How Can Orthopedic Practices Improve Patient Access?

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0:00 In MedTech, the difference between a good quarter and a great one isn't always the product. It's the friction standing in the way. Broken sales cycles, misaligned teams, deals that stall at the finish line. Every leader feels it, and the best ones know how to remove it. Welcome to Zero Friction, the podcast where we go inside the minds of MedTech's top commercial leaders to uncover the real barriers they face, the decisions they make, and the systems they build to keep the revenue moving. I'm your host, Terry Coutsolioutsos. Let's remove some friction.

Well, welcome folks to the Zero Friction Podcast. I have a really exciting guest today, Dr. Jason Jones, who is a board-certified orthopedic surgeon. He's been doing um knees and shoulders for more than 13 years right now, and he is uh heading up a practice in Nashville, Tennessee, and we're excited to have him. So, Jason, if you could just give us a little background on yourself as a specialist as well as some background on your practice. Well, thanks for having me, Terry. I am an orthopedic surgeon by training. What that means is I I did my 4 years of medical school, and then I matched into an orthopedic residency. Uh I did my orthopedic residency on Long Island in New York. I spent 5 years learning the basics of orthopedics at that point. That's everything from foot and ankle to neck surgery to trauma, which was really actually high volume in Long Island, unfortunately. And then, after finishing my residency, I went to uh the city. I was there for about 2 years. There I specialized first with

Sports medicine. So, I spent a lot of time working with teams all the way from high school teams to the professional level. I spent uh a little bit more than 2 years doing that. And then, I did my last fellowship, uh which is kind of a focused learning on a certain body part or certain specialty or certain technique. And that last portion was done in Nice, France, where I just studied shoulder surgery. And that was about a 4-month process. Following that, I immediately turned around and went back close to home to Nashville, Tennessee, which is where my wife's from, and it was I grew up in small-town Tennessee, but it was always kind of written, you know, in the stars that we'd be in Nashville. We kind of I knew that from the day that I met my wife.

And we went back to Nashville, Tennessee, and we've been there ever since. I quickly after going back, I joined a small private practice, and by small, I really do mean small. It was me and one other physician. And we've grown from a patient volume quite a bit since then, but from a provider standpoint, we haven't grown overly the abundantly in those 13 years. That's great. Well, Nashville's a huge healthcare town. I think one of the largest hospital corporations in America is based out of Nashville with HCA.

2:42 Um it's a great healthcare town, and so tell me a little bit about the practice and like how your practice has evolved over the last 10 to 15 years with healthcare changes and patients and all that type of thing. Medicine's evolving quickly in a lot of different ways, so I I I can't, you know, just sum it up with one specific example, but the practice has evolved from a services offered standpoint, from a what patient expectation standpoint, and the way medicine's delivered. All that's changed significantly over the last 13 years. What's What's also changed is the economics of medicine, which are constantly evolving really at kind of at warp speed right now.

It's crazy, you know, um and I hear that quite a bit from all kinds of healthcare practices that, you know, the volume is is getting massive, and the expectations of the patients are changing. Um you know, the economics in healthcare, you know, are probably really challenging in terms of trying to run a practice with higher volumes with with the the capacity to to meet patient expectations around experiences. What are you finding are the biggest challenges, or where are the biggest sort of hurdles for you as a practice today and what do you what what are some of the things that you're trying to modify and transform around?

So our our number one goal or number one obstacle that we're trying to overcome is just providing the best patient care possible and that has been true from day one. That'll be true until the day I retire and that's just something we always keep in focus within the practice because if we're not doing the best job we can do then we're doing something wrong and we need to we need to be better. Now what that means is changing. It's changed over the last two years, over the last five years, over the last 10 years. The biggest problem we have with patient delivering the best quality and service to the patient is accessibility right now. The patient volume, you kind of referenced this a second ago, is as high as it's ever been. We have more patients than we've ever had for better or for worse. The model actually encourages more patient visits so that the current reimbursement model in medicine you're rewarded for the more patients that you

See. From a provider's standpoint, I only have a set amount of of time during the day so if I have, you know, 40 units of time to give but I'm being asked to see 50 patients, there's there's a number of crunch there and trying to figure out how to make that work is has been like a tricky aspect of medicine especially in the private sector. Some of the hospital based physicians are able to overcome that because there is a built-in safety net by the hospital for either collections or reimbursement.

