Dr. Alejandro Badia Keynotes Cornell Univ. Zoom Conference on Fixing the U.S. Healthcare System

He was sorry. He he’s study physiology at Arts and Sciences and graduated 1985 and he is alpha sigma Fy brother. But DEA obtained his medical degree at NYU, where he also trained in orthopedics to hand fellowship at our Hattie General Hospital in Pittsburgh was full by trauma fellowship in Freiburg, Germany. He runs an international hand fellowship and served on the review board of hand surgery techniques journal. A 100 previously organized a yearly meeting for surgeons and therapists devoted to upper limit trust, trust copy, an arthroplasty which was held in their norm Miami anatomical research center, which Alejandro co-found in 20052008, he created, but Zaha, hand to shoulder center and surgery center in Europe. In 2010, he launched ortho Now the first immediate orthopedic care care center in South Florida. Layer franchising the concept which now can be used at licence to orthopedic colleagues and healthcare systems. He’s a past president of the International Society for, for sport dermatology of the hand. He is a member of several orthopedic societies, an honorary member of more than ten international hand surgery and arthroscopic associations. Honor professor and the procedures. Philadelphia had a course in 2012, had been lectured in all seven continents, is currently focused on improving healthcare delivery in the orthopedics and sports medicine. A 100 bestselling book. Healthcare from the trenches, is an open discussion of the failure of the US health care system. From the perspective it’s providers and patients. Perspectives from today’s health care debate, there are sorely lacking. Even if you have not read the book, I highly recommend it. It’s a fascinating story or what it takes to become and what it takes to thrive as a top-notch doctor in today’s complex us health care industry. Clearly come through in Alexander’s book as he’s relentless pursuit and commitment to deliver the highest possible care to his patients. I quote from his book, I will remember that I did not treat a fewer chart. It counselors wrote. But a sick human being who’s illness may affect the person’s family and economic stability. My responsibility includes this related problems. If I’m to care adequately for the sick. With that, I’d like to turn over 2000. Thank you. Thank you so much. Omics that we would turn Miami. My talk, I thought I grew up in combinatorics. And this has been journey here. So I sincerely ironic that you have this kind of discussion with the Cornell Ian’s, I’m really, really proud to be a cornell yet. And in fact, because I’m not used to lecturing to a lot of people. I had my Cornell bear. So this way I feel like I’m speaking to somebody who had helped the dust into the, into the web. So I’m going to get started here and share my screen. Okay? And okay. Okay, see the title slide. Yet other. Perfect. Okay. So, so well, first of all, I want to give, I want to give thanks to what? Once. It’s not presenter view just so you know, it’s on. Oh, okay. So you’re not seeing full screen now. Oh. First technical visits, you try shirt and again, it’s a problem when you have several screens. That’s an extent. Okay. There we go. Okay. Okay. Better. Perfect. Okay. Alright. Okay. Okay. So but again, i, i and money that people listening, of course I will like to point out, and I just found this picture with no wonder, unions with Frank Rhodes, really beloved president of Cornell. And I’m hoping there’s my children and that we missed the reunion this year. I’m thinking that at the next reunion, my daughter there next to me may actually a freshman at that time if everything works out. So look forward to many visits on the hill. So why is this discussion even needed, right? We think we can all recognize that these costs are not sustainable. And talked to most people, they really often dissatisfied with us self-care, but not the accessible, the hassles related and certainly the cost. And despite the cost, the, the markers that you would look at in terms of measuring quality of healthcare delivery are really not where they should be considering, are the expenses and its effects. All of us matter background. Thank you, Alex for that. So again, I, I graduated Phi by some of my rock ledge brothers I think are listening. It was at alpha signify and went on to medical school, New York, and then came to Miami. Once I’ve finished training a decade later in 95 and I’ve been to Miami for the last quarter century. I founded the ortho now, which is kind of the genesis of a how to book came about and some of what I’m going to be talking about because it just demonstrates that innovation. It is really difficult. And our health care system. And I really, I, this is my tag. I think LinkedIn is aha, I’m a reluctant entrepreneur. So the book was, was rare and because of the, the frustrations and to tell the story to the public about what the problems I don’t necessarily offer. What I think are foolproof solutions, although we’ll discuss some potential solutions today, along with 27 other contributors of my book. So it’s not just me, although I will say I wrote about 85-90 percent of the book. In terms of background. Everyone can read this, but I’ll just say that we are the most expensive health care system in the world by far. My field of orthopedic surgery can count almost 10% of that. So, so my, my discipline within medicine really has a responsibility to try to rein in costs while maintaining quality. We are in this perfect storm. We know it’s expensive and inefficient. It’s often unpleasant. We, we don’t talk about that enough, but it should be a more pleasant experience when you’re going to a hospital or to your, your physician’s office. And because of the stress in a bureaucracy, it often isn’t. And then the pandemic is thrown in. So that made this perfect storm. And this cartoon, the law maybe funny. Too many people, I think most clinicians would cry when they seen as because the combination of the pharmaceutical companies and health insurance are really gobbling up a lot of the