August 20, 2025 • 40 mins
Orthopedic care is experiencing a fundamental shift from mechanical fixes to joint preservation, and Dr. Jason Jones is at the forefront of this evolution. As founder of Nashville Knee and Shoulder, he's spent 12 years building a thriving practice focused on delivering personalized care for knee, shoulder, and musculoskeletal conditions.
Dr. Jones takes us behind the scenes of his journey from training in New York to establishing his clinic in Tennessee. He explains how orthopedic approaches have transformed over the past decade – moving away from immediate surgical interventions toward more conservative, joint-preserving treatments. We explore the exciting world of regenerative medicine, including PRP and bone marrow aspirate injections, and how these therapies are changing patient outcomes.
The conversation delves into the business realities of running an independent orthopedic practice in today's healthcare landscape. Dr. Jones candidly discusses the challenges of negotiating with insurance companies, keeping pace with rapidly evolving technology, and building a practice centered on people rather than systems. His perspective on handpicking the right team members offers valuable insights for any healthcare entrepreneur.
What makes this discussion particularly compelling is Dr. Jones' passion for helping patients maintain active lifestyles. He articulates why physical activity is fundamental to both physical and mental wellbeing, and how his work directly contributes to patients' quality of life. Looking toward the future, he shares exciting developments in minimally invasive procedures and joint-preserving surgeries that promise to transform orthopedic care.
Whether you're a healthcare professional, someone experiencing joint issues, or an entrepreneur interested in healthcare business models, this episode offers valuable insights into the evolving world of orthopedic medicine. Subscribe to hear more conversations with healthcare innovators who are shaping the future of patient care.
Guest Bio – Dr. Jason Jones
Dr. Jason Jones is an orthopedic surgeon and the founder of Nashville Knee and Shoulder, where he specializes in advanced care for knee and shoulder conditions. With over 12 years of experience serving the Nashville community, Dr. Jones combines surgical precision with a deep commitment to joint preservation and patient-centered care. His clinic emphasizes innovation, minimally invasive techniques, and regenerative therapies to help patients maintain mobility and return to the activities they love.
🔗 Guest Contact & Socials
- Clinic: Nashville Knee & Shoulder
- Website: https://www.nashvillekneeandshoulder.com
- LinkedIn: https://www.linkedin.com/in/jason-jones-35718870/
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Andrew Greenland (00:03):
Hello everyone and welcome back to
Voices in Health and Wellness.
This is the podcast where weexplore what it really takes to
build, grow and sustainmeaningful healthcare businesses
in today's changing landscape.
I'm Dr Andrew Greenland andeach week I sit down with
clinicians and operators acrossthe health spectrum, from
functional medicine to surgery,to talk about the reality, the
real world side of patient care,business ownership and
(00:24):
everything in between.
And today I'm really pleased tobe joined by Dr Jason Jones, an
orthopedic specialist and thefounder of Nashville Knee and
Shoulder.
His clinic has been serving theNashville community for over 12
years, with a strong focus ondelivering personalized, high
quality care for knee, shoulderand other musculoskeletal
conditions.
So, Jason, thank you very muchfor being here.
Are you calling from Nashvilletoday?
Dr Jason Jones (00:46):
I'm calling from San Antonio today.
Dr Andrew Greenland (00:48):
Okay, wonderful Okay.
Dr Jason Jones (00:50):
Yeah.
Dr Andrew Greenland (00:50):
So maybe start a little bit at the top.
Can you just tell us a littlebit about Nashville, knee and
Shoulder and what inspired youto create this clinic?
Dr Jason Jones (00:58):
So my roots are based in Tennessee.
We, so my roots are based inTennessee.
This is a very southeasternstory, but I kind of grew up in
southeast Tennessee, went tohigh school, college and
everything there, and then movedto New York for a long time.
I did all my training in NewYork and then, when it was time
to start a practice, to kind ofmove into the real professional
(01:21):
world, I very much wanted to beback in Tennessee, in the
landscape at that time.
We're very large groups.
There's not a lot of hospitalfocused physicians, at least in
the orthopedic world in middleTennessee, especially in the
Nashville area.
So in order for me to kind ofpave my own way, I started a
small clinic.
It was initially just me andone other physician, a gentleman
(01:45):
that trained at the samehospitals as me, just, you know,
15 to 20 years prior.
So it was just us for you know,about 10 or 11 years.
And then just recently we'vekind of started the next phase
of the Nashville Knee andShoulder Clinic, where we're
actually starting to grow andadd in some additional
clinicians.
Right now we're at a total offive clinicians, including our
(02:07):
mid-levels, and actively tryingto expand across the Nashville
landscape.
Dr Andrew Greenland (02:14):
Amazing.
So I think you are a raritywhen you said orthopedic
physician.
It's not something we have inthe UK.
So where's the separationbetween an orthopedic physician
and orthopedic surgeon?
Obviously there's the surgeryinvolved, but in terms of the
way they work and operate andkind of interface with each
other, yeah, that's aninteresting question.
Dr Jason Jones (02:32):
When you say orthopedic physician, I think
our term would be a sportsmedicine physician or a
non-surgical orthopedist, andthere's definitely both of those
entities operate.
They both exist in the UnitedStates.
The biggest difference is inour training.
Whereas the sports medicine orthe non-operative orthopedist
(02:55):
will go through three to fouryears of medically-based
training focused on soft tissueinjuries, rehabilitation
non-operative soft tissueinjuries, rehabilitation
non-operative means to improvethe patient and get promising
results, whereas the majority ofour training I would think
about 60 to 70% of our trainingis in the operating room or in
(03:18):
the surgical world.
Dr Andrew Greenland (03:20):
In the clinical side, it's really about
30 to 40% of what we end updoing during our residency okay,
so in terms of what a typicalweek looks like for you in
practice, from clinic hours andmanaging the clinic, how does it
pan out for you?
Dr Jason Jones (03:35):
so I'm in the operating room about 60 of the
time.
I'm in the clinic about 30 to40 of the time.
Um, seeing that I do own andoperate a business, there are
some administrative tasks aswell, so that takes up, you know
, whatever little bits left over.
My OR days typically run from,you know, about 7 am to about 5
pm and we do about 15 to, youknow, 20 surgical cases a week
(04:01):
In the clinic.
It's a mixture of my partnersor mid-levels sometimes seeing
urgent cases acute injuries,that high school football player
that twisted his knee sothey're managing kind of the
more urgent issues.
And then we have scheduledfollow-ups with myself during my
clinic time, which for me isabout, on average, about 10
(04:25):
hours a week that I'm in theclinic, got it?
Dr Andrew Greenland (04:28):
Okay, and what sort of population or types
of cases are you typicallyfocusing on most today, and how
has that evolved over the yearsthat you've been doing this?
Dr Jason Jones (04:37):
So we're called Nashville Knee and Shoulder and
it's very poignant.
We're very much directed at thetype of patient we're
recruiting.
I do 90% knees and shouldersand that's kind of A to Z in
that world.
So within the knee world, I'mdoing everything from meniscus
(04:58):
tears to ACL tears, all the wayto joint replacements.
In the shoulder world, sameidea.
I'm doing everything from themore minimally invasive shoulder
type of surgery all the way toshoulder replacements and the
shoulder world same idea.
Dr Andrew Greenland (05:06):
I'm doing everything from the more
minimally invasive shoulder typeof surgery all the way to
shoulder replacements all right,and how do your colleagues
complement them and do they havea different sort of skill set,
see different things, or are youfocused primarily on anything
to do with those two joints as ateam?
Dr Jason Jones (05:21):
we we have kind of divided and conquered.
I have a partner that just doeships, I have a partner that
currently just doesnon-operative sports medicine,
and then we're actively kind ofrecruiting to fill in some other
gaps, such as hand surgeon orfoot and ankle.
Dr Andrew Greenland (05:41):
So you're going to become fairly holistic
in terms of treating the wholebody at some point with your
team.
Dr Jason Jones (05:46):
We are, yeah, but we're piece-milling it
together right now.
But we have taken thespecialist approach where we all
stay in our lane, do what wethink we're really good at.
For me, that kind of lives inthe knee and shoulder world, for
my primary partner, dr Ferguson, that's just hips, and then
we're filling in the gaps inbetween.
So we want to provide the bestquality care at what we think
(06:11):
that we are the absolute mostqualified at doing.
Dr Andrew Greenland (06:15):
Amazing.
And what shifts are younoticing in the orthopedic field
today, either from a clinicalor an operational perspective,
or a patient expectationstandpoint?