5:23 They have a large extremely large staff and, you know, a a big business arm behind them. There's a big access to ancillary and potentially they're rewarded for uh introducing patients into their ancillary service but for a small private practice providing access for a growing number of patients has been a challenge. Yeah. You know, I know like probably 10 years ago there was a big move in health care where hospitals were purchasing private practice groups and I know that when you and I discussed earlier that you know, there's kind of a shift back to you know, going back into the private practice arena, but like you know, how do you accommodate like are you using new technology? Are you phasing in different levels of service in terms of like a mid-level nurse practitioner or PAs or how are you accommodating the higher volumes of your patients because care is number one and I love that you say that because um the quality of care is what we're all here about whether you're on the the giving end or the receiving

End. And I'm just curious how you and your practice are sort of evolving to maintain that level of care even though there's friction and or inertia coming from you in multiple angles. Well, the two things you just mentioned are two resources we've utilized already. Being mid-levels, which is the is the oldest solution for this problem. Mid-levels being physician assistants and nurse practitioners. The I I've been blessed to have excellent mid-levels my entire career. Currently have two fantastic mid-levels that really do streamline the process for me. And what we are able to utilize them to do is is to see kind of standardized patient visits. Uh patient visits that are they're they're trained to do and that they can do without my direct oversight and that encompasses maybe 40% of our patient visits. They're either long-term follow-up visits sometimes just a post-surgical consultation. So, patients that have already undergone their primary treatment and it's just more of they're still in that follow-up window.

Um And that that works. It's not always ideal, but for you know, the given parameters around having a private practice in this medical economy, that that is a solution that a lot of practices incorporate. Uh there is some oversight needed. You have to make sure that your mid-levels are well trained, that they understand sometimes some more of the nuances of your specific specialty, cuz they have to be aware at all times that nothing's being missed. But, as long as the mid-levels are well trained, they're good with people, like that that model helps and's almost necessary in a lot of specialties, especially surgical specialties. The other thing you mentioned was technology. That's a more recent implementation for us, but we've incorporated ambient dictation, which has saved me 45 minutes to an hour a day. It's saved my entire team the same amount of time. So, over the course of a week, I think, you know, me and my two primary mid-levels, we've gotten probably 6 hours back, Which is great.

8:26 Unbelievably valuable. The electronic medical records, which is that's that's been kind of a standard in medical practices for a while. We've just recently kind of incorporated that into our billing system, into our our note-taking system. So, the accessibility for the other parties that we have to work with, being, you know, billing, insurance carriers, sometime third parties that, you know, patients need to transfer medical records to, all that has become much more streamlined, as well, which is also probably saved us, you know, an hour to 2 hours a week.

Well, good. I mean, you're able to clip an hour here and a clip an hour there. Mhm. So, is has AI entered your practice yet in terms of, you know, low impact, maybe it's just informing, educating, um, you know, things that are easy questions to answer. Is is AI played a role yet or are you just looking for the future on on how AI can enter into your practice from a healthcare perspective? Well, both. AI is is very prominent in healthcare now on both sides and and by I'm splitting sides by saying that, but on the, you know, insurance reimbursement side, AI is very much already been implemented to review provider notes, to check for uh to check for uh you know insurance validity, to follow up on surgical necessity, things like that. They can they now kind of scan these provider notes to make quick judgments on that. And then from our standpoint, we standardize a lot of the things that we are able to do. Most importantly, what I mentioned earlier

Was ambient dictation, which essentially is that there's a recording and process. So, all the entire interaction between myself and patient is recorded. And then that's distilled down into a medical note, which is is the most useful uh product of AI that I've experienced yet as a healthcare provider. I also use AI to do some quick just data search. For a lot of times that's like like codes, cuz there's a lot of medical coding that insurance companies require. I mean, there's, you know, tens of thousands of codes, and it's it's it's impossible for any provider to know even 50% of the codes that they use on a routine basis. So, quick code searches with AI is is is very helpful. It's crazy, cuz the whole medical reimbursements, I mean, there are specialists that you know, it's created a whole occupation for medical reimbursement specialties, right?

