Intro: 00:00

Steven Huskey: Welcome to Portfolio Pulse a money podcast for medical professionals and entrepreneurs. I'm your host, Steven Huskey, owner of Husky Financials Consulting and Wealth Management. Our goal is to help leaders accumulate wealth and empower them to build a life they deserve. Each week we interview a purpose driven leader or medical professional that is building a thriving business with community impact. We ask tough questions, learn the habits they practice to build successful careers, and discover a secret they can pass on to help others build their businesses. It's time.

Hello and welcome to Portfolio Pulse, the go-to podcast for medical professionals and entrepreneurs hoping to learn more about achieving financial wellness, accumulating wealth, and building the life they deserve.

In every episode, we either interview a purpose driven leader or medical professional that's not only building a. Giving back to the community as well. We also present subjects and finance that are relevant today. We're not just here to talk money. We're also here to talk about meaning and maximum impact.

I have a guest today who is the epitome of maximum impact, and that is Rich Palarea. He is the CEO of Kermit. Rich as the CEO of Kermit, which is a Baltimore based healthcare cost reduction and spend management company is bringing automation and insight to the high spend category of implantable medical devices within hospitals and health systems.

Since it's founding in 2011, Kermit has saved hospitals more than 200 million and manages 40% of the implantable device spin transacting in Maryland. Super happy to have you on my friend. Thanks for joining.

Rich Palarea: Yeah. Thanks for having me, Steven. It's my pleasure.

Steven: Yeah, absolutely man. And I gave just a brief bio about Kermit and, the business and all the stuff that you're doing right now, but can you tell us why you got into it? What originated Kermit? Was it an idea? was it a problem you saw a fix for? Tell us more about that.

Rich: I think like a lot of entrepreneurial journeys, mine was just kind of happenstance. I was doing something already that was totally disconnected from healthcare. I had a kind of a lifestyle business.

It was it was negotiating FedEx and UPS contracts for some of the nation's largest shippers. And I do this in a way, That I'd only get paid based on the savings that I would drive for them. So it was easy for them to say yes. They wanted to understand this really confusing billing. There wasn't there wasn't any transparency to it.

You couldn't understand when they negotiated some savings, why they didn't actually recapture that in their bottom line. So it was an outsourced kind of consulting play. And there was some technology involved. Most of it was spreadsheets. If I'm being. And I was doing that, it was a company, I actually started for my wife while I was doing other things in technology, and that was 25 years ago.

And I was having a nice ride and about 10 years ago, two former medical device reps, and I'm talking about the folks who do sales in the hospital. For knee and hip surgery

Replace hip, knee and hip replacement surgery for implants. They walked into my office. They were introduced to me through an attorney contact that we both knew, and they said, she said to them, You're trying to set up this business where you want to go back into hospitals, Help them save money and take a portion of the savings.

Have a client who's doing that in a different industry. And already has a successful business. Maybe you guys should just go talk. And so they came in to my office, they told me this fantastic tale about how a salesperson for the implant company stands in the operating room with a surgeon. They tender devices into the sterile field.

There's no price tag on the box, and they tally everything on a piece of paper and walk that piece of paper down the hallway to purchasing after surgery and turn it into a buyer and expect to get a purchase order. And immediately I. My mom just had her hip done and one of you guys was standing in the operating room with her.

She was under anesthesia. She had no say in the device. The doctor didn't know what it cost, and when I kind of got past the personal part of it, the entrepreneur brain kicked in and said, Wait a minute. You rarely find anything that is at the intersection of healthcare and technology and cost reduction, which I was already quite familiar.

And still paper based. It hasn't been automated yet. And so I went home that night, Steven, and I thought like, I can forget about this conversation like it never happened and just come back into my business tomorrow and be just fine or. We could really have a legacy, we could have a lasting impact on something that's been done for 50 years.

Basically, we can walk in and change that and you rarely get an opportunity like that. And I thought, if I don't try this, I'll be kicking myself wondering what if for a long time. So yeah, that was 10 years ago. We kind of started a. Like a joint venture, like a partnership. I kept the other business open and we landed two hospitals very quickly who wanted to try this.

They loved the idea and the company took off and I wasn't being an effective CEO of either of them trying to do both at the same time. So I sold the other company and been doing this full time now. 