money that’s in the system, it, and really we need to work together. So of course, these industries think it’s fine. I mean, if you just look at the profits are this year alone because it a pandemic, it’s really staggering. But our system is stick and we need to work together because I’m gonna exert de la I don’t what I get when his injury and trauma and, you know, almost three quarters of a trillion dollars related to injury. That that’s not just health care costs. But when you have your best worker, sheet rocker yours receptionist, who, who has a family member, who has an orthopedic problem, we’re going to miss work and there’s a consequent loss to the economy for this. So we have to pay attention to this big number that came from the CDC. And we are twice as expensive as the next country on the list as you see here. On the next slide for right now, you can see that the growth of health care spending is, has been since the sixties and over 800%, real wages have gone up at 16%, while our GDP has gone up nearly a 170%. So we are way above that. And you can see here 2%. The GDP is currently over 18% and still speculated to climb. So we cannot continue to ignore this. And I mentioned already we are twice as expensive as the next country. Another other I’ve seen nor Norway is often up there as well, but there’s no question we are foreign above all, all of the other industrialized countries. And it’s just because again, it’s, you know, it’s just inefficient. Certainly it’s again, it’s not pleasant. Is a long waits. Thank God for our our mid-level providers, our PAs and nurse practitioners, because we do have a physician shortage in this country. We need to talk about that. Now I mentioned about ortho now and I, I, I, I read a paper some years ago from the Harvard Business Review and I want to recognize our Harvard colleagues from the Harvard alumni club is joining. I think yale, Yale alum club is on as well. This from the HBR outline. Really six major reasons why healthcare innovation is so difficult. And there’s a lot of middlemen who want, who influenced sat at that, that causes problems of funding. I can tell you that I’m trying to get funding now. Finally. A fourth on how I should have done this earlier, but I’m running into all these issues. The regulations this year were relaxed, right? That’s why we have a vaccine pretty quickly because we finally relax some of the regulations to make sense. There is an economic consequence to that, okay? And of course, the innovations have to be, have to be safe unlike other industries. So there is accountability and our customers happened many patients. Telemedicine benefited, right? We relaxed a lot of these regulations. Hipaa, which is, occupies a dreadful four or five pages of my book. It’s talk about regulation, what privacy. And now we’re seeing that yes, we needed to use telemedicine. And this is an article that came out this year locally. But if you notice this is from Mexico. I had an interview three years ago. Notice the date. Three years ago we were talking about this so well before to pandemic, I and many other clinicians were using telemedicine for we couldn’t get the health care system to really adopted or even our patients. So despite everything you see on the news channels, most of the times you do not hear feedback from people like myself and many of the other folks on this this call are the clinicians, physicians, and other healthcare professionals really doing actual work. We actually provide a Candida patients and we are in the trenches as the cover of my book shows. So we have to be involved in this broader discussion. And I mentioned that that it’s not often the best system despite the cost. Look at these figures for the percentage of patients who don’t even get the recommended tested treatment because many times it’s so difficult every day. I have trouble getting things authorized by the insurance carrier. Many times, whether it be the clinician or the patient, they just give up. And in many cases there is a downstream cost to not following through on the appropriate care. So the efficiency is a huge parliaments you can see here talking about the time spent on paperwork, ribbon disputes, on medical bills. So I I really wrote the book because in the trenches I was seeing how difficult it was to provide care. And then I started ortho now because I said Why is it that the average person see me as a hand surgeon has already been. So anywhere from two to four different clinicians. Before seeing me. It’s imagine having an AI problem and having to C3 Dr before you see an ophthalmologist? I mean, I’m a physician. I remember some anatomy of the eye, but I know I know very little. I don’t even know what my prescription is for my by myopic lens. I just know nothing about the eye and it’s the same thing in orthopedics and many other fields. So the average consumer of health care doesn’t often recognizes. And this case it’s just one of course of thousands, thousands. It really represents the problem. So rather than looking at statistics, let’s just take a middle-aged female, walk in her dog, twist. Her ring finger in the leash and goes to the hospital like that’s typical reflex, Right? Well, you know, she’s competing with somebody with chest pain or maybe now with trouble breathing from COBIT. She’s given is ridiculous aluminum splint that doesn’t really do anything and a narcotic prescription. And she’s told all you need to see in order to pietas. He then goes to an urgent care centre and they say you need to see a hazard and here’s a fracture. You don’t have to be a physician to say, wow, this doesn’t look good. It’s rotated, its fracture adherence is totally displaced. And this is what she walks with. So by biopsy, a foia to Congress homework. She gets homework. Homework is now trying to find somebody like me. So this was then treated by a doctor on call at the hospital who happened to be a plastic surgeon, who really are focused on hand. And he puts two pins. You can probably see that that doesn’t even look very good, right? I mean, the fracture is not reduced or put back into place. So this is