Because it's so complicated, and our government makes it so easy for us to get paid for the things we do sometimes. So, um the patient's changing. I'm sure your patients are more informed than ever, too. Not, you know, not just with the internet, now you have now you have AI telling patients about, you know, what's going on and how they should be treated and what their options are. Has that changed anything from like when you're engaging with patients in terms of the conversations you have today versus maybe a year or two ago?

11:16 It does. Uh a lot of times we have patients come in that are looking for something specific, as opposed to looking for answers. And that's not universally the case by any means, but it's it's much more common now where a patient comes in and tells me, "I've had shoulder pain for 3 months. I've tried physical therapy. I've taken anti-inflammatories. AI now tells me I need an MRI. Can you order an MRI for me? Right. It doesn't always kind of play out that simply, but it's that is a thing where patients come in and they have a very specific request. That and that that is different. That's much more common now.

The other thing I see with AI is patients tend to go down a rabbit hole and it's just it's the it's the Google doctor syndrome. It's that they are that they they have a symptom and a symptom can represent 25 different, you know, pathologies and sometimes there's a fixation on the wrong pathology. That's just where you need a provider with experience and, you know, the medical knowledge to distill what really is a risk and what's not. But so that that the so the Google doctor syndrome's certainly magnified now that AI's is so accessible.

Doctors, right? Instead of Google doctors. Abs- absolutely. So they'll they'll probably be a new stream of patients coming into healthcare now, which, you know, probably play when you're on the other side of it and you're the doctor, that's certainly can bring challenges at times too, I'm sure. It can. And I think for what I do in orthopedics, there generally patients that they're they have trouble with activity. They have joint pain. There's something that they want to do and they can't do anymore. So for patient to seek out an orthopedic isn't always a stretch. You know, that there's I don't think there's a whole lot of fear in the system right now about orthopedics.

Right. But because a patient's limited, the patient knows that they're limited. They can feel it. Their knee hurts. Their shoulder hurts. So for them to seek out an orthopedic provider isn't typically a big reach despite their feeling on the medical system. There is this kind of growing distrust within the medical system that, you know, maybe you are or unaware of, but there is a concern especially about some medical providers that they're they can be misleading. You know, that they they treat diseases. they don't prevent diseases. That's kind of a little bit of a mantra right now in certain communities. Yeah. So, I I think that's challenging for a a sector of physicians. Well, and I think health care is all moving in that direction. And so, what what I'd love to hear more about is like So, the Yeah, the practice today and and where do you see your practice going, you know, in the future? You know, as all these changes are coming, uh innovative health care, home health care, you know, people wanting different

13:54 Levels of care, when when they want it, where they want it. What is it What are you and your practice doing to sort of accommodate like this new consumer of health care? Yeah. So, what when you say consumer health care, that encompasses this kind of growing sector of of health care that I think a lot of times gets called the wellness sector. It's growing quickly. It's not necessarily led by medical practitioners in a lot of cases. I would actually I'm completely guessing here, but I would I would say less than 3/4 or 3/4 of those businesses are not led by medical providers. So, maybe a quarter of them actually are, you know, medically directed. And that is introducing a treatment regimen that patients research on their own. They they hear about it through different resources. They're curious. They believe in it. And all this is important. And then they seek it out on their own and they can freely purchase these services, these, you know, the modalities, the medications completely on their own. So,

At that point, we, you know, the these businesses, these wellness centers, they're just supplying a product. Um and there's a role for that. There's absolutely a role for that. It's a It's a growing part of medicine. And currently, there's not a And I'm lumping this all together. I mean, the wellness sector encompasses everything from like IV therapy, which actually is very effective. It has tons of you know, data supporting this for, you know, you know, decades. And then there's the peptide sector, which is kind of new and at this time unresearched. And to say Say peptide is very confusing because a insulin is a peptide. Insulin has saved millions, tens of millions of lives.