What are you kind of seeing?
Dr Jason Jones (06:25):
Yeah.
So orthopedics is changingquickly.
Orthopedics has always beenevolving because orthopedics
gives physicality back topatients and that's especially
in our at any point in our lifeand especially in our later
years.
That might be the mostimportant thing is giving the
patient the ability to be activeand do what they want to do,
(06:45):
and the way that we'veaccomplished that is changing.
And if you rewind 40 or 50years ago, it really was more
based off mechanics.
So if there's a problem withthe joint, we're going to
mechanically fix that joint.
If your joint is broken, we puta plate and screws on it to fix
that.
If you have arthritis, so theend of the joint is worn down,
(07:08):
we'll resurface that joint andput a new metal surface on it
and allow the patient to resume.
You know a improved and muchless painful.
You know speeding up is there'sa lot more focus on conserving
(07:33):
joints, being a little bit moreconservative and maintaining the
integrity of the joint as longas we can.
So saying that in a differentway, we're not trying to push
directly to joint replacements,where we we would like to try
everything in between.
So if the patient has arthritis, we might start with some sort
(07:56):
of injection and even when westart talking about the
injectable world.
There's so many options forinjections.
You have the tried and trueinjections, such as steroids,
which which have a place buthave kind of very much kind of
fallen out of favor in themainstream.
You have things that have somedata behind them, like
hyaluronic acid, but then youreally have the more
regenerative type of medicineand the more regenerative type
(08:18):
of injections that are startingto become well-known within the
community.
Patients are coming and lookingfor these and the data and the
potential capabilities of theseinjections just seems to be
improving as the science behindthem improves.
And when I talk about thoseinjections most specifically in
(08:39):
the clinic, we use PRP, which isplatelet-rich plasma.
We use BMAC, which is a bonemarrow aspirate.
Those are the two primary onesthat we use and these are kind
of stem cell like dots.
Stem cells is an incrediblyconfusing term, um, but, but
those are the ones that are mostaccessible and easily used, at
least in the united states.
(09:00):
So those injections have a muchbigger place than they did 10
years ago, um, and patients.
Dr Andrew Greenland (09:07):
Do patients have an expectation?
You know they arthritis.
They're coming in with theexpectation of having a joint
replacement and are theyreceptive to these other more
conservative, preservingtreatments, or how do patients
perceive this?
Dr Jason Jones (09:22):
Patients tend to know what they want when they
come in, which is also, I think,another shift that I've seen,
where patients come in almostasking for a service now more
than they did 10 years ago whenthey came in looking for a
diagnosis.
I think there's a lot moreself-diagnosed patients, if
you're following my train ofthought here.
So a patient comes in with kneearthritis.
(09:44):
This is an incredibly commonvisit for me, so the way that
conversation typically goes ishey, you have knee arthritis.
It's this on a scale from oneto 10.
So let's just say it's a fiveon a scale from one to 10, which
is not how we medically woulddiagnose arthritis, but it just
makes sense to a patient.
So that's your diagnosis andwhat options do we have?
(10:07):
What treatment modalities do wehave to treat that?
And some patients are at apoint in their life where
they've dealt with this problemlong enough and they just want
it to be over with.
And those are the patients thattend to seek out just a
resolution or a cure, if we cancall it that, and that tends to
be the more aggressiveapproaches, such as the knee
replacement.
(10:27):
Or there's a whole other half ofour patient population that
would want to do everythingpossible to avoid a knee
replacement.
Those are the patients thatsometimes will clean the knee
out with a camera, which youknow that varies wildly from
patient to patient on theeffectiveness, but it is an
option.
Those are the patients that wemight go down and try a few
(10:50):
injections with.
Those are the patients thatsometimes we do the in-between
surgeries, the surgeries thatexist between the kind of very
basic sports medicine injectableworld and then the total knee
arthroplasty world.
And that's a space right now,like the kind of in-between
arthritis world that we don'thave a good solution for.
And it's just that the world isjust waiting for a surgery to
(11:15):
come through, I think, andchange that game to bridge the
gap between the patient that hasthat kind of five out of 10
arthritis that's limited butisn't quite ready for a total
knee replacement, and do youhave on your team things?
Dr Andrew Greenland (11:32):
like physiotherapists or manual
therapists, to sort of supportand integrate with what you do,
or is it primarily orthopedists?
Dr Jason Jones (11:38):
Well, we have physical therapists that very
key component of what we do.
Dr Andrew Greenland (11:43):
Okay, what about pandemic and how that
affected things for you, and hasit changed sort of patient
behaviors and expectations afterthat whole pandemic thing
settled down?
Dr Jason Jones (12:03):
The pandemic it caused a in America.
So when the pandemic hitthere's a lot of just
uncertainty.
They're a very you know kind ofworried and scared population.
So the practice of medicine, atleast in the private sector for
what I do, which is electiveprocedures, you know nobody has
(12:26):
to have a knee replacement theaccess in the patients seeking
that care dropped offsignificantly because everybody
kind of went into like a duckand cover type of mentality.
The hospitals themselves becameextremely busy.
That affected us somewhat, butnot nearly as directly as the
(12:53):
frontline medical providers, notnearly as the ICU doctors and
the emergency room physicians.
So our patient population itkind of it changed for a short
time while patients just madesure that the world was going to
be okay.
And then when they came back, Ithink the biggest differences
(13:19):
were there's a big focus ontelemedicine.
That very much changed duringthe pandemic.
Patients wanted to have Zoomtype of consultations because
that became a real valid way tohave patient interactions and
that stemmed in the UnitedStates from the pandemic and
(13:42):
this wasn't really to thepandemic.
But in the last five years justreally the emergence of AI has
changed the way patients gathertheir own information and that's
changed a lot of patientinteractions because they will
come to me with data they'reshowing.
They're showing me data thatthey've discovered and asking
(14:02):
this is this is what I have,this is what I know.
Help me make sense of this.
And and that's not necessarilya direct cause of the pandemic,
but that is very much somethingthat's changed in the last four
to five years.
Dr Andrew Greenland (14:18):
Interesting .
Are you seeing more casesrelated to sedentary lifestyle?
I don't know how aging andsporting injuries are playing in
these things that youspecialize in.
I just wonder where you've seenany trends in this direction
and how that's kind of alteredyour model of care the sedentary
lifestyle.
Dr Jason Jones (14:34):
I, I'm a, I preach activity.
Um, my whole job and philosophyis focused on on being out,
doing things, doing the thingsyou love, because if you're not
being active, your body isactively declining and that
becomes more and more importantthe older we get.
So do I see injuries fromsedentary activity?
(14:58):
Absolutely, it's the patient.
I mean, one of the most commoninjuries I see is the
40-something that decides to goplay basketball and hasn't
played in 10 years and tearstheir Achilles, tears their
patellar tendon, like this.
This happens surprisingly often, um, and that's a form of
sedentary lifestyle, absolutely.
(15:20):
I think the other end of that is, you know, the patient in their
seventies that has just kind oflost the motivation or they
live with a degree of pain thatprevents them from being active
during the day and that leads toa type of physical decline.
I also think it leads to a typeof mental decline when you lose
(15:40):
that ability to do what youwant to do, to be active and to
pursue hobbies and activitiesthat you love.
And does that lead to jointproblems?
Yeah, it does.
Disuse of your joint leads toactive thinning of your bones,
loss of some of that structuralsupport.
It leads to muscle wasting andall that plays into degeneration
(16:06):
of joints.
I think, more than peoplesometimes realize, one of the
biggest protective agents of ourjoints is actually muscle
strength, and I think physicaltherapists have known this for
you know centuries.
But that's something, I think,that gets overlooked with
general medicine fairly often.
Dr Andrew Greenland (16:25):
And presumably your work includes
sort of exercise prescriptionsand everything else to try and
keep people out of trouble andalso to optimize them when
they've had any particularsurgery that they've had done.
Dr Jason Jones (16:35):
That's correct.
Dr Andrew Greenland (16:36):
Yeah, interesting.
What about staying up to date,sort of clinically and
strategically?
Obviously, orthopedics is ahuge speciality and I know
you've narrowed down on a coupleof joints, but you and your
team are covering more and more.
How do you guys keep up to datefrom from in this, in this kind
of ever-changing world?
Dr Jason Jones (16:52):
it's hard?
Um, it is, and you so?
It's funny because I actuallyam lecturing today on this exact
same topic like what?
