BoneChat #87 - open discusion

I've got a different angle now we can talk about. Okay. So I, we can start talking about that now. So I, yeah, the Joint SAVE Consortium. So I love the idea. Everybody, everybody gets it. Right, the little guys that have preservation technologies need a way to compete, and yeah, they need money. Wait a minute, Elizabeth needs the link. Huh, I don't know why we have link problems. Hang on, copy link.

Murphy's Law.

Murphy's Law. Yeah, I guess everything's supposed to be. But anyway, so the consortium idea is, I've come to the conclusion it's, it's way over my head. It's, it's complicated. You know, you'd have to finance and roll up businesses and geez, it's a huge undertaking. So then I started thinking, but there's still a need. Patients still, you know, patients are looking for other solutions that can delay surgery. And so I said, why don't we just start a, why don't we just start a telemedicine consulting service?

Yeah. That was, that was your fourth option that you had listed, right? The, the kind of a concierge services.

Yeah.

Concierge service. So, boy, good memory, Vinay. So, uh, so I went out, I've been thinking about it, been chewing on it the last week. I went out and bought, uh, the website domain holdthenife.com, and I'm gonna, I'm thinking about just throwing up a website, putting it on Facebook, Instagram, TikTok, and just, and see what kind of traffic I can drive, just to do it, basically test the model. And, and then, and, and totally coincidentally, a spine, retired spine surgeon reached out to me and he said, you know, in my early days of spine surgery, I used to talk patients outta surgery. He said, I used to give them exercises and injections and everything. And he's, towards the end of my career, I was just doing a ton of fusions. And he said, now that I'm retired, he goes, I would love to help talk patients outta surgery. And so I asked him, would you, would you be a consulting surgeon for holdtheknife.com? He said, absolutely. And I said, can you do consults still? And he goes, absolutely. So, I'm thinking about, I'm just off the top of my head, charge a patient, $3,000. Okay. And they get, they get access to an MD or a nurse in their, their ailment area, you know, joint, spine, sports medicine, whatever. And that person will look at their medical records, say, hey, you may be a candidate for this trial. Have you, have you heard about this? You know, go, go see this other doctor. They've got this other treatment. Basically hold their hand. But the thing that scares me is, I don't know, you know, for some patients that may just be one phone call, one video call. For other patients, they may want to talk about it for 6 months. Yeah. And I don't know how to deal with that. Um, and I would give the surgeon or whoever's doing the work, give them part of the $3,000, right? Um, anyway, that's what I'm thinking about. What do you guys think?

Why not use, why not use an AI doctor to talk to the patient?

Yeah, I, I, I love that idea, but is it gonna feel real or is it gonna feel a little, you know, the AIs are still not, I mean, they, they're smart, You'd have to build an agent, I think, that knew everything, every treatment for hip OA, every treatment for knee OA, every treatment for rotator cuff. And then you'd have to send that agent to the patient.

And you, I mean, AI, I mean, it can be used to kind of analyze their medical records or images and then kind of, you know, help the consultants kind of give their opinion and guide these patients. But this definitely is a need. I think this handholding, even if it is one time or 6 months, maybe all the way up to when they go under the knife, you know, but you can then tier your package accordingly.

Yeah, I think with a caveat, an AI narrator would provide a lot of information to your typically medical semi-literate consumer. That would be more than they had. Again, with a caveat at the beginning and a caveat at the end. That I think it would be very helpful. It's like an AI therapist.

Yeah.

As a human, you know, you're not talking to a real person. But right, for the love of God, you got to tell somebody what's going on, you know what I mean? It's funny, I just got off the phone with, uh, it's why we go to confession in the Catholic Church. Yeah, it's an— there's an anonymous screen. Yeah, theoretically. Okay, and you unburden yourself and you walk out shriven, cleaner, unburdened, right? It could be an AI back there. In fact, it probably is.

Oh, that's pretty— anyway, yeah, one of my theories is that all psychiatrists in the future will be AIs. You'll just have— you'll have a psychiatrist on your phone, you know, walking around, and, and it'll, you know, that's, that's a given, I think. Yeah, how would you build that, Mark? How would you build the AI? So, so a patient goes to see an orthopedic surgeon, they say, you need a total hip. And they're gonna go, wait a minute, I'm only 55 years old. You know, what are the other options? Well, I don't, you know, there's some other treatments, but I just do total hips. And then they find holdtheknife.com somehow. And they— so how would you build the agent?

Well, talk amongst yourself, and in about 5 minutes I'll show you. Okay, okay. Let me first of all— let me first of all build a knowledge base that I'll need to educate the AI with. That'll just take me a minute.

Gee whiz, Mark.