Like so like that that we we can't really drop insulin into this peptide market. But there's the newer peptides that have been really publicized recently and there there's a lot of excitement about them. But there's not much research around them. My general idea is that they're they're safe and they can be effective for certain patients. But I think what's interesting is that patients are researching these, coming coming up with their own conclusions on them and then seeking them out on their own without any kind of prescription or necessarily a medical recommendation to use these. And that that's new in healthcare. I can't think of any other specific like medication These are typically injectables. So this is this isn't a all This isn't typically a cream you're rubbing on your joint. I mean these are things you're actually putting, you know, more substantially in your body. And I can't think of another example where just the consumer market has sought out a medication or any kind of treatment to that degree.

16:26 It's kind of crazy and you know, we have we had the Google doctor and then we had the AI doctor and now you think about peptides and I think about the Facebook doctor now, right? So Yeah. You know, who aren't really doctors by the way, but you know, it is exploding and I think the peptide market I think I think Eli Lilly sold $36 billion last year in GLPs and I think that the entire peptide market is getting close to $100 billion a year in the US. Just to throw out some macroeconomic factors. So you're right, it's increasingly becoming more accessible and acceptable.

But at the same time I think that, you know, how does a practice, an orthopedic practice, sort of embrace that energy and that acceptance, right? And that ability to engage patients with a peptide. Maybe, you know, I'm sure there are peptides There are peptides just about for anything. I'm sure there are peptides for joint pain or you know, things like that. How do you embrace that in your practice? Do you think one day does that become a part of your practice? Does that is that off to the side of your practice? How does or not a part of your practice at all?

We are making it part of our practice. That's exciting. Consciously. I'm sorry. What did you say? That's exciting. That's great. Yeah, it's it's I think it's necessary to kind of accept the evolution of medicine and the my I I've done my own research on peptides and I I typically don't recommend things that I haven't tried myself. So I've most of the common mainstream peptides I've I've tried myself as well. In general like peptides are safe, which is incredibly important. Peptides taken in the correct amounts are a safe treatment. Now, how effective they are can change from one person to another. And the placebo effect is incredibly real. Not that that's a bad thing. If a patient I think believes in their treatment regimen and they feel better than we've accomplished what we're trying to accomplish. I think of really paramount here though is just following the scientific method, being we have to track what these medications are doing, how they affect patients over time and we have to be prepared to

Adjust if there are issues with these medications. There's still a lot of data coming out about GLP-1s and in general GLP-1s have are are safe. They're unbelievably effective, but there are some things that we still don't really understand. People's heart rate variability uh decreases when they're on GLP-1s. Uh what does that mean? It's hard to say exactly what it means, but it it it does in some way suggest that they're just their bodies are not adapting to normal recovery that the way they were prior to the GLP-1s. There's concerns with bone mineralization of GLP-1s, but none of this is necessarily been shown in structured research at at this point. So it's really a matter of the medical world like the the physicians, the providers, the the research scientists tracking these and and really putting a lot of time into seeing are there concerns with how these affect patients over time. And I think that that's our role as like the scientific community to try to identify

19:26 Any concerns or potential problems with these medications. I think that's great too that, you know, you think about the gray market in the peptide arena, right? Yeah, and you have companies like Hims and Hers and Ro and all these sort of online pharmaceutical that have you know, physician prescriptors and things like that that Mhm. they don't really engage you fill out a form online and you send it in and then they send you drugs, right? And plus the needles. And so, you know, as I think about it, like what a if you're a patient wanting to go take a peptide of any kind, why wouldn't you go to the doctor that you're currently going to any So, I think it's, you know, you pivoting to this is really not Two things. One is it's it's great for your patients, number one, that they they have a clinician who they can trust that is, you know, scientifically and board certified in in a specialty and they practice medicine.

