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forward slash beckerspodcast.

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This is Gracelyn Keller with the Becker's Healthcare

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Podcast, and we are recording live at the

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twenty second annual Spine Orthopedic and Pain Management

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Conference. I'm currently joined by Doctor. Daniel Choi,

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who is an orthopedic spine surgeon and the

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owner of Spine Medicine and Surgery of Long

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Island. So Doctor. Choi, thanks for joining me

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today.

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Would love to have you start off by

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sharing a little bit more about yourself, your

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role, and your organization.

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Great. Thanks for having me.

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It's a pleasure to be at another Becker's,

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Spine Conference.

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And,

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I,

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am the owner and operator of Spine Medicine

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Surgery in Long Island. We cover two counties,

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in Long Island, New York, Suffolk County and

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Nassau County.

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The practice was started by me during COVID,

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in February

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2021.

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And I had actually been with another group

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for about three and a half, years prior

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to that.

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And, this, private practice

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has actually now grown tremendously,

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over the last four years. We are now

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actually at three orthopedic spinal surgeons total,

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and two,

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interventional pain management physiatrists,

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as well as one PA and one NP.

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Last year, we did over 10,000 patient visits,

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between two offices.

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And we're really filling a need in Long

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Island,

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especially where it's a pretty consolidated market with

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a lot of hospitals,

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hospital systems, as well as private equity groups

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growing. We're a 100% independent, and we're really

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meeting a demand, not just for patient care,

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for specialized spine care, specialized minimally invasive spine

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care. But also, we're meeting, I think, a

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demand for,

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physicians who are looking for different

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form and different way of practicing, especially young

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physicians who are really just really just being

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presented with options for employment with big health

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systems.

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We're providing a an alternative to that to

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be in a true private practice,

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model.

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And we're meeting that demand, and we're we're

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really seeing a lot of interest in private

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practice again.

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Wonderful. Well, thank you for being here to

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share your insights.

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And let's start off with what trends or

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shifts you're currently seeing right now in the

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industry that you think are most important for

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leaders to pay attention to.

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Absolutely. So,

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Scott Becker, I read all of his LinkedIn

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reports and as well as,

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what what he's writing on x these days.

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And I have to agree with him that

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one of the biggest

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trends and concerns about the current health care

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system is our physician shortage.

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And it's an it's it's a shortage now,

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and it's just going to get

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worse as there's multiple factors that are dry

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that are exacerbating,

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the shortage. There's early physician retirement happening,

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typically due to, I think, burnout,

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as well as intolerable working conditions.

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And you're seeing,

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that a lot of the consolidated systems are

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utilizing,

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mid level care, so physician assistants and nurse

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practitioners to try to fill in the gaps.

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But that gap is only gonna be filled

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that way,

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you know, for a limited time before some

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something breaks in the system.

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So I think that's really important for industry

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leaders to pay attention to that there is

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this physician shortage.

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There's a lot of physicians who are retiring.

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We don't have enough,

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younger physicians to

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fill the gap as well as, I think,

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we also see a trend

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where there's,

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disparities between, male and female physicians too in

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in this,

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setting too where,

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I do see that younger female physicians, who

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are now 50% of graduating

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US positions,

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are looking for,

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different types. Not all the time,

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but I have noticed that, you know, as,

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they,

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are shifting more attention to maybe their families,

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that they're looking for part time work or,

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you know, less than full time. And so,

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more flexible hours. And when that happens, that

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also is going to inherently

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exacerbate the physician shortage.

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And you've actually,

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provided a great segue to my next question,

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which touches on staffing

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and workforce challenges as those continue to be

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your concern across healthcare.

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So how is your organization navigating these pressures

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and what strategies have you seen work well?

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Absolutely. So, you know, I I think that,

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you know, our private practice

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having,

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workforce,

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challenges is, kind of a theme that I

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talk about with a lot of practice owners.

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We have hard time filling those basic

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roles of medical receptionists to

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as well as,

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front sorry, front desk as well as billers.

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And it's it's hard. So, you know, we

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have definitely,

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have a human resources department

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within our practice that spends a lot of

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time

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posting,

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job posts and finding those people locally that

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have the experience that we need to fill

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those, spots. We're also using creative ways to

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offload

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some of the more,

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mundane and burdensome tasks. So,

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generating letters of medical necessity, we've actually started

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implementing CHAT g p t.

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And,

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we actually have a,

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BAA with OpenAI,

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where we can actually put in patient specific,

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materials to,

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CHA2PT, but they can't train

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on that data. And they, basically have to,

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you know, delete that patient specific data after

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we generate our letter of medical necessity. That's

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actually what a letter that used to take

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thirty minutes

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to forty five minutes for a a staff

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member to write,

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now we can do it in literally fifteen

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seconds on chat gbt. So that's we're utilizing,

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AI in very creative ways,

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to try to,

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decrease the strain,

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in the workload on our staff in house.

