BoneChat #62 - P28 acquisition, AI, storytelling in marketing, Open Payments challenges, innovation.

You just walk into any OR you wanted.

Yep.

And just, just talk it up with the surgeon. The surgeon made all the decisions for products.

Yep.

It's like, wow, I just forgot.

Well, believe it or not, we could scrub in, so we would be sitting there scrubbing in with the doc. So you're there, you could be— you're in the cases in the sterile field. The only limitation was that you couldn't touch— you could touch the body or you could touch your instruments, but you couldn't touch the body. You couldn't touch the instrument if it was a— if it was in the body. And it was, it was pretty heady. I just thought that's the way it was because that was my first, um, surgical job. And so it was, it was crazy back then. So yeah, it was parking in. Matter of fact, I used to have to have my reps rent cars to go to work because they all drove Porsches and all this stuff because back then you made money, right? And so I said, you guys cannot be parking in the physician's— the surgeon's parking lot or physician's parking lot with your Porsche. So I used to rent Tauruses and go to work.

I remember I met a distributor in New York and he picked me up at the hotel in this giant BMW. Yeah, man, this is a nice car. And he said, yes, and my customers will never, ever see this car.

That's right. That's right. Drive the old jalopy.

Yeah, exactly. He said, I drive, I drive a Bronco to the hospital every day. Yep, yep.

Yeah, one of the docs in Birmingham, the old Highland South Islands Hospital where Andrews built his empire, was a guy named LeMac, and he asked me to scrub in on his first arthroscopy. And so he looked at it through the scope, you know, And he pulled it out. He said, you know what, I just made $1,800 looking through this thing. I think I'm on to something.

I'm gonna look at everything.

He's— from then on, he looked at everything. Yeah, I was gonna say, he still opened them up, but for a while anyway.

Yeah, they do that today when you, uh, when you do a lot of knee procedures, you stick a scope in first just to, just to check things out.

Really?

Right.

Yeah, and that's another bill.

Back to your idea about scrubbing in, I'm thinking, wow, the, the sterile field was quite different back then.

Yeah, yeah, people were paying attention to it.

Well, you know, it's, it's funny because we, um, I don't remember it being different. I just remember being able to access it, you know. Um, it's even because the training that we had back then seems pretty much like you do, you know, you are, you know, you, you are the way you act in the OR right now, you know?

Well, let's, let's face it, US Surgical had probably some of the best training ever.

Yep.

Yeah, they did. The best training. Yeah.

Not a lot of people, they, they'd have 100 people come to training and about 30 would, would pass. So a lot of people have been to training but never worked for US Surgical.

That's right. Yep.

Hey, Colleen.

Hello there. Thanks for having me here today, Tiger. Took me a minute to figure this whole like panelist business out, but yeah, sorry about that.

Colleen is our newest Bone Shot member. Why don't you tell, why don't you introduce yourself?

How are you? How are you? So Colleen Ferrari, I have a, I'm a fractional COO. I work with a lot of fractional folks through Peak Fractional. But, you know, in 2012, I started a consulting firm and fell in love with the medical space, clinics, medical device. And then the last few years have been working for Vadim at JLW and previously NovaStep. And so here I am going out on my own in that, in the fractional COO world. So really enjoying it.

Great to have you.

Welcome.

Thanks. Yeah, foot and ankle is hot right now after that acquisition. Yeah, I thought we'd talk about that today, the, uh, sort of the ramifications of the Paragon 28 acquisition. It really changed the industry. Uh, I think a lot of the smaller— well, Trace is a target now, and they're going to have to develop products, more products quickly. But the little guys, I think I see a trend where the little guys are gonna start partnering up. What does, what does everybody think about that?

Because it's hard to— I got an invitation to the consortium on Wednesday at the Academy. It's, I think it's called the Orthopedic Innovation Consortium. Are you familiar with it?

I've heard of it.

Yeah, so it's a bunch of startups.

Oh, oh wait, there was a guy on here telling us about it a few weeks ago.

Yeah, I'll try to find it in just a minute on the email. And it's just a bunch of startups, and, uh, one of them is Arcura Medical out of Israel, uh, Abanza out of Spain.

Well, you said you're leaving like at 12, right? Easy.

And Tiber, but not Ty— not T-Y, but T-B-E-R, T-B-Y-R, I think. Anyway, several others, and they're all either pre-commercial or, you know, just still in kindergarten, and they've banded together as kind of the cool kids club. To do like a happy hour. It's really a good idea because that's, you know, if you're a doc and you're going to the academy, do you really want to go over and see your buddies at Smith Nephew again? Or, you know, you want to see new stuff, some shiny new object. So it's really pretty, pretty cool.

I like that idea. Yeah, I promise when we get to 100 members, we'll do an in-person Bone Chat meetup. It's one of the big conferences, at least. And if anybody needs a button, I made magnetic buttons you can wear at medical conferences so you can find each other.

Oh, that's cool.

Yeah.

So this is open discussion today. We can talk about anything. I know Patrick threw out a question about open payment submissions, and Colleen had a couple ideas for him.

Oh, I didn't understand the question. Yeah, I sent him a few options. The one person that I knew that was really good at it is kind of AWOL right now, but I sent him a couple different solutions. But if anybody else has anyone that they use for open payments, that would be great too.

