BoneChat #82 - Mastering new product sales in the VAC era.

All right, so this is Bone Chat Discussion 82 with the Vac Whisperer, Mark Copeland. Uh, today Cope's gonna explain why selling is becoming harder in the US and how we got here and what small companies should do differently. So I'm handing the mic over to Cope. Welcome aboard.

All right. Thank you, Tiger Buford. It's good to see everybody. So I will be sharing some slides here in a minute. But Jesse, we were talking about, I'm still a sales rep. I look at most things as a salesperson and I'm still in accounts. My consulting business has made me much busier, but I feel like I need to be in accounts to actually still know what I'm talking about, and I'm gonna show you what selling is different now. And certain people like that I know who've been around the block with me, Doug Hawkins, Jesse, like you guys will look at this and you'll, I think you'll say, yep, that's, he's, that's exactly what we've seen. And it shows why this value analysis, I'll use that broadly, process has changed everything in the United States healthcare in about the past, 10 years. And I'm gonna try to show you what it looks like, why it looks like that. And then I'm gonna give you some things hopefully that you could start doing tomorrow that increase your likelihood to get your product approved in health systems sooner and with a higher percentage of success at a higher price. And we'll try to answer some questions because this is how I sell today in health systems. I don't know any other way to do it. I don't know how if you don't do it this way, this sound, I don't mean it sound arrogant. I don't know how you do it because the way we used to do it just 5 and 10 years ago, the diminishing returns is clear. So I'm gonna see if I can share these slides and I'll, and I'm also, when I, when my slides come up, you should see a guy wear it with a big cigar. And then I'm gonna, uh, so hopefully you see a guy with a cigar because I'm going to tell a story before we jump in. So do you guys see this?

Okay, got it.

All right, so now let me see if, uh, I can present from the slideshow and see if I can— okay, do you see my cheater?

Yes.

See, all right, so I'm going to swap it. So now you should just see Yes. Full screen. Okay.

Blue background.

Yeah. Okay. Let's see if it works somehow. If we get through this, I'm going after Jesse's record. No. All right. So this is the topic today. Value analysis committees are killing your growth and it's what's making U.S. healthcare selling completely different. And then some things to do about it. But I'm going to tell a story behind it because I actually think it has— it's an interesting story. It's a World War II story, but it's also appropriate. So some of you may have heard it because I posted something about it. So, and this would be your product. This would be Jesse's Bone Bridge. The B-29 bomber, Superfortress, 1944, was designed to basically hit Japan's industrial complex in Tokyo to try to end World War II. We spent $3 billion of taxpayer money. To build this. It was the greatest technological advancement in the history of air, but maybe in man. Flew farther, farther, higher, faster, and had a bigger payload than any plane that had ever been created. Right. And it's 1944, fall of 1944. And it's— we actually spent less money on the Manhattan Project than we spent on the B-29 Superfortress.

Right.

