August 7, 2025 • 11 mins
This episode recorded live at the Becker’s 22nd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference features Dr. Daniel Choi, Orthopedic Spine Surgeon and Owner, Spine Medicine and Surgery of Long Island. Dr. Choi shares how his independent practice is thriving amid industry consolidation, the critical role ASCs play in spine care, and how AI and independent dispute resolution are transforming operational and financial efficiency.
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Episode Transcript
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(00:00):
Looking for a solution that helps alleviate administrative
tasks for your staff and also helps your
patients cover their out of pocket health care
expenses?
Find what you're looking for from CareCredit because
CareCredit is a credit card and more. It's
a helping hand for staff and a flexible
payment solution for patients. For over thirty years,
CareCredit, a Synchrony solution, has offered patients a
(00:22):
credit card with promotional financing options to get
the care they want while helping staff do
what they do best, provide care. To learn
more, visit carecredit.com
forward slash beckerspodcast.
This is Gracelyn Keller with the Becker's Healthcare
Podcast, and we are recording live at the
twenty second annual Spine Orthopedic and Pain Management
Conference. I'm currently joined by Doctor. Daniel Choi,
(00:45):
who is an orthopedic spine surgeon and the
owner of Spine Medicine and Surgery of Long
Island. So Doctor. Choi, thanks for joining me
today.
Would love to have you start off by
sharing a little bit more about yourself, your
role, and your organization.
Great. Thanks for having me.
It's a pleasure to be at another Becker's,
Spine Conference.
And,
I,
(01:05):
am the owner and operator of Spine Medicine
Surgery in Long Island. We cover two counties,
in Long Island, New York, Suffolk County and
Nassau County.
The practice was started by me during COVID,
in February
2021.
And I had actually been with another group
for about three and a half, years prior
to that.
And, this, private practice
(01:27):
has actually now grown tremendously,
over the last four years. We are now
actually at three orthopedic spinal surgeons total,
and two,
interventional pain management physiatrists,
as well as one PA and one NP.
Last year, we did over 10,000 patient visits,
between two offices.
And we're really filling a need in Long
(01:49):
Island,
especially where it's a pretty consolidated market with
a lot of hospitals,
hospital systems, as well as private equity groups
growing. We're a 100% independent, and we're really
meeting a demand, not just for patient care,
for specialized spine care, specialized minimally invasive spine
care. But also, we're meeting, I think, a
demand for,
(02:09):
physicians who are looking for different
form and different way of practicing, especially young
physicians who are really just really just being
presented with options for employment with big health
systems.
We're providing a an alternative to that to
be in a true private practice,
model.
And we're meeting that demand, and we're we're
really seeing a lot of interest in private
(02:31):
practice again.
Wonderful. Well, thank you for being here to
share your insights.
And let's start off with what trends or
shifts you're currently seeing right now in the
industry that you think are most important for
leaders to pay attention to.
Absolutely. So,
Scott Becker, I read all of his LinkedIn
reports and as well as,
what what he's writing on x these days.
(02:52):
And I have to agree with him that
one of the biggest
trends and concerns about the current health care
system is our physician shortage.
And it's an it's it's a shortage now,
and it's just going to get
worse as there's multiple factors that are dry
that are exacerbating,
the shortage. There's early physician retirement happening,
(03:14):
typically due to, I think, burnout,
as well as intolerable working conditions.
And you're seeing,
that a lot of the consolidated systems are
utilizing,
mid level care, so physician assistants and nurse
practitioners to try to fill in the gaps.
But that gap is only gonna be filled
that way,
(03:34):
you know, for a limited time before some
something breaks in the system.
So I think that's really important for industry
leaders to pay attention to that there is
this physician shortage.
There's a lot of physicians who are retiring.
We don't have enough,
younger physicians to
fill the gap as well as, I think,
we also see a trend
where there's,
(03:56):
disparities between, male and female physicians too in
in this,
setting too where,
I do see that younger female physicians, who
are now 50% of graduating
US positions,
are looking for,
different types. Not all the time,
but I have noticed that, you know, as,
they,
are shifting more attention to maybe their families,
(04:18):
that they're looking for part time work or,
you know, less than full time. And so,
more flexible hours. And when that happens, that
also is going to inherently
exacerbate the physician shortage.
