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This is chanel Bun with the Becker Health
care podcast, and I'm recording live at the
Sec Health care 20 first Annual spine orthopedic
campaign pain management
Driven As plus the future of Spine Conference
in Chicago. And right now, I'm sitting with
Doctor. Daniel C, the founder and owner, Ox
Spine medicine and surgery of Long Island. Doctor.
Troy. Thank you so much for joining me
today. Thanks for having me. You guys always
on a wonderful meeting, so I'm just happy
to be here. Glad to have you. Well,
to get us started. Could you please tell
us a little bit about your background and
current members?
Absolutely. So I'm a
orthopedic spinal surgeon.
And I practiced in Long island in New
York. I actually started,
my own practice back in February of 20
21 during the Covid pandemic,
this is when there was no lending happening
to startups, and I shopped around a 65
page business plan to multiple banks. Asking them
for a startup up loan.
My Eighth bank that I approached was M
t Bank, and they provided this term loan,
that allowed me to get started. And now,
3 and a half a years later, we've
actually grown
to 3 physicians total, 2 orthopedic spinal surgeons.
1
Ph
as well as 1 nurse practitioner and 1
physician assistant. And together, all of us take
care of about we've done last year in
20 24,
sorry, in 20 23, we did over 7000
patient visits. So
we're meeting a high level of demand in
the community for specialized minimally invasive spine care.
As And we've done it staying completely independent
with no private equity
backing,
really just on our own revenues,
growing the practice slowly in steadily,
and
the 2 physicians and I that we work
together were big believers in independent practice. I
believe this is 1 of the most p
ways to preserve the patient physician relationship that
makes health care sacred.
Perfect. And can you kinda talk about that
a little bit more in the age of
health care consolidation? And private equity. How are
you able to stay independent?
Absolutely. So, you know, we use a lot
of novel techniques. I think that in this...
Type of era, you have to really stay
lean. You have to keep overhead low, and
you also have to have a pulse on
your revenue cycle management. So as the owner
and operator type I'm constantly meeting with my
billing team. We're looking at claims. We're looking
at how they're being appealed, how they're being
denied.
And we're looking at different strategies to try
to
make sure that our payments stay intact from
our insurers,
we also have a out of network model
with our practice, where it's very tough actually,
with
physicians. It's very hard to have any negotiations
with the large payers
because they're not really interested in talking to
a small group. And so, we're all... We've
almost been enforced into this model with as
out of network.
But if you are detail oriented and you
look at plans and patients who have out
of network benefits, a lot of patients. Don't
know that they have added network benefits. And
if you do some education and financial counseling,
you can actually have those patients use data
network benefits.
We also use a lot of novel strategies
in terms of decreasing our overhead. So we
use utilize virtual assistance, so we offshore a
lot of our work.
That maybe is just electronic based and using
a computer
at a much lower hourly rate than, maybe
you have to pay someone who's here based
in the United States. And this is usually
tasks that are in place here don't even
wanna do it anyway because it's very mundane
task where you're doing a lot of clicking.
We use a lot of social media advertising
as well, which is very cost effective. And
we find that we can actually do niche
marketing in social media,
where we're actually able to tell the community
about very specialized treatments, like minimally invasive spinal
surgery endo skeptics spine surgery,
intra at procedure,
things that maybe the big corporate entities are
not necessarily as agile in marketing. So we're
using all these novel techniques.
I think that the way That's why way
I think about my practices is that we
are, like the speed boat. We're smaller, we're
more agile, nimble, we're able to adapt faster,
make decisions. Quicker,
and that makes us... That helps us to
stay competitive with the larger corporate entities in
this era of healthcare care consolidation.
Gotcha. And do you have any
partnerships that help you stay independent? Yeah. Absolutely.
So, you know, 1 big...
Recent development that I do wanna mention is
that
there has been a lot of advocacy work
done with the No surprise act in the
last 4 year, 5 years. Actually, I was
deeply involved in this in 2019 I actually
spoke at the conference yesterday about the advocacy
work that was done by the American Medical
Association, American Academy of orthopedic surgeons, as well
as North American spine society and various specialty
societies
that really pushed hard and advocated or the
no surprises act to become
more, I guess, physician friendly and to also
allow independent practices to stay viable.
If you look at the marketplace really
surprise billing where patients would get a bill
for healthcare care services rendered,
and they were they would be
they would maybe go through the for their
care and they wouldn't know what that out
of network bill would look like. There was
2 models in this country. There was 1
in California.