What's the— and what— explain the question, Colleen, because I don't understand the whole, uh, Yeah, it's tracking—

is what I understand that he's looking for is you have to— it's part of the compliance program where you have to track all the money spent towards doctors and log that into the government system. And that's the open payment strategy. So being able to do that, one, I mean, anybody who's done anything with regulatory, you know how convoluted and challenging the government's websites are. So it's really trying to navigate that and putting that in. So if you haven't done that though, and you are in medical device and you're working with surgeons, as you know, that information has to be reported annually. And that, so we can see, you know, exactly how much Dr. Tiger Buford has taken from, from us to, you know, use our product.

So Colleen, actually, so, um, I started a company in 2016. We started not only doing OIG exclusion screening and other regulatory compliance actions. Yeah. We start, we automated the open payments reporting. So we do this for over 1,000 medical practices, a few hospital systems. And if you as a medical device company send me a list of 100 doctors in a particular area that you're interested in, We'll send you a report back in an hour that tells you everything about their open payments, royalties, payments, whatever. We simply automated the software service. So it's really easy. You can do them one at a time, but our software will allow you to do it. I think our limit is 250 doctors. And if you also subscribe to like Definitive Healthcare Acuity, for all of that money, which is a lot, they also pack it in. But we just, you know, we do it for pennies.

That's great. Did you reach out to Patrick?

Is that Patrick Jamnik that wants it?

Yeah, Patrick Jamnik. He sent a message on Slack. You may not have seen it, Mark.

I must have missed it.

Yeah, I had. Yeah, he definitely needs your help, Mark.

Yeah, a perfect fit.

Yeah, I had no idea you did that. So it's great to meet you and great to be able to meet you.

Well, we're, we're, uh, we're We're really good at ideas, but we're terrible at marketing.

Hey Colleen, what was that? Uh, you said you had a recommendation for Patrick.

Well, now it's Mark, right?

Yeah, so Mark is the new recommendation.

Okay, yeah, now it's Mark.

I will, uh, I'll put it in the chat.

Okay, of the odds and ends things I've helped out here our office. Our general counsel is not the most savvy whenever it comes to these types of things, and he's typically in charge of handling the Sunshine Act, those types of regulations, and submitting that payments around this time of year. I've helped him with that year after year, but it would be nice to get that a little bit more structured.

Well, we can, we can give you the information easily and cheaply Um, you know, for like, if you send me a list of, you know, all your clients, you know, we'll, we'll like run it through for a couple hundred dollars. Perfect. And it gives your general counsel all, all he needs. And what we do for medical practice is see every— the, the OIG of Health and Human Services requires any healthcare entity to, uh, check all of their employees, contractors, vendors, and doctors, you know, anybody that they pay, it requires that you check all of those people against all of the list of excluded individuals. Those are all people that have been convicted of Medicare fraud.

Wow.

And not only are there several federal agencies that have published the list, like the SAM, the GSA, the OIG of Health and Human Services, a couple of others, list of, you know, Medicare opt-out. But every state has a list. So, and you're supposed to do it monthly, for God's sake. So if you're like a big lawyered-up practice, you do it, or you outsource it. But if you're just like a regular rural hospital, you know, and, or a small medical, medium-sized medical practice, you're just trying to make payroll, go home and see the kids, you don't worry about it too much until you, until you do. And so, um, the, um, what we do is we sell a service that I think we charge them $10 per year per, per person. So if they have 100 people, or, you know, whatever, you know, $1,000 or whatever it is, uh, so we do it really cheaply. And if you, they think, if you try to do it on your own, it's absurd. It's a full-time job.

It's not, Joe. I mean, if I could just throw something out there, it's not something you want somebody who's not incredibly tight and organized with. It's one of those— I mean, I've gone into companies after the fact and had to, I mean, taken a solid of my time just doing cleanup. And, and so it's not even just what your company spends, but your sales reps spend on your behalf. Like all of that needs to be tracked diligently. So not anything that you want to ever mess around with. From my— yeah, I mean, Mark, I'm sure you'll weigh in more, but I'd never take that. I'd never put that in the hands of somebody who is just willy-nilly and is doing it on the side. Because it's important.

Yeah.

And I don't want to come across like we're giving it into the hands of a child. But we're small, you know, we're able to handle those types of things with the size and the amount of payments that are being output. But we know that that's going to grow, like with a medical device or our medical board here to help kind of consult on things. As that grows, you want to track those payments much closer.

Yeah, makes sense. Joe runs a small Total Knee Company that is doing things disruptively.

Yeah.

Yeah.

I wouldn't call it, I wouldn't say that I run it, but I definitely take a big part in it for sure. But yeah, small, small knee and hip replacements, primaries focusing on the knee system right now.

So everybody see Globus bought Nevro? It's their, Neural stimulation company. It's— they have those little pacemakers that you implant under the skin. Um, I guess that was a big hole in Globus's product line, otherwise they wouldn't have done that. $250 million for a little implantable pacemaker company. I can— oh, I can send everybody— I can put that in the link.

So isn't there a lot of competition for that?

I mean, I would think there established players already.

I think it must have been a hole because, yeah, you're right, everybody's— all the big companies have them. Huh, it's a really good question. Anyway, I just—

are they based—

Globe, Pennsylvania, but they're never I was thinking.

They've got offices in, you know, San Diego. I don't know, 4 or 5 locations now.

Okay, that was in Redwood City, California.

Okay.

Yeah, so they've got an SI joint pain option as well.

Yeah.

Interesting.

I guess those things work. I guess there's enough data to show they work. I don't— Eric, do you know if those things work?

No, I have not really covered that area very much.

