes to shove and they've got an exciting new product launch and they're busy, they're going to focus on the surgeon.. But there's time during that meeting, you know, to connect with others in the business. And you just come by. And what I would say is don't just go spend the money to go and just hope that you're going to get a meeting. Try and set some definite, you know, times or window time frames to connect with people, to say, okay, I'm going to— let's meet on Wednesday, let's have a cup of coffee at 10:30 or whatever. Let me know what works for you and let's get it on the schedule.

You know, Andrea, I'm on a committee for one of the big meetings and they have started an innovation nexus and they're going to have a meeting next year. I don't know how public this is, but I think it's public enough because it's on the schedule. At NAS. So one of the things that I'm going to bring up in that committee meeting is, is IP development, because this is all about innovation and IP is a major focus of that. I mean, that's a starting point to do a search. And so I think that— I think one thing that these conferences could do a better job at, and I would be interested in other people's perspectives on not only this but also evolution of these conferences, is segregating, segregating companies, partnering them together that are consulting companies, not, not just— so if there's an additive manufacturing group, they're all together. So you're directly going not all over the map, you know where you're going. IP, having a— eventually having IP booths there to speak with consultants. I think that's maybe the next step in bringing in some additional revenues into these and actually solving problems for people that are attending. Because when I was shopping for a manufacturer, an additive manufacturer, we went all over the world for testing our products. And so it would be nice to be able to just go to one direction and say, without knowing the company's name, knowing that that area is all additive or all IP. What do you guys think about that?

If you can get them to agree to that. I mean, like the book, the textbook companies are usually all in the same area, you know, and it's interesting. You go to a neurosurgery conference versus an orthopedic surgery conference. The neuro guys are, are more the nerds, you know, from medical school. So they, they line up for it. They actually line up in front of a book, you know, to buy a new textbook where the orthopedic guys are usually at the booth that has the putting competition, the knuckle draggers.

I would love Dr. Glaucomflecken to do a skit on that.

Oh yeah, he's great.

No, I mean, it would be nice to have like a Q&A and then like, yeah, bring all the additive manufacturing people there at the conference and they can answer questions from the audience. The same thing with IP. IP and, and that, that way sort of kind of get to know people and see how knowledgeable they are. A lot of the IP conferences I go to, they have different tracks. I don't know if that, that is something that is done at these more ortho conferences, but yeah, there would be like any manufacturing track, IP track, 510 track, and then people who are actually interested in that go and listen to those presentation. So not everyone needs to be there at the same time.

The other thing to consider is host an event, you know, it just— it doesn't have to be— have a booth even. You just basically organize it and say we're going to meet and get a spot we can meet and, and, and folks, there's going to be an IP, you know, meet and greet session and discuss, you know, current trends of medtech intellectual property. And we're going to be at the Marriott Marquis lobby bar. Meet us there on Wednesday at 7, and yeah, yeah, do things like that as opposed to just kind of having a couple days there just working hard trying to drop cards off at different booths.

No, that's an interesting idea.

Yeah. David K has raised his hand. I think he I think he's on audio.

Yeah, hopefully I am. Yes, we can hear you. Okay, I must be having some internet issues. So the OMTEC meeting might be more inclined to do that sort of thing. The thing about the clinical meetings is the vast majority are just going to look at the new toys, not just putting contests, but it's the new toys. Let me go play with the new toys. I want to see the hot newness. How much innovation they really do, not really so much. Again, there's, you know, that'd be a whole nother topic. But, you know, the OMTEC meeting is more inclined to have the manufacturers there, and it does have a small number of clinicians that do go, sometimes by invite. I've actually spoken at that meeting, but that's where I think you might find more interest in the whole IP issue. And understanding IP and IP tracking. It's, it's, it's this black box that either somebody is incredibly interested in or incredibly uninterested in. It's, it's— and there's nobody in between.

Yeah, yeah, yeah. How do you spell, how do you spell the meeting name?

OMTec.

O-M-T-E-C. O-M-T-E-C. Chicago every year in summertime.

You know what would be interesting is to have a bone chat booth for the surgeons that actually do want to invent product.

We'll get there.

The bone factory.

The bone factory.

Yeah.

Yeah. I mean, we could pitch in, right? Like we could all potentially pitch in.

If we— we've got 52 members right now. I think when we hit 100, I'm kind of making a promise that we'll have an in-person presence at some of these conferences because it is a powerful group. We've got collectively hundreds of years of startup experience.