Way of how they got purchase orders in the fact they have to pay someone to stand in a surgery room and, notate these things on a piece of paper and hand it in that just, that screams dollar signs to you. And so you're thinking how can I make a bigger impact for the hospital?

Yeah, I would say, a lot of the credit goes to my partners, Jason and John, who were the med device reps.

I mean, they stood in the operating room. They were told by their employer how to steal from the hospital. Bar none. You know how to put an extra drill bit on the case or an extra screw? These aren't screws you find at Home Depot, although they looked very similar, right? But it's a $1,200 screw.

Nobody's going to know the difference. Just put it on there. Nobody's checking the paper. Bill the buyer. The purchaser is an administrative staff. They're not clinical staff, so they can't really interpret anything that's on that bill. At best. They're spot checking, looking for big anomalies, but nobody can have the contract in one hand and the bill in the other and try to match it up in real time.

So that's where we saw the need for this technology. So it's one part service. We'll go into a hospital, help them negotiate better pricing because we understand what the street price ought to be for these implants. And we get to keep a portion of the savings as our. Identical to the business I came from.

So I kind of already had a paradigm for that. I knew how to make that work. What I didn't know was how to run a software company that was all brand new. How do you build software? How do you price it, how do you sell it? How do you have it as a compliment to the services you provide? So we are pretty much a tech enabled service.

I wouldn't say we're a pure software company, although some hospitals have taken our software and use it straight out as a subscription and they don't want any of the advisory services we provide. But by and large, it's probably 90% of our engagements are, please come help us save money and save us a lot of money, and then we'll use the software to manage and kind of keep track of and retain the savings you provide.

That's the spend management part of what we do That's been elusive for 50 years. Everybody can get cost reduction. Nobody can hang onto it because a human being who's incented to keep buy a commission, they're getting to keep the price high. Is basically running the scheme.

So it's costing them money that they never even knew that they were missing. It's not for everybody though. I mean, you think about that as a lay person maybe. I mean, you're exposed to some of these ideas, but many hospital users are kind of offended by this whole way of doing business.

It's, are you coming in on my watch and are you saying that I've left 10 million on the table because you found it? I don't know that I want my manager to see that. So there has to be a distinct cultural fit between our hospitals to buy from us and our services. They have to want that, but a lot of them, they wanna do things different.

They're willing to be disruptive. If they turn over a stone, they're not afraid of what's under that. They'll actually go clean that mess up and then there are just a handful that don't. Anything to do with this at all? , I think if you went directly to those managers and said, Hey, I don't want to call you out in front of the people that you should have been saving money for, but what if we made you look very good and you said you found me and you brought me into consult and it didn't cost them a dime.

That's it. That's it for sure. That's the way to do it

Steven: That's right. So what makes you unique in this space? How come no one's thought of this in the past 50 years?

Rich: I think people have thought of it. What's been really, it, this is kind of like a head scratcher and almost could be a concern for people who are in the healthcare space, is people who have tried to do this have realized how difficult it is.

What we've achieved is collecting the data inside of the operating room at the point of use. So people who have come in and tried to do this, it might be big. Consulting companies like Deloitte, for example, what they're doing is they're going directly to the enterprise data after the case has already been done.

And that dirty data that exists on the piece of paper, all the upcharges, all the overcharges, all the waste, fraud, and abuse has been committed to the data stream. They're sifting enterprise data. They're pulling it down and they're trying to make judgment calls or predictions from that dirty data, and they're wrong.

And so what they've realized is in order to do this properly, you have to be in the operating room, which is a very delicate situation. You don't wanna upset any of the workflow. There's kind of a choreographed ballet. It's. It's almost beautiful to watch a really tight operating room running.

You'll see. People handing instruments to the surgeon without the surgeon saying a word. I mean, they all, it's a well-oiled machine, and if you disrupt that in any way, you're gonna upset the surgeon who's got just a routine that they're used to. You're gonna upset the nursing staff. I mean, one thing we've done to nursing staff is we've launched electronic medical records far and wide.

Now it's mandated by the federal government. They're much better at providing patient care than they are at keying in stuff in an OR. But we're asking them to do that. So one more thing might break the camels back. And that's what we've seen with people who've come before us trying to do this.

And they've looked around and they've said this is really difficult to build this thing, but if we go over here, there's another problem we can solve. Make almost as much money. Let's just leave that. And so a lot of it tried and a lot have failed. I think we came at it from a different place because my two co-founders were medical device reps.

