Hi, everyone. Thank you for joining us for our Adding Service Lines, What's Changed, and What's Works webinar. A few housekeeping notes to get us started. All attendees are in listen-only mode. We will be using the Q&A function today to gather questions for our speakers. We will not be using the raise hand function, though. Please submit questions to the Q&A and interact with other attendees by posting comments to the chat. When using the chat function, just be sure to select all panelists and attendees from the drop-down above the message box before submitting so that everyone can see your message. This webinar is being recorded, so please know we will be sending out all the registrants, the webinar recording, and the PowerPoint slides via email in the next couple of days. The Association wants to encourage participation and collaboration while maintaining everyone's rights to privacy. With this in mind, we do not allow any artificial intelligence software bots to attend our public or private events. This also applies to Association webinars. These are only available to members and paying non-members and should not be captured by AI bots. Our Association staff will remove any AI bots from meetings. Today, we have three speakers. Alyssa Ashley High, who is a Practice Administrator at Orthopedic Associates of Marvell. Sorry for stumbling over your practice, Alyssa. We also have Andrew Carlson, the Director of Growth and Strategy at Growth Ortho. And we also have Ross Rigdon, who is a COO of Raleigh Orthopedic Clinic, PA. I will now be turning it over to our moderator for today, Jessica Thornburg, who is AAOE's Education Manager, to get us started. Welcome, everyone. Thank you so much, Katie. So, welcome, everybody. Today, we're going to go over just quick introduction and a little bit more in-depth from each of our panelists, and then just start with a really lively discussion. And we're going to leave lots of time at the end in order for the audience to ask questions. So, as you're hearing our thoughts and feedback throughout the presentation, if it's triggering anything for you or you want to know a little bit more, definitely drop that in the chat or the Q&A, and we'll have lots of time to have discussion at the end. So, without further ado, I'm going to ask each of our presenters to share a little bit more about their practice size and mention any current service lines or previous service lines that they've had in their practice, just to give you a little bit of context. So, we'll start ladies first. Alyssa, why would you kick us off? Thank you, Jessica. So, as Katie mentioned, my name is Alyssa. I am the Practice Administrator in Central Massachusetts. I represent a small, independent orthopedic surgical practice. We are general orthopedists. And my representation here today is kind of a little different than the other two here is Massachusetts has a lot of rules and regulations about what ancillary service lines you're allowed to have. So, kind of seeing like what we can do with what we have. You know, we have regular x-ray, and we do injections, and we're looking to expand. So, you know, we don't have a whole lot, but we want to be proficient in the service lines we do have. And then we are looking into the market to see about some other things that we could possibly add on. Awesome. Thanks. I see Ross next. So, Ross, why don't you introduce yourself, please? Hey, so I'm Ross Rigdon. I'm out of Raleigh, North Carolina. So, our practice is a little bit larger than Alyssa's. So, we have 29 physicians, 28 APPs. We're spread across six different clinic locations, four of which have their own urgent cares. We have 11 physical therapy sites, two ambulatory surgery centers, and there's two locations that we offer MRI. We are a little expansive as far as ancillary services, trying to cover as much as we can. So, that includes, you know, VSCO, MRI, as I mentioned, DME, things of that nature. So, been working with this for a few years and always looking to expand and offer any advice that we can. Awesome. Thanks. And without further ado, Andrew. Yes. Hello, Andrew Carlson. I'm the Director of Growth and Strategy with Growth Orthopedics. It's a national MSO. We partner with practices across the country, but my home base and where I came from was Bluegrass Orthopedics in Kentucky. Each of our practices have a bit of a mixed bag of ancillaries. The practice in Lexington, probably a little more robust, including an ASC. The group in Texas has some imaging, but not MRI, just because it doesn't reimburse super, super well there, but they do have therapy. We've launched that and are growing that. And we have a new region kind of coming on board that has the full breadth of ancillaries as well, including a surgery center. So, thanks for having us today and look forward to chatting. Awesome. So, I want to get started talking a little bit more from the strategic standpoint here. So, my first question is, how do you determine what service lines align best with your practice's strategic goals? So, I'm going to start with Alyssa here, if that's all right. So, we are a community-based practice, very small. So, we really rely on what our patients' needs are. We are looking at the demographics of the patients. And so, when we're looking at service lines is, really, it's going to be reimbursement. What is going to be covered by insurance, first of all, and what is our payer mix? Our payer mix is very heavily weighted on the Medicare population. And then, Massachusetts has always had a very robust Medicaid program. We call it MassHealth. And so, a lot of those things are not covered by MassHealth products or Medicaid. It doesn't cover DMA. So, we want to make sure that we can offer products that our patients are actually going to use. You know, we've looked at some of our competitors. We can't really compare ourselves to Boston. We're about 45 minutes west of Boston, but that is a whole different demographic of patient population that can pay for things. So, it's really important to understand what your patients need and what they're willing to spend their money on. Yeah. Well, and, you know, coming from a little bit bigger standpoint, and you've already got a lot of service lines, Ross, what would you say as you guys are looking to bring something new on? Yeah. So, you know, obviously, echo a lot of what Alyssa said. It's always going to be about patient care. But one of the things that's most important is access, particularly in our area. Raleigh is one of the fastest