So, um, One of the things that always interests me is I'm one of those people that collects domain names. Yeah. And one of the, uh, some of the domain names I own are like jointreplacement, uh, USA, jointreplacement Europe, jointreplacement Asia. Um, I don't have hold the knife. That's a pretty good one. I like that one.

Well, I used AI. I I just, I wrote out a kind of a thesis and I said, what, what domain names would capture, were easy to remember and are available? And then that was one and they popped out.

Okay.

The other reason I did Hold the Knife is 'cause you could, we could eventually get it into cardiovascular or pulmonary or anything with, with the generic.

Sure.

And I, and there was one called Pause the Knife, Stop the Knife, stuff like that. But, We're not necessarily gonna stop surgery. We may just delay it or do a different surgery. Yeah. I just got off the phone with a, and a really smart medical writer, an Indian background from Duke. And she was telling me her father went to see, he's got back pain and this, went to see a spine surgeon. He's dying to do a lumbar fusion. And she's telling her father, you gotta get other opinions. There's gotta be, you know, you're burning bridges. There's gotta be another way to, you know, solve the pain or delay surgery. And he won't even, it's the white lab coat effect. You know, he, you know, he believes the surgeon, you need a lumbar fusion. You know, so. I mean, it's everywhere. There's a lot of more distrust of doctors now, but, um, there's a— just the medical profession's really tainted, you know. And I think— and the Like Him or Not RFK is exposing a little bit of that on, you know, the website. Um, so what are you up to, Vinay?

Nothing much still, uh, um, I mean, nothing much going on, uh, so still kind of pursuing and trying getting a customer for my consulting. Yeah, yeah, I've been— I have spoken to like 3 or 4 different startups locally here as well, uh, but nothing has kind of fructified so far.

Got it. I was talking to, yeah, I was talking to this medical writer and she was at, she's got the same issue where she's always looking for clients. And one of the tips I gave her is you, you should always have Google Alerts going on. So you should put in keywords for the kind of companies that you may need your services. And you wake up every morning and there's, there's a news story.

About? Yeah, but I think the challenge that I have is one that I'm not known out in the world having, you know, worked in these bigger companies. So, you know, it looks like a lot of these startup medical device companies, they want to go with established players who provide these kinds of services.

Yeah.

You know, CROs or maybe some people who have been in this business for a long time. Or someone like me who is new to this, uh, getting, getting them to kind of trust me to be able to provide their services, I think, is the, is the hurdle.

Well, one way to do that, there's, there's one hack, which is— I think we've talked about this before— is offer to do work for free at the beginning, a small chunk of work. Just, yeah, just say, you know, I'll Yeah, I'm gonna do— give me a chunk of work that you can't handle, and I will do it for free, no strings attached. And then they— if you do a great job, they'll remember you, and they'll either hire you immediately or later.

You know, one company, I gave them a quote as well, actually. So it went up to— the discussion went up to at least that level. So that was encouraging, kept me busy for some time. But then they ghosted me. But what they were interested in was getting me as a full-time. And I said, well, I'm trying to set up this consulting. And so it will be an opportunity for you to see, you know, how we work together. But even that, that did not work out ultimately in the end. So I think they were more and more interested in finding someone to come, come full-time rather than consulting.

I mean, you could give them, you know, 30 hours a week or something if you want and carve out a little further on the side. If the, if the, if the business was good enough for you, you could give them most of your time.

I mean, I was going to give them all my time even for the consultancy, given that they will be the kind of the first, you know, client.

Yeah.

Yeah.

That's, yeah. First client deal or something.

Yeah.

Yeah.

But I, yeah.

Okay.

I'll try, I'll try reaching out to them again. Yeah.

Just tell, give me a little piece of, give me a little tiny chunk of work that you can't do or don't have the bandwidth for. And let me, let me do the clinical work for you. And, and then, yeah. And then they'll, if you do a great job, they'll, they have to use you again. Yeah, next time you, you give— you quote them.

Yeah, but I think that they all— they were— they had some consultant that they were working with, and now they were looking to kind of replace, maybe do away with them and have someone in-house. So that's where I think is the, is the hitch.

Um, budget— there's probably some budget stuff going on behind the scenes. Another thing, Vinay, is you should, you should call other firms, you know, that maybe do a really good job with regulatory and quality, but they're light on clinical and— Yeah. Yeah.

I have reached out to another group that does the, you know, consulting actually works with. So yeah, that's what I have been doing, reaching out to people and see, you know, just, just waiting for that first hit.

Yeah.

