This is Alan Condon with the Becker's Healthcare Podcast, and I'm thrilled to be joined today by doctor Michael Ast, a fantastic leader who wears many different hats at Hospital for Special Surgery, including chief of the knee service, chief medical innovation officer, and director of ambulatory surgery center strategy. Doctor Ast, a pleasure to have you back on the Beckers podcast with us today. For those who mightn't be as well acquainted with you or Hospital for Special Surgery, do you mind taking a moment to give us a little bit more about your role and your background at HSS? Sure. And thanks so much for having me back. Always appreciate the invitation. So as you said, my name is Mike Ast. I'm a hip and knee replacement surgeon at HSS. HSS is a large orthopedic specialty hospital in New York City. It is the oldest orthopedic specialty hospital in the world. We've been around for a hundred and sixty years, and specialize entirely in musculoskeletal care. Myself, personally, I I trained at HSS, and have been in attending there now for the last eight years. And as you noted, I also hold a couple of other roles, including, partnering with, our chief innovation officer to run our innovation institute as well as a role as a director of our ASC strategy. All that on top of what I do on a day to day basis, like I said, which is just hip and knee replacements. Fantastic. I don't know where you find the time to do it all, but, excited to dive right in and hear a little bit more about that, Mike. So to kick it off, I think, obviously, a couple weeks into 2025 here. What are the the two or three trends that you're really focused on this year, whether as it relates to orthopedics or the ASC field, more broadly? Yeah. Well, I think in orthopedics, we're gonna see another year of growth. I just think as the population continues to age a bit and try to be more active, certainly, I still think we're coming out of the pandemic, although we're pretty far out. I think volumes will continue to increase. So that's the positive side of it. The negative side of it, of course, we're always watching that costs also continue to increase. We're continuing to watch the shift from inpatient to outpatient having a significant effect on how patients are treated, on how patients seek care, and also on the revenues to whether it's our ambulatory surgery centers or our hospitals, and some of those are working in opposite directions. But I think combining that with the very rapid pace of innovation, I'm hoping that, as we start to see interest rates come down, we'll see some more reinvestment into innovation. We that was really, really hot in 2021, '20 '20 '2, slowed down a bit over the last couple of years. I think we're gonna see a big reinvestment both on the digital side as we start to talk about lot big data and machine learning and AI and also on just the general, digital health care innovation side. I think there's a lot of really exciting tailwinds on that side that may help balance some of the headwinds everybody in health care is facing right now, combining, of course, with the new incoming, regulatory changes that we may all be seeing in the next couple of months. Absolutely. I think AI is something no secret to you, to any of our listeners here as popping up everywhere across the health care space and even outside it. Specifically as it relates to your practice with HHS, are there any specific areas within the AI technological field that you're particularly excited about? Are there any early, initiatives that you're focused on, any early results that you can share? I know it's such a big, big area, but I'd love to kinda get a specific example or two that you see a really, potential big impact. Yeah. I mean, I can give you three very concrete examples that we're dealing with, even today in my practice, and they're very different. And some of them are very simple, some a bit more complex. So, obviously, one very, very simple example that was, talked about this morning by many of my colleagues and I is just making basic tasks easier. So every single, professional out there has to get their resume or their CV in place. And it's just a task you do every once in a while, certainly when you're, like myself as an academic surgeon preparing for promotions within our medical school or things like that. It's just a tedious task, and we've been hoping for this AI making tedious tasks easier. And this morning, we launched, just internally, but very excited to most of the doctors, a way that AI is gonna help us do all of that. Very simply, it searches the Internet, brings up all our recent publications, brings up anywhere we're mentioned in the news, brings up anywhere that we, have given some local lectures or invited symposium talks, structures it for us, puts it all together. We can simply review it and probably save me ten to twelve hours of work just when the next time comes, to apply for another promotion or send my CV somewhere. So it seems like such a simple thing, but such a powerful tool that, has been unlocked, with very, very simple machine learning and and AI type stuff. Take that one step further on the clinical practice. One of the things we're most excited about right now is the development of our AI powered postoperative chatbot. So when our patients call us with very basic questions of when can I shower, when can I do this, when should I can you help me make my appointment, tell me a little bit more about what I should be expecting on day one, day two, day three, as opposed to that having to be a person calling back with the use of generative AI? We've been able to create a tool that patients can interact with that has seen ex incredible success in our early pilot data with our patients. I mean, patients love it, responds right away, responds with the with the information that we gave it to respond, and responds in any language that you can speak, which gives it a huge advantage over someone like me who doesn't speak, let's say, French or Japanese or any language that a patient might want. So that's a very, very concrete clinical example that we've had very early success with, and I'm super excited about moving forward. The two in development that are the most exciting obviously are, ambient listening devices to help us write our notes and get things done, make our offices more efficient, bring us up to being able to get back to face to face conversations with patients without having to worry about writing my note, getting through, making all my orders, having ambient listening devices in all of the rooms that we do is something that HSS has actually made a pretty significant investment with. Thanks to a very generous donation, from a grateful patient to help us develop and work with this technology to bring it to more patients such that the patient doctor interaction came back to being just that, not the patient doctor computer interaction. And then the last thing, of course, is that the future where we all wanna see this go in surgery is how can we make surgery better? How can we make surgery more predictable? And the combination of advanced surgical tools like computer navigation and robotics, certainly in joint replacement and in spine surgery, is a big topic right now. And combining that with machine learning algorithms and AI and large datasets, we could start to help develop decision support tools that are really gonna help us bring personalized patient surgery that hopefully will give us improved patient outcomes in the future. I see. Yeah. Mike, I absolutely love those specific examples and kinda early results as well. The the ambient listening device is something I still hear come up time and time again. But even