They understood that world. They didn't want what they knew was happening in the operating room to exist any longer. They had a personal mission to change that. So that makes us different. We're former medical device reps who came at this building a better mouse trap, so to speak, because we were the mice The other thing that's really different is we've built a purpose built system to ingest this data where it's happening.

Others are trying to come at this from the enterprise level, so big software companies trying to kind of crawl back up the pipe and solve the problem. But when you reach it, it's a very. It's a very difficult thing to solve. You have to have subject matter expertise. You can't just attack it with technology.

So I'm not sure that a pure play technology company can actually compete with us. It has to be somebody who has the specialized knowledge, the services and the technology altogether. And that's kind of what makes us unique. So if we're trying to minimize the amount of disruption that the surgeons are used to, but we're also trying to help save the hospital money.

Steven: I sense that there may be a conflict of interest for surgeons to prefer a specific tool and then the price that they have to pay for it. Can you tell me how they get around that issue?

Rich: Yeah. So this is the crux of the industry that we're in. The acronym is PPI or Physician Preference Items, which is really curious when you think about it.

Why does a surgeon have a preference? Shouldn't they be choosing the best item at the best price? And yes, I think you could argue that. There is no consideration of price when a surgeon comes through med school does a residency is then fellowship trained. They get a set of instruments in their hand provided by one of the big orthopedic companies, and they go through a program to understand how to use those instruments, that instrumentation and those implants.

And they pick one, right? And so now they have a preference toward. It's in a vacuum. It's without regard to price. And they get in the operating room and there's no price tag on the box. They really don't have an understanding of what the stuff costs all they want, and rightfully is the best outcome for the patient.

They want to make sure that patient is in and out of that operating room as quickly and safely as we can do that, and that they can heal quickly and have a great. And now here we are, hopefully post, Are we post covid? Hopefully we're post covid. I don't know where we are. 

I mean, the pandemic has made us all look at things differently. I don't know what the quote new normal is, but I sense we're not going backwards to the way we used to do things. I mean, look at us, We're communicating via a medium and a technology that before was a novelty, and now it's the normal way of doing things. So I think one of the things that's happened in our operating rooms in the United States and our hospitals is there's a real sense, a real awakening to what these things cost. Medical device, implantable medical devices are 60% of supply chain costs in any hospital. 

So it's the vast majority of what they're spending on. They're very expensive and they can drive the price of the cost up, which means that you and I as consumers, as patients, will end up paying for that in our insurance premiums. So now we have a real eye on how can we get the cost down? We wanna do that.

We want to drive the cost down. Without impacting the quality. So what is that magic quadrant? We can get the cost down as far as we can without the quality or the outcome being impacted. And to the extent we can measure that's what Kermit is doing. We're bringing the cost down and we're not impacting the patient quality.

In fact, we tell the surgeon, We don't care what you use. Pick any vendor you want. We know the price point for that item, and we'll make sure that this knee and this knee are all from different suppliers are all compatible with regards to their outcome. They ought to be the same. We don't care if something is 3D printed or made out of titanium or whatever.

This is all the same price. So we're kind of preserving the physician preference, which is interesting. But there are surgeons and there's a website the open payments website that Medicare provides, centers for Medicare, CMS. And you can just Google open payments and if you know a surgeon's name, you can plug it in there and you'll get.

How much money they received during any given year from any of the device manufacturers is now the law. So we have to disclose these things. If they had an invention, They have a royalty they spoke on behalf of even if they just got a small gift from one of these guys at Christmas, it'll has to be documented in the database.

And the federal government did this successfully with pharmaceutical sales many years ago. So I think what we're getting to this place of transparency and everybody's agreeing, it's good to bring the price down. It benefits everybody. No longer will we be doing this without the transparency we're demanding.

It's a long haul to get. There are many parties who are resistant. You don't want this information to come out. But it's fascinating to talk about, should we have any kind of merit to price, or should it all be altruistic about the patient outcome? I'm gonna argue that you can actually manage both.

You just need the data to do it.

The patient outcome obviously should come first, but if we can also make sure that we're thinking about the corporation too and saying, Hey, how can we save this company money so they can be more prepared to help in other areas. They have the funds in which to do that cash flow generates, the lifeblood of any business, whether it's government run or it's private or whatever.

You need the most cash where that can come in.