growing areas in the country. So, we always have an influx of people coming in. One of the things that we have kind of learned is that the mindset of patients have changed over time. They're not as, you know, particular about where they go. It's about how quickly they can get in. So, access is king here. We want to make sure that we offer any service possible within the realms of, you know, legality, of course, and what we're able to do. But we want to make sure we're doing so in a manner that we can continue that optimum quality of care. So, if kind of a rule of thumb, if they can't get in with us, they're going to go to a competitor up the road. So, we want to make sure that not only do we provide the best care, we have an avenue for them to get in a very quick and efficient manner. That's good that you hit on that. And Andrew, you probably have some different perspectives too, just because you're looking at a lot of different regions. And, you know, you've had experience with a variety of different things. So, do you have anything else to add that Elissa covered? Yeah, great. I'll ditto and echo everything that was shared so far. I mean, at the end of the day, it's going to be driven by patients. It's going to be driven by the local need. And each area of the country is going to be a little different. As Ross said, access is always important. So, whether or not folks are launching, you know, ortho-urgent care, walk-in style clinics will be kind of specific to their region, but generally they work pretty well. And, you know, really I think hopefully each year the practice is kind of looking strategically at where they want to grow and how they want to grow, how fast they want to grow. And it's not just growing physicians and providers and locations, it's also internal growth on the ancillary side. So, even if, you know, the ancillary options are small, are you optimized the best you can in those ancillaries? But I think we'll talk about it today a little bit, but in today's market, in today's healthcare world, if you're not growing, you're shrinking. So, looking strategically at what makes sense for your individual practice, your individual providers, and then making a decision and going from there. That's great. And I think I'm going to keep with you, Andrew, for a minute here, and especially because of your view with the MSO being so, a little bit more broad, obviously, than just one state. What trends are you seeing in the market that have influenced your decisions to add, or maybe even avoid, a new ancillary service? Yeah, great question. You know, the name Growth Ortho, it is what it is. We help practices strengthen, keep independent, and grow. And oftentimes it's growing through the ancillaries. I shared this morning, I'm actually at a healthcare conference today, and I shared this morning that a patient might come in and see a provider or physician two or three times, but they're going to see a PT 10 or 12 times. So, if you have the ability to add therapy, your impact to not only the patient care, but just the impact of your brand is going to be tenfold compared to what they might see in the practice. But again, as Ross and Alyssa have already mentioned, what works for your practice? So, you know, different parts of the country are different. I mentioned the urgent care, I think that's a really big one to look at, as far as access goes. But we're all trying to hustle, we're all trying to be competitive, and yeah, I think each region is going to be a little independent on that. Honestly, for us, we've leaned in on the practices that feel like there's growth opportunities, but if there's not really growth opportunities, then, you know, what can we bring to bear? It's kind of hard to determine that. And ultimately, the surgery center is the biggest ancillary, let's be honest. Yeah, yeah. Ross, what about you? Are you seeing any trends, whether it's in your market or just, you know, being involved on, you know? Yeah, so, you know, we are in a position with our region that later this year, the CON for the surgery centers will be going down, and then the following year, MR will be going down. So, just that, you know, internal competition with other groups and practices is just going to explode. So, again, as I mentioned, access, you know, and to kind of echo what Andrew said, you know, we want the patients to come in, but as they continue to see each of our service lines, we want to make sure that they have a reason to stay with us as we go through the healthcare journey, right? How they come to us from the very beginning and, you know, on through the clinic, the MRI to surgery to physical therapy, and then even something sort of like a bridge program to get them back to their activity of life. You know, a lot of patients are apprehensive when they come out of a surgery, whether it's, you know, something acute like from a fracture or something a little long term from, you know, a total joint, where they may not have that confidence that they once have had and, you know, swinging a golf club, for instance, something that seems very simple to a lot of people, you know, after a shoulder surgery may not have that level of confidence. So, how can we make sure that you develop that confidence to come back and get back to your quality of life, right? That's what orthopedics is all about, is keeping you moving. Now, Alyssa, you know, you mentioned before Massachusetts having some restrictions. So, how are you balancing that with, you know, seeing a trend and having someone go, oh, do you guys offer XYZ? You know, is that something, you know, that's hard to balance and, you know, just kind of set that expectation, not just with your patients, but maybe with your docs if they're asking about something new they're seeing anybody else doing? It kind of fluctuates. It depends on what exactly is available. Being in New England, we have, you know, five states very, very close by, and people go across the border all the time for different things. So, you definitely, you know, see people asking for something and, you know, if we can't offer it in Massachusetts, they'll go someplace else. But in the same thing with, you know, owners, they'll say, well, I can open up a practice, I can get a medical license, and I can do something else in this state or, you know, do a joint venture with someone else. So, that can be a little bit hard. One of the things that we really rely on is doing a market analysis of, you know, what's going on and what is needed. You know, we've