Hi everyone, and thank you for joining us for the strategic planning for orthopedic practices, building a roadmap for success. A few housekeeping notes for us before we get started. All attendees are in listen-only mode. We will be using the Q&A function today to gather questions for our speakers and at the end of our presentation when Alejandro is answering questions, we are also going to be using the raise hand function. Please submit questions throughout our presentation in the chat box so we can interact with other attendees by posting comments. When using the chat function, just be sure to select all panelists and attendees from the drop-down menu before submitting your chat so everyone can see it. This webinar is being recorded and will be available in the AAOE Learning Center. Please know that we will be sending all registrants their webinar recording and PowerPoint slides via email in the next few days. The association wants to encourage participation and collaboration while maintaining everyone's right to privacy. With this in mind, we do not allow 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 these events are not to be captured by AI bots. Association staff will remove them from meetings. Our speaker today is Alejandro Fernandez, the CEO of Synergy Orthopedics. I will now turn it over to Alejandro to get us started. Welcome, Alejandro. Good morning. Good morning to me because I'm in California. It's 9 a.m. my time. So for some of you, it's probably you're getting lunch. It's noon or somewhere in between. So today we're going to talk a little bit about strategic planning for orthopedic practices and particularly just building the roadmap for the actual strategic plan. We'll discuss the actual essentials of what it takes to get an orthopedic practice set up to do a strategic planning. Actually, in my case, I just did mine two weekends ago, the beginning of the year. So by the end of the year, trying to finish the end of the year and then immediately getting ready with a collecting information as well as getting prepared for a presentation with our board and some other physicians and other executives within our group. A little bit about myself, I've been in physician practice management for 30 years and Synergy Orthopedics Specialist is in San Diego, California, where 25 physicians, about 45 all-in providers including physical therapy, PAs, radiologists, anesthesia, CRNAs. And we have about 10 sites with 5OR, ASC, and we also have a magnet, we have an MRI. I've been in orthopedics for four years and I'm very happy to be involved with AOE. So I look forward to helping all you guys in whatever way I can. So again, going back to what we're going to be talking about today. So strategic planning particularly, it's essential for the growth and sustainability of the orthopedic practice. In my case, I look at it as just a way to get a roadmap, develop a roadmap or a game plan for the next year. A lot of practices, a lot of businesses do this towards the end of the year in order to prepare for the following year, but I tend to feel that doing this at the beginning of the year just sets the right tone for 2025 because it's really not about budgeting, it's more about trying to get a pulse of the practice and understand where the physicians are at and what they're thinking. We'll try to guide you in developing a comprehensive plan, some actionable strategic items, and talking about some of the best practices that are used to run a good strategic planning meeting, both to prepare prior to and to actually have the meeting. We'll also explore incorporating physicians' insights, setting measurable goals, and leveraging technology and streamlining planning and execution. A lot of that will come through just basic information that I'll give you in regards to the actual tools. And then we'll also highlight the importance of clear communication plans to ensure everybody in the team understands what their role is to be achieved in a particular strategic plan. I think, again, the most important thing we're going to talk about is why do this, why is this important? And more importantly, I think that it's very important that we get the physicians' feedback from the ones that are participating in the meeting and the staff that's in the meeting. But I tend to do a little bit of pre-work or get some homework done prior to coming to the meeting by asking the physicians to, you know, some of the things that I'm going to talk about, like what is a SWOT, I'll go ahead and ask the physicians and managers. We have a large group with 10 sites, so I have 10 middle managers, office managers for every site, as well as PT, as well as MR. So we ask all the different managers, feedback, we ask the physicians whether they're employed physicians or people that just started out of fellowship a year ago, or they're partners that have been with the practice for 30 years that are not on the board. We ask everybody to provide feedback. And I think that's extremely important because it kind of sets a foundation, at least for me, to know how to navigate the meeting and come with already some KPIs or tools that I'm going to discuss in the meeting. But for you guys, I think that the best thing is just to get started. I really kind of went over the learning objectives, but again, gain a solid understanding of strategic planning of the orthopedic practice, learn the techniques to set and track measurable goals, and explore ways to optimize planning through