In late 2016, I was able to sit down with Kevin Sidow. At the time, he was President & Chief Executive Officer for Moximed, and had been since 2008.

Prior to his time at Moximed, Kevin was President & CEO for St. Francis Medical Technologies, a privately held, venture-funded company focused on developing innovative treatments for patients suffering from degenerative spinal disorders. In January 2007, St. Francis Medical Technologies was sold for $725 million to Kyphon, which was acquired by Medtronic later that same year.

Previously, Kevin was the Worldwide President of DePuy, where he supervised the global orthopedic, spine, trauma, and sports medicine businesses, with annual revenue responsibility of over $3 billion dollars. Kevin holds a B.S. in Accounting from West Virginia University.

Scott Nelson: All right. Well, let's start with Moximed. You founded it back in February of 2008 or at least started there back in February 2008 and we're now recording this conversation almost nine years later towards the end of 2016. That's a long time, I think, from anyone's perspective especially in sort of that the startup Medtech ecosystem. So, tell us how you felt when that first patient was treated with the Atlas System for your IDE that was announced earlier this month.

Kevin Sidow: Yeah, not great. I mean, you're right Scott. It really is a long time, but we've always felt that the size of the opportunity will make it worth the wait. So, when the first Atlas went in Boston recently, it's really the culmination of eight years of clinical history with the predecessor device, which first went in in June of 2008 in Australia. All of the studies between the Atlas and that first implantation of the KineSpring device is what we call it. Really showed consistent success across a patient that we feel has been underserved by current surgical therapy. So, yeah, we're absolutely, tremendously excited about prospects and happy to see the first case take place in the US.

Scott Nelson: That is probably almost hard to describe that type of feeling, like looking back over the past eight-plus years or so and all the efforts that went into the product. The regulatory approval process, clinical trials, etc. So, obviously, I wish you congratulations for sure. So, let’s go ahead and level set things for the audience. Can you go ahead and provide a high-level overview of Moximed and the Atlas System. I think in the past and doing some research for our conversation here you called it a shock absorber for the knee. So, just curious to get your take on how it differs from other knee implants that are on the market today.

Kevin Sidow: Yeah, that's a great question. So, I guess I'll back up a little bit and just say that Moximed came out of the incubator ExploraMed that also spawned Acclarent and Neotract which are both companies that built great success in treating patients and filling in on that need.  ExploraMed and Moximed were originally and continue to be funded by NEA. So, we've been very fortunate in that they share our vision that the area around that need is one that's well worth investing into. So, what makes it different is I think first of all it's a procedure that if for some reason it doesn't work for a particular patient you haven't compromised any downstream therapeutic options. So, what we're offering really is this proposition for patients. You can maintain your own natural anatomy.  

In other words, we're not cutting out any bone or soft tissue. You can maintain extremely high activity level without compromise and as I said you can also maintain those downstream therapeutic options such as unicompartmental knee arthroplasty and total knee arthroplasty. So, what's different about it versus those things are knee replacement surgery works great and my background was I worked for Johnson & Johnson's Orthopedic unit and a lot of the time was spent on the hip and knee division. It's great therapy, total knees, but it's really targeted and most successful for those patients who have moderate activity levels or low activity levels. What we targeted with the Atlas device are those patients who are high activity levels who either because of their job or because of their hobbies require or desire high activity levels. We think in 2016 that's a fair proposition two to allow patients to maintain and not compromise their quality of life.

Scott Nelson: Sure. Thanks for that overview by the way. That makes a lot of sense and I couldn't agree with you more in regards to your comment about in our current era patients are becoming that much more proactive about their health. I've got to think that bodes well for Moximed into the future when it comes to that type of patient population and aging and needing maybe something like the Atlas system. So, before we go back in time and learn a little bit more about your career in Medtech help us understand your current commercialization efforts. So, you started your IDE trials, as I mentioned before here in the US. Are you currently commercializing in Europe right now?

Kevin Sidow: No. We have a few cases being done and being paid for in Europe because it is CE marked but our primary focus of the company is really addressing the US market availability through the regulatory processes. The activity in Europe really is to do either registry or single-center studies, support the clinical portfolio that we will submit to the FDA for approval?