And there's, there's, you know, there's a couple, there's easily 200 kind of, it's probably more than that. It's probably 500 consulting companies just in orthopedics in the US that do quality regulatory, clinical, you know, they have a whole list of stuff, maybe product development. And a lot of times they are really good at regulatory, but they're weak at the other things, but they say they can do it. So, um, say, you know, you can sort of, um, they can hand off the work for you and give you 75%, 80% of the fee. And they'll take 25% of the fee or something like that. That, that would be, that's a good way. When I first started recruiting, um, I actually, I actually did recruiting for another firm. And they, they said, well, we don't know anything about R&D recruiting. And so every time they got an R&D job, they would hand it off to me and I would find the candidates and I would send them. And then they, they, they were the customer-facing thing, but I did the work. And that got me, that got me started for the first 6 months.

So that's good advice. Even, even in the '80s, I would, I would give these Saturday seminars on how to get into medical sales, and I would rent a room at the Holiday Inn in Birmingham downtown, and I would often— and basically the, the hook was learn how to get into medical sales and how to write the perfect resume. So you— they walked away with something tangible.

Okay.

And I could boil it down. My pitch on how to get into medical sales was find a company that will let you sell your— their products for free on straight commission.

Wow.

And in 12 months, if you can manage to pay rent and you know, not starve doing something else like selling pizzas or encyclopedias back then, or vacuum cleaners or something, or— you would have what was called a resume. Exper— you would have experience. And because I would tell them that people that hire medical device reps are not creative people, They're not imaginative. They're very low risk. And they only want to hire somebody that's already done what they want them to do. I said, they don't know how to measure potential or talent or any of that. They only know what you've already done.

Yeah, they're looking at the rearview mirror instead of the front windshield.

Yeah, yeah. And I developed the mantra myself that product knowledge and experience are highly overrated. But that's what basically sells to most of those people. Anyway, I got it ready to go.

You want to do it?

Yeah, yeah, it's all yours.

Let me share my screen.

Yep.

All right, Sales Closer AI.

Let me move a couple of tabs out of the way. I want to move you out of the way. All right, what, what's our— what's it going to be? Hold the knife.

Knife. Industry is going to be, uh, orthopedic consulting, orthopedic, um, uh, treatment, counseling, counseling, orthopedic treatment. I think we don't have to be exact right now, but let me look at my notes.

Um, Elizabeth is a therapist, so she's— she'll be our resident. She'll, she'll, She'll hold our feet to the fire here.

She's in the back. Yeah, I'll see who needs— I'm here, I'm driving. I'll see who needs additional psych resources.

So, okay, the agent's role is to—

My tagline is exploring non-surgical options for orthopedic issues.

I— let's see.

How about a medical advisor for the agent's role? Orthopedic advisor.

Explore, educate, and advise. Patients on non-surgical. That's good. Emily, so the agent's role, is that to help train the AI? Is that part of the background of what their knowledge is?

I'm gonna give her a knowledge base.

Got it.

Okay, let's, let's give her a phone number. Phone number.

Give her an Atlanta phone number.

407. I could give it an 800 number, but this is what I got here.

I don't know, let's just keep it simple. 407. I'm going to call this later today too and play with it.

Let's get— make her creative and patient. Casual voice speed. Say 100% normal.

Upload text files.

I took— I, I was building that while I— while you guys were chatting.

So is this going to be for the under-40 crowd, for the 40-and-under crowd?

Not necessarily. No, it'll be, it'll be for anybody that wants additional options. I think 25-year-old, 85-year-old.

Yeah, there was a case that I will share, uh, Tiger, I, one, one of my colleague, her mom was, I think, well into her 80s and she couldn't undergo joint replacement but suffering from knee arthritis. And so she was exploring options like nerve blockers and, you know, injections to kind of help her regain her mobility.

Yeah.

And she did that on her own and she probably just Google searched or something.

I think into her 80s. I don't know the exact age. Yeah. But, uh, uh, I think her doctor probably suggested that, that option.

Okay. Well, that's good. Good for that doctor.

Yeah. I don't know why it's not uploading. Hang on a second.

You're pretty gutsy to do this live, Mark. I like it. Elizabeth, are you— where are you driving to?

Can you hear me?

Yeah, we can hear you now.

Yes. Yeah, yeah. It's just, you know, elder care, routine elder care stuff. Things that have to be handled. It's, uh, elder care itself is a full-time job. So, uh, yeah, it's just been a lot, but I'm trying to, trying to pitch in and participate here.

Absolutely. Anything new on the Tulane front?

Um, I am going to be turning in the application tonight, which doesn't mean anything because Tulane's rather glacial. But this position has been open a while. For the rest of you, I'm applying for a job in orthopedics at Tulane. I've been a freelancer for 21 years, and as I told Alex Vaccaro and Mike Ciccati, I'm ready for steady. So, you know, we'll see what happens. But definitely qualified, I would think so. Yeah, but it will be, it will be good to you know, to actually be in a work environment again.

After—

I'm ready for that after 21 years.

So in the sand— and you're in the sandwich generation too, which makes it even harder.

