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dot com forward slash

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test.

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This is chanel Bun with the Becker Health

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care podcast, and I'm recording live at the

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Sec Health care 20 first Annual spine orthopedic

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campaign pain management

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Driven As plus the future of Spine Conference

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in Chicago. And right now, I'm sitting with

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Doctor. Daniel C, the founder and owner, Ox

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Spine medicine and surgery of Long Island. Doctor.

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Troy. Thank you so much for joining me

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today. Thanks for having me. You guys always

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on a wonderful meeting, so I'm just happy

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to be here. Glad to have you. Well,

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to get us started. Could you please tell

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us a little bit about your background and

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current members?

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Absolutely. So I'm a

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orthopedic spinal surgeon.

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And I practiced in Long island in New

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York. I actually started,

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my own practice back in February of 20

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21 during the Covid pandemic,

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this is when there was no lending happening

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to startups, and I shopped around a 65

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page business plan to multiple banks. Asking them

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for a startup up loan.

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My Eighth bank that I approached was M

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t Bank, and they provided this term loan,

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that allowed me to get started. And now,

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3 and a half a years later, we've

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actually grown

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to 3 physicians total, 2 orthopedic spinal surgeons.

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1

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Ph

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as well as 1 nurse practitioner and 1

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physician assistant. And together, all of us take

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care of about we've done last year in

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20 24,

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sorry, in 20 23, we did over 7000

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patient visits. So

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we're meeting a high level of demand in

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the community for specialized minimally invasive spine care.

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As And we've done it staying completely independent

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with no private equity

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backing,

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really just on our own revenues,

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growing the practice slowly in steadily,

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and

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the 2 physicians and I that we work

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together were big believers in independent practice. I

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believe this is 1 of the most p

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ways to preserve the patient physician relationship that

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makes health care sacred.

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Perfect. And can you kinda talk about that

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a little bit more in the age of

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health care consolidation? And private equity. How are

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you able to stay independent?

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Absolutely. So, you know, we use a lot

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of novel techniques. I think that in this...

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Type of era, you have to really stay

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lean. You have to keep overhead low, and

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you also have to have a pulse on

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your revenue cycle management. So as the owner

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and operator type I'm constantly meeting with my

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billing team. We're looking at claims. We're looking

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at how they're being appealed, how they're being

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denied.

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And we're looking at different strategies to try

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to

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make sure that our payments stay intact from

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our insurers,

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we also have a out of network model

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with our practice, where it's very tough actually,

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with

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physicians. It's very hard to have any negotiations

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with the large payers

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because they're not really interested in talking to

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a small group. And so, we're all... We've

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almost been enforced into this model with as

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out of network.

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But if you are detail oriented and you

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look at plans and patients who have out

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of network benefits, a lot of patients. Don't

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know that they have added network benefits. And

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if you do some education and financial counseling,

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you can actually have those patients use data

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network benefits.

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We also use a lot of novel strategies

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in terms of decreasing our overhead. So we

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use utilize virtual assistance, so we offshore a

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lot of our work.

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That maybe is just electronic based and using

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a computer

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at a much lower hourly rate than, maybe

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you have to pay someone who's here based

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in the United States. And this is usually

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tasks that are in place here don't even

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wanna do it anyway because it's very mundane

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task where you're doing a lot of clicking.

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We use a lot of social media advertising

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as well, which is very cost effective. And

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we find that we can actually do niche

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marketing in social media,

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where we're actually able to tell the community

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about very specialized treatments, like minimally invasive spinal

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surgery endo skeptics spine surgery,

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intra at procedure,

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things that maybe the big corporate entities are

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not necessarily as agile in marketing. So we're

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using all these novel techniques.

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I think that the way That's why way

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I think about my practices is that we

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are, like the speed boat. We're smaller, we're

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more agile, nimble, we're able to adapt faster,

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make decisions. Quicker,

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and that makes us... That helps us to

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stay competitive with the larger corporate entities in

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this era of healthcare care consolidation.

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Gotcha. And do you have any

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partnerships that help you stay independent? Yeah. Absolutely.

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So, you know, 1 big...

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Recent development that I do wanna mention is

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that

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there has been a lot of advocacy work

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done with the No surprise act in the

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last 4 year, 5 years. Actually, I was

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deeply involved in this in 2019 I actually

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spoke at the conference yesterday about the advocacy

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work that was done by the American Medical

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Association, American Academy of orthopedic surgeons, as well

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as North American spine society and various specialty

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societies

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that really pushed hard and advocated or the

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no surprises act to become

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more, I guess, physician friendly and to also

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allow independent practices to stay viable.

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If you look at the marketplace really

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surprise billing where patients would get a bill

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for healthcare care services rendered,

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and they were they would be

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they would maybe go through the for their

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care and they wouldn't know what that out

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of network bill would look like. There was

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2 models in this country. There was 1

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in California.