Scott Nelson: Okay. Very good. On that note, is there a date in mind that you sort of anticipate FDA clearance, or is it too early to tell?

Kevin Sidow: Yeah, well, it's not too early. What I would say is that we expect that first of all the patients have been enrolled and the primary endpoint will be hit early in 2017. So beyond that probably not too much.

Scott Nelson: Okay. Very good. Well, yeah. We're going to circle back around to Moximed here later in the conversation but let's use it sometimes as a transition to rewind the clock as I mentioned before. You started out at DePuy in the orthopedic division as the VP of sales for the Midwest. So, what were you doing before then because I'm curious about your entrance into the medical device arena?

Kevin Sidow: Well, I started out with Howmedica actually as a sales representative and at Howmedica I was promoted up to the level of a Director of Sales position. In Howmedica, I always had this entrepreneurial instinct and interest so at a certain point I went to work for a small spine distributor which was selling at that time, Medtronic products. I wanted to learn about the spine business because my main involvement had been hips and knees. A financial partner and I were considering buying a small, independent hip and knee manufacturer. That did not come together but in the meantime, I got to know the spine business very well. Certainly later, because of one of the worldwide businesses reporting into me at DePuy was the spine business. So, I had a sort of baseline understanding of surgeries, the needs of the patients, etc. 

Scott Nelson: Got it, makes sense. So, you ended up not buying that manufacturer but instead ended up kind of landing at DePuy. Is that correct?

Kevin Sidow: Yes. So, it just came up. A friend of mine had recently started with DePuy and he said, look we have a need for, I think originally they were proposing VP of Sales, but I didn't want to move, so I became sort of the VP of Sales for the central part of the country. I didn't want to move to Indiana at that point. So, that's where it started with DePuy.

Scott Nelson: Okay. Oaky. I guess before we get into kind of yours, what seems like a meteoric rise within DePuy. It's pretty clear just in our early conversation here that you did in fact have that sort of entrepreneurial bias or bent early on if you were considering purchasing an actual device manufacturer. Have you always had that instinct or was it was your career sort of post-undergrad that really kind of fostered the type of behavior?

Kevin Sidow: Yeah, that's a great question. I think I always felt like I wanted to be able to build something fairly directly. I think you cannot substitute for the things you learn by working for a big company in terms of process and in terms of even strategy and needs. But I also think there are lessons that you learn as an entrepreneur that you can't learn anywhere else. Part of that is a really hard lesson about your capability. I know it sounds funny, but you find that you could really do a lot more than you think you could do. You can work harder than you supposed that you could. So, those sorts of lessons I learned fairly early on in just sort of regular jobs. I always wanted to put those lessons work for myself, or at least at a small company that I could play a heavy part in building.

Scott Nelson: Yeah. I can completely appreciate that and your statement about the lessons learned at a big company. I've certainly experienced that in my career, and you just don't fully grasp the nuances at a large device company unless you've done that and had that sort of experience. So, cool, it sounds like your similar thoughts anyway, So let's talk a little bit more about your time at DePuy because, like I mentioned the VP of Sales in the Midwest but then within 2.5 years, you were President of Orthopedics and I think less than a year later if my timeline is right here, you were the Worldwide President of DePuy. So, can you talk to us or help us understand what led to those rapid promotions during your time there?

Kevin Sidow: Yeah. So, it was interesting because shortly after I joined and really I think it was a matter of a couple of months DePuy was acquired by Johnson & Johnson. So, I think that accelerated my ability to be offered promotions because the work was intense in integrating the companies. I think people had greater visibility, we're spending a lot of time together and I think people have greater visibility to who works how and produces what results maybe a little more quickly than they would otherwise. So, for me, it really was a unique situation in that at that time there was no Worldwide President of DePuy, excuse me, of the combined company, there was an international president and a US President of the hip and knee division now. This is what I'm talking about, the hip and knee division only. So, what happened was I actually was offered the International President position on the hip and knee division. 