Uh, yeah, well, you've seen my thing. It says, uh, I'm the sandwich— living the sandwich generation, and I'm the baloney.

Hang on a second. Oh, I got it.

Hold on.

Got it. Yeah, Alex Vaccaro is a huge name, and Bunny— Buddy Safwa is a huge name.

Right. Yeah.

Yeah.

And I mean, Savoie treated me a few years back, and then I sent a friend to him. And I, when he was inducted as the president, I, you know, at AEOS, I walked up and congratulated him. So he knows me. I mean, interviewed him years ago and whatnot. So we'll see.

Yeah. When I was back in the early 2000s at Wright, we were developing a rotator cuff product out of graft jacket. And we didn't, you know, we weren't in sports medicine business. We didn't know anybody in sports medicine. And we went, we went to Barry Bays and he goes, well, I know everybody. He goes, you know, they, they created Concept Medical back in the '80s and they, they ushered in the arthroscopy technology in the '80s. And Barry goes, I know everybody. And so Barry just opens up his Rolodex and he calls buddy Savoie, Steven, uh, anyway, he had the top 10 arthroscopy founders and he calls them in 1 hour. And then all of a sudden we had, we had 10 guys that they would do anything for Barry. They say, yeah, we'll, we'll look at your graft jacket. Let's, let's meet anytime you want.

Geez, that's great. I know it, it really helps when it's a, you know, referral like that. I mean, people so much more comfortable with people they, you know, they know or they know of through someone. It's just, yeah, it's really important.

Oh, I remember they told the story that Concept Medical launched a suture anchor that was failing in some patients and, you know, it was a low rate, maybe 1 or 2%, but Barry called everybody and said, we're pulling this off the market because it's not ready.. And all the surgeons said, you're the only company that would ever do that. You know, you, thank you.

Well, that's a damn shame.

Yeah. Oh, it is. And they, they, they remembered that forever. You know, it's a, sure. Barry's an ethical standup guy. They pulled off the market for a year and they fixed the problem, then they relaunched it.

Probably had more success than before. Mm-hmm.

That's how you build trust.

Absolutely. Yeah. Being there when doing what nobody else does. Yeah. Well, let's see if I can send you all something while we're waiting. Mark, you still fooling with it, right? You're not ready for prime time.

I am. Yeah. Yeah. They've changed the software. They changed the upgrade.

Okay. I was just going to see if I could find something, screenshot and send it to you guys. See my new creations.

You got my t-shirts pictures, did you?

Yeah, yeah, we were chatting about that. Yep, absolutely. Um, see if I can— oh, here it is. Okay, so, uh, let's see, that's not the one I wanted to send you. Let's see. I have a number of— okay, okay, well, go ahead. I'll send this later.

No, you go ahead. I, I, I, I've got time. All right, I'm going to share my screen when you're— I'm going to share my screen when you're done.

Okay. I'm not— I don't know if it gives me the option.

Are you driving?

Yeah, don't—

no, God, no. Oh, no, no, I've just I've just pulled over.

Good.

Okay, it's not letting—

that's the rule on BoneChat, no, no car wrecks.

Yeah, can you imagine?

That would be horrible.

Um, okay, I can try one more time. Copy. See. All right, thanks for your patience. Where's this? Okay, there we go. All right, I'll try to paste it. Well, let me— I don't know if it's gonna come through for you guys. I sent it. Yeah, if you can open it.

Okay, we're gonna try. It's, uh, it's a file name, but it's not a file.

PNG. Okay, don't worry about it. I'll send it to you later. Um, okay, what you got, Mark?

Okay, here we go. Let me share and go back. Yeah, they changed it. They changed the software on me, so I had to regroup a little bit from the way I used to do it just 2 weeks ago. So let me now— hang on a second. I'm going to be— I'm going to dictate what I want this agent to do. So let me talk for a second. So I would like Emily to receive a phone call from a patient or a person who has a medical condition that is painful and chronic, like osteoarthritis of a total hip or knee or shoulder, or some other orthopedic joint condition. The patient may also have some other type of chronic condition, but their goal is to avoid surgery or possibly have a non-surgical therapy or regimen that would enable them to avoid the knife, hence the name "Hold the Knife," as long as possible. So Emily needs to give them whatever information that she has and also caution them that she is an AI agent and is not giving medical advice, but rather simply sharing information that they should verify and confirm when they talk with their healthcare provider or physician. At the end of the call, Emily should ask if they need other information, take their contact information, and even offer to connect them with a healthcare provider should they not have one for this condition. Uh, and that will be Emily's role.

Emily greets the caller, asks about the chronic, provides general— yeah, this is a summary of what you just said. This is good. Cautions about giving money, handles requests, collects. Okay. So you've basically given Emily, uh, you've sort of put her in a box of what she's allowed to do.

