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what they do best, provide care. To learn more, visit carecredit.com forward slash beckerspodcast. Hello, and welcome to the Becker's Healthcare podcast recorded live at the thirty first annual business and operations of ASC's conference. I'm joined today by Bob Bishop, chief designer at JointSpace. Bob, to kick us off, can you share a little bit about yourself and your work in the ASC space? Sure. So, Jeremy, this is this is a picture of me in, like, 1959.
This is my my sister and I in my grandma's backyard in Jackson, Michigan after she's just had her hips, which she was born with dislocated, reattached to the socket. And so I've literally been involved with ambulation and surgery for sixty five years now because I was about four or five then and we're now in 2025. So I've been deeply involved both with family results as well as I got involved scientifically and entrepreneurially involved in this whole space for a long, long time.
So the ASC market in The US is projected to reach, 60,800,000,000.0 by 2030 and continues to experience strong year over year growth. From your perspective, what would you say the most significant trends and market forces driving this expansion, and how should ASC leaders be preparing today? So I'm gonna give an answer that is very simple on one level and very complex on the other, and it's the advancement of knowledge.
And by that, what I mean is something very specific, which is that we now know what we know and we know why we know it in ways that are exponentially growing. And that is the driver for why we are now labeling what we say as an ASC. And in most people here are going to think, Oh, that's a separate building, not the hospital where we do surgery. As far as I'm concerned, ambulatory surgery is not where you walk in or walk out. It's to actually change the ambulation of the patient.
And it's our knowledge about what makes that happen and what causes good results and bad results that's accelerating massively rapidly primarily through advanced technologies, but most of which are computer related. So from AI and robotic surgeries to advanced EHR systems, technology remains both a make or break factor and critical driver of ASC operations at scale. How do you see deeper tech integration shaping the way ASCs deliver care and manage their businesses over the next few years?
So the distribution of incredibly powerful technology has gotten to the point where we all have it in our side pockets. And the availability of networks that can connect those devices. And regardless of where you are in space and time has just incredibly become ubiquitous with Musk putting up satellite systems that create a internet from the sky. This device I have in my pocket will connect to that satellite. Not all do, but this one does and
all future ones will. So the connectivity of the power of Silicon calculations, which is incredibly powerful is everywhere all the time now. And that's the primary driver of what is changing things so quickly. And we're adjusting to all of the ramifications of how that was originally delivered and how it's evolving. So is there one particular technology or innovation that stands out to you as especially transformative?
So I think that the use of blockchain in the sense of what zero knowledge as they call it, platforms is going to drive a massive change. I created a company that I sold to Zimmer that collected x-ray that was originally when I started doing it using film and chemicals.
And I conceived of transforming that to a digital acquisition and distribution of those x rays for reasons that had to do with the fact that I owned a distributorship in the Detroit area and I hire somebody that worked in Traverse City four and a half, five hours away in good weather. And I had at that time to buy my own implants and instruments, which is not the way things work now, but I had to make an investment in those and then hire people and had to
have the whole operational environment for it. So I had seen the digital x-ray systems that were in hospitals. And the metaphor I use is I sort of took what was a digital imaging system designed as a Peterbilt and turned it into a bicycle where it could be used by everybody and yet still get the most incredible results. In fact, I just saw a thing on x yesterday showing that humans on a bicycle outperform every other animal in terms of the speed
and distance that they can transport themselves. There is no other animal that we can't ultimately beat on a bicycle in terms of the thermodynamic efficiencies. And in the way, what I just did was take the systems that were in hospitals and moved it into the regular orthopedic office. So that became model in which while I was doing that, it was the eighties and the nineties. And we were just breaking into what we
now call sort of web two. We moved to these dynamic web spaces, but they were wide open protocols that we ultimately then put security on and called them HTTPS, which became secure, still breakable. And what we have now are systems that do those computations locally and distributed simultaneously. And yet they're on secure protocols that are private from the beginning to the end where they're encrypted on device and decrypted
later. Only if you have public and private keys that is going to change the game because the, the whole supply chain of moving all of the people, the equipment, the information, and the decisions that go into performing a, a, an operation successfully is being transformed into an infrastructure where you can not only collect that information, but process it and then still retain the privacy of everybody involved at their pleasure, not at
the system's pleasure. Right. So I believe what's going to happen is that that will transform the system economically in ways that it will no longer be necessary to have a monopoly directed by striker Zimmer Depew owning a massive portion of the production in selling of total joints of spinal implants, etcetera. And there are a few other companies that fit into that category, but those technologies that they're actually delivering turned metal. Right. It's been around for nearly a hundred years.