I was in the process of taking that position because I thought it was the right time for my family. and it would have been a great opportunity for an English speaking company because DePuy's international headquarters are in England, which makes it a little bit easier for the kids. In the middle of that, actually, when we were just about to move, the US President resigned and moved out of the company. So, it left us with a dilemma. But in the meantime, and what that was resolved by then asking if I would take the US President's job, which I did. But in the meantime, I learned quite a bit about international business. So, a year later when they looked to flatten the organization a little bit and combine some things on the hip and knee business, I became Worldwide President of the hip and knee business. At that time, the worldwide trauma business started reporting to me as well. It wasn't until maybe another year or so, I think it was probably a year or two maybe that worldwide sports medicine business, Mitech, and the spine business started reporting into me as well. So, that's how it went.

Scott Nelson: Got it. Okay, so it sounds like definitely some moving parts along the way that sort of opened up a path for you for sure. On that note, though, I mean, I think for most listening is there hearing you describe that looking back, it sounds like it's okay that makes sense at the time. I mean, those were rapid advancements, especially at a time when J&J was acquiring DePuy. There's a big business involved. So, I guess I'd like to ask the question for those listening in the audience that is at a similar point in their career, whether it's at a mid-cap or a large strategic, really want to go to a startup. But they sort of like they want to continue to advance their own career, where their ads you have any tips or tricks or advice that you can offer up?

Kevin Sidow: I think it's just the stuff that you hear constantly Scott and that is you have to go where the work is. You have to go where the challenge is, and you have to be willing to step outside of your comfort zone or you're never going to grow. That's one thing I did. I put myself in a position where it would be slightly or more than significantly uncomfortable because I knew that's the way to accelerate learnings and to become a better ultimate general manager. So, I did do that. But fundamentally you also have to believe in and trust in the people you work with and either engender that trust or develop that trust, depending on which side of the equation you're on and also with the company and the products you're working with. Johnson & Johnson is a tremendous company, they really are, and there are a lot of really good people there, so that made it easy for me every step of the way. But that's the advice I would offer, including when you look at those opportunities, you really do have to be flexible in terms of role, location, and everything that goes along with this.

Scott Nelson: Thanks for those notes. I mean, they sound relatively straightforward, but maybe easier to speak to, less hard to actually put into action. But your last point about being flexible. I remember a point in my career where I had a similar conversation with a regional sales manager, and he made the same point that throughout his career has always been flexible and have been willing to make the necessary moves from a geographical standpoint. If you don't have that flexibility, you're kind of making it hard on yourself. So, that makes a ton of sense that you sort of reiterated the same thoughts. So, let's kind of move on from your time at DePuy. I think you spend about three years as Worldwide President of DePuy and then made the move to St. Francis Medical Technology and to be honest, I have never heard of St. Francis Medical Technology, it’s where you agreed to do this interview, so I had to do my research. But can you tell us a little bit more about what drew you from DePuy to St. Francis and then where the company was at the time you joined.

Kevin Sidow: So, it's an interesting question and it caused me to think back because this is the question. I was asked about a lot when I made the move. People thought, this really looks like a bad career move, you moving from large responsibility to start-up that as you say, not that many people knew about the time. But what attracted me was as I mentioned earlier. I always had a very strong interest in doing entrepreneurial work. I love the space. I love the fact that there was a large unmet need, and in this case, it was that the need was just pure numbers. There were a lot of people with spinal stenosis which is what the company, St. Francis's product addressed. So, I really was attracted to that, and it was a less invasive device that was reversible. So again, for some reason, if the product didn't work, you could take it out and you haven't compromised any other therapy that the patient could go to. So, those are the things that attracted me to it and quite frankly was also based in San Francisco in the Bay Area. So, that was also a positive. But the main thing was it was a big space and it was a startup that had many of the elements that I had always had on my list of interests.

Scott Nelson: That particular device that became the X-STOP at Kyphon. 

Kevin Sidow: Yes. That's exactly right.

Scott Nelson: Okay, okay. Got it. 

Kevin Sidow: That's exactly right.

Scott Nelson: All right. When you joined St. Francis was there a product in commercialization or was it still pretty early stage?