Like, that's— And it had every technological advancement, was better in every way. However, there was a problem. When our pilots in February and March of 1945 would come around Mount Fuji and try to hit Tokyo's industrial complex from 35,000 feet during the day through a bomb site, they would look down the bomb site and they were hundreds of miles off.. And nobody could figure out why. They're coming from the east, from the west, south, north. And they, every time they looked down, they were way off and they were, could not put their bombs on the target. I mean, they were, it was bad. And the Joint Commission or Joint Commission, Joint Chief of Staff comes in and they're like, hey, we're like, the guy's name was Haywood Hansell, famous pilot. He was running all this. They're like, you're out. Because you're not doing what we need you to do, which is put these targets on. So 35,000 feet at the day through a Norden bombsight, missing everything. Strategic bombing, they called it. And they bring this guy in and he's right out of central casting. Curtis LeMay, Bombs Away LeMay. And LeMay says, well, he's a problem solver, right? Very serious guy. The stories about him. I mean, Gladwell basically wrote the book about this. And this is where I learned all this. LeMay's like, well, maybe we have a Hansel problem. Maybe it's him, not us. And so they go back up 35,000 feet, try it from everywhere, and they still can't get on target. And it's now April of '45. And he's like, I'm paid to get results and we are not getting results. I'm going to change strategies and tactics and I'm going to change ordnance. And I'm going to tell you guys, that's what we need to do when we're selling a med device today. Not just orthopedics, med device. Our old strategies, our old tactics, and our old ordnance don't work like they used to when we are not getting on target. So what he does is he sells those pilots, you're flying at night at 5,000 feet. We're taking every gun off your plane except that little one on the tail gun, and we're putting another technological advancement in. You're going to start carpet bombing with napalm, right? So now this is not a referendum on whether Curtis LeMay was right or wrong. The first time he did it, he actually told his commanders in Washington, sent them a message saying he was doing it intentionally when he knew they wouldn't get it for a day when his planes were already coming back because he knew like, this is bad. But he knew we got to end the war and I'm going to end it. And it was a very, very effective Morally, ethically, you can question it, but he solved the problem. What they were running into, by the way, the equivalent of that today was the jet stream. They just didn't know it, right? Because nobody had flown at 35,000 feet and tried to drop a bomb in a pickle barrel, which is what they thought they could do. So he changed strategy, tactics, and ordnance. And that's what I'm going to urge you guys to do. If you're gonna, if we're gonna be successful selling small med device, frankly, any med device, but small med device, we have to change it. So here's our agenda. I'm gonna show you the history of these value analysis committees. I'm gonna show you what their process is today, why they have it, who's on it, what matters to them. And then I'm gonna show you who should deliver it, what they should deliver it, the ordinance, if you will, I'll show you an example and then I'll show you some things. I think that if you just start doing this today, get your reps, but you have to start thinking this way. If you do this, I think you'll sell more rapidly and I'll show you examples. And I say this to everybody, I am here to help. I'm going to show you examples. I'm going to go through some stuff fast. You can have the slides. I have examples. I have a LinkedIn Live tomorrow at 11. Where I'm talking about business, this stuff, business cases, and I'm gonna show reps how I do it and how I think they should do it. But it's gonna be the same thing as here. So the goal of this is I want to demystify the United States selling in this marketplace and these VAC committees give you a strategy, a different ordinance, because the ordinance I'm gonna tell you is the business case in a, an executive business summary, but we're gonna deliver it differently. But I think this is the most important takeaway. We have got to change our mindset from product-focused to problem-solving. And it's hard for reps to do this. So if I'm talking to a surgeon, I used to go, hey man, you should check this out. It's the coolest thing. It's the B-29 Fortress. It flies fire. And they're like, I don't really care. Whatever. My plane's fine. But if I come and say, hey, did you ever notice like you're trying to get there, but you can't get there from Saipan, you keep hitting these And they're like, well, we just flew that mission the other day and I lost like, like, yeah. And, and like, you can't get there. And then when you get there, you get, they're like, yeah. I'm like, well, I might have a solution for that, right? Because I started with the problem, not the product. We in this current healthcare system need to change. We do, reps got, get as reps get good, they get good at that. But then they turn around and say, well, my product, I can't get it approved. They're talking product, not problem, and they don't know what problem to solve. I'm gonna try to show you some of them, okay? So this is, it's an overview, but I'm hoping you guys take some of these things away from it. So here's the status report, I would call it, and I'd love to hear what Jesse and Doug say, but I'll bet I already know. Healthcare used to be regionalized, mom and pop. I used to joke, I would call on Our Lady of No Air Conditioning Hospital and there were 2 spine surgeons in it and I could go spine surgeon by spine surgeon, hospital by hospital, 'cause doctors got what they wanted and I could win. Now I might run into Jesse who's a competitor and so he and I are elbowing each other, but we know if we get that doctor to like our product or us or whatever it is we do, I win. And then I go see Jesse over in Reading and we're bashing each other's heads in again. Same thing. This is no longer the reality in the United States healthcare system. This doesn't work. Here's why hospitals have become health systems, and I'm gonna show you what this looks like in a very simple graphic because I found people like this. We know there were 5 mergers a month between 2020 and 2024. That's 60 health systems or hospitals merging a year. Hospitals became health systems. Look in your backyard. I mean, I was looking at this, Florida has something like 15 health systems of 10 hospitals or more just in Florida, right? And doctors became employees. You hear these numbers all the time. 77% of doctors are now employed. I think it's somewhere around 62% for orthopedic. It's hard to tell. It may change and the pendulum may swing a different direction, but the snapshot is this. And doctors have less juice in bigger systems. And I'm gonna show you how little juice they have at some one point. But here's what it used to look like when I was calling, or Jesse and I were calling on Reading Hospital, now part of Tower Health, or now part of, I forget what bought 'em. We were calling on Our Lady of No Air Conditioning or the doctors in it. And there was a value analysis committee. It was a small group, but they would decide on new products. So I'd call on this doctor, he or she would say, I like this, get it approved. I'd go talk to those 3 people or I'd have the doctor talk to 'em and they would say, cool, they'd make a decision. Usually took about 30 days if not faster. Around 2019, it started to look a lot more like this and it was more rapid in other places. That same hospital was now part of Our Lady of No Air Conditioning's health system, medical, right? As opposed to just the medical center. Still the same people on the VAC, maybe a couple of other people, supply chain, risk management, same VAC. So I could still call on the same people and instead of it taking 30 days, it might take 45 or 60. You'd at least get an answer and you could kind of predict what, what the answer would be. Here's what it looks like now in the average health system in the United States. Our Lady of No Air Conditioning is now part of a 10-hospital, 2-ambulatory-surgery-center, at least, health system. And this is kind of small in the United US right now. 8 to 14 is probably average, but we can all think of bigger ones. And there's one value analysis committee.

Wow.