There's nothing very special about that. It's only the technology of the capture of that operating environment and its improvement that has become difficult. This will help resolve that in a massive way. So I think that's gonna transform the economics massively. And I just wanna rewind a little bit and say so, you know, Blockchain, it was the big buzzword
a few years ago. I think, you know, you you hear it a little bit less, but I think, you know, maybe a lot of people listening to this podcast are gonna have kind of, like, well, I've heard the term. Yeah. I know it has to do with Bitcoin or not Bitcoin, but, digital cryptocurrencies in that space. But can you give a very kind of high level and easy to digest overview of, you know, how blockchain works and and, just kind of, like, as it pertains to what you're talking about? Yeah. So
you know what? When I was a very young kid, I got a bank account and it only had a couple bucks in it, but they gave you that savings account booklet that somebody actually wrote in it how much was in the bank that I had given them. And when I went to get money back, they would not only give me the money, but they would scratch in there on what was called a ledger, which looks just like a spreadsheet. It's just a grid. And it would say how much money I had, how much I took out, what was
the net and what date it was. That information is the essence of the currency environment of Bitcoin. It's simply a ledger, but what's different is that it's digital. That's not magical, but what gets magical is that it's encrypted, meaning that simply that it has a, a hash up of the information in such a way that if you don't know what the key is that unlocks it,
you can't see what it is. And that key system is just like if you go to that same bank and you put money in the safety deposit box, the bank has a key to your box and you have a key. Without both of them, you can't get in it. You can't get in it because you don't have the bank's key. They can't get it because they don't have your key. That's how the encryption works. There is a public key that everybody can see
And then there's just your private key. So is it like in the movies where there's, like, a nuclear launch code and it takes two people to turn the key? You got it. Just like if you were watching exactly. Denzel Washington. Right. Right. Right. Right. That's what you're thinking, Don. Yep. Yep. Yeah. Exactly. That's it. That's awesome. That complicated until you let it be. Mhmm. Otherwise, it's just plain old simple easy stuff. Okay.
Okay. Well, with 60% of health systems considering ASC joint ventures and many ASCs already partnering with systems in their communities, what opportunities do you see for collaboration whether with other providers or vendors to strengthen patient care and operational efficiency? Okay. So I think that what's happened from when I was describing to you when I was a little kid, this surgeon whose name was doctor Stolberg and my mom and dad and my sister
had a deep relationship with. Mhmm. And it was one of trust. And it was one where there were almost, there was almost nobody between them. Today, I just had lunch with a surgeon who basically started the spine business with a company called sophomore organic that became a Medtronic company at Texas back Institute. And he's 83 I think he told me now.
And we were talking about this a little bit and I said, yeah, what I want to do is get all those people out from in between the surgeon and the patient because that's what's changed is that at this point there are so many players entailed in having a simple conversation. Was that going to get repaid? Is it my deductible met yet? Because on January 3, I'm going to have to start all over again. But on December 28, if I can get in, it's free. Right, right. How does that make?
I want to know is, is it okay for me to play tennis? Right. Right. Right. Right. What the hell? And so we need to find ways to remove all of those intermediaries. And Mhmm. That's what I think the massive opportunity of the technology change that's beginning to happen is we're going back to that possibility again where we can reinitiate a relationship between the patient and the doctor. Those same doctors don't want all those people in between, come to the Becker meeting and come to
any others. You will hear them all say things like that over and over again. And when you talk to the patients, they're so frustrated. They don't know what's up and what's down. A 100%. And it's primarily because they can't go talk to a trusted doctor Mhmm. And have a conversation without a whole bunch of people being in between for reasons that seem unexplainable other than for the fact that that's how it accidentally evolved over the period of the last two or three decades.
Right. It hadn't been that way before then, but it was the initiation of this web two world where we had these expectations. You may not be old enough to remember, but we were told the electronic medical record is going to revolutionize and make so efficient. And all it has done is resulted in the exact opposite of that for most people who are in the system. It's web three or blockchain sort of reinitiating that opportunity, but changing the inertia of the culture, right?
Getting all of those systems back into place where I literally can communicate directly with my doctor and not have to tell anybody else. There are some people who want to say, you know, you shouldn't be able to do that. Right. And I say, well, exactly who the hell do you think you are? Right. That you should tell me what I can do with my life. And I think we just went through a whole transition of my body, my decision.
And I think that's the essence of this is that we all have a responsibility to ourselves to take care of ourselves. Mhmm. And if we need help, we should find somebody who we trust, and nobody else should be a part of that. Right. Right. Right. Well, Bob, you know, this has been a great conversation. Is there anything we didn't touch on or any final thoughts you'd like to leave with our audience today? Well, I like to say that the opportunity for the progression and innovation is infinite.
And that's not to say that what will happen will be good. Mhmm. But my perspective is that the growth of knowledge is unstoppable. Mhmm. And that can also mean that people with bad intentions can capture that knowledge and do things. So that's not to say that everything will turn out well, but it can. It is possible. And that to me is why I'm optimistic. It's not that it is certain, it's that I can decide to have an impact in a positive way.
And when I see things that aren't right, I can speak about it and I can change it. And that's kinda where I'm at with this is I would like to see the reconnection of a doctor and a patient in a trusted relationship in which there are not impediments that are artificial Mhmm. To people being able to take care of themselves with a trusted adviser. Mhmm. Mhmm. Well, Bob, thank you again for the great conversation today. And, again, thank you for joining us, and I hope you have a lovely
rest of your day. Thanks, sir.