What what a better way to get a prescription for a peptide that than than to buy it off of Facebook or another market. So, I think that's a a great pivot there and it's probably a really good thing for for you from a business perspective, too, in running a running a practice. It's probably you know, a great way to keep your patients engaged over a longer period of time as well, I would imagine. You can give better experiences. Mhm. I think a lot of patients are looking for these medications and as as long as I feel like it's an appropriate treatment regimen, it's probably in everybody's best interest for us to distribute it. And I'm saying that blanketly to like a whole wellness sector and obviously we have to pick and choose what peptides, what medications, what supplements we should give to patients that can help provide the best outcome and I think our our role is to provide to provide direction.

It's awesome, too. I mean, cuz you know, and from an orthopedic perspective, I'm sure there's a there's probably a group of peptides there, too, right? Cuz they're not all subcutaneous. Some of them are oral, some of them are nasal. I mean, there's all sorts of different ways to ingest the peptide, correct? I'm wrong? That No, you're absolutely correct. Uh subcutaneously is kind of the most effective way. So, you know, the small shot, typically in the abdomen, is for almost every peptide. There I can think of one or two that that's not the preferred method, but for the other 120 kind of marketed peptides right now, that's the best way to to take the medication.

So, we have the peptide market, we have wellness. Another emerging space, I think, in healthcare is the concierge medicine part, too. And is that something that you're considering for your practice, as well? It is. The idea behind concierge, from our perspective, is access, time, and availability. And I we started this conversation discussing what the the difficulties are in medicine right now. And the squeeze is that I need to see more patients, I need to provide more access when I don't have the time and the staff to do it to the the depth that I would like to, especially in the medical world, where things are confusing. I I I think a lot of patients don't understand the details of medicine, of orthopedics, and the treatments recommended, even after we've had the discussion. This is an entirely new concept majority of patients. So, in order to provide that extra time, the concierge space gives us a window to give patients more accessibility to have conversations after their appointment, clarifying confusion that they may have, you know, asking for answers to

23:01 Questions that they, you know, they didn't think of until they were in their car on the way home. Uh and also giving more time to patients during the consultation. And your your time problem, I don't think is going to change. It's not going to get better either. Just with the aging demographics as well, between Mhm. the baby boomers and the Gen Xers, at least in your practice of time frame, right? The math behind it is not going to support less. It's you're going to only going to have to serve more. And so that concierge space is probably How do you go, you know, either reach that customer? Have you thought about like how you're going to go try to connect with that customer and who that not customer, but who that that patient would be that that client from a concierge perspective might be? I thought about it. We are close to un kind of unrolling this program.

Oh, good. Yeah, but we we currently have a large patient base. Right. So, our our goal here is to provide more access uh in time to the patients that choose it without without isolating uh the patients that that don't choose to follow this path. So, that as far as like marketing, getting the word out there, it's different with orthopedics cuz most concierge models, they followed the the medical model where patients have three to six month month follow-ups routinely. They they'll be seen by their primary medical doctor three to four times a year and if they have any kind of acute illness, then that's also kind of built in and offered during that that same window. Uh with orthopedics, more often than not, a patient has an acute event. We treat that event. They get better and they no longer require our services. So, when we offer the concierge model, I think one of the big questions is, you know, what patient are we actually kind of going after?