technology and communication. So- Alejandro, before you go on, your presentation isn't being shared, and some of our listeners are having a hard time hearing you. So if you could speak up, that would be amazing. Is this better? Can you hear me better now? A little bit louder, maybe. Okay, a little bit louder. That's perfect. And then I had to steal the screen share when I was showing my slides. So we're going to have to pop yours back up. Okay, let me know. Yes, we see your screen now, and whenever you're in presentation mode, beautiful. Thank you so much, Alejandro. Okay. Only problems I can't, there you go. I'm not sure that I can, when I'm in presentation mode, I can move, there you go, okay. So this is the first thing I was talking about, learning objectives, like I mentioned, and then the strategy planning framework. So we do have a question we'd like to ask the group, and the first question is, does your practice currently have a strategic planning meeting on an annual basis? Forty-one participants responded, so we'll wait for everybody to respond. We're getting a lot of answers in. So far, the majority is, yes, they have a strategic planning meeting on an annual basis, is the majority of our attendees. Yeah. Okay, excellent. Well, correct. I'm going to move the poll down, so thank you for that. So I think, you know, again, as a framework, you guys see the pop-up, correct? Yes. Okay. I'm going to stop sharing. I got it. Okay. So we'll do that. So within that, I mean, when you're having this strategic meeting, what's really important is you have a lot of different people within their group that are diverse, and you talk about a lot of different processes, but the most important thing here in this meeting, for the physicians, typically, is, oh, I want to lower my costs, I want to make more money, you know, those are probably the most important things for them, but I always start out the meeting with just rechecking our mission and vision, making sure that as an organization, we know who we are and where we're heading, and if we don't have one, you know, when I came on board, I came on board to a group four years ago, we had one, but it was very elaborate, and at the same time, I don't know that it really said who we were, and I took probably the first meeting to use that mission and vision and just kind of work it through with the group and make sure that we came up with one or tweaked it, we tweaked the mission and vision to elaborate and say, is this who we really are, is this what we're doing and where we're going? The next part is developing a systemic process and understanding all the different factors around operations, strategies, performance, all the different stakeholders in the practice, your practice is of one or two doctors, stakeholders, again, it's basic, it's the patients, it's the staff, it's the physicians, and then the community overall. As the group gets larger, you might be tied in with health systems, there might be other partners in your ASC, et cetera, that might be important, but making sure you understand all the different influences that are both external and internal that can develop, put pressures on the business. The next thing that we're going to do in the strategic planning is set up some goals, and that comes from, again, feedback that was generated by physicians that attended the meeting and managers that attended the meeting or not, and the ones that are there, and then go through the whole process and get everybody's feedback and discuss it, and then develop some goals for the following year and some goals that might be for two, three, four, five years. Within that, you have to develop a process to basically develop the process, come up with a very specific plan, very specific SMART goals, and then implement that plan and then develop a monitoring or evaluation process of the plan, making sure on a monthly, quarterly, or annual basis, you're making sure you're hitting all your markers. Let's see. I'm going to make sure I can't get a page down. Let me, there you go. Within that, these are some of the tools that I use, the SWOT analysis that talks about strength, weaknesses, opportunities, and threats, a balanced scorecard. We use that with myself, with the managers, with directors, with therapists, with PAs, and we tied in the scorecards. Our balanced scorecards are tied into actual bonus and compensation programs. Instead of just giving people an annual bonus that's tied into a percentage of whatever, it includes other KPIs, other things that are involved. The PEST analysis, I'll go into that, Porter's Five Forces, scenario planning, strategic planning, software, and other key areas to focus on in regards to implementing as well. SWOT analysis, strength, weaknesses, opportunities, and threats. We have another poll question here. You need me to turn up the mic higher? You can barely hear me. Yes, please. Just a little bit louder. It's funny when we were talking earlier, but I didn't see. I mean, I'll talk louder. Yeah, that's perfect. Just talk louder. Yeah. I'll do my best. Sorry about that. So we'll talk a little bit about the SWOT analysis and look at, number one, have you practiced that SWOT analysis? And number two, have you answered yes? Did you find it helpful or not? Okay. We have the majority so far is yes. And out of those yeses, most of them have found it helpful, but we'll give another minute or so on the poll before we share the results. Correct. Thank you for that. Of course. Okay