Yeah, yeah, one of the— yeah, I think you could, you know, certainly like at AAOS where he covers all different market segments and at least, at least, you know, probably there's the higher propensity of a quorum from this community that would be there. And you could even, if not have the expense of a booth, have some type of event or meeting place and say, like, we're gonna have a bone chat reunion, or not a reunion, but a reception. And we're gonna, you know, hand out new hats, you know, make orthopedics great again.

Keter. Ha!

I love that idea.

I would be right there if we would do something like that.

We may do it.

Yeah. There's, there's a couple of other places that I would like to bring up. One is called JOEI, Journal of Orthopedic Experience and Innovation. It's online journal, highly, highly recommend it. It's a lot of practical. It's guys who tend to write in the academic journals but also are practical. It's, it's that, small segment. I'm actually an editor on that journal and they welcome, let's say, and it's about orthopedic experience and innovation, you know, how do you do it? So you're gonna actually be going to your target group. The other one is a group called Ortho Founders. And there was actually a presentation, I missed it, it was a couple nights ago by somebody who came up with a device and is looking for funding and, Again, it's putting, it's going in front of the right audience. And that was meeting with regularity and probably went a year, year and a half without much. It looks like there's a little bit starting back up again. So those are two groups that I think would be more inclined and you would have a better audience. The trouble with AAOS is you could get stuck underneath the staircase and nobody knows you're there, you know, unless they happen to stumble across you. I mean, it's so easy to get swallowed up in AAOS. Yeah. Um, plus the expense is, it's insane.

It's too much noise. It's hard to stand out among the noise. And at NASN Academy, it's mostly just sales reps sitting in booths with suits on. And you, like, Andrea needs to talk to the R&D teams, and the R&D teams aren't, they're not in the booth. You know, even if they're there.

One of the things I was going to quickly suggest, André, and I know it's not specifically all related to orthopedics, but as part of some of the marketing that I do, I work with 3 different mentor groups, and they're mentoring groups through EIT Health, the Innovation Space, which is a DuPont Delaware collaboration, University of Delaware, and then World Upstart. And all of them are incubating startup and early-stage companies in various forms and fashions. Connections. Some of them are paid early mentorship, some of them are, you know, you're giving your time and energy, but it's a great way to meet a whole lot of folks in the service provider space as well as then these companies that are innovating new products and technologies. Again, not specifically all within the orthopedic space, but that's another great way to kind of make connections. And through EIT Health, I had I had a client reach out to me earlier this week about, you know, becoming kind of a permanent advisor to the organization. So it does work. It certainly is out there.

So, yeah, I always thought incubators would be a great place for those reasons. Startups and— I mean, I think about IP and would benefit so much from someone like me.

Right. I mean, I think you mentioned Project MedTech, that's another incubator, and certainly the MedTech— Project MedTech and then MedTech Innovator are, you know, two other ones that— but they typically have people that join and are part of them, are contributors to them.

Yeah.

Yeah.

Thank you. Thank you so much.

Yeah.

Andrea, I was going to add, I think the MNVC conference, which Alyssa mentioned earlier, and LSI might also be good options just because most of those are early-stage companies, and so they're kind of at that point where they need the service.

All right, thank you.

Asher, are you going to— are you going to MNVC?

Yeah, we're presenting. We're hoping to get FDA clearance on one product, the Fusion product, and then I'm hoping we get FDA clearance on the motion preservation product beforehand. But if we don't, we may back out, so there may be a new open slot.

Well, I'll be there regardless. So if you're there, it'd be good to see you. Absolutely. Well, I'm sure I'll see you next week in Chicago.

Oh yeah, that's right.

I'm going.

Yeah, I had a quick question. Just, just going back to David, the name of that journal, 'cause I'm looking for one that sounds like what you're describing.

Yeah, Journal of Orthopedic Experience and Innovation.

Yeah, Dr. Kirschenbaum started that. Is a, a better journal. Yep.

Yeah.

Thank you. I'm— Sean, you should come to Memphis for, you should come present your ACL tensioner in Memphis. That would be perfect.

I've actually got an invite, Tiger. And I'm, I'm trying to juggle a couple of things to make sure I can get across for it. So we've, we've got labs that we've got to run at the same time. So that's a bit of the juggle that I'm, I'm trying to manage at the moment. So, but that it's, it is part of the plan.

Excellent. You're in the right time. You're pre-commercial. US is the perfect time to go to Memphis.