And uh orthopedics does encompass something beyond the ACL injury, beyond the rotator cuff injury, beyond those acute injuries. I think there's the patients with chronic joint pain. Mhm. There's also the families. There's the families with young kids who are active in sports where, you know, injuries are unfortunately kind of part of that of their of their normal uh you know, activity like with their normal lives. Right. So, I think that those a lot of times those are the patients that we're kind of looking at for the long-term concierge model. And as far as reaching them, we plan on doing it through uh our current patient base, just maybe starting an email marketing campaign. Uh there's going to be information around our office, and then we'll do kind of a small marketing campaign within Nashville as well, just to reach out to our current physician providers, to our current, you know, patient large kind of patient-focused uh sets, whether that be in the gyms, whether that, you know, be in like some of the larger workplaces,

25:43 And just kind of let them know that we you know, we're here, we're doing this. If it's something you'd like to look into, you know, contact us here. And then the last portion of this is kind of within the surgical realm. So, when I when we start offering surgeries, especially joint replacements, something that's very standardized, something that has a 8-month window from consultation to kind of pre-treatment to the surgery, to the post-treatment, we want to package that as also kind of a concierge plan. So, instead of signing up for a uh a multi-year or like a membership model, we would just say, you know, over the 6 to 9 months uh you have access to, you know, these preferred modalities, to these preferred treatment algorithms, to these uh if you want access to peptides, we can provide that. Um and we're going to optimize you on the front end prior to the surgery, we'll execute the surgery, and then on the after the surgery, you will have that same access, and you're going to follow a protocol

That we kind of really invest in and work with you on more of a day-to-day basis as opposed to the current medical model where we might see a patient every, you know, 2 weeks after some kind of procedure. Or 6 or 8 weeks or, you know, just my mom just had a couple hip replacements last year and so I I do I do understand that kind of process and routine and any thoughts of like, you know, engaging in an app or anything like that as well, you know, just for Yeah.

You know, education, information, you know, SMS engagement, notification engagement. That's That's sounds like a very cool thing to do and and it's smart because the I think as you know, one of the frustrating things as a patient is like, you know, it might take you 6 to 9 months to get an appointment with a specialist. And having I can just, you know, not orthopedic-wise, but I know that in Florida, like to get a new neurologist, it'll take you 6 to 9 months to get a new appointment with that specialty.

Mhm. So, you know, I think that you're providing access to care, you're providing, you know, more knowledge, more information and, you know, if if that all happens, then the goal is to have a better outcome. I bet everybody's very happy with that. Yes. Yeah, that that that's always the goal. The the best outcomes, the best patient experience. And these are all we have to keep in mind during very difficult times in these, you know, in these patients' lives. I mean, nobody wants to go to the doctor's office. I mean, I think that's universally true.

28:14 Nobody wants to go to a doctor's office. And so our our goal here is that if you need to go to the physician's office, you need to go see an orthopedist, let's make it as smooth, understandable, and accessible as we possibly can. Get them in and get them out and get them healthy again, right? I do love the idea of the app, though, and that's something that we've thought about, but I don't really know what pathway to go to explore that. Yeah, there's a couple different pathways. I know app, you know, if you're not going to go like market and try and sell it on the Apple, the podcast, or the app store, I think there are different versions, but you know, I just know for in general purposes if you have an app that you're engaging with and that concierge service is a nice way to you know, it's a different way to schedule, it's a different way to get informed. You know, you might even have

Patient information that they can have access to along the way. It's just you know, in today's digital environment people want to kind of have that info at their fingertips and it's a pretty reasonable way to do it and it's just another part of the overall experience that you're trying to create anyhow. Like you're trying to create an optimal experience for all your patients whether they're concierge or non-concierge patients. I mean, your your whole goal is to treat and create, you know, better lives and higher quality lives for people. So, I I think that those are all good things.

It'll be interesting to see how you you go from this traditional model of probably, I'm guessing 95% plus of your work is built through a referral network or you know, being on staff in hospitals and that type of thing and now you're you're branching out into this sort of patient acquisition mode, right? Where you're trying to go capture a new channel of patients in a new way. It's pretty exciting. Yeah. And I think what you said is really pertinent too about patient you know, metrics and data.