ventured and talked about, you know, do we join the PT market? We can't do MRI in Massachusetts. We're not allowed to own our own MRI. And there's, again, very strict rules with the ASCs. That has to be a whole other kind of designation. So, the PT is, you know, would it be something that was sustainable? And we have tried leveraging some of our relationships with our affiliated hospital. But it ultimately came down to that the staffing too. If we did it, could we staff it? Because, you know, we're dealing with, you know, these crises of we can't get x-ray tech sometimes. And then, you know, people are, our patients are needing therapy. Well, they can't get home services because there's none of the home services have therapists. And then outpatient, they can't get in for weeks. So, yes, there is a need, but it's not because there's no revenue. These locations don't exist. They are. It's just the staffing that goes along with that. So, I think there's this larger picture that you really need to analyze. And for us, in looking at those trends, you know, when to pull the trigger. And then also knowing that it's going to wax and wane. You know, you might have overabundance of staff and what are you doing to their time? How do you make it work for the times when that staffing level drops significantly? You know, you know, traditionally, I would save questions to the end. But since you mentioned staffing, we have something in the Q&A here that may be good to talk about right now is, how are you managing all the rad tech shortage with the growth of ancillary services? So, I'd just open it up to any of you, whoever wants to speak first to that. It's called an unfortunate, well, not unfortunate. It's a $10,000 bonus we had to give to our rad techs to stay last year. I mean, honestly, it is a shortage. And we're battling hospitals that pay sometimes a lot more. You know, we are independent in nature. So, we did bonus, we did right, you know, right the ship as far as salaries and compensation go. Ultimately, they like working for independent practices versus hospitals. But depending on the pay, it just, it depends on where they're going to get pulled. And then locally, we try our best to identify students. We welcome students to come through our facilities and really leverage the relationships with the local educational institutions to hopefully bring some new blood in because, you know, you're always going to have turnover, not as much as front desk and phones, but you're going to have turnover in rad techs. It's been challenging. It's been expensive. It's an ancillary that this year's impact to the P&L was not as strong as years before. So. Yeah, I think our experience has been very similar. We leverage the local schools to get as many students in as possible to provide them as much, you know, education as we can, but also kind of show them what the lifestyle is like. You know, a lot of people will sacrifice a little bit of money to a degree for that quality of life that they can get at an independent orthopedic practice that they may not be able to get at a hospital system. They don't have the nights. They don't have the weekends in most instances. So, just giving them that, you know, quality that they wouldn't get at a hospital and just kind of showing them what it's like to be in an independent group as opposed to the hospital system, giving them that option. I'd much rather work for Alyssa than a local hospital. You're saying. Thank you. Me too. Yeah, we, you know, we are still constantly struggling with that and because we run one x-ray room. So if we don't have our tech here, we're down. And a lot of our urgent cares run without techs. And a lot of our hospitals, they'll drop a room. So one of the things that I have been very vocal about and trying to work with, I'm part of the advocacy council with AOE and then working with the Massachusetts Medical Society, the Mass Ortho Association is we do not allow limited licensed technologists in the state of Massachusetts. And we're one of the few states that doesn't. And so seeing if there's something that we can do to petition the state to allow that. So we at least can train our staff. I mean, I have staff that have been here 20, 25 years that if we could get them certified, they can help out. Cause it's not going to take away anybody's job. It's going to add a skill and you know, a good skill for somebody else. And it's going to help provide access to care. So we can prove all those things and it's going to be safe. If a doctor can press a button, we can get someone else to be able to press a button as well. And it works. But also, you know, we've done some surveys in the states that allow limited licensed technologists and people are not utilizing them. And I don't know if it's just we need more education on the states that have it for why that is important. Why should we be certifying these people? Is it just, we have never done it, so we haven't looked to that. And so I think, again, that's a good way to expand a service line and use it to the best of your capabilities is if you have that capability, do it. I come from, originally got my nursing license in Virginia and Virginia, the medical assistants were the rad techs at the urgent cares. And it was great. You didn't have to pay for another person to necessarily be sitting there. You didn't need the three people staffing something when you could only go with the two. So it really would behoove people to kind of look at that avenue and say, how can I better utilize the staff I currently have? Yeah, that's a great tip. Awesome. Feel free to keep dropping questions in and I'll keep an eye on the Q&A too. And if it's anything relevant to what we're talking about, we can talk about it now or we can hold things to the end, but I just, I love to see that coming through. We've talked a little bit about that planning process and trends, but let's talk a little bit about the finance piece of it because I think that's obviously the next step once you kind of decide where you wanna go. So Ross, I'll start with you. What financial metrics or tools are you using to evaluate whether something's gonna be profitable to your practice? Yeah, so ultimately we wanna make sure that we are capitalizing on anything that we do. We don't want to bring in a new platform or a system that will overextend you from a budget standpoint. They may have very cool bells and whistles, but if you're spending more to use it than you are on the return, is it really worth it? So one of the