Having the doors open to dispute insurer underpayments has been a “game changer” for spine surgeon Daniel Choi, MD.
Dr. Choi, of Ronkonkoma, N.Y.-based Spine Medicine & Surgery of Long Island, joined the “Becker’s Spine and Orthopedic Podcast” to discuss the growing importance of ASCs and the No Surprises Act in his work.
Note: This is an edited excerpt. Listen to the full conversation here.
Question: As outpatient care continues to grow, how do you see the role of orthopedics and spine evolving with the broader healthcare ecosystem?
Dr. Daniel Choi: I do think that ASCs have a very critical role. Within the spine and orthopedic world we’re seeing it in orthopedic sports medicine and we’re seeing a huge push in total joints. I would say that spine is probably one of the last orthopedic specialties to push over to the ASCs. This past year was the first year that I started doing spine cases in an ASC. I did my first cervical disc replacement at the ASC. I’m also doing endoscopic spine cases at the ASC.
The ASC is definitely a different environment. I remember in my residency and fellowship I didn’t think I could ever do spine surgery in an ASC. That’s crazy. But as I’ve talked to other spine surgeons who are doing it, I remember my jaw dropping when I heard about that. I’ve learned more about the protocols that they’ve implemented, the anesthesia protocols, the hydration protocols, and blocs that allow them to do these.
It was very exciting to do my first cervical disc replacement in the ASC. You have to be meticulous. I think the technique, not every spine surgeon can do cases at an ASC. I don’t recommend new graduates to do these cases at an ASC because you have to be technically very sound as well as know what may create more of a tendency for post operative complications to happen. A combination of all that knowledge and experience will be driving more spine cases into the ASC for our practice.
Q: As many organizations are exploring new technologies, partnerships or care models that improve efficiency and outcomes, are there any innovations or initiatives that you found particularly promising?
DC: We’re like a unicorn practice in the sense that it’s five young physicians, 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. Our professional fees are never valued at the proper market rate, and it’s always been fee setting by the government or by payers benchmarking our payments to Medicare rates, which have only gone down year after year.
The big shift in our practice that has allowed us to grow is utilization of the No Surprises Act and the independent dispute resolution process, which allows us to take an underpayment by an insurer and actually go and argue in to an arbitration company. I can say “Actually the ACDF that I did is not $1,000. That’s not a fair payment. It should actually be $15,000.”
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 some much bigger percentage of it than is currently being paid. So this independent dispute resolution process has been the game changer for us, and we’ve been implementing it very successfully. I believe that what will happen as there’s more utilization of this arbitration is that in network, rates will also improve, allowing doctors to have more fair contracts with payers.