what she comes to me with. Okay. The finger is short. It’s bent, it’s a little rotated and it’s affecting her hand function. So it’s just a little fracture, right. That’s what she might be told. But it heeled like this. The pins were removed by the other doctor. There is hyperextension, deformity and that I have to do something complex corporate osteotomy, sorry for the graphic picture, but there’s a tourniquet, so there’s no behind. But you can see this is, this is a difficult operation where I have to release a capsule, get their fingers straight, hold that with a pin, put this plate, then I had to later remove the plate. Unfortunately, this is a result and I don’t you can see it’s it’s he still is little stitches absorbing. So I I’d love to get a more recent picture, but she ended up with good result. Thank goodness. But that doesn’t happen with everybody. So in fact, this study, oddity Academy of orthopedic surgeons. So that almost a third of emergency room consultations for orthopedic problems are inaccurate. So we all assumed we go to the husband are going to definitely take care of us. But you have to understand the hospital ER physician is really focused on, on those other patients or admitting the little old lady with a hip fracture who obviously needs to stay overnight and I’d get to surgery. There are many fractures like you one you just saw. I don’t need that. And how about our children? This is an amazing statistic. And I actually discussed this with, with, with the surgeon who did the study showing over 90% of pediatric fractures are incorrectly splinting and immobilized. And in either urgent cares or even hospitals. Hey, so the point being is that health care, we know so much more that we use them. And the reality is getting, you write physician involved early, saves money. And, and in the eighties we talked a lot about the gatekeeper. And that actually paradoxically cost more money. Now, or primary care colleagues are vital because they take care of us and our families throughout life. And then they will decide when to refer. But oftentimes forcing patients when insurance company force the patient. For example, when an AI problem to see their primary care physician, that doesn’t really save money. So now this is a revolutionary concept and our industry is undergoing a major metamorphosis. So that’s what was the genesis for me of starting ortho now and many other clinicians have started similar concepts about how to streamline care. So again, I don’t pretend to have the actual solutions to our health care system, but these are some ideas that I think we can start talking about. So I, I already mentioned we’ve got to involve the people who are actually in the trenches delivering care. It’s not enough to talk to Dr. Fouchier, Dr. Gupta of the world. You’ve gotta get the people in, in the trenches and try to minimize the middleman. The middle man is often an insurance company that ends up adding cost. Okay? This is a radical concept put, making insurance companies, perhaps nonprofit. Alright, now I don’t want to spoil the last chapter, the book, but one of the countries are well-respected country for technology, efficiency and economics, has private insurance companies, but they are nonprofit, get encouraging, more efficient all in one centers. And now we’ll cope and we’re seeing that outpatient centers are really have big advantages and we may not go back. I’m proud to say that yesterday in our center we did our first outpatient total hip replacement. We’ve been doing nice. I’ve been doing shoulders for about eight years. And now we did our hip replacement. We’re doing pacemakers. So these are examples. So what do patients need really a rapid, efficient access? It should be cost effective and pleasant, right? That has, that goes a long way in health care, just like in the hospitality industry, right? One-stop shopping. So we have to not be adversarial with our patients. We have to work with them. And the problem is with the insurance industry and often creates this adversity. And we want to correct that. So we need to be involved in that conversation. Okay. We need to be able to and I can tell you it locally from here in Miami at the state level, at the federal level. I have had an incredible a bear of a time trying to speak to anybody who helps make public policy. Okay? And that really shouldn’t happen. Okay? Because I am a constituent, I’m a taxpayer, just like anyone else. But the physicians need to be able to speak to folks who make policy decisions, especially when it comes to health care. And this is what we feel like oftentimes in these in these circles were, the doctors were not used to this. You have to. Okay. So I mentioned minimizing the middleman. It just adds cost. Gave so many years ago we didn’t have this currently. This in the book, I have a subsection entitled this authorization is really an absurd concept. Why, why should a physician had somebody sitting at a desk really doesn’t know a lot about about that specialty. Approving something. It just adds another impediment, what we should have this oversight. So let’s, let’s scrap all of this and just have oversight and wonders outliers, then you could look at that and say, you know, doctor, you’re ordering to many MRIs or too many. Many of these type of blood tests. And the problem is that there are so many of these folks that obviously they, they were told to do something. And the astronomical growth of administrators and healthcare, you know, just dwarfs the growth of physicians. And I already said we are population growth. That we do not have enough, enough clinicians to care for the public. And the salaries. That’s not the issue. Many people thinking there’s a chapter in my book about, about physician compensation. It’s pretty eye-opening people who are really not aware. So now we know what And believe me, I’m a capitalist, as Alex mentioned, I am a proud Cuban immigrant. I, my family fled communism, but there has to be a middle ground. And this is E, a pharmaceutical industry in almost a 100 millions of, This is a lot of money. But again, if this was not for