great tools, and it comes from AOE, the technology council just put out the request for proposal template. So allowing groups to utilize tools such as that and really evaluate, compare, contrast different tools, the ability to reach out to your peers, to the network, to make sure you're utilizing your time wisely. You can reach out to groups that have already used these systems and provide references so that you're making the most of the questions that you can ask to vendors as they come in. But ultimately with staff, we want to continue to grow, but make them more efficient. How can we make their lives easier so that as we grow, we may not need to add an additional staff for that particular department because we're able to leverage some form of technology or tool to make them more productive and not feel like they're being overburdened with additional work. Yeah, that's a great point. And maybe someone else on the AOE staff can link to that tool in the chat. So if anybody's interested in using it, it's available to you. Andrew, what about you? What are you guys using to kind of determine that factor of bringing something on? A couple of things I'll share. Nothing will replace a good financial plan, good financial performer. However, one thing I hear a lot from doctors is time and money. They're working their tails off. They're not seeing the return necessarily. And oftentimes, ancillaries, they may be continuing to bring in more revenue, but their margins are shrinking. So again, if we're not growing, we're shrinking, but nothing can replace a good performer. Nothing can replace a good analysis. Don't be afraid to bring in outside resources. One thing I'll continue to share is the collaboration that I see at AOE and amongst peers and amongst friends. It's pretty remarkable. And I've never seen it in any other industry. I mean, I've been in healthcare my whole career, but it's just the relationships you build through this is pretty important. So leaning on each other is great. And knowing, hey, I know you've had success here in North Carolina. Let me pick your brain a little bit. Most everyone's open to chat and talk about it, which is awesome. So leverage that, leverage a good performer, leverage other partners. But in the end, understand that physician's time is important and an ancillary should be something that the practice is making money on without having the physician to be there. But the physicians have to understand the margins are dropping. And so you have to grow it, otherwise it's just going to continue to shrink. Absolutely. So when we were kind of prepping for this session, Alyssa, you kind of mentioned reimbursement a lot. So I wonder if you could talk a little bit to how reimbursement challenges or payer contract considerations have influenced your offerings that you carry in your practice. A big thing that is always a hot topic on Collaborate is VSCOs and HA injections. That's a huge one. Joseph Matthews has been awesome with coming up with little spreadsheets and things about plugging data in. Because as we know, unfortunately, Medicare, they change their coverage every quarter. So what you made one quarter, you're not going to make the next quarter. And then your cost depends on, is reflected directly to that. So it is having these resources, but talking to each other. We were doing great. I think we all were. We were giving injections left and right and making money. And then all of a sudden you have one or two kind of oops or wastes or something. And now it's like, why am I now in the red? Like what's going on? So then ultimately we decided we're not going to do them anymore. But that wasn't good for our patients. They didn't like that. They didn't want to go someplace else. And so I, you know, sitting there talking with Joseph and one of our industry relations members discovered that we have a relationship with Fideo Pharmacy that we can buy a program through them and get a discount through AAOE. I didn't know anything about it. I had read about it, but I hadn't really utilized it. Sat and I talked and I said, wow, this is great. I can offer something to my staff that I can now get. And I think that that's important that we use the connections as Andrew said, like talk to your colleagues. What are they doing? Maybe you need to relook at your, you know, your GPOs. And are you in the best one for you? Do you need to switch a vendor? And we all build these great contacts, but sometimes you do have to look and get a competitive offer. And then one of the other things I'm going to kind of plug my talk for a conference is I'm doing a talk on negotiation is don't be afraid to ask for a deal. Ask for a discount, ask for something. And that can go with anything that you're buying. So, you know, make sure you're getting the best price that so you can offer the best things because ultimately at the end of the day, if you're going to walk away, is that company going to want you to lose all that money? So. Yeah, absolutely. Andrew, what about you? No, everything there. That was awesome, Melissa. Everything that you shared there, ditto. So I look forward to sitting on that talk actually, because that's one thing that I think we don't always do or we don't always negotiate really well and understand that we all have relationships and friends who are vendors and partners, but you got to negotiate and you got to do what's right for the practice. So. Yeah, absolutely. I'm going to crack the nut. I'm not sure if it's something that we're going to talk about today, but the college address things is something that's, I want to make sure we grab some time on it. I know that's something that a lot of practices are looking at or doing. Some of our practices are, at the end of the day, being careful is important there. I know there's some resources that have been out on Collaborate to make sure that folks understand how they're doing it and doing it appropriately and whatnot. Our physicians are always going to hustle. They're always going to look. I was going to push, I'm based in Kentucky. We have Calipari. Calipari was there for over a decade and he pushed hard and on the recruitment firm, on the recruitment side, same thing on the physician side, they're going to push hard. So I guess just be careful and make sure it's physician or patient appropriate, but leverage the resources, leverage the people that have been doing it for a while. But that's one ancillary that I know is on a hot topic for a lot of folks. Yeah, absolutely. Awesome. So let's move