But yeah, I mean, I think there's a lot of data backing it now.

So, you know, I just think as far as insurance reimbursement, you know, I don't know where they stand, right? That's always going to be kind of the bottom line issue as far as getting it to scale.

Yeah, you gotta— and there's a code, there's existing codes, which is nice. Um, it's kind of like Exogen, but it— this is implanted. Everybody knows what Exogen is for post-traumatic non-fusions. It's basically electrical stimulation that, you know, you wear a thing that creates electricity and makes the bone grow a little better. Exogen actually works. They've got lots of clinical data. It can, has a better chance of turning a nonunion into a union.

That's pretty cool stuff. I was a director of sales at Orthologic way back when.

That's right.

That's right. You know a lot.

There's a lot of bone growth stimulators. So I found that consortium. You wanna see it real quick?

Yeah, sure.

There it is. Cool. Showcasing everything in one little place at the San Diego Wine and Culinary Center.

Hmm, that's right by me. I'll see you all there.

Really?

Yeah, I'm in San Diego.

Cool, cool. See if I can find another one here.

That's something that you need to—

there it is. Perfect. So these are the companies. I thought you want to see that.

Neutron.

Wow.

Tetris. I know Tetris. I know Pristine. I know Albonza.

Interesting.

Lipogems.

That is—

I've heard of Lipogen.

So they're, they're originally out of Italy. And they're an adipose-derived, fat, fat tissue, progenitor cell play.

Their website says, discover the power of fat.

Yeah. You can't fat shame these guys. They're good. Let's see who else.

On.

I don't know, Innovatus. Innovatus. Anyway, there it is. Now you know.

Another Academy thing. So, um, the, the CEO of OREF reached out to me, uh, Lee Grossman. Does anybody— have you ever interviewed Lee Grossman, Elizabeth?

The name's familiar. I, I might have gotten a quote from him at some point.

Uh, Sure. I'm sure you bumped into him. Anyway, he reached out to me and just wanted to talk about Bone Chat and everything. And I started asking, you know, I, I've known the OREF for 40 years. You know, they just fund research mostly in hospitals. And he started telling me all the things they do now. They have a venture studio. Wow. Yeah. And so I said, why don't you come on Bone Chat and tell us about your venture studio? Uh, we, he said, yeah, we help startups succeed. And, and they obviously have tons of clinical experience and they, I think they're trying to put clinicians together with startups and help them. Anyway, he's going to come on in 2 weeks.

Oh, great.

Yeah. Lee Grossman at OREF. I like these open discussions better than presenters, don't you guys?

I was at the, I was at the manufacturers conference in Anaheim yesterday and I heard about the coolest technology ever. It's a, there's a company out there and they are making a screw that goes through the brain, surpasses, they figured out how to get it past the blood-brain barrier. And will drip chemo in to cure cancer. Unbelievable. It's like something I read about a couple years ago that they couldn't figure out how to open that blood-brain barrier and to just be able to create something like— it's just unbelievable to slow drip.

What's the name of that technology or the company?

They— you know what, I actually was talking to the manufacturer who's making it, so I don't know. But I was like, you know, I was out there just kind of looking. It was all robotics. I mean, the whole show, robotics was probably the biggest thing. AI is really prevalent. You know, I just, there's a lot of conversation about AI. But really that was probably the coolest thing that I heard. So definitely keep an eye out for that.

Well, is it on the market or are they doing clinicals?

No, no. I was actually, they're doing trials for it right now. I was actually talking to the manufacturer. That is doing, you know, beginning to end manufacturing of that. And he couldn't share what company it was, but I thought, wow, this is, this is pretty impressive technology on the forefront.

Wow, that's interesting. Hey Mark, right before I got on, I talked, uh, Sarah Vansini and I had a really good long talk. You'll, you'll find this fascinating. You know, Sarah was here 3 weeks ago talking about How to tell stories to raise money. Her company's called Stories with Substance. Anyway, she, she's creating an AI marketing tool for medical device companies. So it's the coolest thing. It, you literally just, it's a service you buy and you just, you just click boxes. You say, okay, I want to do an email campaign or a blog or, and you just start filling out what you want it to do and then it generates it for you and sends you an email within like 30 seconds. It's really cool. It's not ready.

I'm going to say boo. You're going to put me out of business.

I tell you, you got to— I think we all have to learn to use these tools or we can't keep up.

Yeah, I just finished this program at MIT about AI and integration into business strategy. And they said your AI isn't going to— and professor after professor for the last like 6 months has pretty much drilled this into our heads, but AI will not replace humans. AI will replace humans who don't use AI. And just kind of on that front, Tiger, one of the things that we were like, one of the things that we were digging in that's out there is even bringing that sales piece to the next level. So if you put in your company and you say, hey, this is what I sell. These, these are the doctors that you, the surgeons that use it. You put that all together and the system says, well, listen, your typical doctor is part of this fellowship. It tracks this. They, they like to make changes with this. This is what they're posting in their LinkedIn. This is what they're interested in. And then it goes out there and searches for all surgeons with all of that relevant things in common with who your core market is. And then brings it down to the salesperson where now the salesperson gets a list and they say, hey, I'm gonna be in Kansas City this week. So all of a sudden AI will draw, drill down the list of surgeons in AI that have the best, like the top 10% chance of using your product based on what they post on social media, what's out there historically, what is public information, who they, you know, like Salesforce right now can tell you who you donate to and what your political affiliation is, right? I mean, it's unbelievable. So you kind of take that and then your salesman goes and meets with maybe 5 doctors that now, instead of having a 3% chance of converting or 5% chance of converting, now has a 90% chance of converting. And AI has also said, hey, here are topics that are really interesting to this this particular surgeon, and you might wanna mention that you're involved with this person from this fellowship and this person. I mean, it's unbelievable where it's going.