Yeah.

Good.

And I can show you all the right barbecue places, Sean, to go to.

It sounds excellent.

Just walk across the street to Gus's.

That's right, Gus's Fried Chicken.

Yeah, and you can, you can visit Elvis while you're there too.

Yeah, sure, he's walking around still.

I heard he's still alive.

Yeah.

There's rumors. All right, that was a good topic. What else do you guys want to talk about? What's bothering anybody?

I've got a question just for, for, um, I'm trying to finish a contract proposal. Uh, this is actually one that, uh, that they're working on with another colleague here on the, on the BoneChat community, indemnification language as a consultant. If you're doing, for example, due diligence for a private equity or investment firm, and how, what are your, what's your experience? You know, like, like Barry, I mean, if you have any standard language, you know, to use, and there's kind of standard, pretty standard. You just, you know, concern is you don't want to get into what you're providing advice, and particularly to investors that then the investment goes bad, which is going to be 80% of the time in startups anyway, but you want to be protected.

What's your experience?

So in all of my contracts, I have kind of standard indemnification that, you know, the client bears the risk associated with my work unless there's some type of gross negligence on my part. So, yeah.

I think I've got what I need, but I'm just—

yeah, I can get— we can talk offline if you'd like. I'm happy to share what, what I kind of drop into my, my contracts.

Yeah, I'd like to compare it. That'd be good if I can help it. I don't have to call up, uh, Andrea's, uh, law partner and get, get the hourly rate to get it done.

I mean, that, you know, I think that's worth the investment. And yeah, I think a lot of times something like that, that someone else already has, it's, it's probably has been vetted along But, but yeah, if that, that should be a small, you know, less than an hour for someone to draft for you.

Certainly on that project you and I were talking back and forth, that was certainly one of the things that went through my mind in terms of liability.

Yeah.

Yeah, that's the same project.

Yeah. Okay, and Joe, I'm going to put you on the spot. So Joe's got a startup called NovaSource. They have a total knee. And I maybe a total hip. Are you, do you guys go to the Current Concepts meetings? Where, where do you go for total joints?

Yeah. No, no problem putting me on the spot and I can't take ownership. I'm just the general manager here at NovaSource. Doug Hawkins is the CEO and owner. But yeah, we have a total knee and a total hip. We are kind of late or we have kind of laid low in the past couple of years. We go to OMTEC for Contract Manufacturing. It is a great— I know you guys mentioned it earlier. We've always had great success there. It's a good way for us to talk to the people who are making a lot of the parts for us and also network a bit, get a couple, couple more contract manufacturers. And we see a lot of innovative technologies there. But beyond that, we go to AAOS. We don't often get— we haven't gotten a booth there yet, but we're— as we've talked with Tiger, or Doug has talked with Tiger, with some of the things that we have, in the pipeline. We're hoping to start going to AAOS, start going to AAOS, getting booths at both of those places and getting our product a little bit more in front of surgeons and, you know, in front of the— in front of you guys as well. So in terms of conferences, there hasn't been too many that we've targeted, um, but I think that'll change 2025.

Yes. Total joints is a tough market as well as spine. It's just so hard to get noticed. There's so many products.

I think that, you know, we've talked about, you've talked a lot about the, on the single-use stuff and that's something that we're interested in developing for sure. And I think that that's what we want, you know, that's what we want to grab people's attention with. But we'll see, you know, that the only, the only, you'll only find out whenever you put it out there and take that leap.

Yeah, explain the single-use, Joe, to everybody, 'cause when total joints, you don't think of single-use.

Yeah, so it's, I can't take credit for the idea either, but it is our owner's baby, a total single-use disposable knee instrument kit. So, not only is it, covers everything that you need for a total knee replacement, but it is also assembled in a, it's pre-assembled and organized in a manner inside of each of the sterile kits. That way it's chronological, kind of. It goes in order from one step to the next. You're gonna start with your, your IM finding the canal, you're gonna go into the distal cut and so on. Everything, all the parts are ordered start to finish. That way it's very easy for a surgical tech who might not be as familiar with a system to just go, all right, this is clearly number 1 'cause it's in top left corner, read across our instrument kit, pull the next instrument out and then hand it to the surgeon and they take it away. Um, it is targeted toward ASCs. It's like I said, it's, it's supposed to be small and easy to move around with, uh, with the sales reps transporting it and whatnot. So that's kind of the focus of it. Um, but that's, that's where we're putting a lot of our emphasis right now, and we're happy with a lot of the prototyping. It's just a matter of getting all the validations done and product cleared.

