Some caused us to run over a little bit, but we're happy to take any questions for the next five or ten minutes or so. Anything from the, yes, I see a hand back in the darkness, far away. There's a question, for the take away, for those of us in the office, I have guys, others that do the PRP of the stem cells, or excuse me, the genitour cells, but in the office for the average orthopedic surgeon, if it is a busy clinic, is there an alternative to disco supplementation that you recommend and that's fairly readily available? And two, what can we do in the OR that's cost effective now? For example, like the bursal cells that are going to the cup of beer, can you take those and process them, inject them back? Or, you know, some of the vendors, like Arthrex has a system for harvesting PRP, which is fairly cheap, and they have a BMAC system. And so, take away from what I want to do in the operating room, the information you have, there's a lot of stuff that's on the horizon, but what can we use now? So, just to repeat the question for everybody, it's kind of a question along, what can we use in the office and in surgery now if we want to use these products for our patients? Maybe Jason, any thoughts? Yeah, so there's many, I think, parts to your question. So, one, what can we use now? And so then, basically everything we talked about, right? So, the adipose-derived preparations, the bone marrow-derived, the BMAC, which is either aspirating it in a concentrated form or spinning it, which is concentrating it using a machine, that's usable. Lipogems, usable. And all versions of PRP, usable, both in the OR and in the clinic. The main differentiation, and this, I think, might be better answered, is be careful of the separate charges aren't always legal. You can't just add them on as you do in the clinic. And in the clinic, you have lots of options, and this is done all over these approaches. And PRP, there are systems with which you can create a flow within your clinic, and it's very well tolerated in a busy clinic environment. The cell aspirations are more specialized type of setup that, again, that is better in a procedural room part of your clinic. The whole cost-effectiveness is another thing that you asked about, and that's a whole other story, right? Because then that's very individual to your reimbursement. And so then, what is cost-effective in the OR? Much less so, right? And then more cost-effective in the clinic environment. If we were just to summarize everything, but then, you know, it's what you charge, and it's what you're getting your kits for, and the cost of doing that service. I know it's a little bit broad. Yeah, the approach I took in my practice is, you know, obviously, if patients are going to be paying out-of-pocket for these substances, then one, they're going to have to be safe, and two, there's going to have to be some significant efficacy for their use. So I use PRP in the operating room for all my meniscus repairs because there's some fairly good randomized clinical trials that show that that significantly increases healing rates. I think you're justified in using PRP for that reason in rotator cuff. Also, there's also some good studies on BMAC. But once again, it's a price-point thing, and patients have to know they're going to pay out-of-pocket. Some patients can't do that. I took some patients to the operating room for BMAC just so that they could get the procedure because they wanted it, and then I didn't really bill them for that. At the time, I was a hospital employee, and, you know, so the hospital billed for a bone marrow aspirate, and I just billed for an injection. So the patient wasn't billed $4,000. And she did quite well, right? So you can do things like that also. There's ways to skin the cat, but I think, you know, if you want to establish. . . I think the way to do this is to establish it as an ancillary service, right? So that you have a structured way to do it. You have the proper full-time, you know, FTEs to help you do it, and that you track it as a business to make sure that you're not underwater with it, right? Different markets also will have. . . You'll have different ability to do these things in different markets. In my market of Westchester County, which is, you know, a fairly affluent community, there's a lot of people that are willing and able to pay for this out-of-pocket. In some practices that I deal with now in Mississippi and Alabama, that's not the case. So their utilization of these entities is really low, and it's hard to convince the doctors there that this would have value for their patients because they really can't pay for it. So once again, since it is an out-of-pocket cost, I think you need to really sit and justify the cost and the time. And the literature, I think, is starting to emerge that, you know, I think PRP is, for arthritis and for rotator cuff and for meniscus, is effective and worth it. You know, micro-fragmented fat for arthritis, recent meta-analysis by Zeng showed that it was micro-fragmented fat more effective than PRP or HA for pain relief. So evidence is emerging, but I think it's going to be even better when we start to segment the populations, especially in regards to osteoarthritis, the more targeted treatments, and I think that's when the cost will really be justified because, you know, you'll be targeting the patients. One last thing. There is enough evidence in the literature for a CPT code for PRP. We put it together. We have the literature. We have the vignettes for the patients. We have the time slots. It's ready to go, but we got a lot of pushback because there is still a significant segment of the membership of the AOS that wants to be able to bill this on a fee-for-service basis. So I think you will see a CPT code for that in the reasonably near future, and you will definitely see a CPT code for micro-fragmented fat because that procedure probably takes about 30 to 45 minutes for that, correct? That's going to be worth about 12 RVUs, right? So it's going to be like doing an ACL. So I think that that will progress to a CPT code sooner. Okay, well, we're out of time. I want to speak for the whole panel, but I'm happy to stick around and answer questions. Thanks for coming and getting up early in the morning. We really appreciate it. Have a great rest of your meeting.

disco supplementation

orthopedic surgeons

adipose-derived preparations

bone marrow-derived preparations

lipogems