You must add a start call element to your sequence before saving. Okay, start call sequence. See, they've just— they've modified this in the last 2 weeks.

Sorry everybody, I had to get in the house.

Okay, you made it. Mark is building Emily, huh? So this— he's using salescloser.ai, which is— I've never seen it before, but it's, uh, looks like a way to build Yeah, build an AI that for telephone calls. Oh, look, it even has a, a process flow diagram.

Wow.

Start call, greet.

Wow.

Okay.

I'm glad. This is really brave of Mark to just let us see the sausage being made here.

Really, it's really foolish of him.

No, it's amazing.

You got— this looks good. This looks amazing. So let's wrap it up and create the sequence and do a demo.

Okay.

Cool.

Thank you, thank you, thank you. Did you guys see the little gorilla videos I made?

No.

I'll have to show you that. So there's these— the, the text-to-video tools are getting ridiculous. Here it is. It's building, building a sequence.

Wow, it's a little hard to read.

So Mark, is—

is—

do you have a subscription to salescloser.ai? Is like a monthly subscription or something?

I'm actually, um, or investor, or I actually have the contract for the healthcare industry for the United States.

Wow, that's a big— it's a big chunk.

Big chunk.

Well, good for you. And where— what is the company? Is it a tech company in San Francisco or something, or—

they're a Canadian company.

Okay.

And they're Canadian company, and, uh, the owners are Iranian.

Iranian.

Oh wow. And, um, in Iran? Pardon?

In Iran?

No, they're in Vancouver, Canada. They're, they're immigrants. Um, and I helped one of the partners a couple of 3 years ago, pro bono, with a lot of information about the healthcare industry and introduced them to a couple of medical societies. And so they're, they're all PhD types from the University of Vancouver.

Wow.

And as a result of that, when they built this, they asked if I would be interested in representing them for the healthcare industry, and I said, hell yeah, that's an easy one. So let me call this number. Let me see if Emily's ready to roll here. I'm going to put it on speaker. Let me stop sharing. Sorry, you're right, this is the part— who knows if this is going to work or not.

Like I said, you're very brave, Mark.

You know, I've met a lot of Persians that—

I'm Emily, an AI Hello, Emily. Again, just a quick reminder, I'm not a doctor, but I'm here to help you explore your options. Do you have a specific joint or pain issue you want to talk about today? If not, no worries. Just let me know.

I do.

I do. I've got a hip that has been hurting for a couple of years. My doctor wants to do a total joint replacement, but I really want to avoid surgery if at all possible. Uh, do I have any options, do you think? Uh, and I know you're not a doctor, but whatever you can advise me would be helpful because my doctor just wants to schedule me for surgery.

Hey again, just a reminder, I'm not a doctor, but I can share some ideas. Sounds like you're hoping to delay or even avoid surgery. Honestly, that's pretty common. If your pain isn't too severe yet, there are things like injections, physical therapy, weight management, and supportive devices that might help reduce your discomfort and slow down the progression. But it's really important to chat with a specialist who can guide you through the best options for your specific case. Hope this helps a bit. Take care.

Before you go, can you connect me with anybody that might be non-surgical?

Hey again. I can't directly connect you, but I can help you find specialists who focus on non-surgical treatments. Things like regenerative therapies, physical therapy, or support devices. And remember, I'm not a doctor, so it's always good to chat with a healthcare provider about what feels right. Do you have a specific condition or joint you want to ask about? Yeah. If not, no worries. Just let me know when you're ready. Thanks for the chat.

Okay, I'll let you go. Thanks a lot, Emily. Take care. Hi, so that was quick and dirty, but you see, and they always need tweaking. They always need to be modified and so forth. And this is kind of where I've learned over the last 3 months of playing with this, at that point I have to bring in like a specialist from the company because piloting the AI build is like piloting an airplane. You just don't walk on to, you know, walk in the cockpit and make it right. But in that, I just chose that voice at random too. That was kind of, whoa, hey there. Um, there's about 30 or 40 voices you can choose. But anyway, that's kind of like, that's just a demo playing. So we're playing around today. I thought that might be interesting.

So that's a basic, right? I mean, that's for somebody who hasn't been to a doctor, has no idea about the things that come to our, our minds.

Yeah. But I mean, I put a, uh, I mean, I, I built a knowledge base on that in like a minute. Wow. Oh, we— while Tiger was talking, I mean, I did it all. So that's— there's really no work in this particular model. This was just sort of a demo of what you could do if you— the more information you give these agents, um, the smarter they are.

Yeah, yeah, you got— it's all about the training. Yeah, that my little, uh, Delphi clone thing that I mean, it's been trained on, you know, thousands of articles and hundreds of videos.

Oh yeah, that's very smart.