into implementation. We've kind of talked about that next stage. And as you're looking at that, what are the biggest hurdles that you're encountering when you're bringing these new service lines in? And have you been able to navigate through those challenges and would you give any advice? So Ross, I'll start with you on this one. Yeah, I would imagine we all kind of have a similar answer to this. You have to have the physician buy-in, right? Because they're the main source of where a lot of this is going to come from. If you don't have their buy-in, it's going to be dead on arrival. Any kind of implementation of a product, you have to know it in and out so that you can answer any question from the physician as it comes available. And ultimately from the staff as well, they're just as much a part of it if you don't have their buy-in and have the evidence to show that their lives are going to be made easy by it and it's not going to impact them in a negative way. You're going to be failing straight from the beginning. So you have to make sure that you have some sort of champion of a physician or staff member that can really rally the troops and help you to push it to practice as a whole. Yeah, that's great feedback. Alyssa or Andrew, do you have any other tips that you want to provide? Yeah, I think the one thing I'll share, yes, physician buy-in, but don't be afraid to leverage a partner. We're not experts at everything, let's be honest. And so there have been times where our physical therapy side of the house, we brought in a partner to help launch that, to help manage that. It's a very complex ancillary and it's oftentimes outside of the surgery center, the largest ancillary. So make sure you're doing it right, make sure you're leveraging the intelligence out there that's available. And sometimes that means an outside resource. Yeah, that's great. So, you know, Ross, you touched on this a little bit and I'm interested to hear from everybody else too, how you manage, you know, you've got your staff to buy in, how do you go through that, you know, training and then also like reallocating your resources to meet these new service lines you're adding? So maybe Alyssa, do you wanna touch on that first? Sure. So kind of, again, piggybacking on what Andrew said is it's finding that champion and sometimes it's not always the most senior. You got to find the one that's the most excited because, you know, we've found our way of thinking has totally changed and the culture of a practice is so important. And so if you can find someone who's eager and excited and wanting to get there, and that is contagious because if you find the person that might be good, but they're toxic, they're never, that toxicity is what's gonna spread. So find the positive one and work with them. And, you know, I've had some great success with that and, you know, it just, they wanna learn about it. They're excited. They can't wait to use it. So then they talk to their coworkers, their other medical assistants. Hey, have you learned this? This is great. Let's do this. And then the providers get excited because they see the staff's excited. And then the patients are excited because the person is excited about it. It is this great domino effect. And I find that that has been my biggest key to success in doing something is, again, going outside of my traditional old ways of trickling down from the top because that way isn't working anymore. Andrew, do you have thoughts on this one? Nothing more than that. I mean, I think physician champions are always important. So. Awesome. All right, let's get into a little bit of, you know, innovation and technology here before we open it up to Q&A. And I do see someone has their hand raised. We're not using that function right now, but feel free to drop something in the Q&A or the chat. And that way we can make sure we address it. So when you're looking at, you know, innovation, are there any examples of innovative services or technologies that you feel like have really added that significant value to your practice? Ross, would you like to start on this one? Yeah, sure. So, you know, like I mentioned, you want to make sure that, you know, the staff that you have, you're using the technology to, you know, make their lives easier, make it more efficient. So as you continue to grow, you may not need to add on additional staffing, right? You know, we've mentioned it a couple of times, it's using the resources that we have and AOE being a very excellent one of those sources. And, you know, we even have the upcoming vendor days to evaluate that, right? So you can truly look at these sources, these technologies, these vendors, and understand them without the pressure and threat of the vendors themselves trying to sell something to you, you know, directly and hounding you. You know, you have that freedom and capability. So just continue to use your sources and, you know, don't be afraid of anything that's new. Obviously AI is a very hot topic these days and, you know, is going to continue to be for a period of time. But there are a lot of new systems that are coming out that are very exciting. And don't be afraid to take a look at them. Don't be afraid to try and leverage them. But, you know, again, use those that have maybe tried them out to find the right questions to ask, to make sure that you aren't making the same mistakes or, you know, you're following the same paths of success. Absolutely. Yeah, AI is definitely, you know, still in its early stages with folks from what we're hearing at, you know, just in orthopedics. And we're trying to address a lot of that in conference. So I would say if you're looking for resources, I mean, Ross is a great one, but, you know, and collaborate and at conference networking with people about that, you know, it's going to be great so that if you're talking with a vendor, you're starting to understand like what it really means when they say that their service or their product has AI. So go ahead, Andrew. I was going to say the only thing I'll add, because I want to learn more about AI. I mean, I'm using a little bit in work today, but I think if you're not really leaning in and learning more and more, you're probably going to be behind the eight ball. But the one thing I'll share with technology is that it really truly has to be a more efficient, make you more efficient. We know there's natural attrition in our practices at front desk and the phone system. I don't ever want to bring a technology in and then say, hey, sorry, we