And do you have IP around that?

Yes. Yeah, so I was listening to Andrea talk, uh, talk on that front, and I know that, uh, we've already addressed it and we've got some patents pending on the front for the, the flow of, uh, going in a sequential pre-assembled kit. And amongst a couple other things, some tibial trialing, I believe, is another patent that we've got pending on it.

Hey, Joe, are you aware of the work?

Sorry, Tiger. Joe, are you aware of the work that they did at DePuy with the Attune knee system and their single-use kits?

I wouldn't say aware of the work. I'm aware of the system.

Okay.

So really, they put a big effort into it about 10 years ago. Give or take, when it was related to the first Attune primary launch, which there's been a million launches over 15 years with that product line. I don't know a ton of details. Two things I do know is they moved completely away from doing the single-use kits, and I don't know the exact reason why, but I think it was mostly cost ineffective. And I believe the driver for that was that they completely over-engineered all the instruments. Everything was just extraordinarily fancy, and every button had a different color, and it all clicked and clacked, and it was just way too overthought. And if you're going to do single-use stuff, you— that is the opposite of what you got to be thinking of. You got to think about simple, easy, cheap, because you're going to throw it all away.

We've seen— and thank you, Kyle, I appreciate the, the honest feedback there. And yeah, that's what we've seen. The Attune is some— one of the ones that we looked at for our predicate. And yeah, you look at it and there's about 50 different pinholes for your distal cut and you're like, how do you need that many? Just 2 and then maybe plus 2, minus 2, if that. So yeah, like, and that's the thing is we definitely want it to be simple. We've— that's, I know we— I didn't talk too much about our current products on the market. We've got our knee and our hip. Both of those are very efficient systems. Our CRNE system is only 2 instrument sets. We try to keep it very lightweight and, you know, we're not trying to hit every single anatomical need for a surgeon, but 90% of the patient population is plenty for us. So it's a generic knee system and we're trying to follow suit with this single-use, make it as simple as possible. We don't want there to be any sort of ambiguity. A surgeon should be able to pick it up and be able to know exactly what, exactly what they're looking at and exactly how to use it. So we've taken a good bit of feedback from, from different opinion leaders on that front. But yeah, I, I, we have looked at the Attune and as well as the Medact GMK Efficiency, I believe is the, is another single-use system out on the market right now.

So I'll go back to the Journal of Orthopedic Experience. An innovation. Uh, there's a few articles written by a person named Charlie DeCook who's down in Atlanta. Do you know who I'm talking about? Does anybody know?

Charlie does a ton with DePuy hips, uh, with Phellus and with the concise automated impactor. Yeah, Charlie's a big guy in the DePuy realm.

Okay.

What was the last name?

DeCook.

D-E-C-O-K. So the reason I would men— I'm mentioning them is in their surgery center, they'll do 12 to 14 joints from 6:30 in the morning to 10:30 or 11 in the morning. They are moving. So if you wanna talk the mastery of, it's two rooms. If you wanna talk the mastery of efficiency and it's a group of 10 and they're all pretty much hitting the same targets, absolute masters in efficiency. They measure every single element of the procedure from draping to positioning to dressings. Everything is measured in time. So they know exactly how long everything takes and there is no room for, for, for anything. I mean, they're, they're just incredibly efficient.

They're robots. That's something that I can, I've always kind of had a knack for. I even commented on one of Tiger's articles about data collection. And I think that, that, that surgery center that you talk about, they might be doing it quite well. And something that I think, I think is gonna be more and more important. And I think that systems like we're working on right now, you can start using that data to really leverage your point and leverage your product into those centers.

They don't use robots. No robots.

Robots slow you down.

Yeah.

Robots are, they add steps, they add, they add labor, they add registrations.

Yeah.

Yeah.

It's an amount of expense.