profit, then I’d be OK with this. Well, when it’s for profit, we shouldn’t be his company shouldn’t be answering to Wall Street, to investors, okay, not what the costs we have and we should be worrying about this. I mean, I’m personally outrage at what happened recently with some of the greatest frog. I’m embarrassed to say that in Miami really the capital of Medicare fraud. And yet we are letting these people off the hook. And this is a lot of money in the system. It could go to patient care. Some years ago, I was very hopeful because we happen to have a health and human services secretary who’s orthopedic surgeon, Dr. Price from Georgia. And the same year, the first and only orthopedic surgeon president of the AMA was Dr. Edgar Amin, who happens to be a friend of mine. He’s a hand surgeon, lever or not. And I thought, okay, this is a chance that I tried to discuss or thrown out with them. And we just ideas as to how we could streamline at least orthopedic care than being Arthur Peters. And really I got nowhere. So that that told me and, and again, that was part of the genesis for the book as well. So I mentioned this already. This is perhaps a radical idea, but it’s going to take the public really making enough noise to figure something out. Because what we have now is not sustainable. And I mentioned already the, the more efficient one all in one facilities, streamlined care. So me being an orthopedics, that’s the best example. But there are pediatric urgent care centers. There’s women’s health centers where they can walk in and have a past me and have an exam because maybe they can’t get into their their family. I’m not an ecologist. Right? And these are shifts that are occurring now. And I think that, that Cove, it is accelerating these shifts. I mentioned that that ortho Now we are seeking investors or strategic partner. There’s a, there’s a huge interest now in moving surgery from hospitals to ASC, ambulatory surgery centers. And all of these components work hand in hand with that concept. And this is an article from ten years ago. You notice a lot less gray hair, but this was in the Miami Medical magazine. And yet it didn’t get much fanfare ten years ago I talked about this. So. There is no question that there’s decreased cost. The quality is often superior to traditional access for, for at least my specialty for orthopedics, as I, as I mentioned. And we can, we can have multiple partners to work together. And so if you look at this graph, expertise in a, in an emergency room is often loaf orthopedics, but ease of access as well. Why? Because, you know, you may wait there 68 outwards. So urgent cares are easy access, walk in, wonderful, but they don’t have the expertise. So our concept really sits in this space. And we’ve done it. We’ve done the chocolate data user numbers that there’s no time to go into detail. But bottom line is, it’s a huge difference if an injured worker goes to occupational health center or the emergency room that has he studied started therapy when really they needed something different. Though in my community, even the South Florida Business Journal almost five years ago, I had a cover story showing fractures on the cover, which was amazing to me. And talking about our centers. They realized, the business community realized that if their workers or even their employees were able to access orthopedic musculoskeletal care easier. That has a direct impact on the bottom line. And one of the challenges we’ve had is going to business is going to be companies saying will help provide a well-being service. We’d be able to get some of these things directly. I think health care is going to go that way. We were going to reach out to the employer because most of us are ensured buddy employers. And that’s of course a whole nother discussion. Now when Kobe came, you know, really the, the, the, accelerated all of this and this was right a year before converting. If you can see I’m talking about it already. It’s accelerated this the past administration and I’m hoping that the current administration, Washington will keep pushing for this transparency. Okay. Now, this wasn’t talked about much. But in late October, we we we didn’t get make some headway in this, but so far it hasn’t been implemented. I’m happy to send anybody who reaches out to me a copy of this report. Now that implies that AS clinicians need to collaborate and that is, that has been a big problem. Like I talk in the book about the fact that we became Competitive. Elisa Cornell them any you remember organic chemistry? That was what Chemistry? 357358. I remember my sophomore year. I mean, the competition for preimage starts there. But it really should end once we get into medical school, but it does it. So there is a competition amongst clinicians and the other entities and health care knowing. And they the pit us against each other. And that has to change. So the public needs to know that there are these problems. And as much as we all care about whales and saving the whales, or now racial injustice. Now I’m not saying that the public needs to go hunting for cars, to break windows for healthcare. But we need to show the same kind of passion as we do for other important societal issues. Because patients are consumers. And whether you agree or not, you know, in the US, we are a capitalistic free market society. And there’s been many studies that have shown that we can bring down the cost of care. By that I recommend many books here. This is one called The Case for free market healthcare. This can be read in two or three nights and makes it a very compelling argument for that. And I, I do talk about that in the book. And perhaps health insurance should be more catastrophic. You see, you go see your pediatrician or you’re you’re got to colleges or your ophthalmologist, you might pay for that consultation. And then if something really catastrophic happens, that’s where insurance my chicken. But that would require a major about face in our society. And we’ll see how bad it has to get before, before we make these decisions. No question of bureaucracy is really excruciating