Like how do I stay up to dateon certain in my world?
It's implants, like what?
Because there's so many options, there's so many vendors,
there's so I think that'sworldwide, but especially in the
United States.
So how do I stay up to date onwhat's changing, either
(17:16):
technically, which is, you know,a surgical technique, or with
the types of implants that I'musing, you know, in patients in
surgery?
And it's changing rapidly, notone from a business perspective,
but secondly, just from patientdemands.
Patients are looking forquicker recoveries, they're
looking for smaller surgeries,they're looking for better
(17:36):
outcomes, and those are threepretty bold requests.
And, amazingly, like medicinedoes continue to progress and
for the most part, every yearthere's some sort of advancement
in my world that changes thegame, so to speak.
So how do I personally stay upon it?
(17:57):
The most common way that I willlook into or potentially adapt a
new technique, a new treatmentfor a patient, a new implant for
surgery, is discussing with myother colleagues.
So a lot of this is communal.
I discuss what my shouldersurgeon friend in California is
using versus what my friend inNew York is using and when they
(18:20):
have a good experience with theproduct they've noticed a
quicker recovery, they've saidthat it's easy to use Then I
look into it.
That is probably the mostcommon reason that I start to
look into a new technique or newproduct.
The second most common reasonis if just data supports it.
(18:40):
It's rare, if ever, that I'lleven consider using something
that doesn't have some sort ofpeer-reviewed data behind it.
So if there's and I read theorthopedic journals, you know,
fairly regularly so if there'ssomething that seems to be
changing with the dynamics ofcare, potentially improving
patient care, and if there's aseries you know one or two
(19:05):
potentially more trendingarticles that kind of show that
this, hey, this is potentially adifference maker, that's
something I definitely look intoand whether or not I implement
that, that's kind of the thirdstep of this.
So I I have ideas fromcolleagues, from journal
articles, sometimes just fromthe community, I implement into
my practice after doing my ownresearch.
(19:27):
And then the last part of it ishow do my patients do?
So generally I see how atreatment does over the course
of six months, let's say kind ofdoing them on a basis that I
wouldn't say limited, but justvery particular about the
patients that I'm using thetreatments on, and then I
evaluate how those patients didand if there's an improvement,
(19:49):
then it's something that Iconsider incorporating on more
of a regular basis into mypractice.
Dr Andrew Greenland (19:56):
So this whole thing of using colleagues
and journals and all the goodstuff that we do in medicine, it
is hard to keep up and, likeyou said, the rate of change in
all specialities.
I mean, my day job is emergencymedicine and then I do
functional medicine as well, soI've got double the amount of
things I've got to keep my eyesand ears open for.
So I think you're right,chatting with colleagues and all
those things are the only waywe can really stay afloat with
(20:18):
all the sea of information thatwe're kind of bombarded with.
But interesting to hear how youdo so.
What's currently going well foryou in Nashville, knee and
shoulder, from either a businessor patient care perspective, or
both.
What's going well?
Yeah, I mean the practice isgoing well.
Dr Jason Jones (20:41):
Owning a small practice is difficult,
especially in the ever-changinglandscape of the United States
healthcare system.
The benefits that I have arethe ability to kind of run,
operate, make my own decisions.
If I want to incorporate a newsystem into practice, I can do
it.
If I want to change locations,expand locations, pursue a
(21:08):
different patient population,but there's no limitations on
what I am able to implement inthe medical world based out of a
small practice.
The difficulties, though, arebeing a little guy.
My ability to communicate andto negotiate with insurance
companies is somewhat limited.
(21:30):
We've been able to do it, butit's much more difficult for me
to come to an insurer and sayhey, I have, you know, n is
1,000 here.
Like I have 1,000 cases and Ineed for you to change my rates
in some degree for this 1,000cases, whereas the hospital
comes and they're like we have 1million cases.
(21:51):
So the insurer is not nearly asinterested in working with a
small number that has a verysmall change on the whole
ecosystem as they would be justworking with a hospital system
and potentially making onechange that affects what would
considerably be a thousand of myclinics.
So that's the difficulty.
(22:12):
The other difficulty is keepingup with the current
technological landscape, becausethe technological side of
healthcare is shifting rapidly.
That involves improving EHRs,but right now, in the moment we
live in, it's the development ofAI and how AI is kind of it's
(22:36):
on the doorstep of taking oversmall medical practices, not in
a bad way I don't mean to takeover in a negative effect but
just to implement it in a smallmedical practice.
Even midsize medical practices.
It's there and we're kind of atthat stage where the
(22:56):
implementation part is startingand everybody is not really sure
what the best route to go is.
You know, what is this productworth?
How do we use it like?
What does this mean for ouremployees?
So that that's a currentchallenge that we're working
with.
Dr Andrew Greenland (23:14):
So my next question was going to be
specifically around sort ofbottlenecks and challenges, and
you just mentioned about thewhole insurance thing.
I think every conversation I'vehad with North American
practices the insurance thinghas come up.
So have you got a solution?
Have you found ways to kind ofease that rather bumpy path or
relationship's?
Dr Jason Jones (23:33):
the relationship with insurers is very third
party.
I don't have real directcommunication with the insurers.
Everything kind of runs throughportals and billing submissions
.
So the it's a tricky landscapeand that ensures that it's a
(24:04):
business they're trying to make.
You know they are looking for aprofit.
So sometimes there's a directconflict between patient care
and being paid and that can betricky to navigate.
You know, as a clinic our firstallegiance is always to our
(24:25):
patients.
But you know we do have to havesome kind of like financial
security to run the office.
We have rent, we haveinfrastructure to support, we
have employees and that comesfrom our payment system, which
is the insurers.
So when we negotiate withinsurers it's generally a six to
nine-month process of justdiscussions, kind of back and
(24:46):
forth on you know what's worth,what like how do we handle
certain you know, eitheremerging treatments or even just
, you know, changing how we'vehandled past treatments or kind
of the more tried and truetreatments.
And then the other side of itis sometimes being judged by the
(25:07):
insurance company that you knowthis was worth it.
Like you checked these boxes,like you know we'll pay you for
this, and then sometimes theopposite happens.
You know we're not going to payyou for this, and our recourse,
when we don't get the answer wewant, is generally sending in
(25:27):
some sort of you know, rebuttalor following denials is what my
biller would call it, and it's aslow, tedious and sometimes
unrewarding process.
Dr Andrew Greenland (25:42):
Yeah, I'm hearing the same thing from so
many and it's something we don'treally have in the UK.
So I find this whole thing veryinteresting, but it seems to be
, almost like a universalchallenge.
So, speaking of numbers fromanother perspective, were there
any particular business metricsor performance indicators that
you, as a business owner,operate on, whether that's
patient related things or thingsrelated to running the business
(26:02):
per se?
Numbers as far as patientencounters or Just in general,
the metrics that you want tokeep an eye on, as a business
owner, in your practice.
Dr Jason Jones (26:13):
Yeah, I mean, I think the most common thing that
we really look at is just ournew patient volume.
I think as long as we have ahealthy new patient volume, then
everything else seems to fallinto place.
The workload theoreticallyshould continue to increase if
(26:34):
we have the same new patientvolume because we have our
established patients returning.
But you know, every monththere's, you know, 100 new
patients.
So that just, I think,resembles a healthy practice, a
growing practice, and as long aswe see that, then we can
continue to kind of slowlyevolve the clinic, which is the
stage that we're at right now,to grow in regards to
(26:57):
administrative staff, as far asproviders and then as far as
honestly just services offered.
Dr Andrew Greenland (27:08):
I was going to say so you say you're
growing in terms of healthypatient throughput.
Are you managing to keep upfrom a sort of staffing and
systems and admin perspective inyour clinic?
Dr Jason Jones (27:21):
We try.
It's a changing landscape andwhen you make a technological
decision in medicine, it's a bigdeal.
If we adopt an electronichealth records system, it's a
big deal.
It's going to affect yourpractice for 12 months.
It's a very costly financialinvestment and it will change
(27:43):
the way the clinic runs fairlydrastically for 12 months and
it's very hard to undo.
So any decision we make on theinfrastructure and the
technological part is incrediblywell researched and thought out
because it's a very bigcommitment.
Well researched and thought outbecause it's a very big
commitment.
From that standpoint, are weable to keep up?
I don't know if anybody's ableto keep up.
(28:05):
Things are changing so quickly.
We do the best we can with theinformation we have and try to
make the best decisions, butthere's literally something new
out there every single day.