That's amazing.

That's incredible. We just talked about this a few weeks ago. Mauricio said, don't weaponize the outbound AI, but it sounds like it could, you know, it's so getting so good that people can't even tell the difference. There was a, there was a huge election in India and everybody knows the candidates' voices and they, they used AI. They had AI candidates calling everybody in the country simultaneously and talking to them at the same time.

That's incredible.

Yeah.

Well, these political guys love it right now because they can go— I think it was South Korea's president. He was elected this way. And even the person that was running against him, but they put it on there. They love it. If you're a campaign manager, you know, just a little bit of time, you can make that mock version of you. But instead of like somebody going off script, like I'm sure Donald Trump's campaign manager would have loved, right? You just type in what that person is going to say, what the speech is, and this complete replica of who you are, looks real, you can't tell the difference, delivers that speech or that message without flailing, without going off script. I mean, it's unbelievable. If you've ever seen— I don't know if you guys watch this, but Reid Hoffman, the founder of LinkedIn.

Yep.

I know Reid.

Did you see—

yeah.

Did you see the interview that he did with his AI?

He's talking to himself. It's incredible.

Unbelievable. He said it was the toughest interview, right? Because he had all of his best interview questions.

So, you know, Colleen, let me show you something real quick. This, I'm doing this next Tuesday. Oh yes. This is using AI in your medical practice.

Oh, I saw that. I put it on my calendar, Mark.

I didn't know.

Great. Yeah.

Yeah. And I've been since December, you know, on the 17th, I'm rolling out a product called ProvenSys through VenOps, which is the ability to create an AI persona for your medical practice, your hospital, your medical device company, or anything. Inbound, outbound. I've been playing with it, trying to learn how to be a navigator, because I— like you said, AI is not going to replace you, but AI is going to replace those who don't use AI.

Yeah.

And they— one of my sons is a software developer. He did like, you know, the, the mobile app for the NBA and PGA and so forth. He's trying to look for— a lot of that is going away because of the AI. A lot of the software coding people. And I told him, I said, you need to learn how to be a master AI pilot because everybody will use AI, but AI will either be like a little car in your driveway or it'll be a jumbo jet. Learn how to fly the jumbo jet.

Yeah.

So I'm doing a dinner next week and I created an AI agent named Zoe, after Franny and Zoe by J.D. Salinger, by the way.

Oh, nice.

And if you call, you know, and so I send you an email and I say call this number for more details. And so then you call that number and Zoe answers. She'll say, thanks for calling, appreciate you, you know, considering the dinner. We're hosting 4 companies with 4 products. She can tell you anything about them. And at the end of it, she'll say, well, thanks again. If you want RSVP, you know, text Mark Maloney. At this number and blah blah blah, just like talking to a human.

Brilliant. So Mark, you've got that, you've created that, you and your son? Yeah, yeah. I think it's going to change customer service for medical device, quite frankly.

Absolutely. Say, okay, so I say I created— I'm creating the actual, uh, company to market it to healthcare, but this came about, I helped a couple of, uh, PhDs a couple years ago, kind of pro bono, and they were in Vancouver, Canada. One of them has a husband with a marketing company, international marketing company, and they created the actual AI program. And then they came to me and they said, do you want to bring this to US healthcare? I said, hell yeah, that looks like a lot of fun.

Oh, I'm looking forward to your—

yeah, I'm gonna do the press release and probably the website might go live even as early as this week. We'll see.

Brilliant.

It's called Provencis. Let me spell it out because it's a, it's, it's a couple— it's a made-up word out of a couple of old Latin cognates from a guy who spent too much time in parochial school. Funny, you know. Here we go. There it is.

Yeah, yeah, we've got to all get on board with this stuff, you know. It's— I'm, I'm an advisory board member for a company, and we're trying to acquire another company, and, you know, we have a, we have an acquisition contract, and the board's going, uh, should we add this clause, should we add that clause? And I just uploaded it to AI and said, tell me where the holes are in this clause, and it came out 4 came out with 14 things instantly. And I sent it to the board and I said, here's, I just threw it in AI. I think these ones, and they said, well, that's brilliant. But I mean, I'm, I'm, you know, I'm not the smartest one around, but that's why didn't everybody on the board use that to, to review a contract?

No kidding, Tiger. I was working with a company Monday, I think it was.. And I'm like, I don't really understand why I'm still seeing communication like this. Like, you know, I'm going through and I'm like, what is going on? So I was working in this one department and there was these two really educated people and they weren't really like, you would think that I'm describing somebody who's 70 years old or something. I said, you know, why would you send something out like this? Why, you know, wouldn't it be easier? You take, you took all this time. Wouldn't it be easier to just throw this into AI? And have it generate it for you and then just spot check it? They're like, we can't. Both of them said the same thing. We can't do that. I'm like, well, why can't you put it into AI? And they— and there was this real fear of crossing over. They thought they were cheating. It wasn't their real work. Everybody would know that all company secrets would be like shared with the universe. I mean, it was really kind of interesting naivete associated with it, even in a younger generation. But you're right, I mean, why isn't everybody using it? It saves so much time.