Hey Tiger, I went and visited, I went down to watch him operate and, uh, I'm a spine guy. I don't, uh, I don't know anything about knees or hips other than I got two of them. And, uh, I went down to watch how they ran their operation and he made his first incision at, when I got there at, I think it was 6:30. Uh, I shook his hand thanking him after watching 16 total joints at 12:52 in the parking lot. He was playing pickleball and he was seeing— and there were 80-year-olds in there and there were 50-year-olds in there. He was not— they— I went down to watch it happen. It's the single best operating room organization I've ever seen. I'll never see one better. And you'll also never see— I don't think I've seen an operation that's more efficient. Maybe like the Navy Seabees building a bridge somewhere is better, maybe. But, um, it's— and, and Joey is— he has published two big articles in, uh, Joey about, um, 12x12 and their efficiency, and it's spectacular. And I, I would tell people this, and I would have my hip or knee done there by him in a nanosecond. I mean, because all the delay, all the wait, all the waste is eliminated, and the outcomes are excellent, and their HCAHPS scores are great, and, and their Google 5-star rating is a 5-star rating. Like, they are truly innovative. And if you want to go see what the future— I don't think the future will ever quite look like that because they're— what they have is, it's repeatable, but it's not— you can't equal it, but you can do what they do. But they're the future of this, um, and you'll learn a lot just by watching what is possible. So I would urge you to reach out to Dr. Cook's group and see if you can just go observe. I told him I wasn't selling anything, I just wanted to see it, and I'm so glad I did.

Wow, maybe we could get him on BoneChat to explain. So David, how does it— how does, uh, I mean, you own a hospital and you're a surgeon, how do you convert an hour-long total knee into 30 minutes? I mean, what How do you do that?

Yeah, well, that's a hot topic conversation because we're not able to do that because a lot of people just don't want to move. I mean, we deal with the same issues that any place else deals with. In some ways it's actually worse because I'm paying for the inefficiencies of others. And if I squawk about it and people are— last night there was a meeting, people were squawking. About why are we paying for this. So I can't give you a great answer. I really think it takes, you know, a group of people who go, look, let's be as efficient as we can be, not cut corners and just be efficient. And you can still provide phenomenal outcomes, you know, just really what you're hearing. You know, I haven't seen any of this firsthand, but I mean, what I keep reading and when you read the articles that he's written, again, I'm going to keep referring all you back to Joey because you don't need a subscription, it's all online. You're going to see some amazing things discussed in there. You're going to see things that are not mainstream, should be mainstream, but they're not mainstream. And it's about people who are doing things to provide far superior outcomes, but in novel ways. Do they have the wherewithal to say, hey, we can we can bottle this and we can capture it and subsequently, you know, commercialize it. Now, a lot of them don't understand the steps necessary to do that. And because it's such a— it's so different from what again is mainstream, what people are used to. And again, you know, the pushback is, well, they've got to be cutting corners, the results aren't that good. And actually, the results are good. And you don't really want to push away a very effective efficient surgeon. There's, and it's the, it's not just the surgeon, it's the entire team, it's the entire center is set up for efficiency. How many steps do you take? How, you know, how far are people away and how far do they have to go? None of the spinals are done in the ORs there. They're all done in the pre-op areas. Everything is just really honed down to say what do you need to do and what don't you need to do. And it kind of fits a little bit like, you know, Ted, you know, Tiger Buford, our conversation yesterday. It's how do you have an implant design that does things once and you don't have all this fiddling around. And a lot of it goes back to what is the original intent. And, you know, where they probably can stand some help might be in, again, that instrumentation, the turnover. Side of things because you still have the turnover, you still got to clean the rooms up. And they're only using 2 rooms when they do it. Wow. Yeah.

Yeah.

Incredible. Yeah. Like I said, it's worthwhile to read about what they're doing because I would completely agree. It is the model that you want to look for. It's not cutting corners. It's just doing what's needed.

And are they a hospital or an ASC? I mean, they do think— yeah, they can't— they could do things a hospital can't do.

Well, there's also something that, um, I, I'm— it sounds like they specialize in one thing and they do it well and they do it better than anybody else. Is that correct?

Or are they— they're just doing hips and knees.

Okay. So yeah, if you— and I've had several surgeons like this— if you have people that really focus on what they do very well and the team is fluid, their, their, their reps are fluid, everybody anticipates and it's the same team over and over and over. That's how you achieve that. And it's— and it is achievable as long as you have a physician leading the room but that respects the entire team and allows it to flow. And nobody starts until we're all together, you're all together. And it is the best thing. It's the greatest team. You get excited to go in those rooms. There's— I think that's awesome that they have that. And agree with Joey being a great jerk.

You're the best. I've been to surgery in lots of countries. The most impressive place was Germany. 'cause it's so frickin' organized. I mean, everything is exactly where it should be, on time, no wasted motion. And that's, the Germans are great at operational efficiency.