That is that is intended andpromises improved, you know,
clinical function, either foryour administrative staff or the
physicians.
Um, so to to weed out what'sreal, what's not real, what's
(28:28):
valid, what's what's invalid,like it's, it's gonna be tricky,
um.
So I think we do the best wecan interesting.
Dr Andrew Greenland (28:37):
So if you were starting Nashville Knee and
Shoulder again tomorrow, whatwould you do differently, based
on what you've learned in yourexperience over the last 12
years or so?
Dr Jason Jones (28:47):
Tomorrow.
I think that the way that webuilt this practice was really
focused on people, that the waythat we built this practice was
really focused on people.
Um, which is in some ways Idon't know if this is true, but
like it's somebody that almostfeels archaic that you build a
practice off of people.
(29:07):
Um, because everything now isis is focused on removing human
interaction.
Um, and when we started thispractice, like, we kind of
handpicked like honestly, I washandpicked by my partner at the
time, who, who was like this isthe, he has the personality, he
(29:33):
has the work ethic to fill thisrole, and then, from there, I
began to handpick out employees,and those employees have
committed to the practice andhelped grow the practice, and we
couldn't have done this withoutthem.
It took everybody being onboard.
It took a whole lot of heartand a whole lot of hard work and
(29:54):
a whole lot of attention by alot of handpicked employees to
make this grow the way it did.
And if I was doing this againright now, I would do the same
thing.
I think an easy answer is hey,you know you.
Just you change theinfrastructure from day one.
That's an easy thing.
Now, because you know one thingI might have done differently
is looking back on it now ismaybe I would have used a
(30:15):
different technologicalinfrastructure, maybe I would
have set up on a different partof town, maybe I would have, you
know, changed negotiations withinsurers or hospitals from day
one, like, yeah, maybe like that, that those things might've
been helpful, but I think whatwe really focused on was just
building a practice around goodclinicians, good people, people
(30:38):
that really cared, and that'swhy I think we've been
successful and I wouldn't changea thing in regards to that.
Dr Andrew Greenland (30:47):
I think people are the center of any
good clinical operation.
So I completely concur with you.
If you had a magic wand and youcould fix one thing in the
business tomorrow, what wouldthat be?
And you may have already sortof mentioned it, I just want to
really get some sense of whatthat kind of big thing is for
you.
You'd love to kind of fixovernight.
Dr Jason Jones (31:05):
Well, yeah, I think the answer for all you
know US clinicians is theinsurance struggle.
We're very much valued,rewarded, um, our ability to
(31:26):
provide care is very muchdirected by insurance companies.
Um, not that we can't provide,because we absolutely can always
do what we think is best andlike, and we that ability, and I
think every good physician inthe United States is always
going to do the right thing atthe right time.
But they make it hard.
(31:47):
They make it hard to run apractice, to provide the care
that we want to, and I wish Icould change that.
I do want to, um, and I wish Icould change that.
I I do, because what we're thefinancial aspect of medicine,
the united states it's, it'sstagnant for clinicians right
now.
Um, we continue to be devaluedevery year from a financial
(32:13):
standpoint, which is hard whenyou're at an inflationary period
.
That's been going on for fouryears at this point.
The cost of living, the cost ofrunning a practice, just keeps
rising and we kind of keep beingdevalued by the payment system,
(32:35):
which is difficult.
And not to complain too muchbecause we're we're, we do fine,
but it just it does make itharder to run a clinic.
Dr Andrew Greenland (32:48):
It makes it harder to run the business side
of it yeah, I hear this fromevery conversation with your
colleagues across the usa.
This is interesting, everybodyhaving the same kind kind of
same challenge and all thethings that you mentioned.
So where would you like theclinic to be in, sort of around
six to 12 months time?
I mean, I think you kind oftalked a little bit about growth
and taking on more colleagues,but any other directions that
(33:10):
you're looking to take theclinic in?
Dr Jason Jones (33:13):
No, we're trying to add in a few extra
physicians now.
That will happen over the nextone to two years, because even
from the time that we identifysomebody until we are able to
actually bring them into thesystem it's very much 12 months
there's always licensures thatneed to be applied for and
(33:33):
received.
There's planning with, you know, movement for the incoming
physician.
Sometimes that physician'sfinishing a training program.
So, um, my hope would be withintwo years we have two new
physicians working with us.
I think that that's that's ourcurrent goal, um, and we are
(33:56):
continuing to kind of slowly addlocations across Nashville.
That's our other kind of morefocused directive.
Dr Andrew Greenland (34:09):
So it's interesting.
You're saying it really takestwo years to grow a new
colleague, as it were, from theconception to actually bringing
them in, which is interesting.
So when you talk about newlocations, is this to serve
patients in more localcommunities or the demand for
your services is such that youneed to expand and you don't
have the space where you are?
It's both.
Dr Jason Jones (34:30):
Nashville is a very booming and thriving city,
which is very fortunate that thepopulation grows.
So, just as a reaction to that,there's more injuries.
So our clinic continues to growas well, and then the
boundaries of what is Nashvillecontinue to change as well.
It's not just kind of this citycenter, it's the suburbs are
(34:55):
rapidly expanding.
So when we grow, what I mean bythat is, yes, we make more, we
increase our ability toaccommodate patients at our kind
of primary downtown location,but then we add clinics in and
more of the suburb areas to goto the patients when needed so
that's a satellite clinics andgoing to other places got it, I
(35:17):
understand yeah, yeah andfinally, what are you most
excited about as you think ahead, in terms of the future of
orthopedic care in general inyour speciality, in your niche?
the um.
I mean I, I love orthopedics.
It's um, I.
I think activity, the abilityto kind of socialize, be active
(35:38):
to, to play sports, to go onadventures, I think it's so key
to people's happiness.
So what's the biggest change inorthopedics right now are
focused on improving thoseoutcomes and getting patients
(36:01):
back quicker.
Now, most specifically, likewhat is happening, I have to
look to the surgical world rightnow.
This idea of stem cells likeregenerative type of injections.
It's there but it's not reallyit hasn't reached its potential
yet.
There are some other emergingkind of conservative treatments
(36:26):
out there.
There's some data resolvingaround exosomes right now, which
is interesting.
That's just kind of another wayto kind of make the body heal
itself and I think that thatkind of Wolverine type technique
where you know the body canlike repair from injuries,
that's been a focus inorthopedics for 20 years.
But is it actually here yet?
It's not where we keep makingsteps in the right direction
(36:48):
every year.
But I think in my practice isthere going to be a time where
we can inject a joint and thejoint heals itself, like truly
heals itself, not that we'reremoving pain, not that we're
providing some kind of temporaryrelief, that the joint.
Truly, I don't think it'llhappen in my lifetime.
So when I think aboutinnovation, orthopedics and what
(37:08):
really is going to make adifference, it really it still
focuses on surgery for us.
So our ability to kind of go inand very directly and very
manually manipulate part of thebody to improve the function and
, to you know, remove pain andget patients back to activity,
that's still during the next 15to 20 years during my career.
(37:32):
That's going to be the routethat I'm, I think, able to make
the biggest differences inpatients' lives.
Going to be the route that I'm,I think, able to make the
biggest differences in patients'lives.
And then what is on the horizonright now?
With surgery, we keep movingtowards joint conserving
(37:53):
treatment.
So there's a lot of more excuseme, there's a lot of more
minimally invasive options nowfor restoring or improving
damage to joints.
There's a lot of new ideas fortreating arthritis and the need
that aren't joint replacements.
It's kind of that intimateintermediary area that I think I
(38:14):
touched on very briefly at thebeginning of our conversation.
That's what I'm excited about.
I'm excited about this likefilling the gap between these
patients that maybe have juststarted to have joint pain.
Maybe injections work for them.
And then the patients that needthe knee replacement and this
applies to the shoulder too.
You can put the same conceptand just put the label shoulder
(38:37):
on it and have the samediscussion.
But those surgeries that aregoing to feel, that are going to
fill those gaps, that's whatI'm really interested in right
now.
And what are those surgeries?
Um, something that I'm a verybig fan of, which is not at all
new, is meniscus transplantation, where you take a cadaveric
(38:58):
meniscus and put it in apatient's knee.
The ability to use that and theindications to use it in a
patient are extremely narrow,but the idea is, you know, we
take a damaged structuralportion of a patient's knee and
we put a new one of those samebiological structures in, and
(39:20):
that idea just makes so muchsense to me in a joint
preservation sense.