And you've actually,
provided a great segue to my next question,
which touches on staffing
and workforce challenges as those continue to be
(04:40):
your concern across healthcare.
So how is your organization navigating these pressures
and what strategies have you seen work well?
Absolutely. So, you know, I I think that,
you know, our private practice
having,
workforce,
challenges is, kind of a theme that I
talk about with a lot of practice owners.
We have hard time filling those basic
(05:01):
roles of medical receptionists to
as well as,
front sorry, front desk as well as billers.
And it's it's hard. So, you know, we
have definitely,
have a human resources department
within our practice that spends a lot of
time
posting,
job posts and finding those people locally that
(05:22):
have the experience that we need to fill
those, spots. We're also using creative ways to
offload
some of the more,
mundane and burdensome tasks. So,
generating letters of medical necessity, we've actually started
implementing CHAT g p t.
And,
we actually have a,
BAA with OpenAI,
(05:42):
where we can actually put in patient specific,
materials to,
CHA2PT, but they can't train
on that data. And they, basically have to,
you know, delete that patient specific data after
we generate our letter of medical necessity. That's
actually what a letter that used to take
thirty minutes to forty five minutes for a
a staff member to write,
(06:04):
now we can do it in literally fifteen
seconds on chat gbt. So that's we're utilizing,
AI in very creative ways,
to try to,
decrease the strain,
in the workload on our staff in house.
And as outpatient care continues to grow, how
do you see the role of orthopedics
and spine evolving with the broader healthcare ecosystem?
(06:27):
Yeah. Absolutely. So, you know, I do think
that,
ASCs have a very critical role,
you know, within,
the spine and orthopedic world.
We're seeing it,
in orthopedic sports. We're now seeing a huge
push in orthopedic joints. I would say that
the spine is probably one of the last,
(06:47):
orthopedic specialties to,
push over to the ASCs. I'm actively at
this point, this this past year was the
first year that I actually started doing spine
cases in an ambulatory surgical center.
I did my first cervical disc replacement
at the ASC.
I'm also doing endoscopic spine cases at the
ASC.
(07:08):
The ASC is definitely a different environment. I
remember in residency and fellowship, I was like,
there's no way you could ever do spine
surgery in an in an ASC. That's crazy.
But as I've come to actually the Becker's
meetings in the last three years,
and I've talked to other spine surgeons who
are doing it, doing now they're doing
T lifts. They're doing fusions or they're doing
(07:29):
O lifts at ASCs. And I remember my
jaw dropping when I heard about that. But
as I've learned more about the protocols that
they've implemented,
the anesthesia protocols, the hydration protocols,
local blocks, erector spinae, blocks that, you know,
allow them to do these. It it is
definitely possible. And so, you know, it was
very exciting to do my first cervical disc
replacement in the ambulatory surgical center. Patient went
(07:50):
home the same day. You have to be
meticulous. I think the technique not every spine
surgeon can do
cases at an ASC. I I don't think
I recommend new graduates,
to do these cases at an ASC because
you have to be technically very sound as
well as,
kind of know
what may,
create more of a tendency for post operative
complications to happen.
(08:10):
And those are not the patients that and
and patient selection too, making sure that you
don't have sick patients that are being done
at the ambulatory surgical center. So a combination
of all that knowledge and experience,
I think will be driving more spine cases
into the AC for our practice, definitely.
Absolutely.
And then my final question, as many organizations
are exploring new technologies,
partnerships, or care models
(08:32):
that improve efficiency and outcomes, are there any
innovations or initiatives that you found particularly promising?
You know, I I think the one
game changer
in our practice are we have a very
kind of like a it's a unicorn practice
in the sense that it's five young physicians
now,
probably
around the age of 40 or younger.
(08:53):
And we are completely independent. We're actually able
to stay independent
and grow.