to your point, some of those other, making basic tedious tasks easier. I imagine resumes, CVs, promotions, getting all that stuff in order. I I imagine saving ten to twelve hours for for a busy leader, but a practicing surgeon like yourself is a huge time saving, which no doubt you can do a lot more with that ten, twelve hours, a week. So really, really fascinating to get your perspective, your insight on some of those AI, solutions and both the boat you're working on now and also they're eyeballing down the line. Jumping into our next next question here, it kinda ties nicely into this, but no doubt you're excited about AI there. But is there anything that you're particularly excited about whether it may be specific to your practice or maybe in the surgical tech field? What are you kind of, keeping a close eye on? Yeah. I think, again, as a hip and knee replacement surgeon within the technology field, all of the different robotic and computer based systems are the things that are the most exciting to us. Over time, we're just trying to hone down our ability to personalize and more exactly perform the procedures that we think help so many patients. And the way I always look at that type of technology is it exist the the growth of it exists in two ways. Number one, the individual technology gets better. Number two, the access to that technology gets more ubiquitous, meaning that more patients can be helped by that technology, not just across New York City or The United States, but even across the world. And I think it's both of those combined together as the cost of these technologies comes down, as they continue to evolve, and just technology in general continues to move forward. I'm very excited to see the next generation of our surgical computers, the next generation of our surgical robots, the next generation of our three d printed implants. But I'm probably more excited to see the democratization of access to that type of technology, where instead of this type of technology being used in five, ten, 15, maybe twenty percent of surgeries, I'm excited for five years down the road when it's 95, a % of surgeries and not just in New York and not just in The United States, but really everywhere around the world. Yeah. Absolutely. And one quick, not to harp too much on with AI, but I've heard so much in terms of the integration of AI into specifically, hip and knee robotics. Where do you see the biggest opportunity in that in that area? I think that really comes down to the concept of this decision support tools. The ability to say, okay. We see a patient and they look like this, and they look exactly like this. Their leg has this angle to it. Their arthritis has this pattern to it. And now we're gonna look at how do we perform their surgery and how did they do. Because not every knee looks the same, not every hip looks the same. And for generations, simply because of the technology we had available to us, despite them not looking the same, they were all treated the same. And I think AI and these large machine learning algorithms have this this huge potential to change that paradigm completely and basically take this to a point where a patient who looks like this and walks like this and has these preoperative functional limitations and has these postoperative functional expectations should be treated with surgery done in this manner with this implant and this recovery pathway, and that's gonna lead them back to the outcome that they were looking for. And that really, really honed down level of personalization is really where I think you can't do it on your own. I can't look at my patients, the however many I take care of each week or each month and be precise enough to know the differences. But when you start using things like AI, all of a sudden you can take very, very large datasets, huge amounts of very specific types of data. And as long as the inputs are accurate and clean, you might be able to get that type of, information on the back end. Yeah. Absolutely. And kind of fascinating, as a bit of a self confessed, gadget and tech tech nerd. It's, fascinating to hear the evolution of this technology and also to your point, the the democratization of access to some of this technology as well. Mike, last question. I'd love to kinda get a little bit more insight from you on before we let you go. HSS, obviously, fantastic institution, ton of growth recently, not just in the New York area, also expanding their footprint in Florida, along with the likes of Rotman, Mount Sinai. Over the next twelve months or so, where are the the core areas of growth that HSS is really looking to focus on? Yeah. I think we have two sort of ways that we think about growth. We have our local growth within what we call our Tristate area, and the most exciting part of that in in, again, in very concrete ways is we're excited to increase our ambulatory surgery center presence in the Tristate area, hopefully, with growth within that core market, but providing more access to more patients closer to home. And I think that does two things for us. Number one, obviously, it helps us expand access to high quality orthopedic care and musculoskeletal care, and it helps it be easier for patients to access the system. It also helps open up space at our main campus where we can continue to drive the most complex orthopedic care from around the world. You know, we take care of, and we're blessed and and privileged to take care of some of the most complex orthopedic problems, not just from New York, not just from The United States, but truly from around the globe. And by opening up more space within our institution itself, we can continue to increase the access to that super high quality, super complex orthopedic care while at the same time providing every patient who wants it access to HSS level care. So that's the sort of local market. Florida, obviously, as you said, is is an interesting market to a lot of people. And we have our West Palm facility, which has been doing great for several years. And then, of course, the facility that we opened, on the E on the West Coast in in Naples in partnership with Naples Community Hospital and both of those now up and running. We're really excited for the opening of the physical Naples facility. So while the program has been in place, the physical facility will be opening q one, q end q one, beginning of q two this year. And that's super exciting because it'll have access to outpatient services, ambulatory surgery, physical therapy, imaging, and all right there on the North Campus Of NCH. So very, very exciting. And then, of course, our recently announced partnership with University of Miami, which I believe you covered within, within the Becker's healthcare sphere. Another very exciting opportunity to increase access to HSS level care for the rest of, Southern Florida. And I think when you combine those two, those are the things that we're doing homegrown. Now we will always continue to evaluate other opportunities whether it's on a national scale or an international scale, and these are often through educational partnerships, working partnerships, or something we haven't even thought of yet because our goal has always been that as a leader in musculoskeletal health around the world, our goal is to increase access to high quality musculoskeletal care to every patient that wants it and needs it. Absolutely. Doctor Ast, fascinating to to have you back on the podcast with us again. A ton of growth, not just at at HSS, but but also your practice as well. Fascinating to get the inside scoop, and, I really look forward to connecting with you again down the line. Thanks so much for having me. It's always a pleasure.