Now, meniscal transplantsaren't the right answer for
everybody, but there's some newsurgeries coming into the market
that are kind of substituting,that they're filling that same
void that the meniscaltransplant fills, and those are
(39:41):
things like there's a hydraulicjoint replacement which is still
needs, uh, some time beforeit's effective.
But this is a new innovation inthe last 18 months that it's
hit the market.
Um, there are some earlydesigns for artificial meniscus
which are still having mixedresults.
But just the fact that that'sthe direction we're moving,
(40:05):
that's what I'll be watching themost closely.
Dr Andrew Greenland (40:08):
So the future is bright, exciting and
orthopedics never stand still,is what I'm hearing.
Dr Jason Jones (40:13):
It is.
There's always innovation.
Dr Andrew Greenland (40:15):
Amazing.
Jason.
Thank you so much for your timethis afternoon.
Really appreciate hearing aboutwhat you do at Nashville Knee
and Shoulder, your clinical work, the way that you operate and
some of the challenges andthings that are going on in your
business.
I think it's a very interestingconversation.
I'm sure our listeners are veryinterested to hear about what
you do.
So thank you very much for yourtime.
Really do appreciate it.
You're very welcome.
Hello everyone and welcome back to
Voices in Health and Wellness.
This is the podcast where weexplore what it really takes to
build, grow and sustainmeaningful healthcare businesses
in today's changing landscape.
I'm Dr Andrew Greenland andeach week I sit down with
clinicians and operators acrossthe health spectrum, from
functional medicine to surgery,to talk about the reality, the
real world side of patient care,business ownership and
(00:24):
everything in between.
And today I'm really pleased tobe joined by Dr Jason Jones, an
orthopedic specialist and thefounder of Nashville Knee and
Shoulder.
His clinic has been serving theNashville community for over 12
years, with a strong focus ondelivering personalized, high
quality care for knee, shoulderand other musculoskeletal
conditions.
So, Jason, thank you very muchfor being here.
Are you calling from Nashvilletoday?
Dr Jason Jones (00:46):
I'm calling from San Antonio today.
Dr Andrew Greenland (00:48):
Okay, wonderful Okay.
Dr Jason Jones (00:50):
Yeah.
Dr Andrew Greenland (00:50):
So maybe start a little bit at the top.
Can you just tell us a littlebit about Nashville, knee and
Shoulder and what inspired youto create this clinic?
Dr Jason Jones (00:58):
So my roots are based in Tennessee.
We, so my roots are based inTennessee.
This is a very southeasternstory, but I kind of grew up in
southeast Tennessee, went tohigh school, college and
everything there, and then movedto New York for a long time.
I did all my training in NewYork and then, when it was time
to start a practice, to kind ofmove into the real professional
(01:21):
world, I very much wanted to beback in Tennessee, in the
landscape at that time.
We're very large groups.
There's not a lot of hospitalfocused physicians, at least in
the orthopedic world in middleTennessee, especially in the
Nashville area.
So in order for me to kind ofpave my own way, I started a
small clinic.
It was initially just me andone other physician, a gentleman
(01:45):
that trained at the samehospitals as me, just, you know,
15 to 20 years prior.
So it was just us for you know,about 10 or 11 years.
And then just recently we'vekind of started the next phase
of the Nashville Knee andShoulder Clinic, where we're
actually starting to grow andadd in some additional
clinicians.
Right now we're at a total offive clinicians, including our
(02:07):
mid-levels, and actively tryingto expand across the Nashville
landscape.
Dr Andrew Greenland (02:14):
Amazing.
So I think you are a raritywhen you said orthopedic
physician.
It's not something we have inthe UK.
So where's the separationbetween an orthopedic physician
and orthopedic surgeon?
Obviously there's the surgeryinvolved, but in terms of the
way they work and operate andkind of interface with each
other, yeah, that's aninteresting question.
Dr Jason Jones (02:32):
When you say orthopedic physician, I think
our term would be a sportsmedicine physician or a
non-surgical orthopedist, andthere's definitely both of those
entities operate.
They both exist in the UnitedStates.
The biggest difference is inour training.
Whereas the sports medicine orthe non-operative orthopedist
(02:55):
will go through three to fouryears of medically-based
training focused on soft tissueinjuries, rehabilitation
non-operative soft tissueinjuries, rehabilitation
non-operative means to improvethe patient and get promising
results, whereas the majority ofour training I would think
about 60 to 70% of our trainingis in the operating room or in
(03:18):
the surgical world.
Dr Andrew Greenland (03:20):
In the clinical side, it's really about
30 to 40% of what we end updoing during our residency okay,
so in terms of what a typicalweek looks like for you in
practice, from clinic hours andmanaging the clinic, how does it
pan out for you?
Dr Jason Jones (03:35):
so I'm in the operating room about 60 of the
time.
I'm in the clinic about 30 to40 of the time.
Um, seeing that I do own andoperate a business, there are
some administrative tasks aswell, so that takes up, you know
, whatever little bits left over.
My OR days typically run from,you know, about 7 am to about 5
pm and we do about 15 to, youknow, 20 surgical cases a week
(04:01):
In the clinic.
It's a mixture of my partnersor mid-levels sometimes seeing
urgent cases acute injuries,that high school football player
that twisted his knee sothey're managing kind of the
more urgent issues.
And then we have scheduledfollow-ups with myself during my
clinic time, which for me isabout, on average, about 10
(04:25):
hours a week that I'm in theclinic, got it?
Dr Andrew Greenland (04:28):
Okay, and what sort of population or types
of cases are you typicallyfocusing on most today, and how
has that evolved over the yearsthat you've been doing this?
Dr Jason Jones (04:37):
So we're called Nashville Knee and Shoulder and
it's very poignant.
We're very much directed at thetype of patient we're
recruiting.
I do 90% knees and shouldersand that's kind of A to Z in
that world.
So within the knee world, I'mdoing everything from meniscus
(04:58):
tears to ACL tears, all the wayto joint replacements.
In the shoulder world, sameidea.
I'm doing everything from themore minimally invasive shoulder
type of surgery all the way toshoulder replacements and the
shoulder world same idea.
Dr Andrew Greenland (05:06):
I'm doing everything from the more
minimally invasive shoulder typeof surgery all the way to
shoulder replacements all right,and how do your colleagues
complement them and do they havea different sort of skill set,
see different things, or are youfocused primarily on anything
to do with those two joints as ateam?
Dr Jason Jones (05:21):
we we have kind of divided and conquered.
I have a partner that just doeships, I have a partner that
currently just doesnon-operative sports medicine,
and then we're actively kind ofrecruiting to fill in some other
gaps, such as hand surgeon orfoot and ankle.
Dr Andrew Greenland (05:41):
So you're going to become fairly holistic
in terms of treating the wholebody at some point with your
team.
Dr Jason Jones (05:46):
We are, yeah, but we're piece-milling it
together right now.
But we have taken thespecialist approach where we all
stay in our lane, do what wethink we're really good at.
For me, that kind of lives inthe knee and shoulder world, for
my primary partner, dr Ferguson, that's just hips, and then
we're filling in the gaps inbetween.
So we want to provide the bestquality care at what we think
(06:11):
that we are the absolute mostqualified at doing.
Dr Andrew Greenland (06:15):
Amazing.
And what shifts are younoticing in the orthopedic field
today, either from a clinicalor an operational perspective,
or a patient expectationstandpoint?
What are you kind of seeing?
Dr Jason Jones (06:25):
Yeah.
So orthopedics is changingquickly.
Orthopedics has always beenevolving because orthopedics
gives physicality back topatients and that's especially
in our at any point in our lifeand especially in our later
years.
That might be the mostimportant thing is giving the
patient the ability to be activeand do what they want to do,
(06:45):
and the way that we'veaccomplished that is changing.
And if you rewind 40 or 50years ago, it really was more
based off mechanics.
So if there's a problem withthe joint, we're going to
mechanically fix that joint.
If your joint is broken, we puta plate and screws on it to fix
that.
If you have arthritis, so theend of the joint is worn down,
(07:08):
we'll resurface that joint andput a new metal surface on it
and allow the patient to resume.
You know a improved and muchless painful.
You know speeding up is there'sa lot more focus on conserving
(07:33):
joints, being a little bit moreconservative and maintaining the
integrity of the joint as longas we can.
So saying that in a differentway, we're not trying to push
directly to joint replacements,where we we would like to try
everything in between.
So if the patient has arthritis, we might start with some sort
(07:56):
of injection and even when westart talking about the
injectable world.