Hospitals are operating on a 1% or 2% margin these days. It's very slim. Some of them are losing money on these surgeries or losing money as a whole, and budgets are really coming into scrutiny. It's really been in the last couple of months as the CARES Act money and the impact of that has dried up. The boards of directors and the executive staff of hospitals are.

It's untenable, it's not sustainable. How are we gonna make our budgets work? We've got to cut costs. They haven't had to lay people off. For the most part, people are laying themselves off and walking out the door. They don't wanna go back into healthcare. So it's a very Kind of tricky place we are at right now.

I think what I feel like is the big pandemic we're not talking about right now is the staffing shortage in healthcare. And that's going to impact us more than ever. If we get into another pandemic and we have to staff beds, we have the capacity in the hospital. That's not the problem. We just don't have the people, the clinical care there to, to provide for the population.

It'll be interesting.

Steven: I don't think they're gonna have anywhere near the amount of people if we have like another huge wave of this to treat those or who are coming in because people have said it was the worst time of my life, I was overworked, I was tired. That's right. Right.

Was put in harm's way. That's for a whole another podcast. But what can physicians or practice owners, if they're not in big hospitals, what can they learn from you and some of the, maybe mistakes you learned along the way or some of the improvements that you've made that they can implement in their own businesses? 

Rich: Think a little bit about your audience. I've listened to a couple of your shows, I've really gotten some value out of, a few of them have been transformational in my own life. So I think about a surgeon owner who might be listening. Maybe they have some ownership in their own specialty hospital, a spine and joint hospital, an ambulatory surgical center where they're doing these and they have an interest in managing the profit margins.

These devices are really tricky. You really don't know if you have the best price you're gonna, you're gonna negotiate your best price. But it's not like going to buy a car where now we get to see what the invoice is. Remember the old days we used have to negotiate everything when we went in to buy a car.

And it was a big trick to do that. That was a whole day's worth of stuff. That's right. Yeah. Research and you bring a folder with you. Now we know. What these things cost. And so you negotiate from a place of strength, hospitals and surgeons, whether it's in their own business or in their hospitals.

They don't have that benchmark. They don't know what that number is. That's a service that Kermit provides. We know what the street price ought to be for about upwards of almost a million skews that are used in the United States. It's a pretty pervasive database, 21 different categories knee, hip, spine, cardiovascular, and even things like trauma or breast implants or really hard categories like biologic implants.

And a doctor can come to us, a surgeon owner can come to us and say, Will you negotiate these for me? So I don't have to get my hands dirty. I'm the user. I have to maintain a really good relationship with my rep. I count on them in the operating room to provide a service for me. So you get your hands dirty and then you get us the best price and I'll pay you a portion of the savings.

It's pretty much a win for everybody. Okay. And then let us use your software so we can determine when we get these bills in how to do it. Faster in an automated way. Most of these ambulatory surgical centers run on a skeleton crew. They're very lean by design, and many of them have private equity ownership in them, so they're run like businesses, of course.

So they want to know, how can I do this if Betty is running all this stuff in a manual process and she gets covid. Or even she wants to go on vacation or she has to leave for maternity leave. How am I gonna keep processing this? This is the kind of thing that's perfect to give to a piece of technology.

It doesn't need coffee breaks, doesn't need vacations. It just chugs through this stuff every single day. For a really lean, focused environment that's very sensitive to profit margins. It's a very good solution. It works great in the acute care setting too. In the hospital, that's where you mentioned we've saved over 200, I t

But you'll find that in the acute setting, it's a big number. It's the same problem in a small hospital. It's just less zeros on the end of that number. So everybody benefits.

Steven: The money you're saving these hospitals, they could be maybe running on less of a lane budget. I would and they could implement different strategies inside their hospitals that could make the experience better, not only for the patients, but obviously their workers.

What are some things that you've seen like firsthand being implemented in these hospitals where you've saved them a ton of money they've then been able to go out and actually budget for that's made an impact?

Rich: The first thing is, I would say there's a human impact to this. Not talking about the patient, that's the obvious one, but really it's the surgeon who, for the longest time, somebody in finance or somebody in supply who manages a budget is telling them.

Stuff you're using costs too much. We have to change. And the surgeon here is blah, blah, blah. Don't tell me how to practice medicine. . You go manage the hospital and I'll take care of the patients and we've created this artificial wall between patient care and the cost thereof. And so what the Kermit approach does is it tears that wall down and we put one source of data right in the center of that table.