I'm gonna end it and share the results with you. Okay well thank thank you for everybody for providing feedback. It seems like I got most the answers yes but some haven't and but we'll talk a little bit about why why this is important. So the first one it's a very very basic uh program. You write down what the strengths, weaknesses, opportunities, and threats are and in our group you know we always talk about the strengths being we just have this we just did this for our organization. So we talk about the strength of the organization from a reputation perspective, our brand, the fact that we're affiliated with sports teams, the expertise of the physicians, the physical therapists, the group overall, the fact that we're integrated delivery system where we have the practice and we have pain management, sports, and also imaging, MRI, and and also the ASC but also anesthesia and be able to provide all the kind of like a vertically integrated program around MSK work. Around the weaknesses particularly for us as a group we're always looking at the high cost of providing care, staffing, rent costs. We're in San Diego which is one of the most expensive cities in the country to live in and just to operate in regards to the cost of staff and then all the different things that have to do with a just reaching out to new businesses, the payers, the hospitals, etc. and us being able to do. If I tend to think in our group strength is a huge list, weakness is actually a short list for us. Opportunities ends up being again a huge list because we're always figuring out ways that we are trying to grow the organization opportunities around like for example our anesthesia division and our new ASC came out a couple of years ago out of the fact of saying hey we want to build an ambulatory surgical center that's owned by the practice not owned individually by the individuals that allowing younger physicians to be able to own but when they become partners of the practice. With that when we went out and searched for an anesthesia provider we found out there was a shortage of anesthesia providers and they were actually asking us for stipends to provide anesthesia and doing some research we figured out as a medical group that we had rates anesthesia rates in our contracts and therefore we were able to bring in anesthesia into the practice and IE are providing those services in the ASC. Something new we actually started third quarter at the end of third quarter of last year and so far so good everybody's very happy with that. Threats that all the different threats that exist today in our in our group particularly around changes in regulation or competition or reimbursement pressures or again expenses we tend to think this list is extensive but we tend to not focus so much on it we tend to focus again on on our strength and particularly the biggest part like I mentioned is the opportunities. Can you guys hear me I want to make sure that you know that as I continue the the speech is better. Any feedback put it in the chat if you wish. Okay I'm going to assume everything's good so I'm going to keep on going. Okay the balanced scorecard so like I mentioned the balanced scorecard we use not only for our our practice overall and where we're measuring our financial performance, patient satisfaction, other internal processes or operational things that we're trying to achieve and then other areas where we're trying to learn or grow or improve the the organization. We develop the scorecard and everybody does it differently but particularly for my directors or where let's say for revenue cycle management some of the information around financial performance would be KPIs around average days in AR or net collection ratios or a particular budget number that we said that we want to collect every month or want to achieve to. On patient satisfaction whether we're using patient reported outcomes data or we're using like a press gaining or some type of a software that allows you to get surveys out to the patient like SurveyMonkey and other people use other different types of programs but just basically figuring out and saying are we doing better and for let's say for revenue cycle management that that performance has to do with measures that we do after every phone call where we ask the patients was your number one were you satisfied with the the outcome of your call and number two would you recommend us it's very important people particularly patients tend to always feel negatively about the billing process because as we know not enough information might come through at the beginning of the process and then when they get the final bills they're always complaining because they didn't know exactly what's going. Okay so it's it says mic is low as long as there's no other noise around I can hear sorry about that again I actually tried increasing the mic several times so sorry about that let me see I'll continue trying to speak louder around the pest analysis this has a lot to do with just the outcomes or things that are going on in our organization outside of our control primarily the first one being political health care policies insurance regulations for example recently the medicare decrease that that we got that got enacted and but at the last minute was supposed to get fixed and then for again political reasons it did not it did not get fixed and we ended up getting a two percent two plus percent cut for medicare other economic factors or things that you have to think