There's so many options forinjections.
You have the tried and trueinjections, such as steroids,
which which have a place buthave kind of very much kind of
fallen out of favor in themainstream.
You have things that have somedata behind them, like
hyaluronic acid, but then youreally have the more
regenerative type of medicineand the more regenerative type
(08:18):
of injections that are startingto become well-known within the
community.
Patients are coming and lookingfor these and the data and the
potential capabilities of theseinjections just seems to be
improving as the science behindthem improves.
And when I talk about thoseinjections most specifically in
(08:39):
the clinic, we use PRP, which isplatelet-rich plasma.
We use BMAC, which is a bonemarrow aspirate.
Those are the two primary onesthat we use and these are kind
of stem cell like dots.
Stem cells is an incrediblyconfusing term, um, but, but
those are the ones that are mostaccessible and easily used, at
least in the united states.
(09:00):
So those injections have a muchbigger place than they did 10
years ago, um, and patients.
Dr Andrew Greenland (09:07):
Do patients have an expectation?
You know they arthritis.
They're coming in with theexpectation of having a joint
replacement and are theyreceptive to these other more
conservative, preservingtreatments, or how do patients
perceive this?
Dr Jason Jones (09:22):
Patients tend to know what they want when they
come in, which is also, I think,another shift that I've seen,
where patients come in almostasking for a service now more
than they did 10 years ago whenthey came in looking for a
diagnosis.
I think there's a lot moreself-diagnosed patients, if
you're following my train ofthought here.
So a patient comes in with kneearthritis.
(09:44):
This is an incredibly commonvisit for me, so the way that
conversation typically goes ishey, you have knee arthritis.
It's this on a scale from oneto 10.
So let's just say it's a fiveon a scale from one to 10, which
is not how we medically woulddiagnose arthritis, but it just
makes sense to a patient.
So that's your diagnosis andwhat options do we have?
(10:07):
What treatment modalities do wehave to treat that?
And some patients are at apoint in their life where
they've dealt with this problemlong enough and they just want
it to be over with.
And those are the patients thattend to seek out just a
resolution or a cure, if we cancall it that, and that tends to
be the more aggressiveapproaches, such as the knee
replacement.
(10:27):
Or there's a whole other half ofour patient population that
would want to do everythingpossible to avoid a knee
replacement.
Those are the patients thatsometimes will clean the knee
out with a camera, which youknow that varies wildly from
patient to patient on theeffectiveness, but it is an
option.
Those are the patients that wemight go down and try a few
(10:50):
injections with.
Those are the patients thatsometimes we do the in-between
surgeries, the surgeries thatexist between the kind of very
basic sports medicine injectableworld and then the total knee
arthroplasty world.
And that's a space right now,like the kind of in-between
arthritis world that we don'thave a good solution for.
And it's just that the world isjust waiting for a surgery to
(11:15):
come through, I think, andchange that game to bridge the
gap between the patient that hasthat kind of five out of 10
arthritis that's limited butisn't quite ready for a total
knee replacement, and do youhave on your team things?
Dr Andrew Greenland (11:32):
like physiotherapists or manual
therapists, to sort of supportand integrate with what you do,
or is it primarily orthopedists?
Dr Jason Jones (11:38):
Well, we have physical therapists that very
key component of what we do.
Dr Andrew Greenland (11:43):
Okay, what about pandemic and how that
affected things for you, and hasit changed sort of patient
behaviors and expectations afterthat whole pandemic thing
settled down?
Dr Jason Jones (12:03):
The pandemic it caused a in America.
So when the pandemic hitthere's a lot of just
uncertainty.
They're a very you know kind ofworried and scared population.
So the practice of medicine, atleast in the private sector for
what I do, which is electiveprocedures, you know nobody has
(12:26):
to have a knee replacement theaccess in the patients seeking
that care dropped offsignificantly because everybody
kind of went into like a duckand cover type of mentality.
The hospitals themselves becameextremely busy.
That affected us somewhat, butnot nearly as directly as the
(12:53):
frontline medical providers, notnearly as the ICU doctors and
the emergency room physicians.
So our patient population itkind of it changed for a short
time while patients just madesure that the world was going to
be okay.
And then when they came back, Ithink the biggest differences
(13:19):
were there's a big focus ontelemedicine.
That very much changed duringthe pandemic.
Patients wanted to have Zoomtype of consultations because
that became a real valid way tohave patient interactions and
that stemmed in the UnitedStates from the pandemic and
(13:42):
this wasn't really to thepandemic.
But in the last five years justreally the emergence of AI has
changed the way patients gathertheir own information and that's
changed a lot of patientinteractions because they will
come to me with data they'reshowing.
They're showing me data thatthey've discovered and asking
(14:02):
this is this is what I have,this is what I know.
Help me make sense of this.
And and that's not necessarilya direct cause of the pandemic,
but that is very much somethingthat's changed in the last four
to five years.
Dr Andrew Greenland (14:18):
Interesting .
Are you seeing more casesrelated to sedentary lifestyle?
I don't know how aging andsporting injuries are playing in
these things that youspecialize in.
I just wonder where you've seenany trends in this direction
and how that's kind of alteredyour model of care the sedentary
lifestyle.
Dr Jason Jones (14:34):
I, I'm a, I preach activity.
Um, my whole job and philosophyis focused on on being out,
doing things, doing the thingsyou love, because if you're not
being active, your body isactively declining and that
becomes more and more importantthe older we get.
So do I see injuries fromsedentary activity?
(14:58):
Absolutely, it's the patient.
I mean, one of the most commoninjuries I see is the
40-something that decides to goplay basketball and hasn't
played in 10 years and tearstheir Achilles, tears their
patellar tendon, like this.
This happens surprisingly often, um, and that's a form of
sedentary lifestyle, absolutely.
(15:20):
I think the other end of that is, you know, the patient in their
seventies that has just kind oflost the motivation or they
live with a degree of pain thatprevents them from being active
during the day and that leads toa type of physical decline.
I also think it leads to a typeof mental decline when you lose
(15:40):
that ability to do what youwant to do, to be active and to
pursue hobbies and activitiesthat you love.
And does that lead to jointproblems?
Yeah, it does.
Disuse of your joint leads toactive thinning of your bones,
loss of some of that structuralsupport.
It leads to muscle wasting andall that plays into degeneration
(16:06):
of joints.
I think, more than peoplesometimes realize, one of the
biggest protective agents of ourjoints is actually muscle
strength, and I think physicaltherapists have known this for
you know centuries.
But that's something, I think,that gets overlooked with
general medicine fairly often.
Dr Andrew Greenland (16:25):
And presumably your work includes
sort of exercise prescriptionsand everything else to try and
keep people out of trouble andalso to optimize them when
they've had any particularsurgery that they've had done.
Dr Jason Jones (16:35):
That's correct.
Dr Andrew Greenland (16:36):
Yeah, interesting.
What about staying up to date,sort of clinically and
strategically?
Obviously, orthopedics is ahuge speciality and I know
you've narrowed down on a coupleof joints, but you and your
team are covering more and more.
How do you guys keep up to datefrom from in this, in this kind
of ever-changing world?
Dr Jason Jones (16:52):
it's hard?
Um, it is, and you so?
It's funny because I actuallyam lecturing today on this exact
same topic like what?
Like how do I stay up to dateon certain in my world?
It's implants, like what?
Because there's so many options, there's so many vendors,
there's so I think that'sworldwide, but especially in the
United States.
So how do I stay up to date onwhat's changing, either
(17:16):
technically, which is, you know,a surgical technique, or with
the types of implants that I'musing, you know, in patients in
surgery?
And it's changing rapidly, notone from a business perspective,
but secondly, just from patientdemands.
Patients are looking forquicker recoveries, they're
looking for smaller surgeries,they're looking for better
(17:36):
outcomes, and those are threepretty bold requests.
And, amazingly, like medicinedoes continue to progress and
for the most part, every yearthere's some sort of advancement
in my world that changes thegame, so to speak.
So how do I personally stay upon it?
(17:57):
The most common way that I willlook into or potentially adapt a
new technique, a new treatmentfor a patient, a new implant for
surgery, is discussing with myother colleagues.
So a lot of this is communal.
I discuss what my shouldersurgeon friend in California is
using versus what my friend inNew York is using and when they
(18:20):
have a good experience with theproduct they've noticed a
quicker recovery, they've saidthat it's easy to use Then I
look into it.