It's our data. It's irrefutable, it's collected in the operating room. It speaks to the surgeon because they remember, Oh, I remember Mr. He had osteoporosis and we did his knee and we had to use a different size implant, and I told the rep, Hey, that wasted implant, you're not charging us for that. The rep said, Don't worry, doc, I got you.

And now they can see the data and say, Oh yeah, they took care of it. They billed me for it. So they've never see this data. So it's real, it's relevant to them. It's got all the attributes of what took place in surgery, but it's got all the cost side too. It's got the finance side. So what's producing really the human element of this is the collaboration that we produce by removing that wall between those two groups, the hospital administrators where finance lives.

Where purchasing lives and the clinicians where they're taking care of the patients. So they're both impacted. So that, that's that's the big aha that we got. I saved the hospital about $5 million on a project we had done in Knee and Hip, and I came back and took the CFO to lunch to thank him for taking a chance on us.

It was only our second customer. We didn't even have the software built yet. So a year later I said, Can I take you to lunch? I want to say thanks. And I said, how do you feel, Bob? We saved you $5 million. Have you told the board, Are you getting attaboys for that? How's it going?

He said, The savings was great, Rich, don't get me wrong. What we really got from you guys was we're collaborating with our surgeons, and I have a different relationship with them. We have a relationship of respect. We're sitting around the table looking at this data, coming up with other ways to save money.

It's really been transformational and I didn't think about that when I put this together with my partners. I just thought, it's all about saving money. That's all anybody's gonna care about. So you've gotten rid of the illusion of the partition between those who are trying to run the hospital and then the surgeons and actually brought them to the same table to negotiate.

Steven: And find ways to be creative. That's awesome. That's your value proposition. We help hospitals save money to bring all the sides together to be creative and find solutions for the practice.

Rich: You're on the same team. Why do you play the game? Like you're not . That's why that's why suppliers have success in dividing those two because they know what surgeons need to hear and they know how to kind of keep that fear base thing going.

Hey, if you take margin out of me- Susie has to go to college next year. I don't know if. I could be here serving you the way I do. No, it's, they've got a 65% gross profit margin than they have for the past 10 years. We've gotta right size that something's gotta be done there.

Personally or professionally 

Steven: Rich, I gotta ask, since this is a money podcast , know, what have you learned about money and what about planning has worked well for you at Kermit?

Rich: Well, so you probably asked this question and get all kinds of journeys back in a childhood, right? , I mean, My head spinning was so many different money lessons.

My dad was a doctor, so he's a cardiologist. I grew up in a house. Did you know we got, we had whatever we needed. There was never any want for anything. At the same time he came from Guatemala, Central America. Made a name for himself, very young. Came and lived with an uncle. Everybody has an uncle.

They're not related to somewhere in the family tree. . That's how he got here. Lived in Texas and skipped a bunch of grades in high school and was kind of a doogie houser, like, became a doctor at a pretty young age. Wow. And so he always valued hard work and even though we had the means for him to buy whatever.

We needed or wanted, I will say. And many times he did. He loved to lavish us in, trips and things that he knew as a kid he'd never experienced. And that was a great upbringing and a great lifestyle. At the same time, he valued hard work and he wouldn't just hand it out, he'd tell us.

Did you try to solve this problem on your own first? Did you try to get a job? I don't care. You were washing dishes. Did you have fun doing it right? And that kind of a thing. And so I've always felt a sense of accomplishment by providing for myself. That's always been super important, number one.

And so I think it's set up maybe a different relationship with money because of that. Even though I grew up in a household where, We could basically snap our fingers and whatever we wanted, my dad would say yes to it. The other thing too, like running a business and especially a startup we didn't raise money to start this business.

We just bootstrapped it. And even today 10 years into it, there's, it's a multimillion dollar business. We're all closely held. I kinda laugh and say it this way. I run this place like it's my own personal checkbook. I'm trying, I'm not stingy, but I analyze a lot of stuff and I said, Do we really need that?

Do we wanna do that? What's the value we're gonna get from it? And it served us well. I'll tell you Steven. When Covid came, we were already at about 21 or 22 staff total, and the last guy to be hired before the pandemic. He joined us from a hospital. He joined us about two weeks before we knew Covid was.

And about two weeks or three weeks after that, we started to tell people you're gonna work from home. And he was packing his stuff at his desk and I said, where are you going? He goes, Oh I'm first to leave, right? I was last in, I'm gonna be first out. And I said, No we're not gonna fire anybody.