For all of them, right? So this has happened. In about the last 10 years, dramatically. And so I, I've joked before, it's the primordial ooze of this value analysis process. It's changing constantly because our customers have completely changed. So here's what Jesse and I did, Doug Hawkins did 15 years ago. I called on a surgeon, Dr. Buford, my Dr. Buford's like, Cope, I like this. And Dr. Buford would call the director of perioperative services and say, Hey, I want Cope's product. And he, like by 2012, he might say, hey Cope, we're gonna get this approved. Don't hose us with prices. I'm like, you know, they used to never even ask. And then he'd be like, hey, don't make me look bad. My God, Dr. Buford, I got you, right? And the perioperative services director and a small committee would say, listen, Cope's product, we don't even really, that's fine, whatever. But like Buford's important. He does a lot of cases here. He brings a lot of revenue. As long as Copeland doesn't hose us, let's give him whatever he wants. And that was how it went, right? That's 15 years ago. Here's what it looks like today. Simplified, by the way. Copeland calls on Buford. Buford's now an employee and he goes, hey man, look, I'd like this. If you want to get this approved, cool. And I'm like, come on, man. I need you to ask for it, right? Buford's like, all right, call Jenny. Jenny's our service line coordinator. She's the one who does all the paperwork. So I go to Jenny. I've known Jenny for 15 years, and Jenny is irritated because now she's also circulating because they're short-staffed. And Jenny's like, Mark, geez, another one of this. There's another shiny object, right? Like, I'm going to tell you right now, Mark, they're going to shut it down. If I'm like, if it's not on our GPO, it's not a contracted, it's not a blah, blah, blah, blah, blah. If you don't save us money, they're going to shoot it down. I'm like, Jenny, come on. Who loves you? It's COPE. Come on, can we submit this? She submits it and supply chain goes, are you a contractor vendor? What's your GPO status? What's your price? Ah, too expensive. And you couldn't even handle our business if you wanted. Beat it. There's like 3 hurdles I have to get through just to be told pound sand. And if I get through that hurdle, which like you'd be amazed at how many never even get put in because people are like, Like Buford's like, Cope, I'm an employee. I'm using whatever juice I got on my navigation system. Tiger's favorite thing are the robots, right? I'm not using it on your Fetzer valve. All right. There's so much that gets stuck at the 10-yard line. And I call like when you're putting it into the Greenlight or Lumiere or whatever their process is to go to supply chain, I call it like red zone. You're in the red zone. You're gonna be kicking field goals if you're lucky most of the time. 5% of the ones that get to the committee all the way to the right, the VAC committee, about 5% of those get approved. And here's what they're asking. Like, I just had somebody tell me today, we had to fill this form out. They wanna know what's our proof of patient outcomes? Does this help the health system strategy? I don't even know what they mean by that. Does this decrease risk? I mean, I think it does. I don't know what they mean. What's it, how much it cost? What's it do? Does it make us money? Does it cost us money? Does it help our operation, right? This is what it looks like. And my buddy said, he's like, man, I got a better chance of getting admitted into Harvard than I do getting this approved in Ascension. And trust me, if you knew him, he's got no shot at Harvard. So there's, he's got no shot, right? This is what it looks like right now, simplified. And you'll notice the difference. Nobody's asking about Buford's revenue. Nobody's asking if he's important. Supply chain. Frankly, here's how I describe it. They've hijacked this process. I'm hijacking it back and I'm going to show you how we do it. And I'm not doing anything illegal, immoral, unethical or fattening, but I'm hijacking this back because if you think I'm going to supply chain people to describe my B-29 bomber They're like, "Well, we use the B-17, it's on contract, dude." Like, what are you, nuts? That's what they say. But here's why Buford can't get things approved. And I irritated a surgeon on LinkedIn with this, and then I talked to him and he was like, "Oh, okay." Your heavy hitter does 400 total knees a year. He brings in $10 million in revenue to Our Lady of No Air Conditioning Medical Center. Take a look at what Kaiser Permanente's revenue is on the right. A day. They do $373 million a day. My heavy hitter orthopedic surgeon who's an employee who operates in my ASC and wants some shiny Fetzer valve, he barely pays for our coffee budget, right? This scares people when they see it. I'm like, do you now understand why your surgeons feel like they don't get stuff? It's because generally speaking, they don't. And I know what some are gonna say, well, we're in ASCs. Enjoy it while you can. Make hay while the sun's shining, 'cause that's going away too. So let's talk about who these value analysis committees are for a second. That's the layout of what the process is. Then I'm gonna show you who these people are and what they want. And then I'm gonna show you how to give it to 'em. So here's the standard value analysis structure in a health system. And it's really representatives of departments. And if you look, there's a bunch on there of executives that are not nurses, are not doctors. And if you manage to get in front of this group, which you won't because none of us get to stand in front of that committees and most likely won't. And they're oftentimes in other cities or states because you're an Adventist, you know, it's a Headquartered 2 states away. But these are the people. Now, if you notice at the bottom, take a look at who's at most of these meetings. VPs of perioperative services, 'cause the OR is still 60% of the revenue for hospitals. VPs of service line. That would be the VP of orthopedic service line or neuro, ENT or robotics or the ED, right? Or the ICU. These are your new champions. I'm telling you right now, if you get in front of these people and I'll show you how we did it with a product, some of you may know, they get— they are the ones who go, I'll get this approved because I know what revenue integrity needs. I know what supply chain needs. I know what we need for staff education because that's what— that's why they're there, right? So people tell me, hey, ASCs, we don't have it. Here's what ASCs look like. Same image on the left, the hospitals. ASCs are starting to do the same thing. They just structure it differently because they're smaller. So these 4 groups within an ASC are the ones who kind of do the value analysis, risk assessment, reimbursement models, revenue integrity. And I think the administrator, or the administrator and the director of nursing, Tends to serve the role of the VP of perioperative services and VP of service lines in a hospital or health system. So if I'm calling on an ASC, I know I need to know the surgeons, but I treat the administrator as a decision maker because he or she is, they are very influential. They actually can say yes many times. And if they're not sure, They'll say, I