Kevin Sidow: So, it was early stage, but it wasn't commercialization. So, it's an interesting tale, really, Because the company was doing a little bit of business in Europe with the device. They had completed enrollment and submitted for FDA approval and the panel meeting was scheduled for US approval. So, they were doing in Europe. I don't know, maybe a million or two at that time. So, what happened was shortly after I joined, within two months certainly. We went to the panel meeting and the company had hit their clinical endpoints, but the panel did not approve the device, so they turned down the device and they sent us back to the drawing board. Now, this is really where I learned a tremendous amount about the regulatory process. So, what happened was we started to have conversations with the next level at FDA. At that time, it was Donna- Bea Tillman and she was great to work with because, well, there wasn't much interaction. She really had sort of more of a big picture perspective. 

So, ultimately, we were granted a meeting with Dr. Tillman and her team and the other reviewers of the X-STOP sort of took them through where we were, the fact that we had had a number of these implanted with no safety issues in Europe and FDA ultimately granted approval to the device. I would say maybe a year, 15 months after we were initially turned down. In the meantime, I also learned a lot about cash burn because when you're dealing with a multi-billion-dollar company, you don't get as concerned about it. But what we did, unfortunately, we had to terminate between I think it was 35/40% of the people. It was a small group, so it was only maybe 9/10/11 people something like that. I don't remember the numbers now. But once we get through the regulatory process and were approved we hired everybody back, which was great and a real momentum builder. Then we launched in the US and we're off to the races. 

It was also interesting because our ability to ramp and take a different inflection on the ramp in Europe really helped save the company because we were in a very difficult position to fundraise, given the FDA decision. So, we really became cash flow positive for the entire enterprise, not just Europe after streamlining and again, unfortunately, terminating some people and driving that ramp to a much steeper level au US. We ultimately, I think the second year went to 10.8 million and became profitable on that and in some ways, save the company because we didn't have to raise any more money.

Scott Nelson: Hearing you describe that situation reminds me of a conversation I had with Ted Lamson and who I'm sure you probably know the co-founders of Neotract, and I know he made a similar comment a little bit different story, but at Neotract, at the time it was just kind of a slow pace at the FDA in terms of clearing new products and so they made the decision to go to Europe. It didn't really miss their lead them to profitability per se, but it really helped them mature in terms of their commercial readiness for eventual FDA clearance in the US. So, I guess it turned out it definitely turned out well for you guys, that sort of squeezed you into a position that maybe wasn't was an ideal initially but ended up turning out pretty well.

Kevin Sidow: Yeah, that's right. Again, it's like anything. It's like going back to your question about what advice would you offer? One of the things that are always guided me is always trying to continue to learn and that experience was tremendous for that kind of thing. Yeah, it was hard, but I've applied it to everything I've done since. So, ultimately it was great and very, very positive for me and for the companies that I've been associated with hopefully.

Scott Nelson: I can only imagine, and I want to get to Moximed in a second. But on that note do you remember that time when you got that thumbs down from the FDA panel? I presume it was probably unexpected and I know you doubled down on that regulatory window and eventually won clearance, but can you speak to maybe a little bit more about your approach. You personally dug into you in all things regulatory. But can you walk us through extreme your mindset and how you approached that at the time?

Kevin Sidow: You're exactly right, Scott. It was unexpected because we had won the trial. The numbers said we won. So, it was a shock, and part of it was there are a lot of members of the team there, including a couple of the guys who had been hired to prepare for commercial launch in the US. Ultimately, those guys and I say guys generically were on the list of unfortunate people who we terminated for a period of time. I remember we went out behind the hotel where the meeting was held and at an impromptu session, saying, look, here's the plan. Also got together in the room with everybody in the company, including the surgeons who were supporting us and just made some brief comments about we won this trial and that's a fact and that's unshakeable. We will use that as a basis to build back to the point where FDA understands that, and we'll actualize the vision that we had for the company. I think that perspective was one that we all kept, and it kept us positive, kept our chins up, and kept us grinding away at that vision because that was the building block for everything.

Scott Nelson: It's probably easy to talk about right now, but I can imagine how much of a blowback that was at that stage for...

Kevin Sidow: The sales guys I thought I was going to have to get some sort of dolly your crane or something to get their jaws off the ground, but we all felt that way, quite frankly. That plane ride back because we were located in the Bay Area, and we were at FDA in Maryland. That was a long plane ride home I can tell you that.

Scott Nelson: Yeah, that's long, let alone with that type of news delivered. You mentioned that it was within about a year that the FDA ended up clearing but now it's the X-STOP device.