How many AIs do you use, Tiger?

I use 3 right now. I use Grok for my number 1. I think it's the best. It's, it's going to be the best in a few months because they're— Musk is building a, he's building a monster data center in Memphis. It's, it's the largest one in the world. And it's, it's within a couple of years, it's going to require more electricity than the entire city of Memphis. It's so big. And then I use Gemini, which is Google's. And the neat thing about Gemini is you have access, it gives you access to the Google ecosystem, everything that Google knows. And then I use OpenAI, you know, OpenAI. I used to pay for the the upgrade. What is— what's it called?

Oh, 4.0.

Yeah, 1.0, but I, I cut that. They, they charge— they charge too much. Um, yeah, these general things are going to be free forever, but what we're talking about is, and, uh, everybody's gonna have private— they're gonna have private AIs that they use for customer service or, you know, um, finance for your business or anything data related. Uh, everybody— and I heard a prediction the other day, it makes total sense— there's going to be more agent AIs than there are people on the Earth pretty soon, because everybody's gonna— it's like cell phones, everybody's gonna have 4 or 5. Um, I think that's where it's going, and we're all trying to figure out what little private AI we can create to make our business or life better. And that, that's the challenge. I think it's, it's hard. It's really hard. You know, I create—

I feel the way you're— you were talking about the— those other people you're talking to. That's how I feel. I feel like I'm so far behind, um, don't know what I'm doing, and like I do need the help. So how, how is it that, that I would start to get up to speed? You just have to—

that I can do, you just have to play with it. Um, you know, just— there's no— there's no wrong answer. It's just like when you get a first— when we got our first computer in the 1980s and we just started playing around with it, you can't break anything.

Um, well, yeah, but like when I made that deal with the Vancouver guy in December, I spent the next like really 2 months now part-time, but spending a lot of time playing with it, like you said. How many people really can do that? I mean, I got the— I, I got my own business. I don't work for anybody, right? I can focus the time and do that. If I were a physician, busy surgeon with handlers and a time schedule, there's no way I could do it. I would need a— I would need a navigator or a pilot or a consultant, somebody like you know what Eric's talking about.

But here, do this. Go to, you know, OpenAI and just put your AirPods in and you can talk to it. You know, you can—

it has a microphone. It's amazing.

Yeah, you can just walk around the house and say, tell me about the history of Rome, you know, and then you tell me more about that, and it'll open your eyes. You can go down any pathway and it'll have a It's like talking to an expert in any field, and you can go as deep as you want, and it records it. You know, it's, it's records the text of your conversation. Yeah, but yeah, that's, you have to play with it. Pretty cool. I'll show you, I'll show you my clone. This will be— anybody have a good question for my clone?

Yeah, what's the most important medical technology invented in the last 25 years?

Oh man, that's critical. That is really good. Let's see if I can find it here.

Um, because I— a reason I asked that question is because before I made that last post on LinkedIn, um, I asked ChatGPT what it was, and the first one that came up was, believe it or not, digital imaging. And it reminded me that in 2001, I gave a talk to the Salesforce at Miami Beach, Fontainebleau for Kodak Medical, the guys that sell old X-ray film and all that. And I told them at this meeting, I said, digital will change everything. And they didn't believe me and they booed and they laughed and everything. But by 2007, that division was shut down.

Yep. It's adapt or die. Okay, I'm gonna try this. What the question is, the most important medical device in the last 20 years, you said?

25 years.

Yeah.

Okay.

Here we go. See if this will work. What is the most important medical device in the last 25 years? I am Tiger Buford.

What is your question?

Whoops.

Whoops. What is the most important medical device created in the last 25 years?

All right, let's cut through the noise. If we're talking about the most important medical device in the last 25 years, I'd argue it's the advent of smart implants. These things are game changers. Take Canary Medical, for example. They've pioneered orthopedic implants that actually talk. These devices monitor patient health in real time, predicting problems before anyone even knows they exist. That's not just innovation, that's a revolution in patient care. It's like having a built-in mechanic for your body. Nothing else comes close to that level of impact in orthopedics or even healthcare as a whole.

That's funny.

So what is the most profitable medical device invented in the last 25 years?

Not so fast. Just because something's groundbreaking doesn't mean it's raking in cash yet. Smart implants, the ones from Canary Medical, are still in their early stages of adoption. The profitability isn't fully realized because the healthcare system moves slower than molasses when it comes to adopting new tech. Hospitals, surgeons, and payers are cautious, and for good reason. They need proof these devices improve outcomes and save money long term. But here's the kicker: the real profit potential isn't just in selling the implants, it's in the data. These implants generate a gold mine of patient health data, and that's where the future dollars are. Companies that figure out how to monetize that data, whether through predictive analytics partnerships with insurers or even licensing it are gonna clean up. So yeah, it's not the most profitable yet, but it's got the potential to flip the entire business model of orthopedics on its head. That's where the real money's hiding.

Okay, we'll stop. That's enough of that. So the rest is—

Tiger, that's fascinating. So it has some of your colloquialisms that you use in there. Did you build that in or did you read the script?

I don't know. That's because it's trained on, all my podcasts I've done, all the YouTube information.

Oh, brilliant.

All my blogs I've written. So that's why it went to Canary Medical, because I've interviewed Canary Medical about 3 times.

It was you. It was you.

Yeah, that's awesome.

So it only knows— it's like a private— it's like a little private clone. It only knows stuff I've written or talked about. So that's why it's very narrow.