about or and then track are you know just in general spending trends things that are going on in the economy in our case one that I think about is is the the fact that in our local market the state of california required health care providers with 25 physicians or higher to pay a minimum wage of $21 an hour where the regular minimum wage in california is somewhere around $16 an hour that was a huge increase in in cost to the organization and we had to figure out ways to to develop and and manage through that that was both economic and political social just the fact that we we have an aging population we have lifestyle lifestyle lifestyle changes people are are aging longer but they're more active they're they're living throughout the their lifestyles and then different markets are react differently for example I'll practice medicine I grew up in Miami Florida and orthopedic in Florida is very distinct than orthopedics in in Southern California where people hike and they're just outdoorsy there's a lot of stuff going on all the time where I tend to think in Florida is more like that the typical medicare uh aging population which are not as active even though many are but there's not as active etc so different markets will provide different analysis and it's again something you have to think about it and keep track of technological advances in orthopedic and treatment and diagnosis whether again it's the use of AI in your note-taking or different other advancements in orthopedic services doesn't necessarily have to be a new implant that got came up or or a new drug but for example uh the osemic the lgb1 uh we know that that's making a change in orthopedic care uh particularly in in in hip um hip and joints uh surgeries whether people are losing weight faster and they're able to get their surgeries or in some cases they're they're losing weight and it's they're allowing for other things to um in the body to to change and therefore um not necessarily going for that surgery right away we're looking at developing a whole program of hip preservations instead of just hip uh replacements um so the part the port of five forces and this is not harry potter and you know and all the different things harry potter does so um i wrote some things which i thought were were cute so i looked it up and it was like uh the five forces of parter and the first thing i came up with was a spectral patron or cofundo obviate or avada kedumbra you know all these different things that all the different magics that harry potter does but no this is not it this is around the idea that if you're starting uh a new business and there's threats to there's threats to entry into a business for example when we started anesthesia we had to develop a business model um and try to figure out what was going to take for us to start a new business and and develop a whole business plan but it require you know and these threats include just recruiting the physicians or recruiting the crnas getting a budget and funds to be able to start this new business line that it's not going to make money for maybe six months or maybe a year um the bargaining of power of suppliers your suppliers continue to grow they acquire each other um you know mckesson grows uh henry shine grows and so on all these different suppliers and they're always you know buying different divisions out etc you have to make sure you you you um are able to come up with ways to uh not only understand what's going on but how they increase the pricing and how that's uh going to affect you and do you have a group purchasing organization that can help you uh provide uh a solution to that um it then the next thing is the bargaining power of of buyers um patients insurance companies continue changing the way that they develop their plans and they're they're coming at you with their their force and saying i'm only going to pay you medicare rates or i'm going to pay you below medicare rates or i'm going to pay you higher than medicare rates and you're trying to negotiate that and you kind of have to understand the the power of that for some groups they have the opportunities to go directly to large employers and provide an alternative uh to that to that those forces um and then the threat of of substance services whether it's and i think in orthopedic i don't i don't know that i can think of something that's going to replace the orthopedic surgeon orthopedic surgery uh but for sure there's uh might be threats from other the hospitals bringing in other orthopedic surgeons into into the community or bringing our internal medicine and primary care groups hiring orthopedic surgeons to take on services for example in our community we took care of a hospital and we took a significant amount of the call in the hospital and it was somewhat profitable they paid us well and the hospital decided to go ahead and do work with an outside group a national organization and they use local intents to um submit or provide those services basically affecting us our revenue of the physicians in the group and and not being able to provide uh services there so in addition to that the last one's rivalry among uh existing competitors again just looking at other groups that might be competitors to you that might be merging and they might form larger groups that might be something that will affect your your organization so again these are just things that you have to think about and kind of look at your your plan so given the the rapidly changing