Kevin Sidow: It was 15 months later, actually. So, the timeline, this I remember very clearly because of what was at stake for us. I think it was August or September when the panel turned us down. We had a meeting in May with Dr. Tillman and her team and our reviewers and there was a signal there that things were going to be more positive. From there we ended up talking about labeling and sort of negotiating that and we were approved in November of the following year. So, again, I think it was about 15 months all in from the original panel down until we got the fax from the FDA saying the product was clear for sale in the US.

Scott Nelson: Did that require additional clinical data or was it just sort of as time went on and through continual conversations, I guess with the FDA, is that sort of led to the ultimate clearance?

Kevin Sidow: Yeah, it was really while we probably submitted some data. Actually, I think we submitted data on the mechanism of action from a study that we had done in Scotland, but it was mainly about making sure they fully understood. It was just a different approach that we hadn't taken to that point that said, look, outside of the US data. We've also got this rich and fairly substantive numbers of cases and clinical history au US and there is no concern with safety. I think once they saw that I think at the time we probably had 1500 implantation devices implanted. 

So, I think once they say that they breathed a sigh of relief and started to look at the bigger picture and the data itself. In the fact that we had won the trial. They were really good about it, but I think perhaps between the panel, you spend a day with the panel and sometimes some of the panel members educate themselves very, very well before the meeting. Sometimes it feels like some of the panel members don't really educate themselves, even though they provided by the FDA with a lot of information until they get to the panel meeting. We felt like we were given a fair assessment after that meeting and that's what led to the reversal of the decision. 

Scott Nelson: Got it and then I guess, shortly thereafter, St. Francis ended up being acquired by Kyphon and then Kyphon, I think within six months if I did my research right, I think was acquired by Medtronic. So interesting little timeline of events there.

Kevin Sidow: That's exactly right. Yeah, that's right. So, Medtronic had been involved in the auction. So, the way this worked way had some offers when we were FDA approved for the company when we're cleared for sale in the US, but we felt like we wanted to execute... We really believed in the team and our ability to sell and we had great, great agents who have been DePuy Spine and Stryker Spine and Independence, really, really good people. We did a great job, and so we executed well that first year of launch and then we filed the S-1 and Kyphon had come in when we're FDA approved. 

When we started selling Medtronic had come in with offers that were significantly lower than what they ultimately offered. Then what happened was we filed the S-1 to go public and we hadn't really overplayed our hand in terms of our results and the fact that we were cash flow positive. We hadn't made that generally known. Once they saw the filings and the information contained in the S-1, then, of course, they saw we were doing better than they had thought and the offers stepped up sufficiently. So, we started an auction process while we were filing revision to the S-1 and getting ready to take the company public, do the roadshow, etc. and the numbers from Medtronic, Kyphon and at the time Abbott Spine were such that we felt that the responsible thing to do was take them very, very seriously and then ultimately Kyphon had the best offer. Then, as you said, Medtronic immediately set about acquiring Kyphon.

Scott Nelson: Got it. Yeah, it's funny how those events all come full circle for sure. It looks like you didn't stay with Kyphon or Medtronic very long. In fact, at that point your career you moved on to Moximed. I remember reading a statement I think from you during your time at St. Francis that you were working on projects that "wouldn't burn bridges." Is that sort of the concept that that sort of drew you to Moximed? 

Kevin Sidow: Yes, it is. It's one of the concepts. The concept of reversibility and not compromising anything downstream is one that I think is attractive to patients and surgeons alike. Moximed, that was one element of it. It was a massive need. When you think about and you look into osteoarthritis, the fastest-growing segment of symptomatic patients in the OA is 35 to 65 right? So, these days, 35 to 65 year old’s are very, very active. I mean, the old joke about 60 being the new 40 is true. So, you have this concept of not burning bridges and you have an unmet need for these highly active patients. Because again, total needs and unicompartmental needs are great for moderately active patients but we think someone who's going to be very, very active, and that big growing target market fits that bill needed something else. So, those were really the elements that attracted me to Moximed. 

