BoneChat #145 - ASC Robots, Direct-to-Patient Marketing & Ortho Startup Reality

No guest presentation — just unfiltered industry conversation on robotics in ASCs, lean selling models, direct-to-patient marketing, and the problems that show up after a startup raises money. Poll results: who wins the ASC robotics race, selling with fewer reps, and why “business moats” barely registered Why big “refrigerator” robots (Mako, ROSA, etc.) struggle in ASCs — capital placement as customer capture vs small, handheld, marker-light systems Tiger’s thesis: “The winners are on the edges” — ultra-simple kits (Arbutus) or ultra-complex systems (Globus-style robots) vs the crowded middle implant market Field Orthopedics: Jansen joining as SVP Marketing, execution at ASH vs CareTouch, and the limits of direct-to-patient in CMC/thumb arthritis vs bunions Why hand surgeons are a different animal than podiatrists when patients show up asking for a specific implant Robotics skepticism: joint-registry outcomes, learning-curve claims, cognitive load, liability, and whether enabling tech is becoming the “auto start-stop / lane assist” of the OR Kyle Lappin on haptic feel, Gladwell’s Blink, and why expert intuition may be the unclimbable mountain for fully automated surgery Where automation might land first (endoscopy, diagnostics, alignment) — and why full autonomy is probably not “5 years away” Reuters + AI billing/coding arms race: providers coding more, payers denying more After funding is solved, what kills companies next: sales friction, quality systems, infrastructure/3PL/QARA, product-market fit, and cash tied up in trays Featuring Tiger Buford, Steven E. Flutie-Davis (Encircle), Patryk Kania (Field Orthopedics), Kyle Lappin, Colleen Gray, Mark Maloney, Eric Lange If you build, sell, or invest in orthopedic devices, this is the kind of conversation you usually only hear off-camera. Become a BoneChat member (first month free): https://bonechat.com/ More industry writing: https://orthostreams.com/