got to let you go. It's more just, hey, we're going to bring a technology in. And over time, as attrition happens, we might save on some FTEs, but really validate what those partners and the vendors are sharing. Because I think some may commit and may promise too much. So really vet it out, really lean on your colleagues who have partnered with them already, get those references on the phone and then make a decision what's best for your practice. I absolutely think AI is the way to go on a lot of things. It's going to continue to improve. Don't be behind the eight ball, continue and investigate, but just keep folks honest too. Absolutely. So I'm going to pause here to open up to questions. So we have one in our Q&A and we'll go through that. Feel free to drop something in the chat or in the Q&A for our panel. The first one we have here, is anyone utilizing bone health programs in the ortho space or have family practice manage is what the question says. We have had it in some of our practices, hasn't been ridiculously successful, unfortunately. Maybe some folks have had some success with it, but we unfortunately just haven't. We have a really, that clinic I'm talking about has a very heavy joint volume. So you kind of picture that that's the clinic that it would be successful with, but it just wasn't unfortunately, so. Not something that's really been on our radar to be honest, yeah. Same. Okay. All right, so next question we have in here, anyone with AI having issues with HIPAA or compliance concerns? So one of the things that I'll kind of touch on here is there are a lot of sources that vet these products to make sure that they're HIPAA compliant. There are certifications that can be obtained by these AI companies to ensure that they are being HIPAA compliant. So it is regulated and it is monitored. So make sure that you're keeping an eye out for those particular things, something like high trust, sources of that nature that really ensure that the technology is HIPAA compliant. I'll add to that in saying that even if you're just thinking about using AI tools from an administrative standpoint, like ChatGPT, for example, if you wanna have it help you in your marketing efforts or even sometimes I use it to help me like do a first pass at maybe a difficult or an awkward email. And I'm like, I don't even know how to start here, but here's what I want to say and the tone I want to use. But I would really, really highly encourage you to be using the paid versions of tools like that. It's very important to read what each of these tools, you know, if you decide to go ahead and use the free version, whether or not they use your information that you're putting in there to train the AI tool. And if you utilize a paid version, it restricts their use of that. And that's one of those benefits. So obviously, you know, you don't want to be putting patient data into ChatGPT. That's obviously huge. But, you know, just in general, it's just good practice to be really paying attention to those kinds of things as you're starting to dabble in it. But it's a big game changer. I mean, I'm using ChatGPT to help me figure out an Excel formula that I can use to, you know, manipulate my data. So there's a lot of great uses in there, clinical or not, and whether or not it's a vendor. And if you are, you know, interested, we're doing a lot of AI webinars coming up. One coming up in February is using AI for difficult conversations. So if you're doing some people managing, highly recommend you attend that one. And we do have a HIPAA AI session at conference. So if you are going to be coming to conference, definitely check that out. So there's a lot of things that we have coming up on the topic. And I would just encourage you to keep an eye out for what's coming up. I think it's also important to make sure you have kind of a good, like a press release as well. Because how are you going to be sharing this with your patients and your staff? Because people are going to want to know what are you using? Is their data going to be protected? I mean, we're always hearing about data breaches and hacking and, you know, stuff coming out. And so, you know, people are worried about voice recognition and, you know, you walk anywhere and you say something and your phone all of a sudden now shows you an ad. We know all those things. So what is it going to do? Like, do they, you know, if they come into the doctor's office and then they're talking about their, you know, their knee, and then all of a sudden now they get this thing, it's like, wow, that's, do I feel violated? I know there's been, you know, cases that have come up for Google and things like that. So I think it's going to, it's going to be important for us, no matter what we're doing, we're also going to need to have a plan for how we present that to our patients and staff. And what if they disagree, like, what is your, like, what's your next step? Is it going to be that, okay, we spent a lot of money doing this tool and I have a patient now that doesn't want it involved. Do we say no? Do we say yes? Do we say too badly? Like, you know, so I think those are some of the things that we need to start thinking about as we're investing in the technology is there's going to be a different resistance than just your physician buy-in. Yeah, absolutely. That's a great point. No, shut up. Kathy, you know, a lot of really quick, you know, she's developing or has developed this AI plan and protocol for, you know, AAU members to kind of reference and utilize that addresses a lot of these things and how to implement AI into your practice safely and efficiently. Yeah. Yeah, absolutely. She's got a few different sessions coming up webinar wise that are going to be related to, you know, creating AI policies in your practice and your clinic. And we have some coming up even with a lawyer to come in and talk through some of those considerations too. So we're trying to cover a lot of bases here because it is new and to be honest, you know, from a standpoint of federal regulation, they're still catching up to everything. And so the more that you can be aligned and in tune with it and at least know what's going on, the better because it's not going away for sure. So a question in the chat here, has anyone used prescribed fit for remote patient monitoring and lifestyle health coaching? And I'll pose this to the panelists, but if you in the audience are familiar with that, I'm sure that the person who asked would be happy to hear any feedback from anyone. So