Scott Nelson: Got it. As you mentioned earlier, the product started off as KineSpring I think if I'm pronouncing that right and then after initial implants in Australia, you sort of took a step back, brought the product back in-house, made some iterations to what is now the Atlas System. Is that correct?

Kevin Sidow: Yeah, that's exactly right. So, the Atlas System really is the culmination of six and a half or seven years of clinical experience and feedback from the surgeons and patients who were part of that implant experience. So, we feel great about it. We feel as though we've kept the best of the KineSpring and that is the restoration of function and pain relief. But we made improvements in terms of making a smallish footprint of very straightforward surgery and a very, very consistently compressed recovery time for the patient. So, we're excited.

Scott Nelson: Yeah, absolutely. It looks like you've raised, I think, close to $100 million or so at Moximed and I know you mentioned NEA is one of the well-known venture capital firms in the Medtech space that's been involved with Moximed. So, can you talk to us a little bit more about your fundraising process? How maybe you're A round was different than your B round and for those Medtech entrepreneurs that are listening and sort of are at that stage with their company where they need to move beyond the friends and family rounds. Do you have any advice for those types of folks?

Kevin Sidow: Yeah, I think that it's interesting because over the years there have been fewer companies that are focused on Medtech investments. We're lucky in that, and again, not to continually seem the virtues of NEA because it's not just NEA, it's also Gilde, Vertex, GBS, Morgenthaler, etc. We've been very, very lucky because those investors and this is the lesson that I've learned. Those investors shared our vision. They see there's a massive market. They see that the product is absolutely directed at the right spot in the patient continuum and the patient mature and their value-added investors and board members. I would say look for those things, talk to the people who have worked with these companies. I know it's a tricky environment now and sometimes CEOs and management teams feel like they don't have a choice, and I think a lot of times that's true. But if you aren't in a position where you have a choice, I think learning about the interaction of the investors and the management team is very, very important. Clearly understanding what the expectation in terms of timeline and company build is from those investors. Those are important things to get your arms around before you commit to those investors. That's what I would say and that's what I've learned.

Scott Nelson: That's good advice. Let's turn the page a little bit and talk a little bit more about the current reimbursement environment. So, presuming the Atlas System is cleared here in the US by the FDA, will it fall under an existing CPT code or is this something that will require a new code all together with the corresponding challenges of getting coverage and reimbursement with both Medicare as well as private peers?

Kevin Sidow: Yeah, that's a great question. You don't know until you actually are cleared for approval and start to make this happen. What we do know is we presented to several key VPS societies and met with the coding representatives, and we've gotten positive feedback from them. So, we feel good about that. Beyond that, it would just be forecasting on my part and I don't think there's much to learn from that. But we do feel like in the meantime, we're collecting the right information that will support our reimbursement efforts. Not only that but they'll show that this is on the right side of the financial equation for everybody involved the patients, the surgeons. Whether it's an ASC in our case or a hospital or an outpatient center that it will be a win-win for them. 

One thing that we have done in terms of reimbursement is we have gotten feedback from the private payers. We do know that they are all over the data. They are very well versed as you would expect on the real cost of, for example, total knee arthroplasty, and what we find encouraging is they realized that there are direct patient expenses for those patients who are waiting to become age or inactivity appropriate for total knee arthroplasty. So, in other words, those expenses are doctor visits, treatment costs, increased medication, and then indirectly, there are lost workdays that these private payer medical directors have insight into. So, we were pleased in our conversations with them that they fully recognized that waiting and watching are not inexpensive. 

There is some data out there that says each of those patients costs about $4000 a year because of meds and treatment and these are indirect costs, meds, treatment, and doctor visits. So, the other thing on the other side of the equation, what we find that the private payers are very, very educated on is the fact that increasingly their patient population is at higher activity levels than so-called younger patients for arthroplasty, are having arthroplasty because they feel like they need some sort of therapy to eliminate the pain and attempt to restore their function. The medical directors we talked to are fully aware that results with those younger, more active patients are not nearly as good as they are with, as I've described before, moderately active, or a patient with low activity levels. All of that bodes well economically for the type of product that the Atlas represents.

Scott Nelson: Yeah, absolutely. I guess the lesson learned, I guess, for me hearing you riff a little bit about this whole concept of reimbursement and coverage and coding is the fact that you're having those types of conversations this early in the process. Those conversations with at the societal level as well as with private peers. So, maybe the lessons learned is you probably can't do that early enough in the life cycle of the product.