might have to take this to the board, but they go and pitch it to the board. And, but you have to have what they need so that they can make a decision. And I'll show you what some of those things are. But this is what it looks like today. And you guys see tenant buys ASCs. I mean, Bain Capital is trying to buy ambulatory surgery centers. You think a clinical case is gonna work with them, but this is better. We lose less blood. Let's hope. I wouldn't wanna bet my company on it. So now that you understand sort of the landscape and the process, let me show you, this is what I start to tell people to think about. Like, I know why surgeons like my product. Why would a health system like it? Because if you can sell a health system on it, you can sell a hospital or ASC on it. Because this is a committee, this is a group, this is a political play. Why would they care about my patellar fracture product, right? Who cares? Well, they do. They just care about different things. These are the things that they pay attention to and, and stay up at night. And it's not an all-inclusive list, right? But it's examples and of what matters. And here's the funny part. I am shocked when I talk to these small companies, they actually help with some of these things. They either don't say it very well or they don't know it and don't say it. And when we, when I work with companies, I kind of act like the VAC committee cuz I don't know much about it. Right. And I'm listening to 'em like, do you hold on? Do you realize you may have a health equity benefit? Or do you realize like your cases being shorter may not be enough, but them being predictable is almost as important. And if you pitch that to supply chain, they'll tell you they don't care. But if you find a person who runs the business of the OR, they'll tell you why it's important, right? And we say, oh, we're more efficient, we shorten turnover time, but we're saying it to doctors or we're saying it to nurses or worse, we're saying it to supply chain. And they don't speak this language. They buy stuff. They're good at buying stuff. I need somebody who tells them what to buy. And understands my business case and my clinical case. That's not what supply chain does. So I'll send you guys this. Again, this is not all inclusive, but like if you start to put your product through some of these filters in your brain, and when I do it, like you'd be shocked at what we find and business cases that are like, you know, you have a good one, but you're either not giving it to the right person or you're not giving it enough depth. And I'll show you what that looks like. So here's what we need to do today. We need a business case and a clinical case. We need both. This is why it's so hard for reps, 'cause we were trained clinical pathology, anatomy, clinical algorithms. And I can, you could put me in front of like a spine surgeon and I can talk intelligently with them for 2 hours, whoever they are, 'cause I was trained to know how to talk to spine surgeons. But if I have to deliver a business case, a lot of reps are like, oh, you mean, dollars and cents? I'm like, it's more than that. And then I say, now you gotta go deliver it to the VP of Surgical Services. And they're like, I don't even know if they'd listen to me. Well, they will. But if you want to get them on your side, you better start learning how to talk to 'em. And I tell this to reps 'cause I had to learn how to do it. I didn't know how to do it either. So here's the process I urge people to take. And I use the operating room as an example because everybody that sells into the ICU, ER, they're like, oh, the OR people still get whatever they want, right? Especially ortho. Like jump on a bone chat on a Thursday and see what you think now. Like, they're like, wait a minute, you mean that ortho guy doesn't get whatever he wants? I was like, whew, no, they do not. Would that the world so simple. So here's what we do today. If I'm selling something for Doug Hawkins, right? And I get the surgeons interested, 'cause you still should start clinically, I believe. I talk to the surgeon and surgeon's like, hey listen, I like this. I like it 'cause it'll make my cases faster, better, safer, clearer, less blood loss, whatever it is. You're like, cool. But we gotta understand why this place will like it too. And I think I know why, right? But I need to go talk to the business people who run this place. Perioperative services director in a hospital, ASC administrator in the ASC. And what we want to do is end up delivering clinical case briefly and a business case summarized to them. And if you follow this process and you do it, and I've simplified it 'cause I end up going back and forth between the doctors and Periop and doctors, business person learning some things like how many of these do you do? How many minutes do you think it'll save you? Those types of things to build the business case. And then go back to perioperative services, they're like, once they see the business case, they're, and it's good, let's assume it's good. They're like, ooh, yeah, we're doing this. Send me your vac pack and I want you to start in October or whatever, 'cause I'll go get this approved. And then the phone call I get from supply chain, if I've done it right in the health system is, hey, we need your part numbers and your pricing. That's a, 'cause we need to put you in. We gotta need to make sure you're not in the mod website. We need to make sure you can do, business in the United States, right? Like standard due diligence. And maybe not at that point, we got a contract and put a price together. But if they're like, yeah, but your price is still too high. I'm like, talk to supply chain, talk to perioperative services. 'Cause I quoted them pricing and they said, oh my gosh, I thought it would be higher because our business case was so good. Well, I'm not having this conversation with supply chain. I'm not interested. This is how we hijack it back. And supply chain people, as you can imagine, get angry with me. Like, "Oh, you gotta bring it to us first." I'm like, "Really? So that I call on your place 5 times, you respond to no emails, no phone calls, refuse to give me an appointment, and then get pissed when I talk to your doctors? You sure? Sure you want me to do it that way?" And the ones who get upset are the ones from 2012 who used to let you come in and talk to 'em. Jesse remembers them. Like, I guarantee he knows who it is in Reading Hospital. Where Jess could go on and go, I know who to talk to. And he'd go in and talk to, Jesse will laugh at this one, Mark Triller at York Hospital. Mark Triller, the margin killer. And Triller would be all serious. And I'm like, look, Mark, I know you're gonna hate me. Or, oh, Tarsieris Vili at Pinnacle. And I'd say, look, give me 2 minutes. Let me show you why this guy wants it and why I think you might like it. Shortened case, predictable. And they would listen and talk to you. Those days are gone. You saw the image. They're in a different city or state and they are not talking to you. So if they're not talking to me except tell me no, I mean, I'll be professional. I'll reach out, but I'm not relying on them. I'm going to talk to these people. So just so you know, I upset them. I sleep deeply at night. I'm going to tell you right now.