And that
requires access to capital, which physicians historically have
been limited from and cut off from through
their professional fees. So professional fees are never
valued
at, I think, the proper market rate. And
it's always been
(09:14):
fee setting, by the government or by payers
benchmarking our payments to Medicare rates, which have
only gone down year after year. And so
I would say that the big shift in
our practice that has allowed us to grow
is utilization of the No Surprises Act independent
dispute resolution process,
which allows us to take an underpayment by
an insurer
(09:34):
and actually go and argue in in to
an arbitration
company and say, actually, no. The ACDF that
I did is not a thousand dollars. That's
not the fair payment. It should actually be
15,000, which is, you know, when you're talking
about a hospital system getting paid $80,000 for
that facility fee, I think it makes sense
that the doctor who performs that surgery gets
(09:55):
some, much bigger percentage of it than is
currently being paid. And so I would say
this independent dispute resolution process has been the
game changer for us,
and we've been implementing it, very successfully. And
I and I I believe that what will
happen as
there's more utilization of this arbitration is that
in network rates will also
(10:17):
improve allowing,
doctors to have more fair contracts with payers.
Well, doctor Choi, thanks so much for joining
me today. Is there anything else you'd like
to share that we didn't touch on in
our conversation?
You know, I think that,
I've heard that there is a pendulum in
medicine that swings back and forth in the
past between private practice doing well and not
(10:39):
doing well. You know, I've been in practice
nine years, so all I have seen is
prior practice getting crushed and steamrolled.
And I'm very hopeful and,
hopeful and that the pendulum is potentially swinging
back the other way. I think there's a
lot of factors. There's a lot of physicians
that are really sick and tired of having
their autonomy stripped.
(11:00):
And I think that it really I I'm
I'm
hoping that our elected
officials and our elected leaders
start to see that,
the viability of private practice is so critical
to the future of our entire health care
system. And so, you know, this is why
I participated in advocacy events. I participated
the American Medical Association, Medical Society of State
(11:21):
of New York to try to get that
message across to our elected officials through organized
medicine.
And, you know, that's what I'm looking to
as, you know, as a hope for the
future for for
medicine.
Absolutely. Well, thank you so much for joining
me today on the Becker's Healthcare Podcast. Again,
we are recording live at the twenty second
annual Spine Orthopedic and Pain Management Conference.
Looking for a solution that helps alleviate administrative
tasks for your staff and also helps your
patients cover their out of pocket health care
expenses?
Find what you're looking for from CareCredit because
CareCredit is a credit card and more. It's
a helping hand for staff and a flexible
payment solution for patients. For over thirty years,
CareCredit, a Synchrony solution, has offered patients a
(00:22):
credit card with promotional financing options to get
the care they want while helping staff do
what they do best, provide care. To learn
more, visit carecredit.com
forward slash beckerspodcast.
This is Gracelyn Keller with the Becker's Healthcare
Podcast, and we are recording live at the
twenty second annual Spine Orthopedic and Pain Management
Conference. I'm currently joined by Doctor. Daniel Choi,
(00:45):
who is an orthopedic spine surgeon and the
owner of Spine Medicine and Surgery of Long
Island. So Doctor. Choi, thanks for joining me
today.
Would love to have you start off by
sharing a little bit more about yourself, your
role, and your organization.
Great. Thanks for having me.
It's a pleasure to be at another Becker's,
Spine Conference.
And,
I,
(01:05):
am the owner and operator of Spine Medicine
Surgery in Long Island. We cover two counties,
in Long Island, New York, Suffolk County and
Nassau County.
The practice was started by me during COVID,
in February
2021.
And I had actually been with another group
for about three and a half, years prior
to that.
And, this, private practice
(01:27):
has actually now grown tremendously,
over the last four years. We are now
actually at three orthopedic spinal surgeons total,
and two,
interventional pain management physiatrists,
as well as one PA and one NP.
Last year, we did over 10,000 patient visits,
between two offices.