Kevin Sidow: Yeah, I agree Scott. It really can take a break at some point and you need to take into your plans. that feedback you're getting on both sides of that equation, both the private peer, medical directors, and the society coding representatives feedback.

Scott Nelson: Yeah, and I recall an experience I had when I was at Covidien, working with some healthcare, economics and reimbursement, folks. I remember a couple of people mentioning the fact that we couldn't go have these types of conversations with the payers until we had an actual code. I always thought it was kind of them. I'm certainly no expert when it comes to your healthcare economics and coverage especially at that stage of the product. But it just seemed always kind of odd to me that why couldn't you have that type of conversation earlier in the process? I'm sure if you get time on the books with a medical director, I'm sure they would entertain that type of conversation if it were going to help them reduce their costs.

Kevin Sidow: Yeah, that's right and I think you're right. You have to go back to what we said about being flexible. In this case, being flexible in how you pose the question to them. So, it's sort of like if we had this sort of data over this kind of experience, what do you think about coverage with your plan?

Scott Nelson: Now, that's good advice. So, as we kind of wrap up this interview with the last three rapid-fire questions; Looking back over your time at Moximed, going back to 2008 is there anything that stands out in terms of things that you're really proud of you and/or situations that you maybe would have done differently or changed if you had the opportunity to go back in time?

Kevin Sidow: I think what I found, and I think the team has found is when you're doing something very, very innovative. It's not a straight line. I think what we as an organization are of proud of number one is we've always stayed true to the vision of really changing the paradigm of care because the patients have shifted as I said earlier. When you think about a 50-year-old patient in 1985 when the PCA knees were really accelerating the uptake of total knee arthroplasty. Very, very different person, very, very different lifestyle. Those people weren't nearly as active and the habits included a lot more smoking, let's say and those kinds of things. We feel like we've maintained our eye on the vision of improving the lives of those patients whose OA symptoms are growing or that group of patients where the OA prevalence is growing more than any other area and meeting their needs. So, through the feedback and the fact that we can look back. Nine years sounds like a long time. We've always maintained that belief that we've gotten it right and we'll get there. I think that's what I'm proudest of.

Scott Nelson: Yeah, let's get the good stuff. So, with the last few minutes we have, let's wrap it up with the three rapid-fire questions. The rapid-fire, feel free to provide brief answers or expound a little bit if you want. First one, is there a favorite business book that you can recommend?

Kevin Sidow: I think the one I always go back to is "Good to Great." I think the lessons have been proven time and time again by me and everybody else I think. That's a great book.

Scott Nelson: It's interesting. That comes up I think regardless of the age of the person that I have asked that. Someone who's younger or older or more mature in their career. It seems like that one continues to come up. So, the second question, is there a CEO that you're following right now or one that's really inspired you in the past?

Kevin Sidow: I think I've learned from everybody, really. I take little bits from here and there. So, I wouldn't say there's a particular person that I'm following, I would say I tried to read about the decision-making process of each of them as much as I can either in the business news or as you said biographical material and learn a little bit from everybody.

Scott Nelson: Got it. And the last question is to take us back to your 25 or your 30-year-old self. What advice would you give him at that point in time?

Kevin Sidow: I think it's what we touched on earlier Scott. First of all, you have to believe in the product that you're involved with and you have to respect and trust the people around you and the company you're dealing with. Beyond that it's the things we talked about, you have to work hard and it's all cliched stuff but it's true. Work very hard and help create a culture of success and a culture that people find positive and healthy for them despite the fact they may be working very, very hard.

Scott Nelson: Good stuff and I can't thank you enough for coming on the show and we'll certainly link up to Moximed and for those interested in learning a little bit more about the Atlas System. There'll be links in the show notes to this particular episode. So, Kevin, I'll have you hold on the line. But again, thanks for coming on the program. Really appreciate it. 

Kevin Sidow: Yeah. Thanks very much, Scott for having me. I appreciate it. 

Scott Nelson: All right, that wraps it up for this particular episode. Thanks for your listening attention and until the next one, everyone takes care.