That is probably the mostcommon reason that I start to
look into a new technique or newproduct.
The second most common reasonis if just data supports it.
(18:40):
It's rare, if ever, that I'lleven consider using something
that doesn't have some sort ofpeer-reviewed data behind it.
So if there's and I read theorthopedic journals, you know,
fairly regularly so if there'ssomething that seems to be
changing with the dynamics ofcare, potentially improving
patient care, and if there's aseries you know one or two
(19:05):
potentially more trendingarticles that kind of show that
this, hey, this is potentially adifference maker, that's
something I definitely look intoand whether or not I implement
that, that's kind of the thirdstep of this.
So I I have ideas fromcolleagues, from journal
articles, sometimes just fromthe community, I implement into
my practice after doing my ownresearch.
(19:27):
And then the last part of it ishow do my patients do?
So generally I see how atreatment does over the course
of six months, let's say kind ofdoing them on a basis that I
wouldn't say limited, but justvery particular about the
patients that I'm using thetreatments on, and then I
evaluate how those patients didand if there's an improvement,
(19:49):
then it's something that Iconsider incorporating on more
of a regular basis into mypractice.
Dr Andrew Greenland (19:56):
So this whole thing of using colleagues
and journals and all the goodstuff that we do in medicine, it
is hard to keep up and, likeyou said, the rate of change in
all specialities.
I mean, my day job is emergencymedicine and then I do
functional medicine as well, soI've got double the amount of
things I've got to keep my eyesand ears open for.
So I think you're right,chatting with colleagues and all
those things are the only waywe can really stay afloat with
(20:18):
all the sea of information thatwe're kind of bombarded with.
But interesting to hear how youdo so.
What's currently going well foryou in Nashville, knee and
shoulder, from either a businessor patient care perspective, or
both.
What's going well?
Yeah, I mean the practice isgoing well.
Dr Jason Jones (20:41):
Owning a small practice is difficult,
especially in the ever-changinglandscape of the United States
healthcare system.
The benefits that I have arethe ability to kind of run,
operate, make my own decisions.
If I want to incorporate a newsystem into practice, I can do
it.
If I want to change locations,expand locations, pursue a
(21:08):
different patient population,but there's no limitations on
what I am able to implement inthe medical world based out of a
small practice.
The difficulties, though, arebeing a little guy.
My ability to communicate andto negotiate with insurance
companies is somewhat limited.
(21:30):
We've been able to do it, butit's much more difficult for me
to come to an insurer and sayhey, I have, you know, n is
1,000 here.
Like I have 1,000 cases and Ineed for you to change my rates
in some degree for this 1,000cases, whereas the hospital
comes and they're like we have 1million cases.
(21:51):
So the insurer is not nearly asinterested in working with a
small number that has a verysmall change on the whole
ecosystem as they would be justworking with a hospital system
and potentially making onechange that affects what would
considerably be a thousand of myclinics.
So that's the difficulty.
(22:12):
The other difficulty is keepingup with the current
technological landscape, becausethe technological side of
healthcare is shifting rapidly.
That involves improving EHRs,but right now, in the moment we
live in, it's the development ofAI and how AI is kind of it's
(22:36):
on the doorstep of taking oversmall medical practices, not in
a bad way I don't mean to takeover in a negative effect but
just to implement it in a smallmedical practice.
Even midsize medical practices.
It's there and we're kind of atthat stage where the
(22:56):
implementation part is startingand everybody is not really sure
what the best route to go is.
You know, what is this productworth?
How do we use it like?
What does this mean for ouremployees?
So that that's a currentchallenge that we're working
with.
Dr Andrew Greenland (23:14):
So my next question was going to be
specifically around sort ofbottlenecks and challenges, and
you just mentioned about thewhole insurance thing.
I think every conversation I'vehad with North American
practices the insurance thinghas come up.
So have you got a solution?
Have you found ways to kind ofease that rather bumpy path or
relationship's?
Dr Jason Jones (23:33):
the relationship with insurers is very third
party.
I don't have real directcommunication with the insurers.
Everything kind of runs throughportals and billing submissions
.
So the it's a tricky landscapeand that ensures that it's a
(24:04):
business they're trying to make.
You know they are looking for aprofit.
So sometimes there's a directconflict between patient care
and being paid and that can betricky to navigate.
You know, as a clinic our firstallegiance is always to our
(24:25):
patients.
But you know we do have to havesome kind of like financial
security to run the office.
We have rent, we haveinfrastructure to support, we
have employees and that comesfrom our payment system, which
is the insurers.
So when we negotiate withinsurers it's generally a six to
nine-month process of justdiscussions, kind of back and
(24:46):
forth on you know what's worth,what like how do we handle
certain you know, eitheremerging treatments or even just
, you know, changing how we'vehandled past treatments or kind
of the more tried and truetreatments.
And then the other side of itis sometimes being judged by the
(25:07):
insurance company that you knowthis was worth it.
Like you checked these boxes,like you know we'll pay you for
this, and then sometimes theopposite happens.
You know we're not going to payyou for this, and our recourse,
when we don't get the answer wewant, is generally sending in
(25:27):
some sort of you know, rebuttalor following denials is what my
biller would call it, and it's aslow, tedious and sometimes
unrewarding process.
Dr Andrew Greenland (25:42):
Yeah, I'm hearing the same thing from so
many and it's something we don'treally have in the UK.
So I find this whole thing veryinteresting, but it seems to be
, almost like a universalchallenge.
So, speaking of numbers fromanother perspective, were there
any particular business metricsor performance indicators that
you, as a business owner,operate on, whether that's
patient related things or thingsrelated to running the business
(26:02):
per se?
Numbers as far as patientencounters or Just in general,
the metrics that you want tokeep an eye on, as a business
owner, in your practice.
Dr Jason Jones (26:13):
Yeah, I mean, I think the most common thing that
we really look at is just ournew patient volume.
I think as long as we have ahealthy new patient volume, then
everything else seems to fallinto place.
The workload theoreticallyshould continue to increase if
(26:34):
we have the same new patientvolume because we have our
established patients returning.
But you know, every monththere's, you know, 100 new
patients.
So that just, I think,resembles a healthy practice, a
growing practice, and as long aswe see that, then we can
continue to kind of slowlyevolve the clinic, which is the
stage that we're at right now,to grow in regards to
(26:57):
administrative staff, as far asproviders and then as far as
honestly just services offered.
Dr Andrew Greenland (27:08):
I was going to say so you say you're
growing in terms of healthypatient throughput.
Are you managing to keep upfrom a sort of staffing and
systems and admin perspective inyour clinic?
Dr Jason Jones (27:21):
We try.
It's a changing landscape andwhen you make a technological
decision in medicine, it's a bigdeal.
If we adopt an electronichealth records system, it's a
big deal.
It's going to affect yourpractice for 12 months.
It's a very costly financialinvestment and it will change
(27:43):
the way the clinic runs fairlydrastically for 12 months and
it's very hard to undo.
So any decision we make on theinfrastructure and the
technological part is incrediblywell researched and thought out
because it's a very bigcommitment.
Well researched and thought outbecause it's a very big
commitment.
From that standpoint, are weable to keep up?
I don't know if anybody's ableto keep up.
(28:05):
Things are changing so quickly.
We do the best we can with theinformation we have and try to
make the best decisions, butthere's literally something new
out there every single day.
That is that is intended andpromises improved, you know,
clinical function, either foryour administrative staff or the
physicians.
Um, so to to weed out what'sreal, what's not real, what's
(28:28):
valid, what's what's invalid,like it's, it's gonna be tricky,
um.
So I think we do the best wecan interesting.
Dr Andrew Greenland (28:37):
So if you were starting Nashville Knee and
Shoulder again tomorrow, whatwould you do differently, based
on what you've learned in yourexperience over the last 12
years or so?
Dr Jason Jones (28:47):
Tomorrow.
I think that the way that webuilt this practice was really
focused on people, that the waythat we built this practice was
really focused on people.
Um, which is in some ways Idon't know if this is true, but
like it's somebody that almostfeels archaic that you build a
practice off of people.
(29:07):
Um, because everything now isis is focused on removing human
interaction.
Um, and when we started thispractice, like, we kind of
handpicked like honestly, I washandpicked by my partner at the
time, who, who was like this isthe, he has the personality, he
(29:33):
has the work ethic to fill thisrole, and then, from there, I
began to handpick out employees,and those employees have
committed to the practice andhelped grow the practice, and we
couldn't have done this withoutthem.