Tiger bias. There's a lot of tiger bias in that.

And obviously smart implants are not the most important thing in the last 25 years. But anyway, it's just an example. And you know, in a year or two, you— it'll be real. It'll be like talking to a real person, and you won't even be able to tell the difference.

Yeah, a word to the wise: I don't know if you saw the, uh, deep seat, that information this morning, that it's, um— I actually had this happen to me in November when I was out in Vietnam. It, it kind of— it gave you a, um What's the word in the communist country? I'm losing it, but it didn't give you the truth.

It gave you, yeah, Communist Party line.

Yeah, yeah, propaganda. Sorry. But look at some of these IA tools that you use and ask it the question, how current is its data? So because some of them are like, I wanted the one by, it might even be Gemini. Maybe that one's like 2 years old, the data. That's so— whereas ChatGPT will be really current. So with what we are doing, it's all innovation. You want to make sure that you're using a model that is current and reading stuff today.

Yeah, good point. Kyle's got a comment or question.

Can you guys hear me?

Yes.

Okay.

So there's— I'm sure we all feel like we've got a long way to go here. I've been playing around with various AI things to try and understand how to use it, but to try and also save myself some time. And what I've found so far is that— I think we experienced it some with what Tiger was just showing— you're asking for something that is subjective, that's going to be at the risk of some sort of bias built into the thing. But if you're— if what you're looking for is something to actually take away work from you, that there's— the better you coach it, the better the output is. So Eric, to give you a couple examples of how I've, I've worked with it so far is I wanted to see if I could create the skeleton of a fresh quality management system. And so what I did is I went in and I said, you're gonna help me write a quality management system, and we're gonna do it from the ground up. We're gonna reference ISO 13485 and 21 CFR Part 820. I wanna start with a template for a quality manual. So using those references, write me a generic quality manual for company named A. And it took 30 seconds, and here was this very rough template with references and sections and headings and everything. And then you have an option at the bottom to simply say copy, and you can throw that into a Word document. Now, I've tried to— so I was able to do that for— I don't know, I did it for a risk analysis. I did it for an IOVV chart, and it was like output after output. What I haven't found a good mechanism for it to do yet is for me to add in there create a Word document out of this and then have it spit that out, create a slide deck. I tried that where I said, you know, create a pitch deck for me doing this. And, and it gave me the guts of it and wrote like a summary, like the bullet points, but it couldn't give me an output of slides. And I maybe just haven't used the right AI for that. But ultimately, when it comes to doing something where you probably could do it on your own, but you'd need to poke around the internet for an hour, Odds are you can prompt and, and coach AI to give you exactly that same output in 5 minutes.

True.

That's the basic level that I've been playing around with.

I think, I think a lot of my issues is I don't know what, what to use it for. Yeah, I don't even think, oh shoot, I, I could have it help me write this quality manual. The only, the reason I was asking about it is, is I've, I've picked up this, expert witness gig, and I'm having to write some reports for that. And I don't know if this— maybe age is kicking in, but, you know, I keep on running up into some writer's block. And I'll go to ChatGPT and I'll type some sort of question that will help me out, get out of that. And it's worked fair. I found a lot of things that were in error. Maybe it's because, you know, questions are so specific. But that's as far as I dipped my toe so far.

Eric, for your expert witness, do you have— do you have— do they provide you with documents about the case? Yes. Yeah, you can just drop those in. You can say, read the entire, you know, prosecution thing and tell me what, you know, what an expert witness should say.

Is that allowed?

It's just a tool.

You can do anything. Yeah, it's allowed, but keep in mind it can be wrong.

You can't be wrong. You have to, you have to keep in mind, it'll get you, it'll get you 90% there.

Yeah, we, I've used it more as prompts, you know, like, like when I can't think of the word that I want, I'm like, oh shoot, what the heck? So I go back and type some stuff and get some words. And then, yeah, I've had to fix everything that it's given me, but at least it got me, you know, through that writer's block. But like you're saying, Tiger, the documents I have, you know, they're all PDFs too. Is it able to read PDFs?

Yeah, it reads PDFs all day long, and Grok does.

I wouldn't have even known that.

Yeah, you just drag it over to drop it, and you put it in the text box, and it'll read— it'll read 100,000 pages in seconds.

The other thing is take the bad data, like it gives you one version and say, no, I don't like it. I want it to be funnier. I want you to write this like a Madison Avenue advertising executive or a top 100 consulting firm and fix this piece of it. And it'll keep spitting it out. I learned that from my daughter. That's how she does her homework in college. I'm paying all this money for chat to do her papers, but it's pretty amazing.

Cool.

Cool. Yeah, I'll give it some more. Effort. I'm running up into a, uh, a hard deadline and it's scaring me, so I could use the help.

Cool.

So do you have to— do you show up in trial or do you have just, uh, produce a document, an opinion?

It— guess it depends on how good my document is.

All right.

So I don't think there's much of a case here, um, but that's what I have to try to get across.

Are you a— do you— are you a PE as an engineer? Because a lot of times they—

expert—

a lot of times the expert witnesses, they want a PE after your name.

Sure. Um, opposing counsel has one that's a PE, and it's not working because the person is so specialized. And you think about our, our field, it's, you know, it's not just metallurgy or something like that. You know, we, we, we cover so much when it has to do with, let's, let's say, a device that, that fails. There's so much, you know, you have to have broad education to, to, to have good, um, you know, explanations of things and whatnot. So yeah, I, I never got my PE. I'm really glad I haven't, but it's—

I think it's very limiting. I see I see a lot of engineers that go for the PE. Um, yeah. Is it— don't tell us anything you shouldn't tell us, but it's, uh, is it a failed implant case? Uh, and the patient suing the manufacturer and the hospital and everything?