us. The most interesting man in the world, he, if he doesn’t understand quotes. And I decided on a conference in Orlando where there’s a lot alligators. I can tell you that there is an ICD ten codes for being bitten by an alligator and a different code for being bitten by a crocodile. That is an absurd abuse of bureaucracy and regulations for something like this. So it’s very representative Indian education. And the marc Center was mentioned before. This is Inderal, about a mile from my office. It’s actually now the second largest cadaver lab in the world for surgical training. And this is, this is where that excess money if if if if we could eliminate the these needless expense and the abuse and fraud. And I mentioned also, could you imagine that money could go towards something like education and improving efficiency in healthcare delivery. But these are things I talked about in the book, which is again available on Amazon or on a website attached to my own website that has a series of videos that introduce each chapter is about 1.5 to 2.5 minute videos. And you could, and you could see what each chapter is about. But I really wrote it for the public. And I’m hoping that everyone listening in can begin talking about these issues and we can roll up our sleeves and really solve it. Because in the end, it’s really about this, about, about our patients is or my patients, whether it be on a medical mission and gada or here in Chile, or write, writing, giraffe. Florida. These are the people who are ultimately going to benefit and our economy needs it. Because ultimately we are all patients and we all or will be patients. So. Thanks for listening and I hope it does stimulate dialogue. Here is easy way to reach me, my, my email, add relevant websites for somebody’s information. Thanks so much, Alex. And I hope that we can get some dialogue going. And are we have questions that started to trickle in. I’ll start with the question from Maryland or the primates departments in your presentation. What’s what’s items are for the primates in your present Toyota primates. Oh, that’s an interesting story. Very briefly, if people are seen as Tiger Woods called tiger came or the AL. Yeah, so I tried to watch for its Episode. I couldn’t I couldn’t make it but consider it. But one of the people featured in that is the dock and two very interesting guy who, who, who loves animals. He had a lot of big cats, but also primates. And I had treated some of the people in his organization. So each time became for follow up he would come with, with chimpanzees are given one time came with a baby tiger. So I’m happy to send somebody post pictures to folks. Excellent. Yeah. So first question is from how he is your brother from alpha signify 81, arsenide, how they work. How I’ll read out his, his common slash question. And this is really echoing some of the things that you have raised in your, in your book which is differentiation. Differentiation in terms of how doctors are being compensated, you mentioned that there’s really no difference between doctors and compensation, between doctors who deliver top-notch healthcare and doctors who deliver okay, ish health care. So the question and comment is L is constant not only the result of height, insurance company rates are exuberant. Gossip pharmaceuticals, does it not also result because payments to health care providers are made in response to shortcut or submitted procedural codes rather than a result of positive health care outcomes for patients. Is it not also that the high cost to the public is somewhat due to healthcare professionals sometimes being paid excessively. Sure. Yeah, that’s that’s a real misperception. What happens is certainly there are people like me are bad apples in any industry and people who either build excessively or many times volume so collectively. But if you look at per, per unit of the work you do. I mean, I think people would be very surprised to know that a a cardiothoracic surgeon gets paid to, to open a sternum, take a vein graph from the leg or from the radial artery and implant that on the heart gets paid for if it’s a single or double, somewhere between a 2100. $2300 and that includes 90 days that what they call the global. So you have to follow that pinch for 90 days so you don’t get my my my legal colleagues or to be able to build for our. So if you look at per hour, I talk about that in a book that is not, you know, Medicare again is going to slash physician payments 9% overall, I believe starting in January. And that is that is just going to make a tiny little dent in overall costs. I think with the presentation it’s pretty clear about where a lot the overall costs are going. Question, How brings up a good point that we should be rewarded for outcomes? And there is a huge push now for value-based healthcare because there’s no question that same heart surgeon I mentioned gets paid the same if his if his mortality rates are, are here. And someone else who’s not as well trained and not as a stew is down here. That’s a difficult thing to change. And I know that the system is looking at that. But there is much more low hanging fruit to, to change rather than d incentivizing clinicians who spent more than a decade 2y to educate and train. I find it’s absolutely fascinating that there are codes to differentiate between a byte by alligator and a croc, but there is no because done to differentiate as to how successful the procedure was. And also very importantly, how long did it take for a person to go back into workplace, right? Because that is something that has direct effect, as you mentioned in your code, on persons ability to provide for their families and provide for economy. Beni to people listening if you walk in some work with a large employer, I mean, talk to your HR department or more importantly, risk manager and ask what happens if if you know, one of our key employees gets hurt on the job? I mean, I you know, Amazon now is a big distribution center and I can tell you it’s like impossible to have a dialogue. They all get sent to a very general kind of center. And everything is called