If I can manage this, you're all family members of ours. We're gonna keep everybody here. And I'm proud to say we were able to do. Fantastic. Just with the cash on the balance sheet. And a lot of that is just, good planning, good fiscal management, and just because the money's there and it's rolling in doesn't mean you need to spend it, now we are spending it on growth at this point.

We need to really go and gain some market share, but It's uncomfortable for me to run a business at a loss. I haven't done that in 10 years. , we're spending ahead of our profits. But it's good. We're seeing a lot of growth now.

Steven: That's an incredible story. Not everybody could say that they were able to hold onto all their employees, especially as they were a new, fledgling growing company.

So kudos to what you and your partners did. Yeah, thanks. Yeah, man. What is it that you'd like our listeners to know about you the business and any upcoming events that you might have, Any promotional opportunities?

Rich: Sure. I think have a unique program that while I have a full-time dedicated sales staff, it's tough to cover the entire nation with just three people.

So I have a really robust referral program. We'll pay a portion of everything we save back to the person who makes the referral. The types of people that we sell to typically wanna tell this story to hospital CFOs vice presidents of supply chain, even orthopedic surgeons who wanna walk in with a really strong idea and take that feather, put it in their cap in front of their management and say, I can help you save money.

This is a novel thing. It's working and we should try it here. If people wanna get ahold of us, they can find us at kermitppi.com. It's just like the frog, K e r m i t. ppi.com. I mentioned that PPI acronym earlier. And there's a way to contact me up there. Have a really neat little two minute explainer video that demystifies all this in.

It's a little cartall this in.That makes it really easy to understand, right? What is the value? Then you can share that directly off the website and send it to anybody. And then follow us on LinkedIn. Any trade show we're going to any podcasts we're gonna do. Any webinar we're gonna provide, we put all that stuff up on LinkedIn.

We manage a pretty robust blog on our site too. So if anybody's interested in a freebie, a tip, or a trick, how can I do this at my own hospital without calling in the cavalry? We put those tips up there on, on blog posts as well.

Steven: You have the same mindset that I have. Give away some of your best stuff for free because they're always gonna come knock and say, What else can you do for me?

What else do you have? I'm sure. It's not your best. Give me more.

Rich: And why not? I think I'm really into sharing this. We're kind of the only ones doing what we do, so I'm not really protective about trying to keep competitors out. I already have a tenure head start on them, but everybody should be trying to optimize cost.

The problem is you're negotiating against Supplier of yours, and you need to understand how they think about this. They wanna help you. They want to help you get a win. But if you don't share all the data with them, they're only guessing if they give you a price, you've gotta give them really real good information to bid from.

Steven: Thank you so much for coming onto our show, Rich. My last question for you is, what is your purpose and lasting legacy that you'd like to leave in your community or even nationally, since that's the way your company is?

Rich: So it's in both regards, right?

So when I think about this we go back to the story I shared with your listeners at the very beginning. I could have decided to just keep putting money in my own pocket with the lifestyle business I had. But I saw an opportunity with my partners and with my team to make a change in this area.

I'm happy to say now, 10 years later we do say the name Kermit, and if anybody knows, they're not watching the Muppets and they know it's not a frog. We're talking about they're in healthcare and they understand. Kermit, everybody sits up a little straighter, and they're like, they're mining their business and they know that we mean business.

So that feels really good. I love to see every hospital in United States manage this, get control of this category, and use our process if they want to, but it's a fit for them to do it the way we're doing it, because it's disruptive in the best way we use that word. It's really changing things. People are shaking things up and doing things differently.

That's what we're about. So that's the legacy we wanna leave is everybody who wants to do it better do it. Don't keep doing it the status quo way. Think about a better way to do it, and then just jump in and do it.

Steven: I have really enjoyed learning all about your business and the value that you're bringing hospitals, and especially breaking that partition between the administrators and the surgeons.

And I know that a lot of the listeners are gonna get a lot out of this. Guys, I'll put. The website, I'll put the referral program piece all on the liner notes and I'll also give his bio in there as well. So you have any questions, please reach out to Rich. He's a wealth of knowledge and he'd love to save you some money.

So thank you again for joining us on the Portfolio Pulse podcast.

Rich: Yeah, it's been a pleasure. Thanks for having me.