So it's, it's an implant that the patient says has failed. There's, there's no— there's nothing out there that points to his implant failed. Wow. But, but suing everybody they can. And it, it's, it's interesting. Case has been around for several years and I really don't understand, um, how, how this thing came to drag on so long. So yeah, I'm trying to make it go away.

Well, I get— when I was at— I guess I can tell this now, it's been so long. When I was at Wright Medical, we had this really nice lady named Debbie, and every time a patient wanted to sue us, the call got funneled to Debbie. And, you know, and, you know, Debbie would get on the phone with the patient, you know, they had a revision, they were in terrible pain or whatever. And Debbie would say, oh, I'm so sorry, you know, you know, make sure when you, you know, make sure you collect all your receipts and send them to us and we'll send you a check, you know, for, and And so, you know, the, the patient would, you know, get a parking, you know, $10 for parking and all this. They'd send it in to Wright Medical, and then Debbie would send them a check with a waiver on the bottom. And, uh, Debbie was worth her weight in gold. And, and then a lot of times we, we had a, we had a rule where we would always sell for $200,000 if, if there was If somebody had a legitimate case, here's $200,000 and make it go away. And that was, that was our threshold. If they wouldn't take the $200,000, we would go to court.

Yeah. So I don't know if any of you guys remember Medtronic had a counsel who did things like this as well, Steve Phillips. And whenever there was an issue, he He said, you know, we just have to call him first and pay for everything. And, you know, that's how we win. And that was, that was true. I had a huge recall and it was like 200 and some cases and not, not one went to trial.

Wow.

Just because he called him first.

That would be a really interesting bone chat for me would be the, the ethics around the revolving around the medical device world.

Yeah, it's a gray area for sure.

Gray area. I had a gray area last night. I, um, told some friends of mine that I would buy them tickets to the movie Casablanca for Valentine's Day, and I forgot. So I got a text at 6-something. I'm cooking dinner, and thanks for the tickets, where are we sitting? And I go, oh man, oh So I got my laptop with my left hand and I'm cooking dinner with my right, and I'm buying these tickets. Instead of the theater, I accidentally went to a reseller. Oh, so instead of paying $100 for like $15 Casablanca tickets, I spent like almost $500 for this reseller. I got scammed and I just, you know, didn't see it coming, and I was in a hurry and I had to take care of my buddies. Or my, you know, my friends, my wife, and everybody. So it turned— it's really, it's really unethical. They haven't even bought the tickets yet. They take my money. And I talked to the theater later, and they said that this is what they do. They trap people.

And she said they're really—

they're terrible with baby boomers and older people. I'm going, oh God, no, I'm not even— don't, don't put me there. But okay, I'm there. Okay, so Anyway, I wouldn't trust— I've been in digital healthcare since the '90s. I'm not that person, but I guess I am. So anyway, it's just, it's, uh, but it's, it's unethical, but it's technically legal.

Yeah, there's a lot of gray area. Oh, let's, let me bring it back to fundraising. So, uh, there's a— I'm writing an article about this— there's predatory, uh, there's, there's financial predators out there. That are preying on startups raising money right now. And what they do is, and this has been going on for years, but it's really gotten bad recently. If you, if you want them to, if they want to read your pitch deck, they charge you $17,000. And, and they, you know, they're a big firm and these are real firms with real money, you know, these are. And then if you, they say, okay, that looks interesting, let's go into due diligence. You need to wire $90,000 for us to start the due diligence. And then after a few weeks, they, eh, we're not really interested. And that's been going on a lot. Um, I'm writing— going to write an article about that. If, if people want money up front, you know, they just run the other direction.

Wow.

I would think that entrepreneurs would know that.

I—

that's—

that's the one— the company I know about They went through their board, they went through all their advisors, and they, they still did it because it looked— it's a legit company. I mean, they've got billions of dollars. You know, it's not like, you know, it's not a, it's not a fake company.

It's not a scam. It's a gimmick.

There you go. That's well said.

Tiger, I'm sure you've heard the scam going on in your industry, right? With if they're taking posted resumes offline. And presenting them to companies as their own clients. Like, I mean, just awful.

Yeah, never put your resume up on LinkedIn. People, people do that. They— yeah, never do that.

You remember, you remember Adam Hocek with Echo? Yeah, I've been talking to him because that voice analysis that they do in a minute is fascinating, and I think it has I think it has, uh, relative value to mental health or to remote patient care to detect, you know, depression and everything. So actually, I built him an AI agent for him to use. So anyway, it— I should do that on one of these bone chats. Somebody, you know, give me a topic or something, and I'll show you how fast you can build these.

And then you could just walk us through it, how to do it.

Let's do that.

Let's do that. Yeah, and I can walk you through it.

Yeah, let's do that.

You could be— and I'll send you a letter of certification. You'd be certified.

Certifiable.

Certifiable. We know that, right? That's funny.

That's great. Uh, speaking of, you know, there's lots of merit bone chat marriages that are happening where companies are working together. It's amazing to me. And, uh I just spawned one. You guys remember, remember the vSurgeon? Remember Lawrence Binder, vSurgeon? Lawrence, brilliant guy. He co-founded Globus back in the day. Well, he's got a company that they have, they have cameras in the operating room and anybody can dial in. Anybody with access can dial in around the world and watch the surgery and chat with the team.