the sprain or a stream. So of course by the time the actual diagnosis. And I think there’s a great example that a book about a patient I saw what a shoulder problem. If we can streamline that person getting to the right clinician earlier. As you suggest Alex, you’re going to get back to providing for her family quicker. And that has a huge downstream impact, I mean, on the economy and productivity. But we are not looking at that. And when we bring these concepts to big employers, when I brought this through City Miami, I hope somebody from our municipalities are listening. Please let’s sit down and have a dialogue so I can tell you what’s, what’s happening. Because you will be quite amazed because this just isn’t looked down. And I would be grateful and she could Forbes for folks who have perhaps didn’t read the book, if he couldn’t nutshell, describe the value proposition of, of ortho now and also the synergy between ortho now and, and your overall practice. So people can. And that, that time saving, that money, saving, the hassle saving. If you could, in few words, describe the business model of, of the, the system, the build. So we can appreciate how war superior and what advantages the system has compared to 22 general setup. Well, let’s just them. So I showed the case of the fingers. So imagine anyone listening that you I don’t know you I woke up tomorrow, you know, excruciating back pain and, and, and that’s happening to me. So but, you know, 80% of people at some point suffer from back pain. So let’s just take such a common example. I’m currently right now would pandemic and that’s why I say change things. People might go to an emergency room and they know they’re ready to, to wait for multiple hours. But in the end they’re seeing a really busy physicians trying to take care of somebody with, with chest pain, they’re going to order some anti-inflammatory. Might they might they might even do an MRI to make sure you don’t have a big herniated disc. But in the end, the person seeing you really isn’t an expert on back pain. Say would urgent care? There’s many urgent cares here in Miami and that’s a great place to go when you might have strep throat and you want a quick antibiotics, somebody looks at your throat, Perfect. But many things, whether it be eye problems, orthopedic problems require certain level of expertise. So Ortho now was started to have the same convenience and function of a general Urgent Care, for example, you can just walk in, but you’re going to be seeing the right type of clinician. And that’s the model and the goal was to bring that National. There weren’t any wreck frankly, even international, We have a lot of interest again now in the Middle East, in Dubai and the Emirates and in Qatar, because these problems are a very international. So the idea is to have a model that you replicate. And we made all the mistakes like any entrepreneur. And this model can be replicated in multiple communities to really serve this, these needs much more cost effective manner. That’s the value proposition of a voice from now. So if, if there’s a clear value proposition you mentioned in your book examples where you were mentioning to the soccer coach, I think your daughter is, if the value preposition so obvious, why there is no why, why their initial resistance at least, well, you know, what would Capital you can then have business development people because I think for people to change behavior, they often need to hear it me now, advertising professionals will tell you right, you need to hear something seven times on average in order to maybe make a purchase or change behavior. And frankly, I’m not a very good evangelist. Alex, We have a small team, so I’m better in the operating room. So we need people to go out into the community, whether meeting with the municipality or meeting with those soccer teams. And say, Folks, look, there’s an app on your phone where you could go. You know, just like you you might be ordering a lasagna and it’s delivered to your house. You can go to the Ortho Now app. You can find out which one is open. You can find out how far it is. You can tell them you’re on your way now, if it’s open and then you can actually send even a picture of her injury. And you can call an Uber or Lyft Now in the app. So when I bring that to the the soccer administrator, it they just don’t get it until I hear it multiple times. Now I will tell you one girl had an ankle sprain and within two weeks we saw three young girls with severe ankle sprains because finally they got it. But that’s, you know, that’s only one team. So how do you, how do you get this message out? I, I’d love to to network with folks listening in and roll up our sleeves together. Because this is just, I am giving you one example look, the frustrations and the difficulty of trying to get something innovative and new in healthcare delivery. I’m trying to trying to consolidate because we got a bunch of questions trickle in. A lot of questions about the upcoming new administration and specifically about Medicare for all. Two-prong question one is, what do you expect from the current administration in terms of their initiatives in health care industry and also, if you could let us know your opinion about medic careful. Sure. Well, I I think that question often often ends up being a very political question unfortunately. And it’s sad that our country is as divided as it, as it is right now. I’m, I’m I’m hopeful that we’ll change. But I think if you look just at our neighbor to the north, I mean, just last week I saw somebody from Canada fluid because to begin with, it takes about eight months to get a shoulder MRI done. You get on a waiting list. I don’t think Americans will stand for that. Canadians have because they started with that. But they’re seeing those problems the same with the NHS, the National Health Service in England. So I’ve been to all these countries, have been in our operating rooms even. And there’s some wonderful clinicians there, but they’re very frustrating. So I don’t know if a completely socialized system, if you look at what a screw driver costs