Yeah, but it's— and it actually, I'm using it more than anybody else because it remembers things I said 10 years ago, which is incredible. Wow, that's really cool, Mark. We need to talk about this more. Now, one of the things ideally that Emily would do would say, you know, you may be a candidate for Brad Estes, you know, hip, you know, minimally invasive hip, what do you call it, preservation implant. And, you know, it would be great if Emily could match you, say you are a candidate for this trial. You're the right age, you have the right symptoms, you're the the X-ray. That would be ideal where, you know, or go to this city, you're a perfect candidate, or refer you. I don't know, I don't know enough about how medicine works, but that would be ideal to point the person to. Here's a menu of options. You're a candidate. Go see this surgeon.

I thought, I have thought that these AI agents would have an immediate place in clinical trial, the building of the trial, you know, the recruiting of patients. I guess everything they do to discriminate or find the right patient. It's not my background, but it just, it seemed like a good fit.

It's Fane's background.

So, But what Vinay should do, what Vinay should do is learn how to use these agents and make that your consulting business.

Oh man. Yeah. Yep. That's a good idea actually. Yeah.

I mean, yeah. You want to talk?

Yeah. Front and center, front and center on your website, Vinay, you should have a phone number and where somebody can call and see if they're a candidate or I don't know. That even in your voice, that is interesting. So the, what I, I don't know a lot about clinical study, but I know there's 3 sides. There's kind of the study design, which is really complicated. And then there's the enrollment, which is really complicated. This is probably where the AI is best is the enrollment. And then there's all the backend statistical analysis.

Um, yeah, approved. So that's the website, Vinay. Got it. Provencis.com.

Yeah, maybe I'll hold the knife will be two, two steps. The first step was you can talk to an AI for free, you know, and But then if you want to talk to an MD, there's a fee to have a real consultation.

Yeah, that's a good idea. You immediately monetizing it. That's the part I always forget.

Yeah, you gotta monetize or it doesn't work. Yeah. Wow, that's really interesting.

Has this been done in other specialties that we know of?

Has Tiger's idea been done?

This is done for ortho, right, Tiger? So I'm just wondering if anybody's done this in cardiology or—

I don't know. I just know that people, there seems to be, Renee and I were talking early, there seems to be a dis— more distrust with surgeons than I've ever seen nowadays. And I don't know if it's the, you know, in the last few years we used to trust in the FBI, CIA, everybody, and now we don't trust anybody. And that even goes to your medical provider. And then I read an article that said orthopedics is the most corrupt branch of medicine.

Where was this article? And what was this? I mean, what's the source?

I'll send it to you. It was a New York Times reporter that did all this research. And they said orthopedics is the most corrupt and oncology is the second most corrupt.

No.

And what, and is it about just malpractice?

Like, it's about, it's about surgeons being paid under the table mostly, you know, and, and every company, J&J, every company's been sued by the DOJ for, you know, for, you know, corruption. They've all, they've all paid big fines.

So more corruption on the company end than the doctor end is what they're saying, hopefully.

What, what's that?

Corruption's more on the company end than the doctor end?

No, the surgeons are paid to use a certain device so they don't tell the patient about any other options than the device they use. I think that's, you know, that's the, I mean, I, I had a, boy, I, I'm gonna try to get the, these guys on. I, I met a company called Kin-O-Matic. And did I tell you guys about this? I love this business model. I'm gonna, I'm gonna scan-o-matic. I'm gonna try to share my screen here.

It sounds like a cafeteria on Fifth Avenue in the '50s.

It is a terrible name, but is, they are, these guys are killing it. And what they have is a concierge service for total hip and total knee patients. To get— let me, let me share first and then I will.

Well, you're looking at— while you're looking for that, I'll share some more of my conversation yesterday with Joe. Oh, first of all, let me say this. When I hear somebody say that they don't trust anybody at the FBI or, you know, a big institution or anything else, I know immediately that person's an idiot. That— if that is as stupid as saying I trust everybody. Yeah, so you Yeah, it's just dumb. It's just dumb. But what Joe was talking about yesterday, the subject, of course, you know, it's the biggest healthcare system in Georgia. He's the top logistics supply guy. And I said, let's talk about product approval and value analysis. He said, oh, he said, oh, Mark. He said, you know, don't get me started. He said, well, let me just start by saying this. You think it's bad now? It's going to be worse.

Wow.

It's going to get worse because we don't care. And they said, if somebody doesn't— if somebody, first of all, whatever they bring me, first of all, has to be head and shoulders in quality above what I already have. I said, uh, or it has to be a huge safety issue. Don't tell me they're going to get out 6 hours early, 12 hours earlier. I don't care. 2 days, I'll listen. I said, we're not very far off, but basically telling that if you come to our hospital system, you're gonna get one brand of total joint, you're gonna get one brand of heart valve because, and, and he told me, he said, and I've heard you say this to me, Mark. He said, we're so high on the bell curve of development of most orthopedic implants, they all work. And they all do well, and these people aren't killing anybody, right? So really, truly, it's not good. What matters, uh, is how soon you can get out of the hospital or not be in the hospital and what it costs. Anyway, he's kind of— he's— that's why he'll be a great guest for us.