There was 1 in New York. And the
model in California
benchmark out of network payments to in network
rates. And what you saw in California in
2014
when that was passed was massive
consolidation of that marketplace where independent practices could
not stay alive. In New York State, we
had a different model. We actually had an
arbitration process where if you as a,
physician did not agree with insurers under payment,
then you could go to this arbitration system
called independent dispute resolution, Id r, in New
york state, and third party independent orbiter would
look at different factors of the case, how
complex it was what your training would look
like, your pricing. And did... It was Baseball
our arbitration, so they would pick your fee
or the insurance payment and say, this 1
is more fair. And so that actually allowed
independent practices to stay very viable in New
York state,
then the federal level Congress took this up
in 20 20 as how do we solve
surprise bills in this whole entire country, and
they
a lot of physician groups lob, and eventually,
we were able to push, a bill that
was actually looking more like California,
all the way to 1 that looked like
New York State. So now, there is actually
a federal
independent dispute resolution process now. And this has
been truly revolutionary in terms of our ability
to fight back against insurer under payments. And
if you speak to any independent practice doctor,
look, insurers are doing,
you know, their part in the marketplace in
health care, You know, they're managing financial resources.
They're pairing out there their if you do
fiduciary your duty. At the same time,
all independent practice and patients will complain about
how premiums are going up and that we
can't get paid for the services that we
render, and it's such a battle and we
spend so much money on our billing teams
to try to keep up with the insurers.
Now they're denying mass denials with Ai. Right?
We've heard about that. So
did no surprise act really this independent dispute
resolution allows us to fight back against
these type of abuses.
And I've partnered up with the company. They're
called the Agility Billing. They've been amazing They
actually did my state Id in New York
State. And now they're doing my federal.
Id r,
independent to dispute resolutions. And we have been
getting been able to actually fight back against
situations where
some of the major peers will pay me
below Medicare rates, and basically, be, like, take
it or leave it, and then we submit
that claim to
Id, federal Id. And Agility Rc cmd really
helped me with this. And when they submit
it, they take bunch of my credentials and,
case logs and a lot of data, and
they submit it and they put together an
application for me, and that's allowed me to
actually get fair payments
for my surgeries. So that's been a game
changer, and I think that's gonna actually help
my practice grow. I actually think that no
surprises act Id r, is actually 1 huge
way that if independent practices, if they can
leverage and they can understand it better,
I can... See the tides turning in 1
tool that they can use to stay viable.
Absolutely. And you've already kind of walked us
through how you've been able to stay in
a independent. But if you could boil it
down to a few pieces of advice for
other physician leaders, what would you say? Absolutely.
I think that... Look, I think that nobody
cares about your money. More than yourself. So
as a physician owner operator,
you have to keep a pulse on your
revenue cycle management. I say that over and
over
and it's hard because bill... Medical billing is
so complex.
It's complicated,
but you can have a general understanding of,
how Rc rpm works and just do audits
within the billing team that you're working with.
I think it's important to have transparency with
the billing team that you work with, that
you're able to access your claims, understand what
stage of the claims processing that you're in
with each of these claims. So you can
check because Then end of the day, if
you can't make payroll,
you can't pay expenses,
that's the biggest way that, you know, your
independent practices at threat.
I think that
that's 1 tip tip that I would say.
I think that,
in general,
you know, a lot of doctors, I think
think that they
should do everything themselves. Right? And that's... You
know, they think they should run payroll themselves.
They should do the counting themselves. They should
act actually, clean the bathrooms themselves. And they're,
like, nobody else can do this better than
me. And I think for me,
I achieved AAAA
level of growth at some point.
When I was able to say, look, someone
else can do this better than me. Someone
else can do the marketing better than me.
They can do social media better than me.
And I willing to like, let go
And once I brought the experts and I
realized wow. This person can do it so
much better than me. And I have so
much more time to now
do the work that actually brings in the
revenue or do some bigger,
higher level planning for the practice as well.
So I would say those are my biggest
pieces of advice Got it. Well, doctor. C,
I've enjoyed our time today, and I wanna
thank you for your time today, But before
I let you go, is there anything else
that listeners should know.
You know, you know, please, visit my website,
I think that, you know, not as a
personal plug. But if you wanna a model
for how
independent practice marketing can be done. I would
encourage you to visit our website. It's WWW
dot spine med l I dot com. Just
to see, you know, I think that 1
thing we do focus on marketing is featuring
our physicians. We don't hide behind the Spine
med Ally logo. We... We're under 1 umbrella,
but patients really wanna know who their physicians
are. We tell the stories about our physicians
and our patients, and that relationship and the
results you've been able to achieve. And you
see that really prominently on our website. And
I think that's something that our your audience
could benefit from.
The company that I worked with for federal
Id r, the... Their website is WWW dot
Agility,
AGILITYRCM
dot com. And, if you wanna utilize federal
Id r, I think your listeners could benefit
from them as well. Got it. Old, doctor.
C. I wanna thank you once again for
your time today, and for joining me on
the Decker Health care podcast. Thank you. Thank
you so much.