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And as outpatient care continues to grow, how

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do you see the role of orthopedics

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and spine evolving with the broader healthcare ecosystem?

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Yeah. Absolutely. So, you know, I do think

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that,

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ASCs have a very critical role,

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you know, within,

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the spine and orthopedic world.

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We're seeing it,

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in orthopedic sports. We're now seeing a huge

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push in orthopedic joints. I would say that

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the spine is probably one of the last,

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orthopedic specialties to,

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push over to the ASCs. I'm actively at

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this point, this this past year was the

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first year that I actually started doing spine

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cases in an ambulatory surgical center.

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I did my first cervical disc replacement

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at the ASC.

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I'm also doing endoscopic spine cases at the

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ASC.

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The ASC is definitely a different environment. I

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remember in residency and fellowship, I was like,

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there's no way you could ever do spine

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surgery in an in an ASC. That's crazy.

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But as I've come to actually the Becker's

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meetings in the last three years,

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and I've talked to other spine surgeons who

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are doing it, doing now they're doing

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T lifts. They're doing fusions or they're doing

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O lifts at ASCs. And I remember my

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jaw dropping when I heard about that. But

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as I've learned more about the protocols that

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they've implemented,

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the anesthesia protocols, the hydration protocols,

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local blocks, erector spinae, blocks that, you know,

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allow them to do these. It it is

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definitely possible. And so, you know, it was

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very exciting to do my first cervical disc

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replacement in the ambulatory surgical center. Patient went

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home the same day. You have to be

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meticulous. I think the technique not every spine

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surgeon can do

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cases at an ASC. I I don't think

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I recommend new graduates,

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to do these cases at an ASC because

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you have to be technically very sound as

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well as,

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kind of know

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what may,

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create more of a tendency for post operative

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complications to happen.

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And those are not the patients that and

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and patient selection too, making sure that you

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don't have sick patients that are being done

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at the ambulatory surgical center. So a combination

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of all that knowledge and experience,

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I think will be driving more spine cases

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into the AC for our practice, definitely.

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Absolutely.

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And then my final question, as many organizations

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are exploring new technologies,

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partnerships, or care models

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that improve efficiency and outcomes, are there any

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innovations or initiatives that you found particularly promising?

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You know, I I think the one

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game changer

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in our practice are we have a very

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kind of like a it's a unicorn practice

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in the sense that it's five young physicians

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now,

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probably

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around the age of 40 or younger.

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And we are completely independent. We're actually able

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to stay independent

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and grow.

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And that

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requires access to capital, which physicians historically have

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been limited from and cut off from through

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their professional fees. So professional fees are never

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valued

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at, I think, the proper market rate. And

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it's always been

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fee setting, by the government or by payers

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benchmarking our payments to Medicare rates, which have

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only gone down year after year. And so

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I would say that the big shift in

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our practice that has allowed us to grow

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is utilization of the No Surprises Act independent

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dispute resolution process,

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which allows us to take an underpayment by

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an insurer

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and actually go and argue in in to

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an arbitration

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company and say, actually, no. The ACDF that

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I did is not a thousand dollars. That's

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not the fair payment. It should actually be

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15,000, which is, you know, when you're talking

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about a hospital system getting paid $80,000 for

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that facility fee, I think it makes sense

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that the doctor who performs that surgery gets

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some, much bigger percentage of it than is

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currently being paid. And so I would say

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this independent dispute resolution process has been the

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game changer for us,

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and we've been implementing it, very successfully. And

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I and I I believe that what will

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happen as

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there's more utilization of this arbitration is that

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in network rates will also

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improve allowing,

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doctors to have more fair contracts with payers.

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Well, doctor Choi, thanks so much for joining

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me today. Is there anything else you'd like

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to share that we didn't touch on in

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our conversation?

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You know, I think that,

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I've heard that there is a pendulum in

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medicine that swings back and forth in the

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past between private practice doing well and not

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doing well. You know, I've been in practice

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nine years, so all I have seen is

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prior practice getting crushed and steamrolled.

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And I'm very hopeful and,

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hopeful and that the pendulum is potentially swinging

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back the other way. I think there's a

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lot of factors. There's a lot of physicians

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that are really sick and tired of having

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their autonomy stripped.

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And I think that it really I I'm

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I'm

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hoping that our elected

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officials and our elected leaders

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start to see that,

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the viability of private practice is so critical

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to the future of our entire health care

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system. And so, you know, this is why

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I participated in advocacy events. I participated

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the American Medical Association, Medical Society of State

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of New York to try to get that

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message across to our elected officials through organized

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medicine.

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And, you know, that's what I'm looking to

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as, you know, as a hope for the

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future for for

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medicine.

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Absolutely. Well, thank you so much for joining

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me today on the Becker's Healthcare Podcast. Again,

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we are recording live at the twenty second

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annual Spine Orthopedic and Pain Management Conference.