I watch it. I watch it.

Yeah, I, I watch them sometimes. So you got that, you got, they're creating tons of surgical content, but just video. And then there's another BoneChat member, um, that's, he's now the president of, or CEO of Clinical AI. And what Clinical AI does is it, it'll watch any video and it'll tell you what's going on. It'll literally annotate it. It'll say, Okay, the surgeon's putting a suture into that tendon. Okay, they just put a knot in, they're doing, and it creates basically surgical notes. Anyway, those guys are talking now because, because vSurgeon's got tons of content, but they don't have annotation. And then Clinical AI's got annotation, they don't have any content. Nice. So yeah, I just got a note today that things are going really well. They just had their first meeting.

So I, I remember Mark, talking about that or something very similar. Is that something that's going to be covered in your symposium here coming up?

What specifically? Because it's, you know, the title is Using AI in Your Medical Practice, and my goal there is to reduce the sort of informational fear of AI and make some suggestions of people that could actually practically use it in their medical practice without spending 6 weeks, you know, like we were talking about, learning about AI.

The thing, the thing that, that, that struck me that I thought was really cool was the potential for, um, the AI, you know, um, watching your surgery and taking, taking the notes for you. Um, because that, that sounded brilliant. I was like, wow, yeah, you should take better notes than the surgeon would.

That's a really good point, Eric. Mark, you really need to get Lawrence Binder there from vSurgeon. He's gotta attend. He will have a mind-blowing tool for hospitals.

One of the people that's gonna be on it is Kishore Tippernini. And although he's an orthopedic surgeon in Phoenix, he's been writing code since high school. In fact, He wanted to, out of high school, to go to college to be a computer scientist, but his Indian father wouldn't let him because that's a— he wanted him to be a doctor. So he made— so Kishore enrolled in a 6-year MD, you know, college program. He's a pretty smart guy, and he kept writing. And he was the guy that wrote, uh, the software for our digital imaging play in 1999 and our first EMR. Crazy smart. And his new side hustle is Tempita, which basically automates and reduces the documentation time in your clinic by 50%. It's not ambient AI, which he thinks, you know, is evil, because it's just— he doesn't want an AI just listening to him like we're talking about and writing it up. He wants to control it. It's kind of like what we were talking about earlier. He's— he wants to be the pilot.

Yeah, the way to be the pilot is you have to control the data set. You don't let the AI go out to the internet.

Yeah.

The reason I thought of it is I interviewed a couple of CROs and I was like, man, you know what, with what we're doing as far as, you know, keeping all the records that we need to for, you know, our IDE studies. Yeah, that, that AI could really come in and help a whole bunch.

I'd love to talk to you more about that. That sounds like an interesting side application, a more interesting application than some.

Yeah, it's pretty practical.

Yeah. Yeah. Okay. Mind if I line up a call?

Um, yeah, not a problem. The, the thing I was going to do first though was see if they wanted to, to attend your, your symposium.

Oh yeah.

Okay. And have them take a look at it. Great. So, and, uh, yeah, then, then we can all get back together and, you know, they, they're the ones you want to talk to.

I mean, like Tiger says on Bone Chat, you know, on that panel, there's gonna be a whole lot of people a lot smarter than me, you know. So it'd be great.

It's always, it's always best when you're not the smartest person in the room, which is 100% of the time. Well, we've kind of bumped into the hour. So next week we've got Rick Bolender from TrackPatch Health. Uh, it's a, he's kind of, you guys, you guys heard of TrackPatch? It's that wearable. It's a little wearable on the outside of the knee and it basically talks to your, your cell phone and talks to the nurse and tells them how your physical therapy's going and If you have an infection, it tells you how many. If you're not doing enough PT, it's—

Wow. Babysitter for PT.

The babysitter. Anyway, Rick's the new president. He's sort of found the perfect solution now. And it's not— it was originally gonna be a huge data play where you're gonna collect data around every hospital, every surgeon, every total knee ever put in. And now it's a more of a labor-saving there's less follow-up visits now to the surgery center. It's a labor-saving tool is what it is. Anyway, that's next week. So, Elizabeth, what's New Orleans like during the Super Bowl?

Oh, you're on mute.

Thanks. Yeah, a lot of celebrity sightings, I understand. I haven't seen anyone yet, but it's Yeah, it's a traffic nightmare. And after January 1st, everyone's very paranoid about safety. So they've got the whole French Quarter blocked off. I actually got a press pass to attend an event. I don't know what the guy's name is. He was the inspiration for— what was the movie about the sports—

Jerry—

Jerry—

Jerry Maguire.

Yeah. Show me the money.

He throws a big pre-party every year. And so he's doing that. And the There's a red carpet and all this business. So it should be pretty interesting. I'm going to try to find an ortho angle. You know, who's the NFL had an injury last year and can I talk to your doc and that kind of thing? So it should be quite fun.

Team doc.

Yeah.

Talk to the team docs.

Yeah, I will.

Yeah, that'll be really interesting. So that's Saturday. I'm not going down downtown, you know, Sunday and then— oh my gosh, the tickets are what? Now they're cut in half. They're $4,000.

Good Lord, crazy.

Watch it on my couch. Exactly. All right, thanks guys, it's been fun. Yeah, we speak next two weeks, we'll go back to the old format. Have a great week.

Tiger, everybody, bye-bye.