So let's take a pause here. Yeah, that is great. 30 minutes, uh, of what the problem is and how to get it, do it. Any— are there any questions? I mean, I get— there got to be specific questions.

Jesse wants to know— he did— can't believe I brought up Mark Triller. Any questions so far? Anybody want to throw in? I got like 2 more things to show. I see a couple of chats, questions up there.

Oh, the chats are just good stuff.

Yeah.

Yeah.

All right, keep going. Keep going, Coach. Okay. So here's what we're going to do. We're going to present to these people a problem that they have that we help with, not our product, because that's what gets things moving fast. And let me see if I can get this to, uh, advance. There we go. We'll do a pro forma depending on what the numbers look like. If we think we save them money, we're going to show them how much. If we think we save them time, we're going to show them how much, and we're going to try to put dollars on that. If we think We attract more cases to them. We're gonna show 'em how many cases, that's what the pro forma does. Then we're gonna summarize it, right? And I'm gonna show you an example of one we used that got us approved in a gigantic health system in Chicago. But this is the formula you wanna run it through. You wanna be thinking clinical, but we don't, like we don't wanna go deep dive with the business people unless they really want to. It's like, I would say this, like we're like a patella fracture system that comes prepackaged so you can put it on the shelf. And when that thing comes in and you're in a rural hospital, you can take care of the patient here instead of having to send them 2 hours away. That helps with health equity. But like clinically, that's an overview real quick, a clinical soundbite. Strategically, we think it helps you with health equity, helps your patients, improves patient satisfaction. But it's not me saying it, it's their staff, right? But I'm putting this through this filter. It's their strategic wins, not Copeland's. There's the financials. Yes, we may cost $22 more. As a matter of fact, if you do 100 cases this year, we've estimated it's gonna cost you $2,200 more annually, right? We don't lie to people. We tell 'em if we cost more. And we also think it's gonna improve operational, if we have operational fixes, which so many of these products help them with their short staff, their understaffed. They don't have enough anesthesia. This helps room turnover, whatever it is. Hawkins has one that like is gonna hit on all these things, right? Like Doug, you, you hit on so many of these and, but how do we summarize it and who do we give it to? 'Cause you know who doesn't necessarily think this way? Our doctors. So Monday, if you figure out a good way to do this, and you still want to have doctors request your product, I would go show them the business case and have them submit the business case and the clinical case because, and they're like, you think this is gonna help? And I'm like, yes, it will. Trust me. 'Cause I know what they want to see. And this is all honest and truthful, right? I'll give you an example. And some of you guys have seen this product, Onetrait. It's a pain in the rear end, hell of a product. Long story, great product, right? Now we sold this for 10 years up until last year into 450 ambulatory surgery centers, hospitals, and health systems up and down the East Coast. We had 22 states. So when I say like, I know this works, it works everywhere because this is what we did. It, we would, this thing works faster, but here's what we, here's how we present to VPs of perioperative services or directors of surgical services, the business people. Sterile processing and vendor trays are brutal right now. You can't, you don't have enough staff. They can't keep up. They make mistakes. And you, like, you could just hire more, but at the end of the day, it's slowing your OR down and it's causing delays and it's driving your surgeons crazy. And they're like, oh my gosh, it's like you've lived in our hospital. I'm like, every place is like this. We've estimated those delays caused by sterile processing and some of my trays, my old spine trays, it's costing you $624,000 a year. Your staff says to just eliminate some of those, they have to spend another $200,000 on two retractor systems and these two ENT sets. Your IUS rates are through the roof, which we know the Joint Commission is on. Your OR block utilization is at 82%, KPI of yours. Your staff thinks buying some OneTrays will help with all of these and it'll decrease the surgeons like, oh my God, it'd be nice not to sit. It'd be nice to go see my kids baseball game at 7 o'clock at night instead of standing here. 'Cause we had to delay cases for 2 hours because sterile processing screwed something up. At least we can fix this fast. Now you'll notice I haven't talked anything about my product, right? But we knew this solved these problems and we would get this information from sterile processing, from the OR, from surgeons. And I would say, yeah, look, mine costs 3 times— my box costs 3 times as much, and every time I use it, I cost 20 times as much. Think about that, right? Asciulab, which is in every building and every— on every GPO, costs 1/3 and 1/20 of our regular utilization. But when we would say, we've estimated in your place that we're going to save you $624,000 in delays alone. And they'd say, where do you come up with that number? And I'd say, here's where your staff told me. We count. They're like, woo, it's actually closer to $1.2 million. Like they would tell me, and they would say, how many of these trays does Sterile Processing wanna buy? Uh, 2, 2. And they're like, what? We're buying 50 of these. 50 thou, we're gonna buy 50. Why would we not spend $50,000 to get all this stuff? Everybody on this call would do this. It's a business case. And when we did this, we got approval everywhere. And guess who never told us, you're not on the GPO, you're not in the contract? Supply chain. Supply chain called us and said, hey, I need your part numbers and what's the price and where do we place these orders? Because the VP of Surgical Services told me we're buying these. Hey, just outta curiosity, why are you guys different from Asculap? That's what the conversations would be like. 'Cause we didn't talk to them. They wouldn't even understand this. They would say soft costs. Yeah, I'll give you soft costs, right? Our surgical services director or VP of, they were our champions, not surgeons, not sterile processing. And they would say, we're getting this, I'll go get this approved. I need you to be ready to in-service. What is it? End of June? I need you in here in early August. Can you come in and in-service? That's how it went. So here's my takeaway. Do not go clinical team to supply chain, which is what everybody does. Go clinical team to clinical leadership. Give them a business and a clinical case. They'll get it approved for you if it's good. And if they don't, Kyle, maybe you have a product that isn't as sexy as you thought. I don't know, right? Or maybe you're not describing it well enough. And then they'll take it to supply chain. And I'm gonna tell you, you will be amazed at how many more places approve your product if you have a good case and how much faster they do it because you're saying you have a problem, not get my, you should approve my product. That goes back to the problem.