Yeah, yeah, man, I can't wait to have him.

Yeah, yeah, he's— I was really happy he said he'd come on board. I told him, I said, it's going to be a tough crowd, man.

Yeah, it's a device crowd.

Yeah. Mark, did he say anything about— I'm imagining, you know, doctors I've talked to over the years saying, well, you know, I really prefer this device or that device. I mean, are they gonna— is that gonna chase doctors away from the hospital if they have no options? They're used to using XYZ device, or these new fellows, they were trained on these but not these.

He said, we talked about that. He said, you know, That meant a lot more to me 15 years ago than it does today. 80% of the doctors that, that operate here work for me.

They're employees. They're employees.

They don't have any control anymore. They can't go, hey, this is a much better hip replacement. Let's use this.

They're, they're, they're part of the system now. This is what every 3 years they gotta negotiate their contract, their RVUs. They gotta play ball. They're on the team.

Yeah.

That's what Mark Copeland explained to us, that it used to be 2 or 3 hospitals gang together. Now it's 12 hospitals and they're in this massive system and the product choice is not— they don't have product choice anymore.

Yeah. Actually, it's funny. I live a block from a hospital and it's gone from one name on the hospital to 3. You know, it's like LSU, Ochsner, Tulane.

Da da da.

Yeah.

That's a good example.

It's a really good example. So anyway, I just, I couldn't pull up, I couldn't share for some reason, but Kinematic. So these guys, I'm gonna try to explain it. So these guys are killing it and all they are is a, patients pay out of pocket and they want the best possible hip replacement. Let's just, let's say, and so they pay out of pocket and this, The surgeon has, they give the surgeon access to about 5 or 6 different company implants. And then they give the surgeon goggles, VR goggles, and they pull in the CAT scans and the x-rays. And the surgeon actually does a lot of pre-op planning and then says, this is the perfect implant for this patient. And the patients pay out of pocket for it. And Kinematic doesn't have zero, they have zero inventory, zero implants. All they do is offer concierge service. And when you go in to see, and the guy, the guy that started this was an intraocular lens guy, and I didn't understand this, but when you go get an intraocular lens, you can get the one that your insurance pays for for free, or you can pay a few thousand dollars and get the one with more features. And I've met a lot of people that paid $3,000, $4,000, $5,000 out of pocket to get the IOC with more features. That's the model they're bringing to orthopedics. You can get the, you know, the surgeon's gonna go in the room and just throw up an x-ray and say, who are we doing today? Okay. You know, and they, there's no product choice. Or you get the concierge service and there's a, there's a menu of implants and they figure out which one works best. And they, anyway, that's, that's the kinematic model and they're doubling sales. Like every few months and it's all cash, no inventory and they're killing it. And it gives surgeons another thing to sell. So, you know, here we can, you can have the regular hip or we can upscale, you can put this premium. That's the idea. I'm gonna get these guys on pension.

So the patient is paying out of pocket for the entire procedure and the implant?

They're paying whatever their insurance or Medicare covers, basics, but they're paying this extra, they're basically paying for pre-op, better pre-operative planning is what they're paying for. The way I understand it.

The implant is still paid by their insurance.

Yeah.

Yeah. Let me, I'll tell Vinay a story. So there was a guy, there's a surgeon in Allentown, Pennsylvania. His name is Ranjan Sajdev. He started an EMR company called xScribe and I was on his advisory board. I helped him out a long time ago, and he, he was always grateful. His mother, uh, was the director of healthcare for one of the big provinces or states in India. He put together a business plan which we didn't implement, but based, based on the fact that about 5 or 5% of the population pays cash for the latest and the greatest. Everybody else gets whatever get handed down, and some get nothing. And here's how he explained it to me. He said, here in the United States, if you tear your ACL, we fix you. He said, in most of India, you tear your ACL, we hand you a cane or a brace. And it was a great idea. We just, you know, we were both kind of too busy with other projects at the time, but it really was interesting. And that concierge idea sounds If you can tolerate talking to whiny rich people all the time, that would be awesome.

Yeah, that's the, the thing. I mean, is, you know, the top 5% of Americans have a ton of money.

I mean, it's kind of similar to what we were just talking about with, uh, with Ranjan.

It is. Yeah.

If somebody had a really altruistic bent to them, they could, uh, take all, you know, just charge an extra 3, 4% and then take that money and fund on the foundation for, you know, kids or whatever, people who need, yeah, more than a cane.