Andrew, do you have thoughts here? Yeah. Look, I've talked to them. I think depending on the practice, depending on the physicians, there might be a place for that. We have not leaned into it, although I think some of the physicians have contemplated it. Ultimately it goes back to, is there a physician champion wanting to drive that? But the thing I struggle with is I don't want to take away from our physical therapy side of the house. And so appreciate some of the stuff may not, but I haven't seen it be as successful for me to say, let's go ahead and do it. But I'm sure some practices have had a lot of success with it, but probably because they have physicians pushing it. Our experience has been very similar. There hasn't really been a place where we feel like it's useful. I think the beauty of physical therapy and just the patient experience is that hands-on experience, having that one-on-one time with the therapist who can get their hands on and visually see various things. I think there is a specific patient that the prescribed fit formula works for, but it's not going to be a consistent across the board thing. Really is going to be dependent on your practice, your patient population, whether something like that works. And for us, we don't feel like there's enough value to it in comparison to, again, that one-on-one hands-on experience. And I think that to me goes across the board for orthopedics in general, just having that face-to-face conversation. We talk a lot about technology and I'm a big proponent of technology, but we still live in a society where people want that human interaction and that one-to-one conversation and the development of relationships. I think you lose a lot of that relationship factor whenever you, for lack of a better term, farm that out to an outside source. And then obviously there's therapeutic monitoring and patient monitoring. The struggle I have with patient monitoring is when I've heard physicians talk about it, and again, this was just my experience, let me preface this. But it's like, oh, all the patient needs to do is this, and we'll be able to get some money. Are we doing this for patient care? That should be the first focus. Is it helping the patient? And then you can make a determination. It looks like Jackie can speak to this. Jackie, if you do raise hand, I might be able to let you talk. So why don't you try here and we'll see if we can do that. There we go. All right, you should be able to unmute now. There, can you hear me? Yes. Yes. Okay. So we actually, I'm with Mountain Valley Orthopedics. We have eight doctors, four PAs in East Charlesburg, Pennsylvania, four locations. I found PrescribeFit at AAOE in 2022, and we actually have been in contract with them since February of 23. And it has not interfered with physical therapy at all. They actually, most of their business is not so much, the doctors have a hard time pushing it in the office because not everyone's comfortable telling someone, hey, your BMI is over 30. This is what you need to do. But most of the bread and butter is through their fast track program. So the doctors sign a standing order, which actually has changed. But for insurance companies, they sign a standing order in the beginning of the year, which then allows PrescribeFit to reach out to any patients. And we, right now, we're doing Medicare, Medicare replacements, UnitedHealthcare, and Blue Cross. Those are the ones in Pennsylvania that pay. And they actually reach out on our doctor's behalf, letting them know that, hey, Mountain Valley is now participating in this weight loss program. If you've been seen in the office in the last 12 months, you qualify for this program. And then each of our doctors did a little video explaining for each patient, like, hey, you know, hey there, this is Dr. Campanova. We're just recommending this program. This is why Mountain Valley is doing this. This is why we recommend it. And it's more of a weight loss, nutrition, lifestyle program, not so much, hey, I have a knee injury, and I'm going to do these exercises at home, and I have to talk to this care coordinator every Friday. It's more of a life-changing type of program. And on average, we've had about 120 patients in the program consistently. It has taken them off of medications, high blood pressure meds, high cholesterol meds. We've had some tremendous success stories. And it is profitable to the practice. Recent changes, the BMI actually has decreased from 30 now to 25. So any BMI over 25 can get into the program. But yeah, it's been wonderful for us. We're a big advocate for it. If we do have patients in the office that fit the qualifications, and they, you know, we have a knee replacement surgeon as well. So he's a little bit more comfortable saying, hey, I can't do your knee right now with your BMI at 40, but I'd like to, why don't you get into this program, and then let's see how you progress. Very hands-off for the staff, very hands-off for the providers. Once a month, they log into their portal, they check off all their patients, they review all their patients, how much weight they've lost, their progression. They sign off on it, and then PrescribeFit sends us the billing and coding information. And then we just have some data entry to do once a month. And it pays without issues. No authorizations are required. So I would recommend it. Awesome. Thank you so much for jumping in and sharing that feedback. Thank you. All right. So another question we have here, are there any specific procedures that you focus on to create a niche in your market? Our hand docs have been leaning into the minimally invasive carpal tunnel. That's probably a good niche, not necessarily an ancillary, but it's definitely a niche for that specialty. More and more hand procedures are being done outside of the ASC and hospital setting. They can be done in the office. So more and more physicians coming out of their training are going to be looking at that and wanting that. So as you look to recruit hand surgeons in the future, I think more of them are being trained to do it under just local, not in an ASC setting, just in an office setting. So that's probably one niche, and we really leaned in on that, especially in one market. Other thoughts? For us in North Carolina, physical therapy and occupational therapy, we're able to receive outside referrals. So it doesn't necessarily have to come directly from our practice. So one of the things, and I don't know that it's particularly niche, but one of the kind of out of