And we're really filling a need in Long
(01:49):
Island,
especially where it's a pretty consolidated market with
a lot of hospitals,
hospital systems, as well as private equity groups
growing. We're a 100% independent, and we're really
meeting a demand, not just for patient care,
for specialized spine care, specialized minimally invasive spine
care. But also, we're meeting, I think, a
demand for,
(02:09):
physicians who are looking for different
form and different way of practicing, especially young
physicians who are really just really just being
presented with options for employment with big health
systems.
We're providing a an alternative to that to
be in a true private practice,
model.
And we're meeting that demand, and we're we're
really seeing a lot of interest in private
(02:31):
practice again.
Wonderful. Well, thank you for being here to
share your insights.
And let's start off with what trends or
shifts you're currently seeing right now in the
industry that you think are most important for
leaders to pay attention to.
Absolutely. So,
Scott Becker, I read all of his LinkedIn
reports and as well as,
what what he's writing on x these days.
(02:52):
And I have to agree with him that
one of the biggest
trends and concerns about the current health care
system is our physician shortage.
And it's an it's it's a shortage now,
and it's just going to get
worse as there's multiple factors that are dry
that are exacerbating,
the shortage. There's early physician retirement happening,
(03:14):
typically due to, I think, burnout,
as well as intolerable working conditions.
And you're seeing,
that a lot of the consolidated systems are
utilizing,
mid level care, so physician assistants and nurse
practitioners to try to fill in the gaps.
But that gap is only gonna be filled
that way,
(03:34):
you know, for a limited time before some
something breaks in the system.
So I think that's really important for industry
leaders to pay attention to that there is
this physician shortage.
There's a lot of physicians who are retiring.
We don't have enough,
younger physicians to
fill the gap as well as, I think,
we also see a trend
where there's,
(03:56):
disparities between, male and female physicians too in
in this,
setting too where,
I do see that younger female physicians, who
are now 50% of graduating
US positions,
are looking for,
different types. Not all the time,
but I have noticed that, you know, as,
they,
are shifting more attention to maybe their families,
(04:18):
that they're looking for part time work or,
you know, less than full time. And so,
more flexible hours. And when that happens, that
also is going to inherently
exacerbate the physician shortage.
And you've actually,
provided a great segue to my next question,
which touches on staffing
and workforce challenges as those continue to be
(04:40):
your concern across healthcare.
So how is your organization navigating these pressures
and what strategies have you seen work well?
Absolutely. So, you know, I I think that,
you know, our private practice
having,
workforce,
challenges is, kind of a theme that I
talk about with a lot of practice owners.
We have hard time filling those basic
(05:01):
roles of medical receptionists to
as well as,
front sorry, front desk as well as billers.
And it's it's hard. So, you know, we
have definitely,
have a human resources department
within our practice that spends a lot of
time
posting,
job posts and finding those people locally that
(05:22):
have the experience that we need to fill
those, spots. We're also using creative ways to
offload
some of the more,
mundane and burdensome tasks. So,
generating letters of medical necessity, we've actually started
implementing CHAT g p t.
And,
we actually have a,
BAA with OpenAI,
(05:42):
where we can actually put in patient specific,
materials to,
CHA2PT, but they can't train
on that data. And they, basically have to,
you know, delete that patient specific data after
we generate our letter of medical necessity. That's
actually what a letter that used to take
thirty minutes to forty five minutes for a
a staff member to write,
(06:04):
now we can do it in literally fifteen
seconds on chat gbt. So that's we're utilizing,
AI in very creative ways,
to try to,
decrease the strain,
in the workload on our staff in house.
And as outpatient care continues to grow, how
do you see the role of orthopedics
and spine evolving with the broader healthcare ecosystem?
(06:27):
Yeah. Absolutely. So, you know, I do think
that,
ASCs have a very critical role,
you know, within,
the spine and orthopedic world.
We're seeing it,
in orthopedic sports. We're now seeing a huge
push in orthopedic joints. I would say that
the spine is probably one of the last,
(06:47):
orthopedic specialties to,
push over to the ASCs. I'm actively at
this point, this this past year was the
first year that I actually started doing spine
cases in an ambulatory surgical center.
I did my first cervical disc replacement
at the ASC.
I'm also doing endoscopic spine cases at the
ASC.