So Tiger, there was a German surgeon visiting with DeCook, and this was posted up on LinkedIn, I think last week. And he said, "I thought we were efficient. My God, we're not even close." Wow.

Yeah, yeah, I want to get— I want to get the cook on Bunchat, or I would love to have him explain how they do that.

But I'll ping him, Tiger. I don't know if he'll do it, but I will ask him because, uh, um, it's, it's spectacular. And, and I was describing— I, and I think the others that have talked about it, everybody here who has been in an operating room will understand this description. So I sat there and watched 16 cases, and no one did the following— rushed. Like, nobody rushed. And also nobody said, where's that thing? Like, where do we keep that? None of it. Like, and, and, uh, and to Cook, actually, I, I urge you to just look him up on YouTube. He's got a bunch of bunch of like 15-minute, 20-minute long lectures that are, I mean, really engaging, really fascinating. He's a great speaker. And, uh, like, he, he now— he, I mean, how he started doing this to get everybody on board, and I think this is brilliant, he started timing himself. He timed everything he does. He said, I can't tell my anesthesia people that they can do the block. He won't let— like he says, operating rooms are operating rooms. They're not— that's not why we don't do anesthesia in operating rooms. Like, you, you hear him say these things and you're like, what? But because his data is so solid and he has such a large N, and he says like, when I'm at this point in case number 3, case number 5 can— you can start getting them back because you, you can predict it because you know how long I take. And every single component of the procedure is timed. So if his exposure should be within a certain amount of time, if it's not, he's looking at himself. Am I doing something wrong? Can I get faster? It's a fascinating— and then he doesn't— he said, we don't pay anybody more than they pay others. And, uh, he said, but you know, we just— everybody starts— when you start to time yourself, everybody starts to try to do better. They figure out ways to get rid of weights, and you look up and you're doing 16. And I think his new goal, I think, is 20. Um, but like, I'm telling you, he doesn't eat. They don't— no one breaks a sweat. It's that well run. Um, so I'm gonna pick him and say, uh, no, no, that's like, it's after the third case I finally said to him because I didn't really know him. I'm like, Dr. DeCook, 'Who's the guy who keeps coming in at like 14 minutes?' He's like, 'Oh, that's my first assist. They come in and close.' But like, nobody— the person walks in like this, walks in, and the gown's not sitting there waiting for him. It's being handed to him. Like, it's like a Broadway show, actually, is what it's like. Like, everybody hits their marks. And, uh, I'll, I'll— you almost have to believe it to see it. But I will ping him and say, hey, is there any chance you would come on and talk to a group of like this bone enthusiasts, you know, and would you talk about this? And I don't know if he will, but I'll certainly— worst he'll do is tell me no.

So, so a couple of things I'll add into— there are contingencies. Let's say something happens, because things do happen. Uh, for example, Lester Cho gets broken. He goes, uh, I think in the one article, it takes me a minute and a half to put a cable around it. He knows exactly how long it takes for each of the different elements that don't work right. And if, let's say, a patient doesn't show up, they have the blocks done such that they're— they can always move somebody else in and never skip a beat. And I think that, you know, the point is, efficiency is not about rushing. It's just about doing things once. That's it. And you're always moving forward. Everything is moving forward. And a lot of that, you know, again, if you want to bring it back to what everybody on the call is about, it's about design and intent through design and setting everything up to say we don't need a tray that has 50 instruments in it. We need 4 instruments because that's all that gets used. We don't have to keep worrying about all these contingencies and getting things confused, overloading central processing, overloading the cleanup, overloading this, getting people confused. You know, it starts really with the intention of the design. Again, you know, getting back to our conversation yesterday, Tiger, you know, what did we talk about? It's one type of implant, one type of device. That's— you don't need all this stuff. Get to what you need.

Yeah, I love that. That's definitely the future. I'm more interested in how Mark talked himself into a case. How do you do that, Mark?

I'm incredibly persuasive. I'm incredibly persuasive. No, I, I literally, I was following and read a couple of his things, was following him on LinkedIn. Maybe it was last year, you know, over a year ago. And I, and I just pinged him and said, hey, I think what you're doing is tremendous because I, I I got so frustrated watching ORs and watched— I want how industrial engineers set things up. And I'm thinking like, this is what we need. And he's basically an industrial engineer. So I just pinged him and said, hey, I love what you're doing. I would love to come watch you do it sometime. And he's like, come on down. I'm like Okay. And I said, just so you know, I'm like, I don't— I'm not selling you anything. I don't— I don't know Valgus from Varus. I don't know it. And I actually said, I actually don't care how you do that, if you do it from the anterior hip or put— I could not care less. And if you start talking about it, I'll probably fall asleep, but I want to see how you run this place. He— I went down, watched it. It couldn't have been nicer. Like, uh, it's fascinating. Yeah, so sometimes you just ask people to do stuff if they're nice and they do it.