the box things that we try and do is with marketing and particularly with hand therapy, marketing to OBGYN practices and patients with new mother tendinitis and having what we call a thumb school and kind of working through those things in a hand therapy setting just to try and expand to all patients and other service lines. Good idea. One of the things we're exploring, we haven't done it yet, but the use of athletic trainers, again, as physician extenders, there are some practices, especially down South, I know in Atlanta, they have a lot of good programs with that. And I know we've been collaborating with AOE and ATTPS and how to use those. So there is a practice about 20 minutes from us that sports, sports med, non-surgical practice that really does utilize athletic trainers. And so just trying to see if that is something that, again, might be a good fit for us to, you know, again, have just a different group of people coming in and provide something else that may attract a younger market as well to be a little bit more sports-focused. As I mentioned before, we're like more than 50% Medicare kind of population in our practice and we want to change that. So that's one of the things we're looking at. That's great. I would just, you know, share that we did a webinar last June, I believe, on utilizing athletic trainers in your practice. And so if that is something that you're exploring, we do have a resource in the AOE Learning Center that should be free for AOE members if you want to go back and watch something about that. Question here in the chat, anyone in office pain management injections? We have a few in certain areas of the country that, frankly, those physicians make more money than the surgeons. It's pretty remarkable. I think if you leverage some connections across the administrators in AOE, you'll definitely find some that have been extremely successful at it. We don't personally have any in-house, but we do closely align with a group in the area. A lot of bi-directional referrals, especially when it comes to spine. Same. Yeah, I think it's a service line that you have to, when you launch it new, you have to be pretty careful and make sure you do it the right way with the right providers. I think it complements the spine team pretty well. One thing that in certain markets you have to be careful of is, and Ross, this might be your situation, I don't know, but if you have a good spine team and a good relationship with outside entities, if you launch that internally, it might siphon or cut off a lot of the referrals to a pretty lucrative specialty of your practice. So obviously, just be aware of that, but I think it's a great opportunity if you don't have it. You just have to have the right provider, driving the right kind of work. Awesome. All right. I don't see anything else, and we still have a little bit of time, but while we're waiting to see if anything else comes in, I just thought we'd start wrapping up with some lessons learned or advice. So Alyssa, I'll start with you. What advice would you give to practices considering diversifying their service lines in the current climate? Network, do your research, come to conference, talk with the vendors. If you need to find a way to get to conference, join the speed meetings, because that is a great way to meet with several vendors. Join the new demo days that are coming up, because you're going to be talking and you're going to be learning, and the more information you have, the better decisions you can make. But then take it a step further and find people who have used these resources and ask them questions. You don't want to know the good. You want to know the bad. You want to know the really bad. My biggest thing is, what does implementation really look like? Everyone always says, oh, this will take two months. This will take up to six months. My practice, it's always double what they estimate, and there's always double the problems. This will never happen. It always happens. So talk to people about what is it, and then after, once you go live, what is it like to get help? What is it like when your project manager is no longer your advocate, and you need to troubleshoot and you need to go to service, because you're going to need it, and if it's going to take you forever to get something broken or really figure out how to work it, maybe it's not the right product. Ross, what about you? Yeah. Of course, everything that Alyssa just said, but make sure you use your resources. AoE is a great tool for networking, for different tools and templated things. Chances are, if you're trying to look at something, somebody has already implemented it, and you don't have to go at it alone. Just make sure ... I probably speak for both Andrew and Alyssa here, but very willing to answer any questions that you may have, and always available as a resource. But yeah, absolutely. Just use your resources. And again, AoE is just very abundant with resource. Andrew, any other thoughts you want to share here? All the things that they shared, the only thing I'll also add is go slow to go fast. It's a slide I have in every strategy meeting, and Alyssa, kind of going to your point, sometimes implementation takes a little longer than expected. Understand that. Don't rush into things. Go slow to go fast. And also understand that when you launch things in healthcare, healthcare growth, healthcare, and it's not like an overnight, you're going to see a huge benefit. So you launch a new service line, launch a new ancillary, it may take some time, and then the physicians get frustrated. So a lot of, a lot goes into that, but yeah, go slow to go fast. Awesome. Okay. I'm not seeing anything else coming in. So I just want to take a second to thank Andrew, Alyssa, and Ross for joining us and providing perspective. And thank you to the audience for putting forward some really great questions and discussion points for us so that we could cover a lot of ground today. And yeah, just really appreciate everyone's time and sharing your thoughts here. And I'll give it back over to Katie to wrap us up. Awesome. Thanks, Jessica. And again, just what Jessica said, thank you to our speakers, Andrew, Alyssa, and Ross. You guys did amazing. So much information that is valuable to our audience. I hope you guys all have a great day and hope to see you at our next webinar. Thank you. Bye.

orthopedic practices

service expansion

patient needs

financial planning

technology innovation

AI trends

remote monitoring

networking

strategic planning