healthcare landscape scenario planning can be valuable for orthopedic groups and to prepare for various future possibilities so just again think about all the different alternatives and things that that can affect the last one is around strategic planning softwares so this could be you might come up with a meeting that you end up with like six very specific things you're going to try to achieve in the next years or in some cases i've had meetings or when we walked out we had literally like a hundred items and we those hundred items we have to like figure out ways to not only track them but um group them and assign the grouping of the different items to different different people within the organization or different or the organization overall understanding the different items so um i in our case we use excel not something very complicated we use excel and we develop scorecards so we we look at everybody's scorecards on a quarterly basis and grab all that information back there is some software like clearpoint and there's when i looked this up there's probably around 15 different other softwares but again you you have to figure out what's best for you and and your organization depending on your size and your budget um i put down seven areas particularly that um that i work on that i think are important but i want to hear your your thoughts and for you guys to say what are the three most important key focus areas for your practice in the next year We're starting to get some answers in. It looks like the two highest ones right now are patient experience and operational efficiency. I'm going to give about 15 more seconds to get your feedback in. Okay. So again, the highest ones on the poll are patient experience and operational efficiency. Our third highest is market expansion. Technology integration and talent management are tied and then regulatory compliance is has the least amount of votes. That's excellent. Thanks for everybody's feedback. So with that said, a good going over technology and integration, looking at your EHR, and whether you do telemedicines where you could I AI, I think the biggest thing that I've looked at in our systems is trying to have a program that has as much as possible within the within the program. Not necessarily trying to figure out what's best of breed for all this and then trying to integrate all these different programs. From the the other one, operational efficiency and streamlining processes, cost management, etc. I think that's probably one of the most important ones, as you guys stated, because we're all looking to try to reduce costs trying to figure out to provide a better experience to the patient, an optimal experience for the patient, trying to figure out how to lower cost, etc. The patient experience overall improving patient satisfaction and outcomes is extremely important, just because if we're not taking care of our patients, not just from a clinical perspective, but they don't feel that they come to an office that looks good, that smells good, that feels good, and people are professional, and they they seem to care for me as a patient, probably not gonna come back and for sure not refer my friends and family. From the recruiting perspective, you know, again, recruiting and retaining top orthopedic talent seems to be hard and harder than ever. And in our case, in the four years I've been here, I've had several doctors leave come back, leave to go to other states, particularly in our case, like I mentioned, costs, operational costs are high, but more importantly, I what we're what I lose a lot of is just our regular staff in our offices, I'm losing them on a regular basis to hospital systems that are paying more, or people that are just moving out of state because they feel that Southern California is very expensive to live and they want to live somewhere where they can afford to have a decent lifestyle. Market expansion is important to us, but I'll skip on that. I'll talk a little bit later about that. And aligning the value based care and the regular compliance, as we mentioned, are important things. But as a group, those are always things that we're trying to achieve. Regulatory compliance, just, you know, it's never ending. And there's a lot of different ways that we have to make sure that we stay on top of it. But I think market expansion continues to be probably for me, one of the most important things as a group, we're always looking at more physicians, we're always looking to add new areas. For example, last year, we expanded one of our physical therapy locations, kept that in the same area, but literally double the footprint of the space. And also therapists, we're looking again to try to generate more revenue and become a little bit more, you know, efficient around the operations and expenses. We're looking to we added three new surgeons, we have sports, spine and joints, this year, get something that we wanted to add in, you know, because we felt there was a need in our community and in our practice. But in addition to that, because of the what we're doing with anesthesia, we added anesthesiologists, CRNAs, we're hiring our third anesthesia provider. And in regards to more expansion, we're looking at adding new offices in other parts of the counties where there were where we don't have a footprint. In addition to the fact that we're looking to add physical therapy in areas of the county that we're not providing care, but we feel that there's a lot of patients in our