Cope, what is the material that you give to the surgeon or, you know, the The perioperative people, what is it? A PowerPoint? Is it a video? Is it text? What do you give them?

So, so I use an executive business summary that I write and I usually have a pro forma that I've sort of prebuilt because I know what my value is, right? I know to go in when I was someone trying to ask how many times you have delays, how many times a week, $50 a minute sound like good for OR delay time. And they're like, yeah, okay. Like, what instruments do you need to buy? To avoid this. And they'd like, I need a SIM frame. And I'd say, how much does it cost? They tell me. And then I go start to show everybody this. I'm using it to internalize it. And then I know I'd have them because they're like, hey, can you send me that? Right now, this is where the regulatory people are like, whoa, whoa, whoa, whoa. I don't know that you can give it to them, Cope. We got to burn a 30-second. But I know this. I would summarize it. And did some of them say hold that up and let me take a picture of it. Or that's what we use. And I'll show you an example of one right after this, like, because I want people to understand, if you do this and your clinicians ask you what is the case, why will they like it, and you say this stuff, they'll try to memorize it. You decide whether you should give it to 'em or not, but I use those things. And it has rapidly caused adoption. And I don't know what else to— like, because you guys sell things that are complicated and we're talking to 3 or 4 different audiences, how could they possibly synthesize this? You have to summarize it. So let me see if I can show you an example of one, Tiger. Um, I'm gonna stop share and then I'll share something else and then I will open it up. But like, I write these for people. Let me see if I could do this so that they can understand it. And their biggest question is that they start to— they don't think it'll work. And I'm like, it works, trust me. Here, let me see, see if I could show this. I'm gonna shut this thing.

By the way, while he's doing that, guys, this is recorded so you can watch it.

Yeah.

And I'll also— oh, this is so valuable. I'll write a summary of it and, and Cope will send the slides and—

Yeah, yeah. I'll meet you guys.

We can go after the hour too. We can just keep going as long as everybody wants to stay.

All right. Well, I can't— I can't— for some reason, Tiger, I can't get this thing up on the screen. I don't know why, but it's a business summary that we had a rep— Send it to me if you want. Yeah. And, and she's a good rep. Like, these are good reps. And they have everybody trained up, but they can't get a decision. She— I had her explain it to me. We summarized it and she went and showed it to the people that were trying to make the decision. And they're like, oh cool, this makes sense. We're buying. And they bought hers and she was like $70,000 more. I mean, but she also sold a well-known product, but like they couldn't get it approved. Let me see. I'm going to try to attach it.

And so price seems like price is not the issue. It's the problem you solve. And And it's the strategic way you go through the system, the bureaucracy.

Yeah. I mean, like some of you guys are CEOs, like you don't, you're not interested in looking at new products to, you, you want problems to be solved. Right. And yet we insist on not doing that with sophisticated buyers that we are, we are dealing with. I mean, it's kind of crazy. And it works out here. I'm going to send it to you here, Tiger, and you can maybe pull it up. Email it. Yep. Um, I don't know why I can't get it to show on the screen there.

Okay, we'll get it.

I'll show it.

Yeah.

And you'll see it's one page. And, and this thing's like— I mean, I know everybody's favorite guy, Matthew Ray. Scott calls it a punch in the amygdala or whatever it is. But this thing's like a punch right between the nose because it gives somebody like Doug Hawkins, who runs his own company, right? If he reads this, Doug goes, Oh, I think I have everything I need to make a decision right now. He may not choose it, but he has everything he needs. And we just don't do that.

So got it now. But here, go ahead, Emmanuel, ask your question.

Emmanuel.

Yeah, really fascinating presentation. Thank you for sharing. We're probably about 12 to 18 months away from kind of trying to get into the health systems. So, you know, really, really great timing. What, what, what's your experience in terms of the— I don't know what the right description is— the quality or the level of data that we need to share? I mean, is this, you know, ranging from kind of back of napkin to like a full health economic analysis and everywhere in between? Like, just, just how robust are you talking about in terms of the data requirements?

That's a good question. I would say that probably less than you think, because when you try to submit, they're like, we need all your white papers, all this published level 1 data, and most people don't have it. And that's where I'm relying on the doctors to say, now listen, I want this because I see the clinical benefit. If you have white papers, you should, you should use them. You should use them to support it. But I, I have found it's less necessary than I originally thought. If you have them, great. But if you think they're gonna, if you think they're gonna read them, they're not, right? So I would say what I'd be doing is pulling them out, pieces out of it that show the business case part of it. That's like, so companies when they're early on, when they know what the value analysis sort of process, what they're looking for. And they go, we know we shorten case times. I would say, well, during your early alpha sites, I'd try to capture some of that data so that like Jesse can say, hey, when you use us, we know we shorten it and we've actually measured it in some spots and it's 15 minutes faster, right? And that's important. And, and if your alpha sites are doing it and they believe it, you can then say, hey, we don't have white papers yet, but we've got the data. You can talk to them. They'll tell you how much time they saved. Right. And sort of, I think you, we always think we should have it. And I think I never tell people don't have it, but it ends up getting overemphasized and we think they read it and they don't. So Emmanuel, hopefully that helps a little bit.