I mean, what we're we're living in an age now where everybody loves their numbers despite what those numbers mean, despite where they got them from. People loved numbers. People love to be able to track progress or to be motivated by, you know, some kind of setback. So, that's something that we that I think about a lot. I've just noticed how many people are wearing some kind of metric tracking wrist watch now. I mean, every like probably 50% of the people that that I that I take care of or you just you just just socially is like almost everybody has some kind of like data tracking device and we we want to provide that as well especially like with these kind of more like the the short-term like package concierge models around surgery. Um, just so patients can really see some sort of validity, you know, how have they improved from pre-surgery to post-surgery. The way we are looking at doing that right now are there's I mean,

30:50 There's extensive lab panels that are easily obtainable in the consumer market and sometimes interpreting those is confusing and like how how much do they actually mean is is debatable. But, there is like the the kind of lab the data portion of it which very much does give you a number that people like and you can see that number kind of change, stay the same, or decrease over time. But, for with orthopedics, we like things such as like your functional age, which is, you know, how how your body moves. Like, how stable are you when you move? And what's your balance? Like, what's your leg strength like? So, those are things that we want to track and I think for our patients in the orthopedic world, that's what really resonates. If they have better balance 3 months after the surgery, that that means that means the world. That's going to save them future injuries. That's going to give them better quality of life. And that's something that's trackable and meaningful.

And it's so beneficial, too. And, you know, so that there's there's the trackable that there's the wearables, but then you also have the connected technology too with, you know, whether it's a Humm health or a Whoop or all these things that are now, you know, collecting you know, how do you get that data back into your practice? That's the other part is that, you know, the information's being collected. I'm sure there's bone like I think on my my Humm, I actually have a bone density tracker on my on my Humm scale. So, it's just sort of interesting how all that that data can and you said balance.

You know, as patients get older, it's you know, after they have a surgery and if they don't fall down again, you're those those are catastrophic things that happen to the elderly as well. So, it's pretty cool how this is all kind of coming together with you and and in your practice. So, when when when this sort of like, you know, you sort of plan a transition or is that the sort of stay the course and go along with what you got and just sort of build these new components into the practice.

How does that How do you plan on sort of looking at that? Our current plan is a transition. Okay. So, we will close one night as our current brand, which is Nashville Knee & Shoulder Center, and we will reopen the next morning as our new brand. That's great. Yeah, and I but it we don't want it to be that confusing, but as far as the signage on the door, I I do think it's going to be that cut and dry. We open the next morning as a different brand, but prior to that, there's a whole website redevelopment that is going to have a lot of new redirects and explanations and just trying to make sure there's continuity that people aren't confused that wait, where did my old doctor go? We need to make that very clear. Uh and then as far as rolling out the the new offerings, that's something that you know, we kind of hit on a little bit earlier where I we need to kind of advertise to our patients that

33:35 Hey, we are in fact doing this now, but then we also need to get to the community and let them know hey, we're uh the same physicians providing the same great care, but we also have these new offerings and and because of like kind of the changes in medical economics, we have a new name to go along with that. It's really exciting, you know, it's always fun to have, you know, take your foundation and kind of boost from that baseline and go into the future and with, you know, wellness, with concierge. I'm really excited to see what your practice is going to bring, Dr. Jones, and and just wanted to say thank you for being here. It's been great hearing about your journey, you know, in the knee and shoulder arena into your practice in Nashville and now you're on to a new phase.

Yep. Thank you for having me, Terry. This has been a interesting and enlightening conversation, yeah. Absolutely. And by the way, for our listeners, Dr. Jones is on vacation, so he's really provided us an opportunity, you know, he's taken his personal time to be here, so I want to personally thank you for for doing that as well. You're very welcome. I've enjoyed it. Right. Well, thank you. Be well. All right. Thanks, Terry. That's a wrap on Zero Friction, the show built around one simple idea, remove the barriers and the revenue will follow. If today's conversation was valuable, please subscribe and share it with somebody who needs to hear it. That's how we will grow this community. I'm Terry Coutsolioutsos, revenue architect powered by AI. Come find me at my website, myrevRX.com, and let's talk about what friction is costing you and your organization. Until next time, keep removing the barriers and keep the revenue flowing.