practice travel to see our doctors that one time or two times for the surgery and post-op. But when it comes to physical therapy, we lose them because we're not near their their location. So we're opening new locations to service that need, but also to generate more revenue. And again, figure out ways to lower our operating costs. Okay. Any, any questions? Any other thoughts around that? So implementation tips, again, number one, involve all the key stakeholders in the planning process. And sometimes we think of key stakeholders as the physicians, but I would say, include physical therapists, the x-ray tech, the, you know, care coordinator or scheduler. Our staff is they're in the in the, you know, in the trenches learning and doing what we what they need to do to provide great care. And sometimes the people that come up with the best ideas, so make sure you you provide a lot of get a lot of feedback prior to to getting there to the meeting, set measurable and goals with our objective, like I said, smart goals. I think it's extremely important that once you come out of this meeting, there's very specific information that you gather, but also that the goals that you set up are clear and measurable, and they're assigned to somebody and in or teams, and that we had developed some timelines on when and how we're going to get those things achieved. A lot of times we also forget about budget, we want to make sure some of these things that we want to achieve might require an investment. So making sure we also include that cash or that budget in order to spend on on a particular objective or project that we want to achieve in the year in the next year or so. And then finally, review this plan on a regular basis, we review it quarterly, we review it quarterly by tasks of the individuals that are assigned those tasks. And we also review quarterly as a group, just to make sure that we do at a board level, make sure that we're we're on task. And again, communicate the strategy effectively throughout the organization is very important that people feel that they know what they do is important and how it affects the the organization. So making sure you communicate that information to everybody in the organization is extremely important. Well, hopefully by incorporating these tools and focusing on these key areas, you'll have a very successful strategic planning meeting and you'll be able to negotiate or navigate the challenges of of your practice and particularly in this health healthcare sector. Thank you very much. You have my email there if you have any questions, and sorry for for some of you that had issues with the with the voice with the mic, but I'm available. Again, if there's any questions, we could try to address those now you put them in the chat. Yeah, we do have one question from Andrew. He said that you may have answered this already, but how long are your typical strategy meetings? Um, there we I feel that they should be about four hours. We start at eight in the morning, usually go to a venue that's different than any of our practices. We usually go to like a hotel, hotel, ballroom or room, typically sits are we usually have around 14 people, and includes myself and my executive team, which is our four directors. And then in addition to that, there's the the board members, which have six board members, typically three to four more doctors that are not part of the board, some that are senior, some that are younger, we try to make sure we involve the younger ones at the beginning of the of the meetings, especially early on, so they start understanding what the business is like, and all the different moving parts that we're creating. So from eight to 12, and then we stop at 12, we usually have a 10 minute break in the middle, but by 12, we have lunch. And then what happens is right after lunch, we're supposed to go for another two, two and a half hours. But I will tell you people start dropping off people leave right after lunch, or they're just the engagement is not as much. So what I try to do, we do a lot of the homework or a lot of the work in the first four hours. And we already have narrowed down some of the areas. So then what ends up happening the next two hours after lunch are more of a debate on which items are more important, which ones are less, I've had it where I've had a day and a half, and I think it's too long. So I think a a eight hour seven hour day works well. Starting early in the morning, because you know, surgeons don't mind getting up in the morning and starting early, and then finishing around somewhere around two or three o'clock. And I always try to keep them on task is probably the the most important thing we do, because everybody just likes to voice their opinion at these meetings and provide a lot of feedback, which is positive, but you want to make sure you're on task, you stay on task. Okay, we have a couple more questions that's popped up. Summer said, Do you have any comments that you can share on facilitation techniques that you found most effective for the strategic meetings? Yeah, so if you, if you can afford it, or the board will provide a budget for you, I would tell you having a facilitator is extremely important. I mean, having somebody that spends probably an outside consultant that spends a couple days gathering some information, and goes into the meeting and provides all this. And that's what I just did at the meeting and goes through the process, and then provide and helps the meeting, go