That's a good lesson for everybody, just ask. Interesting. Oh, we're coming up on the end. What's, uh, anything else? What's any trends? I— it feels like funding is starting to loosen up a little bit. Looks like interest rates are going to go down. And, um, like we talked about, that 7-year cycle with the capital allocators— they've got to do something. It's like a balloon that just keeps getting bigger, and they've got to do something with the money. Once the election's over with, whoever— doesn't matter who wins— there'll be more certainty in politics. Uh, I think after the election, I, I think we're going to see a lot more funding loosen up. It's what it feels like.

I don't know. So here's some pushback on that. So we're— yeah, please. So if you look at it from a historical perspective, it takes about 10 years for, uh, any country to kind of get through that. There's 2 times as many companies out there pitching products as there were before to investors. And as we're seeing, many are holding on to their money for a variety of reasons. And so I'm actually of the perspective where I'm thinking through this is when I raise this capital. So we want to raise $8 million, right? Do I do it in two tranches, knowing that a lot of times an investor will be excited and they'll say, I'm going to give you X dollars amount, and then that money doesn't show up because they got excited about something else. I don't— it doesn't bother me. Everybody has ADD right now. Um, um, but knowing that it's not reliable, um, to anticipate the money from the sources that claim that they're coming from, do you raise the full amount, put it into a money market savings account, um, and, and bear the interest, and now you have an employee paid for or just off the interest, or do you do tranches?

I would take— if the terms are good, I would take it all if you can.

Yeah.

Because, you know, the future is uncertain. Like you said, this is like 2008 where companies that can't raise money just die on the vine. And then eventually the strong companies survive and get all the capital.

Yeah, and that, and that makes complete and perfect sense. Um, and then plus, uh, the economy is going towards a K-curve direction from an economist standpoint, where the rich get ultra-rich and the middle class get dampened. There's, there's a further divide between the middle and the class and the, and the rich. And so, and that's historically relevant many times over. And we're starting to see that now with even just gas prices and commodity products like groceries. So I think that if history repeats itself, that might be advice well taken.

Yeah, this is— if it was 4 or 5 years ago, you could do tranches, but I think now you just need to take everything you get. And, and you can put it in, like you said, a money market. You can get a nice return on the funds you're not using.

Ted, what do you think about that? I'm interested in Ted's position on that.

Yeah, I think Ted has dropped.

Oh man, okay. Well, David would be a good one.

Asher's got a comment here. Asher's back. Asher's having internet problems.

Sorry about that. Um, yeah, I mean, we raised, um, just under $10 million, um, which is way more than we need to get FDA clearance and even do our alpha launch. But we did that on purpose because it's, number one, I mean, we, we were able to, and it was one of those things where we'd rather have the money and not need it than run into a scenario where we need it and suddenly have to go raise it and, you know, change the entire company trajectory. But also, you know, like, we raised money through convertible notes, and we'll probably make, you know, 5% on it, 5.5%, whatever it is. And so it's one of those things where we've got all that additional funds that we wouldn't have otherwise had, just kind of sitting there waiting for when we actually need it. And because it's all through convertible notes and they convert at a certain point in time, like, we won't have to pay that interest rate. So it's sort of a win-win if you're able to structure it that way. But depending on the terms, it may or may not be worth it.

Yeah, we were seeing, um, One of the chapters, uh, that we invested, they wanted 50% discount rate and 30% warrants. I was— I mean, I couldn't believe it.

Yeah, they're not serious investors. Yeah, good comment, Asher. Thanks. Well, let's— we're going over the hour. This has been fun. You guys like this versus a speaker? Just kind of anything goes? I don't know.

I do.

All right, okay, good.

Yeah, maybe we'll do this once a month or something, just have an open mic, uh, because we get to talk about topics you normally don't talk about. And we'll try to get Dr. DeCook on. That sounds great. All right, thanks guys. That'll be a wrap. See you next week.

Thank you.

Thank you. Bye. Thank you.