Right, right. I've been, I've been in surgery in India and it was, I couldn't believe the, how far the deformities were. We, we did knee surgery. I couldn't believe, you know, the, you know, supvarus, you know, varus knees at 30, 40%. I mean, it's incredible they could even walk or, or valgus knees, you know, where they're, Incredible. Their knees are banging together and they just, how do they get to that point?

But I remember going to France in 2009 to bring FH Orthopedics into the United States. They have a really successful ACL that's still one of the best in the world. And I'm in Toulouse. And so the guy does one ACL in 20 minutes. He's like a machine. And then the, the reason I tell the story, then we walked out to the hallway, had a glass of wine, smoked a cigarette.

I'm serious.

And he goes in and does the next case. And then we walk out, back out. He has a cigarette. We have another glass of wine. 3 or 4 cases later, I'm going, I can't believe it. We're still going. They were small glasses.

They were small glasses. Well, French can't work without wine.

So it was so French.

That is so funny.

Oh my God, it was funny.

I was in surgery in India, and every time it rains, all the electricity goes out because, you know, the wires are just, you know, it's ridiculous. And so we're in the operating room, and all of a sudden, everything just shuts down in the middle of the case. And they had a backup generator that kicked in, and then we had to reboot the C-arm and reboot Basically, it's like a 20-minute delay in the middle of the case. It was like, are you kidding me? Just because it's raining?

Where in India were you?

I was in Nagpur and Akola. It's the middle of nowhere.

Okay, so that would—

that's not happening. Rural, a rural area in the middle of the country.

Yeah. Vinay, where are you from originally?

I'm from, uh, it's a state called UP, you may not be familiar with it. It's not very often, but it's in the north, very close to Delhi.

Oh, okay. Yeah, I've been to India 3 times. I've been to Delhi, but UP is the name of the state?

Oh, Uttar Pradesh. Yes, Uttar Pradesh. You know that.

Okay.

Uttar Pradesh is hard, way too hard than UP. So, but you said it perfectly. Yeah.

Elizabeth will always surprise you.

It, it literally translates to North State if you were to translate it into English.

Oh my gosh.

That's funny.

Not human.

Utter is the north direction.

Ah, okay.

Wow. And Pradesh is a state.

Okay.

Well, Vinay, do you want me to reach out to you about that Provensis idea?

Yes. Absolutely. I would love to discuss that.

Maybe you and me and Tiger could get on a call sometime about that. Absolutely.

Yes.

I'm in. I'm totally in. I'm going to play with Emily, and then we should talk again.

I'm going to work on making Emily smarter and a little softer in her tone and a little more patient-friendly. And when I get the tone right, I'll ask Elizabeth to listen because she's sort of going to be a counselor. She needs to sound—

Vinay, I'm a psychotherapist. I don't practice anymore. I'm a 97-year-old mom, my 17-year-old daughter, and myself. So listen, if there's any chance of making any money out of this, count me in, you know, single mom.

Yep. And I would like to work on this idea about the concierge services as well, Tiger. So if you want, I can support with the training of the AI and, you know, what Mark is putting together as the agent. Yeah, you know, I think the training would be the key here, right? But what material do you train it with?

So, exactly.

So like getting that information together.

I think you go to like, you, you guys talk, you heard Brad Estes, right? With Cytex Ortho that, did you, did you listen to that one?

No, I missed that one.

Yeah.

So anyway, he's got a really cool, he's got a little patch for hip OA that will delay, it'll delay a total hip probably 5 or 10 years easily. But he's about to start, he's, he's about to start a pilot study And so the, the, you go to Brad and you say, what are the, what are the criteria for enrollment criteria? And then you, you, you feed the enrollment criteria to Emily and Emily can just literally walk through, you know, how old are you? You know, what is your mobility? How, how do you hurt? She can go through the, she can almost act like a nurse, you know, enrollment nurse, right?

Yeah. Yeah.

I think that would be cool. All right.

I'm gonna let you know, if you take your hold the knife idea and combine it with the concierge idea.

Yeah.

That becomes a real moneymaker.

I know. That's what I'm thinking.

I, yeah.

Yeah. I think it's, we gotta, we gotta think this out some more. I'm gonna, I'm gonna, we gotta test the idea. So I'm a big fan of you test something for very little money. And you see if it works. And then if there's traction, then you add money to it, turn into a business. So I can build websites and create Facebook pages and stuff like that for, you know, less than—

that's good. I'm a big fan of building it and testing it, and it works real well, and then I'm bored with it and I move on.

Well, you just hire a CEO to run it for you, and you have some ownership.

Okay.

All right, thanks guys.

All right, thanks everybody.

All right, I'll reach out about provinces.

Okay, take care.

Yeah, bye-bye.