It took everybody being onboard.
It took a whole lot of heartand a whole lot of hard work and
(29:54):
a whole lot of attention by alot of handpicked employees to
make this grow the way it did.
And if I was doing this againright now, I would do the same
thing.
I think an easy answer is hey,you know you.
Just you change theinfrastructure from day one.
That's an easy thing.
Now, because you know one thingI might have done differently
is looking back on it now ismaybe I would have used a
(30:15):
different technologicalinfrastructure, maybe I would
have set up on a different partof town, maybe I would have, you
know, changed negotiations withinsurers or hospitals from day
one, like, yeah, maybe like that, that those things might've
been helpful, but I think whatwe really focused on was just
building a practice around goodclinicians, good people, people
(30:38):
that really cared, and that'swhy I think we've been
successful and I wouldn't changea thing in regards to that.
Dr Andrew Greenland (30:47):
I think people are the center of any
good clinical operation.
So I completely concur with you.
If you had a magic wand and youcould fix one thing in the
business tomorrow, what wouldthat be?
And you may have already sortof mentioned it, I just want to
really get some sense of whatthat kind of big thing is for
you.
You'd love to kind of fixovernight.
Dr Jason Jones (31:05):
Well, yeah, I think the answer for all you
know US clinicians is theinsurance struggle.
We're very much valued,rewarded, um, our ability to
(31:26):
provide care is very muchdirected by insurance companies.
Um, not that we can't provide,because we absolutely can always
do what we think is best andlike, and we that ability, and I
think every good physician inthe United States is always
going to do the right thing atthe right time.
But they make it hard.
(31:47):
They make it hard to run apractice, to provide the care
that we want to, and I wish Icould change that.
I do want to, um, and I wish Icould change that.
I I do, because what we're thefinancial aspect of medicine,
the united states it's, it'sstagnant for clinicians right
now.
Um, we continue to be devaluedevery year from a financial
(32:13):
standpoint, which is hard whenyou're at an inflationary period
.
That's been going on for fouryears at this point.
The cost of living, the cost ofrunning a practice, just keeps
rising and we kind of keep beingdevalued by the payment system,
(32:35):
which is difficult.
And not to complain too muchbecause we're we're, we do fine,
but it just it does make itharder to run a clinic.
Dr Andrew Greenland (32:48):
It makes it harder to run the business side
of it yeah, I hear this fromevery conversation with your
colleagues across the usa.
This is interesting, everybodyhaving the same kind kind of
same challenge and all thethings that you mentioned.
So where would you like theclinic to be in, sort of around
six to 12 months time?
I mean, I think you kind oftalked a little bit about growth
and taking on more colleagues,but any other directions that
(33:10):
you're looking to take theclinic in?
Dr Jason Jones (33:13):
No, we're trying to add in a few extra
physicians now.
That will happen over the nextone to two years, because even
from the time that we identifysomebody until we are able to
actually bring them into thesystem it's very much 12 months
there's always licensures thatneed to be applied for and
(33:33):
received.
There's planning with, you know, movement for the incoming
physician.
Sometimes that physician'sfinishing a training program.
So, um, my hope would be withintwo years we have two new
physicians working with us.
I think that that's that's ourcurrent goal, um, and we are
(33:56):
continuing to kind of slowly addlocations across Nashville.
That's our other kind of morefocused directive.
Dr Andrew Greenland (34:09):
So it's interesting.
You're saying it really takestwo years to grow a new
colleague, as it were, from theconception to actually bringing
them in, which is interesting.
So when you talk about newlocations, is this to serve
patients in more localcommunities or the demand for
your services is such that youneed to expand and you don't
have the space where you are?
It's both.
Dr Jason Jones (34:30):
Nashville is a very booming and thriving city,
which is very fortunate that thepopulation grows.
So, just as a reaction to that,there's more injuries.
So our clinic continues to growas well, and then the
boundaries of what is Nashvillecontinue to change as well.
It's not just kind of this citycenter, it's the suburbs are
(34:55):
rapidly expanding.
So when we grow, what I mean bythat is, yes, we make more, we
increase our ability toaccommodate patients at our kind
of primary downtown location,but then we add clinics in and
more of the suburb areas to goto the patients when needed so
that's a satellite clinics andgoing to other places got it, I
(35:17):
understand yeah, yeah andfinally, what are you most
excited about as you think ahead, in terms of the future of
orthopedic care in general inyour speciality, in your niche?
the um.
I mean I, I love orthopedics.
It's um, I.
I think activity, the abilityto kind of socialize, be active
(35:38):
to, to play sports, to go onadventures, I think it's so key
to people's happiness.
So what's the biggest change inorthopedics right now are
focused on improving thoseoutcomes and getting patients
(36:01):
back quicker.
Now, most specifically, likewhat is happening, I have to
look to the surgical world rightnow.
This idea of stem cells likeregenerative type of injections.
It's there but it's not reallyit hasn't reached its potential
yet.
There are some other emergingkind of conservative treatments
(36:26):
out there.
There's some data resolvingaround exosomes right now, which
is interesting.
That's just kind of another wayto kind of make the body heal
itself and I think that thatkind of Wolverine type technique
where you know the body canlike repair from injuries,
that's been a focus inorthopedics for 20 years.
But is it actually here yet?
It's not where we keep makingsteps in the right direction
(36:48):
every year.
But I think in my practice isthere going to be a time where
we can inject a joint and thejoint heals itself, like truly
heals itself, not that we'reremoving pain, not that we're
providing some kind of temporaryrelief, that the joint.
Truly, I don't think it'llhappen in my lifetime.
So when I think aboutinnovation, orthopedics and what
(37:08):
really is going to make adifference, it really it still
focuses on surgery for us.
So our ability to kind of go inand very directly and very
manually manipulate part of thebody to improve the function and
, to you know, remove pain andget patients back to activity,
that's still during the next 15to 20 years during my career.
(37:32):
That's going to be the routethat I'm, I think, able to make
the biggest differences inpatients' lives.
Going to be the route that I'm,I think, able to make the
biggest differences in patients'lives.
And then what is on the horizonright now?
With surgery, we keep movingtowards joint conserving
(37:53):
treatment.
So there's a lot of more excuseme, there's a lot of more
minimally invasive options nowfor restoring or improving
damage to joints.
There's a lot of new ideas fortreating arthritis and the need
that aren't joint replacements.
It's kind of that intimateintermediary area that I think I
(38:14):
touched on very briefly at thebeginning of our conversation.
That's what I'm excited about.
I'm excited about this likefilling the gap between these
patients that maybe have juststarted to have joint pain.
Maybe injections work for them.
And then the patients that needthe knee replacement and this
applies to the shoulder too.
You can put the same conceptand just put the label shoulder
(38:37):
on it and have the samediscussion.
But those surgeries that aregoing to feel, that are going to
fill those gaps, that's whatI'm really interested in right
now.
And what are those surgeries?
Um, something that I'm a verybig fan of, which is not at all
new, is meniscus transplantation, where you take a cadaveric
(38:58):
meniscus and put it in apatient's knee.
The ability to use that and theindications to use it in a
patient are extremely narrow,but the idea is, you know, we
take a damaged structuralportion of a patient's knee and
we put a new one of those samebiological structures in, and
(39:20):
that idea just makes so muchsense to me in a joint
preservation sense.
Now, meniscal transplantsaren't the right answer for
everybody, but there's some newsurgeries coming into the market
that are kind of substituting,that they're filling that same
void that the meniscaltransplant fills, and those are
(39:41):
things like there's a hydraulicjoint replacement which is still
needs, uh, some time beforeit's effective.
But this is a new innovation inthe last 18 months that it's
hit the market.
Um, there are some earlydesigns for artificial meniscus
which are still having mixedresults.
But just the fact that that'sthe direction we're moving,
(40:05):
that's what I'll be watching themost closely.
Dr Andrew Greenland (40:08):
So the future is bright, exciting and
orthopedics never stand still,is what I'm hearing.
Dr Jason Jones (40:13):
It is.
There's always innovation.
Dr Andrew Greenland (40:15):
Amazing.
Jason.
Thank you so much for your timethis afternoon.
Really appreciate hearing aboutwhat you do at Nashville Knee
and Shoulder, your clinical work, the way that you operate and
some of the challenges andthings that are going on in your
business.
I think it's a very interestingconversation.
I'm sure our listeners are veryinterested to hear about what
you do.
So thank you very much for yourtime.
Really do appreciate it.
You're very welcome.
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