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There was 1 in New York. And the

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model in California

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benchmark out of network payments to in network

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rates. And what you saw in California in

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2014

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when that was passed was massive

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consolidation of that marketplace where independent practices could

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not stay alive. In New York State, we

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had a different model. We actually had an

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arbitration process where if you as a,

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physician did not agree with insurers under payment,

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then you could go to this arbitration system

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called independent dispute resolution, Id r, in New

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york state, and third party independent orbiter would

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look at different factors of the case, how

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complex it was what your training would look

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like, your pricing. And did... It was Baseball

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our arbitration, so they would pick your fee

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or the insurance payment and say, this 1

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is more fair. And so that actually allowed

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independent practices to stay very viable in New

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York state,

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then the federal level Congress took this up

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in 20 20 as how do we solve

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surprise bills in this whole entire country, and

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they

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a lot of physician groups lob, and eventually,

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we were able to push, a bill that

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was actually looking more like California,

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all the way to 1 that looked like

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New York State. So now, there is actually

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a federal

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independent dispute resolution process now. And this has

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been truly revolutionary in terms of our ability

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to fight back against insurer under payments. And

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if you speak to any independent practice doctor,

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look, insurers are doing,

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you know, their part in the marketplace in

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health care, You know, they're managing financial resources.

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They're pairing out there their if you do

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fiduciary your duty. At the same time,

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all independent practice and patients will complain about

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how premiums are going up and that we

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can't get paid for the services that we

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render, and it's such a battle and we

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spend so much money on our billing teams

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to try to keep up with the insurers.

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Now they're denying mass denials with Ai. Right?

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We've heard about that. So

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did no surprise act really this independent dispute

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resolution allows us to fight back against

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these type of abuses.

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And I've partnered up with the company. They're

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called the Agility Billing. They've been amazing They

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actually did my state Id in New York

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State. And now they're doing my federal.

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Id r,

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independent to dispute resolutions. And we have been

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getting been able to actually fight back against

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situations where

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some of the major peers will pay me

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below Medicare rates, and basically, be, like, take

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it or leave it, and then we submit

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that claim to

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Id, federal Id. And Agility Rc cmd really

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helped me with this. And when they submit

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it, they take bunch of my credentials and,

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case logs and a lot of data, and

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they submit it and they put together an

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application for me, and that's allowed me to

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actually get fair payments

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for my surgeries. So that's been a game

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changer, and I think that's gonna actually help

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my practice grow. I actually think that no

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surprises act Id r, is actually 1 huge

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way that if independent practices, if they can

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leverage and they can understand it better,

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I can... See the tides turning in 1

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tool that they can use to stay viable.

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Absolutely. And you've already kind of walked us

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through how you've been able to stay in

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a independent. But if you could boil it

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down to a few pieces of advice for

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other physician leaders, what would you say? Absolutely.

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I think that... Look, I think that nobody

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cares about your money. More than yourself. So

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as a physician owner operator,

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you have to keep a pulse on your

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revenue cycle management. I say that over and

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over

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and it's hard because bill... Medical billing is

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so complex.

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It's complicated,

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but you can have a general understanding of,

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how Rc rpm works and just do audits

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within the billing team that you're working with.

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I think it's important to have transparency with

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the billing team that you work with, that

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you're able to access your claims, understand what

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stage of the claims processing that you're in

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with each of these claims. So you can

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check because Then end of the day, if

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you can't make payroll,

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you can't pay expenses,

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that's the biggest way that, you know, your

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independent practices at threat.

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I think that

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that's 1 tip tip that I would say.

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I think that,

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in general,

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you know, a lot of doctors, I think

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think that they

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should do everything themselves. Right? And that's... You

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know, they think they should run payroll themselves.

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They should do the counting themselves. They should

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act actually, clean the bathrooms themselves. And they're,

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like, nobody else can do this better than

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me. And I think for me,

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I achieved AAAA

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level of growth at some point.

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When I was able to say, look, someone

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else can do this better than me. Someone

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else can do the marketing better than me.

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They can do social media better than me.

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And I willing to like, let go

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And once I brought the experts and I

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realized wow. This person can do it so

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much better than me. And I have so

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much more time to now

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do the work that actually brings in the

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revenue or do some bigger,

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higher level planning for the practice as well.

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So I would say those are my biggest

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pieces of advice Got it. Well, doctor. C,

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I've enjoyed our time today, and I wanna

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thank you for your time today, But before

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I let you go, is there anything else

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that listeners should know.

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You know, you know, please, visit my website,

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I think that, you know, not as a

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personal plug. But if you wanna a model

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for how

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independent practice marketing can be done. I would

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encourage you to visit our website. It's WWW

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dot spine med l I dot com. Just

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to see, you know, I think that 1

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thing we do focus on marketing is featuring

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our physicians. We don't hide behind the Spine

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med Ally logo. We... We're under 1 umbrella,

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but patients really wanna know who their physicians

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are. We tell the stories about our physicians

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and our patients, and that relationship and the

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results you've been able to achieve. And you

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see that really prominently on our website. And

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I think that's something that our your audience

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could benefit from.

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The company that I worked with for federal

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Id r, the... Their website is WWW dot

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Agility,

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AGILITYRCM

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dot com. And, if you wanna utilize federal

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Id r, I think your listeners could benefit

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from them as well. Got it. Old, doctor.

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C. I wanna thank you once again for

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your time today, and for joining me on

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the Decker Health care podcast. Thank you. Thank

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you so much.