and stay on task is extremely important. Otherwise, like I mentioned, the the biggest thing is just keeping thing people on task have a very specific agenda. And then if you're going to go through some of these tools, and ask questions, of course, they're not going to be set up in the way that I showed them, but ask them as questions, be able to make sure that you collect this information. And it's important. I usually, myself, I take some notes, but I also have a director of operation that takes notes during these meetings. And we want to make sure we collect as much information, because people sometimes say tidbits, like I would, sometimes a physician will say something that really is not really was not intended for the meeting, it was not something that that was that you expected to come out of the meeting, but just just gets blurred out. And it becomes like this golden nugget that you hold on to. So you want to make sure you write down all these golden nuggets as you're you're going through the meeting. So having somebody else there that's taking notes is extremely important. Okay, we have another question from an attendee. They asked, how do you determine what of the strategic plan is shared with the full staff? And then once you answer that, I have a part two to that question. Yeah, so we what we do is we share, we come up with a whole plan. And we dice up the plan in different areas. And what's important is that, for example, the, the staff doesn't necessarily need to know how much revenue generated, how much more you want to generate, if that might be an objective, what I try to do is, there's, there's generic statements that we can do in regards to particularly narrow on the finance, but it's more around operational objectives around customer service objectives, things that really that they can affect. And we we go there, there might be some that are around improving the way that we collect information in the front desk that we've been having, let's say, an issue with collecting information in front of us, and that's hurting our denial rate with claims, we might share that one. But it's probably more of a one pager, PDF type or flyer type thing that gets shared on emails, and the managers talk about them with their their staff in huddles or, or throughout the practice, some practices, like literally put them up and other ones. And I say practice, because we'll have one big practice with multiple sites, some sites, put them up and share them do a better job at sharing that than others. But I think overall, people understand, I feel like sometimes what happens over time is just, we forget, we get into the grind of what we're doing. And we forget. So it's very important that we go on a quarterly basis and touch to see how we're doing on these things and re communicate. Awesome. And then the second part to that question was, how do you get that information out effectively to your full staff? Yeah, I would say email. I mean, we have 200 people in our organization. So email is the easiest way. That's how we communicate a lot of information. And sometimes it's hard because not everybody is looking at our the corporate email, they're looking at their personal emails in some cases. But we'll make sure we do that. And we share it that way. Like I said, some managers will print out the actual information and put it in the kitchen or lounge or in an area where they can see it. So they can remember that information as well as managers will go one on one whether they're having one on one discussions with staff or with in general with like some of them do a weekly or monthly huddle with all that with their staff. They'll share that information there as well. Awesome. Not a question but a comment on Anthony said, thanks for your presentation. Many of the concepts or all are applicable to all specialty practices. As independent practices are faced with some of the same challenges. Yes, I agree. Most of these things are actually applicable to all businesses. But I do agree that particularly we're going right now, orthopedic practices or just, you know, healthcare in general is going through a lot of pressures. People always talk to me about, you know, the rising costs of healthcare. And I said, Well, it might be the premiums are going higher, but we're not necessarily getting increases. And on the other hand, we're getting pressures from, you know, higher wages, higher rent, higher supplies, and I the physician income or earnings to the business are going down and shrinking. And it's in some cases for some physicians can be extremely demoralizing where they don't just see that they see their pay go down and not go up and they have to work harder and harder to try to get there. And that includes getting more staff and going through a process. So I really appreciate everybody's feedback and participation. Thanks. Awesome. Well, it doesn't look like we have any more questions in the chat or in the q&a section. So I want to get a move to conclude our webinar today. Thank you so much, Alejandra for hosting this wonderful presentation. And thank you to all our attendees for joining us. I hope you really enjoyed and again, this will be sent out within the next couple days to your email, and it will be in our learning center. Have a great day, everyone. Thank you. Thank you.

strategic planning

orthopedic practices

SWOT analysis

technology integration

stakeholder involvement

healthcare landscape

patient satisfaction

market reach