No, it does. I, my background was I was at Pfizer for years and we, like we over, like everything with a full health economic analysis. So kind of, I'm used to throwing like the kitchen sink at things and I don't want to overengineer if it's not needed.

Yeah. Yeah. Pharma's different than medical, medical device. They want to give us easy summary of what the white paper says.

Yeah.

Yeah.

Yeah.

Okay. I'm sharing Cope's thing now. Yeah.

So this was a business summary I wrote in a night for a, uh, a really good rep for the company. I, I, I won't say the name out loud. She didn't— they didn't pay me or anything. Um, friend of a friend. And they had a great, um, video laryngoscopy system, airway system. We all know it. And they were way more expensive, and they had ICU that wanted it, and ER was okay with it, and OR didn't, and all over the place. And what she didn't recognize was they had a huge win because the health system wanted everybody across the board to be trained on the same system, right? And everybody liked hers, but one liked somebody else's a little bit more. And she focused, we focused on this saying like, hey, here's a big problem. We gotta train all these people and we can't have multiple systems and bup. And she was more expensive.. But when she said from an education standpoint, your people will be checked out easily by your education team, but who's on value analysis now, staff education is on the value analysis because they realize how hard this is from a quality standpoint, right? So they're like, I mean, she's a good rep. She took this and showed it to somebody, two places. And both places within a week said, huh, yeah, we're doing this because they could make a decision. It's not cuz I'm some wizard. I mean, I'm an English major, but I'm not a wizard writing, but it synthesized everything they needed and showed them the problem they had and that the staff was suggesting hers. And this was some of their data and that was it, right? And so Hawkins as a CEO can look at this and go, Huh, we should probably do this, right? And they might have a question or two, but they're logical questions and then they make decisions. That's what we're not getting right now. And we think somebody in another town who's a supply chain person understands EBL. They have no idea what you're talking about, right? So I can send this to anybody, it's anonymized. I use this as an example to help people. But if you want, if you look at it, it goes through this process, right? Like goes through it sometimes. And you don't, not everybody has wins on everything, but does that help? Really useful. Yeah, yeah. I've yet to find a smart med device company that doesn't have a tremendous business case. I find most of them aren't delivering it effectively or aren't delivering it to the right person effectively. And I can tell you when I put something like this in front of the, the most prehistoric orthopedic surgeon, God bless 'em, they're like, you know who needs to see this? And it's never supply chain. It's always the person who needs to see it. And that's how I know who to go talk to, right? It's, that's how we demystify this. So questions, other questions, arguments. You can be skeptical too, or you can talk about we can napalm somebody. You want. That's funny.

All right, stop share.

Oh, it's all right. Yeah, any questions?

Ask questions about your specific thing if you want.

Yeah, I guess, yeah, I can come in with a question. Um, how important to these guys is the avoidance of risk?

Enormous. The bigger the system, the more, and we tend to underestimate it. I think we're entrepreneurs. We tend to laugh at risk, you know, at least most of us. But I'll give you an example of how I was told by multiple value analysis people not to present one kind of risk. And it may not be appropriate necessarily to everything we're talking about, but like, You know how people say, hey, if you can prevent one post-operative surgical infection, you could pay for a year of Fetzer valves. Every one of 'em. I mean, I've had 10 of 'em say, do not ever say that. We're so sick of hearing that. It's not true. You can't prove it. Where's your paper that shows you did it? And I've said to 'em, okay, how about if I said this to you? 'Cause I field test this stuff with these folks. Like, what if I came to you and said this, your staff, Because I've asked your staff, they think this will decrease the potential of the risk. They're like, oh yeah, that's important. That matters to us. But just don't tell us you're gonna decrease the risk 'cause you're lying. Like, well, I'm not lying. I'm not saying, but like, it's the way we present it. And if their staff is saying it, but risk avoidance is enormous. Joint Commission citation is enormous. Enormous for these places. Sometimes you can help, sometimes you can't, right? But yeah, it's bigger and bigger, just like Medtronic. What's Medtronic afraid of? Risk. Like, they're way more afraid of risk than Hugo is, probably. I don't know. Um, yeah, same thing. Thank you. What else? Any other questions? If anybody wants the slides, let me know. They're yours.

I can email slides to everybody if you like.

Yeah, I love the slides.

Thank you.

Yeah, Eminol's risk is really the preventing revisions, which has an enormous cost on—

Yeah, so I'd say it's not just preventing revisions because quite often people will be in pain for years and years through Alvar without necessarily needing a revision. You know, when I've seen some really interesting stuff around pain scores and Forgotten Joint scores because folks have had a reaction which could absolutely be improved by, you know, making sure the right materials are used. So it's not necessarily just the revision piece, it's that kind of, it's the follow-up, it's the investigations, it's the surgical time. And then the one, the reason they ask the question about risk is it's also about, you know, when the product hits the market, if these tests are available and not used and someone has a reaction, there's an exposure to the hospital. So when I take— when I speak about risk, it's like, okay, can you mitigate legal risk? Hey guys, we did everything we could. We pre-screened the patient, you know, we used whatever, like, we've done what we can. Whereas, oh, you didn't pre-screen the patient. So the risk thing is an interesting one, um, but also it has to be For us, we're like, how do you, how do you, how do you demonstrate the mitigation of risk without sounding like a bunch of ambulance chasers? So we know we do have to kind of get that message right as well.