the military, you remember the famous case some years ago where the Department of Defense found they were paid $4 thousand for screwdriver. Because once when you get big government involved, the efficiency often goes down. So I think it’s a philosophical question as to whether you, you believe that governments can take care of you or you believe in what do you think that this country was founded on? Is the power of an enterprise driving down costs where competition is good. Now we need to have government for safety nets. And I know I’m a big believer in Medicare. I really am, but I’m I’m not a believer in it for everybody. And I think that that would drive up costs astronomically. And what we’re seeing, what our costs are now. So obviously we have to do something different. And I’m not letting it should the private insurance companies off the hook. As you can tell? That that’s my stance on I think if you speak the most physicians, once you’ve worked in a VA hospital, they’ll tell you, you know, the VA is wonderful for events, but it’s not. It’s not a very efficient plates doctor, but your if you don’t start that total knee replacement and next hour we we can’t we can we can bring the patient in a room. I mean, well, why I meet a person, needs it. Why are we holding up the care? That’s what happens in that kind of system. Yeah, it sets. I actually also have a friend from Canada who just flew in from MRI and staggering, shouted that you providing your book is the fact that that Miami-Dade County has more MRI machines, that the entire Canada, which is another extreme. Exactly. That’s the profit. You probably don’t need that many, but it’s really, really telling, don’t we don’t we will we need the right people ordering MRI. That’s my arguments. I I can’t tell you how many patients come see me with with the risk panned out shoulder, I will tell you most patients with significant sold upon need an MRI for for technical reasons. But let’s just talk about risks. And I just wrote an article that came out in the national media talking about risk pain. I mean, it’s amazing how many people order risks MRIs, it does it people like me were risk specialists. It doesn’t help us in many cases. We should decide let let the specialists decide what testing. As you know, Alex, I talk about that. I wanted to chapters in the the the plethora of diagnostic tests being ordered that aren’t necessary. And part of that is defensive medicine. So we’re not even going to, you know, recognize the big elephant in the room is the legal challenges that healthcare delivery housed in our country that has to change as well. Question from Jeffrey. The growing shift from reactive to parental health care would rapidly accelerate health spending over the next two decades. According to Newport from Deloitte, running counter to much more dire predictions made before 19. Doctor Badia, what do you, what do you make of this? Is this a hopeful sign for for for for bending or cost her? Yeah, absolutely. That the problem is we’re trying to figure out how to reward clinicians for that. That’s little bit more difficult, but we need to have an emphasis and that’s, that’s where our primary care colleagues come in. The if we can simply control obesity, diabetes, hypertension, lung dust, just all of these control them and prevent them. That would have been astronomical effect and that’s not the role of a lot of times, especially physician or your intrapreneurs will do then and I, to be rewarded for now, there’s no question MV, What strategies that there is an economic straining that example about. Talk about DIYbio, right? But do you, a lot of the must, a little prompt that we could recognize early in the workplace. We could go in to the employer. And I don’t want to name big companies in Miami that we’ve tried to do this with. I mean, they really just need to listen and try something different. Because at least from that sector, I can tell you we can make a big impact. So there is a lot of preventive medicine that can be done in a variety of different specialties within medicine. Coming from or amanda. It seems the chances of making the health care system, insurance companies, drug companies helps those senators, congressmen is about as likely as a hair transplant center and Marissa within three years, if you people in the streets would be a mere minor notice to, to this parallel system. Wouldn’t encourage you to think that this is actually has even miniscule change chance of, at a scale that matters. Well, I, I, I touched on a very sensitive subject, right? In this country is racial injustice. And yet look at incredible. I mean, since, you know, an unfortunate person lost their life, We downstream effect that is major changes in the workplace. So obviously, the public can be mobilized around the cause. The question will be, what will it take to do that in healthcare? But the politicians listen to, to collective constituents. And if we can, as a voice say that we really care about this. I mean, we have to convey that. That’s difficult. So I will tell you, I have some hope. Senator Cassidy, who’s wanted a few physicians in the senate, has my book now and I’m hoping to meet with him soon. He just buck the tied in with the Republicans. So he’s, you know, he can be a rebel and that’s what we need. We need people who are really going to go against the current status quo. Because the problem is that the money that’s going into lobbying really perverts the entire process. And I think there has to be a groundswell from the public. And that’s, that’s why I wrote the book is really for the public. The question is, how do we get enough people are public to, to, to read data or to read the healing of America by TR read or the price we pay by Marty mockery. These are all books are read from my book. There’s plenty of books out there. The question is, what will make people get interested? I don’t know. I don’t know if there’s going to be a sentinel patient that that will that will raise the compassion that a public temperature questions. And this one is a lot trickier, comfortable answering. And if not, could you