(07:08):
The ASC is definitely a different environment. I
remember in residency and fellowship, I was like,
there's no way you could ever do spine
surgery in an in an ASC. That's crazy.
But as I've come to actually the Becker's
meetings in the last three years,
and I've talked to other spine surgeons who
are doing it, doing now they're doing
T lifts. They're doing fusions or they're doing
(07:29):
O lifts at ASCs. And I remember my
jaw dropping when I heard about that. But
as I've learned more about the protocols that
they've implemented,
the anesthesia protocols, the hydration protocols,
local blocks, erector spinae, blocks that, you know,
allow them to do these. It it is
definitely possible. And so, you know, it was
very exciting to do my first cervical disc
replacement in the ambulatory surgical center. Patient went
(07:50):
home the same day. You have to be
meticulous. I think the technique not every spine
surgeon can do
cases at an ASC. I I don't think
I recommend new graduates,
to do these cases at an ASC because
you have to be technically very sound as
well as,
kind of know
what may,
create more of a tendency for post operative
complications to happen.
(08:10):
And those are not the patients that and
and patient selection too, making sure that you
don't have sick patients that are being done
at the ambulatory surgical center. So a combination
of all that knowledge and experience,
I think will be driving more spine cases
into the AC for our practice, definitely.
Absolutely.
And then my final question, as many organizations
are exploring new technologies,
partnerships, or care models
(08:32):
that improve efficiency and outcomes, are there any
innovations or initiatives that you found particularly promising?
You know, I I think the one
game changer
in our practice are we have a very
kind of like a it's a unicorn practice
in the sense that it's five young physicians
now,
probably
around the age of 40 or younger.
(08:53):
And we are completely independent. We're actually able
to stay independent
and grow.
And that
requires access to capital, which physicians historically have
been limited from and cut off from through
their professional fees. So professional fees are never
valued
at, I think, the proper market rate. And
it's always been
(09:14):
fee setting, by the government or by payers
benchmarking our payments to Medicare rates, which have
only gone down year after year. And so
I would say that the big shift in
our practice that has allowed us to grow
is utilization of the No Surprises Act independent
dispute resolution process,
which allows us to take an underpayment by
an insurer
(09:34):
and actually go and argue in in to
an arbitration
company and say, actually, no. The ACDF that
I did is not a thousand dollars. That's
not the fair payment. It should actually be
15,000, which is, you know, when you're talking
about a hospital system getting paid $80,000 for
that facility fee, I think it makes sense
that the doctor who performs that surgery gets
(09:55):
some, much bigger percentage of it than is
currently being paid. And so I would say
this independent dispute resolution process has been the
game changer for us,
and we've been implementing it, very successfully. And
I and I I believe that what will
happen as
there's more utilization of this arbitration is that
in network rates will also
(10:17):
improve allowing,
doctors to have more fair contracts with payers.
Well, doctor Choi, thanks so much for joining
me today. Is there anything else you'd like
to share that we didn't touch on in
our conversation?
You know, I think that,
I've heard that there is a pendulum in
medicine that swings back and forth in the
past between private practice doing well and not
(10:39):
doing well. You know, I've been in practice
nine years, so all I have seen is
prior practice getting crushed and steamrolled.
And I'm very hopeful and,
hopeful and that the pendulum is potentially swinging
back the other way. I think there's a
lot of factors. There's a lot of physicians
that are really sick and tired of having
their autonomy stripped.
(11:00):
And I think that it really I I'm
I'm
hoping that our elected
officials and our elected leaders
start to see that,
the viability of private practice is so critical
to the future of our entire health care
system. And so, you know, this is why
I participated in advocacy events. I participated
the American Medical Association, Medical Society of State
(11:21):
of New York to try to get that
message across to our elected officials through organized
medicine.
And, you know, that's what I'm looking to
as, you know, as a hope for the
future for for
medicine.
Absolutely. Well, thank you so much for joining
me today on the Becker's Healthcare Podcast. Again,
we are recording live at the twenty second
annual Spine Orthopedic and Pain Management Conference.
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