Right. Well, what I would probably do, knowing very little, is I would, when the surgeon's like, hey, this is great, I'd love this. Cause that's where everybody starts. Although I'm not necessarily saying you should. Like, hey, do you, just out of curiosity, do you think this de-risks some of this stuff? And they're always like, my gosh, yeah. I'm like, Okay, well, I would tell that because at least I don't sound like I would say the ambulance chase.

This came up to us from surgeons.

Yeah, yeah. You're an insurance policy, right? And probably a pretty inexpensive one. And I'd be positioning myself that way in the eyes of clinicians and leadership. And I would also look if there's something that's a good parallel to that, like, hey, remember, just like this, You know, for example, a lot of spine people are going like, look, you're going to have to use navigation just because if you don't, even despite Tiger thinking it's hooey, you may be at more risk, right? Because they're like, what do you mean? Navigation? You know, it's a risk mitigation feature. So it is, it's important. If, but doctors aren't necessarily great at presenting that. So you have to either help them if they're going to do it. Or do it yourself in a way, you know? Yeah. Anything else anybody has?

Yeah.

Thank you.

Well, Hugo's got a better ACL attachment system and Doug's got a faster, simpler, better total knee system. You guys have a question on how to position that?

I love Hawkins. I don't— yeah, Hugo sounds cool.

Now, uh, we, we're still, we we are still learning in this wonderful world of—

Yeah.

Yeah.

Well, if you, if you take away this, I would say think clinical and business, you probably already do. Right. And the other part is you tell, I would, here's what I would tell. I would tell Hawkins this, cuz he, I could tell him this. He and I are friends from way back. I don't ask places, how, so what's your process for new products? 'cause they're like, oh, you get a doctor to like it, then you submit it to Greenlight. I say, here's how people buy our product. Here's our process, right? And my process is have surgeons interested and then go get the business case together. 'Cause this place won't buy anything. I always point to ceiling. This place won't buy anything unless they understand the business case. And they'll buy things that are more expensive if they know what they're getting for it, right? And I would say to you, 'cause supply chain won't listen to you. They won't pay attention to that. They'll reject you out of hand. And, uh, you don't want to take no from somebody who can't say yes and they won't say yes. Right. So you, you, I guarantee you, you already have a great business case. Hawkins has a home run one. I know we sat and had lunch and we talked about it. Yeah. I'm going to tell it. I'm going to, yeah, I, I will, uh, reach out to you, Cope, and we'll be putting together one of these things soon. Planning to launch in the fall and I'm pretty excited. I want to tell the value analysis committees no. I'm going to tell them no. Yeah, I like that. I just want to see my, you know, I want to see my friends win and, you know, my enemies destroyed. I don't know. But frankly, you know, you have to, I demonize supply chain a little bit, but, um, My dad was in purchasing for 15 years. Like I'm sort of, I got nothing against him, but this is a, this is a whole different arena and there's patients on the other end of it. And Hugo's got something better, right? And Doug's, Doug's does a bunch of things. It gets, it gets me my total knee maybe sooner because he, they can get me in sooner because they're not screwing around, right? Like, you guys come up with better things. Patients deserve 'em and so do doctors. How do we get it to them? Well, we hijack the process back. And Hugo, I'm glad to talk to you anytime, just to sort of give you a better sense of where you guys are coming from. And Hawkins knows I'll help him regardless because he's a good dude. But Tiger, hopefully this helped. I don't think I'm going to beat Jesse. Jesse's so much more interesting.

This is good stuff. Hugo, you have a specific question?

No, I mean, still learning a lot. I mean, as you say, I mean, I agree with many, many of the stuff. Unfortunately, I had to miss the very early part of the presentation. If there is any video or whatever, Tiger, it would be because I couldn't. But yeah, I mean, especially coming from another country, another culture, and another even system, you know, public-private, and it's a nightmare, to be honest. I mean, we have been like a year and a half now and we start to understand, but many of the things that you said are true.

I mean, we find that the business cases always—

I mean, the surgeon is a driver. And, um, and I always say, I mean, the guys in the supply chain and the BAC and the back companies, their job is to say no, because it's just to say no. It's their job. They're obliged to say no. Then you, you need to fill all that, you know, um, with reasons, with, um, with examples, with, um, you know, um, feedback from surgeons. Uh, they made a case. We always try to make a case for 3, 2, 3 even is much cheaper and you win much more time. So you try to put things inside and then, you know, bring it to the— but always the driver is the, is the surgeon for us. Always their enthusiasm, their reports, their comments, their everything. And then price, of course. But price, you know, we thought it was more important than it really is. If you make your job really, really well, the price is always part of it, right? But it's not that part that you could imagine in the beginning. And that's when you start to think that you start to be successful. Because, for example, I mean, we made a business plan with— I think it was a selling price of, I don't know if it was 500, 600. We are selling average 750 to 800. So, and that reason why is because we I don't know. I think we have done a very good job in many cases. So, so yeah, but again, still learning, still learning. And yeah, humble enough to say that we're still learning and we will be learning for a long time.

Same here. I like it. I like it.

All right. That's great. We've gone over the hour. Let's, let's end on that. I'll send, I will email I'll get you the slides, Tiger. Yeah, the slides, the video, and the cheat sheet to everybody. Yep. All right.

Thanks. Thanks, everybody. You guys, see you.

Thank you, Mark.

Take care.

See you guys.