mentioned pharma exactly. How do you feel about hospital exact date? Oh, I think it’s gone up astronomically in Alaska for me that I started charts. It’s look again, I’m look if there are private there aren’t there aren’t non for profit hospitals, right? We have one of the biggest ones here in Miami. And we have for profit hospitals. But in for-profit hospitals can deliver really good efficient care. And the Executive leading that charge can demonstrate that I think they should, they should be rewarded. Well, again, I am all about, about a capitalistic approach to this. But it has to make sense and we have to be rewarding the right things. So that debt is naughty and I apologize if I showed a slide that showed exorbitant salaries. I mean, we we nobody seems to be batting an eye. With we all watched the Super Bowl, right? It was not, not a great game, but it’s kind of amazing to me that this is a game that really is 12 minutes, 12 minutes of actual players, 16 games a year. And if you do these, if you do the math about what somebody’s athletes make per minute in plane. And yet somebody wrote in about about physician being paid exorbitant. Well, you know, if you if you’re not going to pay people who have to dedicate a long time. So education and training than our level of care quality may suffer. So I think it has to be commensurate. But I have, I have no problem when somebody delivers efficiency for them to be rewarded for that. And that’s what we need in health care. We need efficiency. Thank you. I think your book echoes some of the some of the things like what it takes to get to the point when you’re when you’re a doctor. I didn’t realize that I worked in investment banking when I was younger and we had crazy hours, but I did not realize that. You had a schedule of what he had to work 48 hours straight and have six hours of sleep or I don’t remember the numbers, but there’s a schedule with two numbers. I remember the 6 sixth power sleep is all you have. Well, we’ll look. The thing is if you talk to most physicians were really not complaining so that it’s not about that. I think it’s just important for the public to know what, what it entails. And and I also mentioned that I happen to be in the forefront of it when the bell commission in New York came around, Birch and Bell made an argument to cut the hours. And it makes sense, right? You think it’s ridiculous to work that much. But I will tell you most of the time, we were not as as a surgical residents, we were not really happy with an external body telling us to limit our hours. We knew what was needed in order to be able to have continuity of care and and to be able to have maximum training. So although those I think are or are not issues, I think the issues are making sure that that surgeons and other clinicians are well trained. And there are, so there are some problems now because of the fact that there is a over-regulation and bureaucracy even in that space where it really shouldn’t be. So those are, those are topics that are covered in depth in the book. Quick question that we are approaching that a cloud actually on the dot. But one last question I guess I’ll take from Maryland. Thus ortho no, offer totally retail services to people who want them. And is it are you able to give price estimates in advance for the procedures? Well, let’s understand that ortho now is it necessary procedure mean import them now is not a surgery center. Although we do have a direct relationship with one at the flagship. But ortho now is it’s like an any urgent care. So I can tell you if you don’t have insurance and your kid has a little risk fracture on a soccer field and a fall, you’re going to get in and out of there. So for somewhere between two hundred and fifty and three hundred bucks on your credit card done within typically 770770 minutes or less. I mean, it’s we’re trying to, to have the quality of the four seasons, but the price of a chick filet with the same a the same attention to customer service. So there is no reason why it can’t be cost effective and efficient. Certainly we work with insurance companies, we’d like to work with mortal. That’s another challenge. Even getting an insurance company to have a dialogue with us, to get a contract is, is a bear. And one of the worst things that we can hear from a patient is o, take my insurance. Well, that is not true. Our staff is trained to say no, he very sure it’s is it giving it? Because we we take Medicaid which pays very poorly if anybody knows, but that’s okay because our role is to serve the community. So we’re we’re more of a more of a volume business. If we’re taking care of the needs in the community, what will make ends meet? But, but there’s no question are people who either don’t want to use or insurance or don’t have insurance. And we’re certainly cost effective compared to all the other options out there. Take headhunter, we’re past our time and I want to apologize for for folks. We we had many comments. I don’t want to say that. I’m sorry that we’re not able to answer all of them. We will record this, we are recording this session and we’ll provide a link to those who were not able to participate today. As a token or a small appreciation, we would love to present the handle. I don’t know if you guys you guys can see it. A bottle of scotch was Oh, that’s wonderful. Out my email. I’m up there. Oh, wonderful. Thank you. But Alejandro, thank you so much. I appreciate we really appreciate your your wonderful presentation and very insightful discussion that we have afterwards. Look forward to seeing you in person when things are going to a more normal. But this is a great start and I view it as a start of a much broader discussion. So we’re naked Christina, for setting this up and thank you everyone who have participated, probably their comments, questions. We’ll look forward to seeing you at our next events. Thank you again. Thank you. Thank you, Alex. And folks have my contact info there. So any questions that we couldn’t answer during this session? I’m I’m happy to respond to them. I thank you all. Thank you, folks. But I helped him.