Category: Provider

Improving Quality of Care and Coding: The Road Less Traveled to Value-Based Care

Q&A with Vatica Health Co-Founder, Dr. Averel Snyder

At Vatica, we pride ourselves on being a company founded by physicians for physicians. Dr. Averel Snyder, a cardiothoracic surgeon, cofounded Vatica in 2011 after becoming frustrated with the mounting challenges physicians were facing. He set out to create a unique PCP-centric model that places providers in the driver’s seat of improving both quality of care documentation and practice revenue. We recently spoke with Dr. Snyder to discuss why he started Vatica and how risk adjustment and quality initiatives fit into broader, and timelier, industry issues including value-based care, the role of the PCP, and the COVID-19 pandemic.

There are not a lot of companies that solely focus on enabling physicians to perform risk adjustment coding and quality of care initiatives. What inspired that for Vatica?

It’s a funny story. Steve, my co-founder, and I initially started Vatica nearly a decade ago to enable physicians to more efficiently deliver the newly created Medicare Annual Wellness Visit. We knew that once we helped providers improve care and practice revenue, we could offer more comprehensive solutions. A couple of years later, I was attending a healthcare conference, listening to the CEO of a home assessment company boast about the benefits of his organization versus alternative methods of capturing diagnostic codes for the purpose of risk adjustment. He stated emphatically that their model was the best method for optimizing risk adjustment coding and stratifying patient risk, which enabled their health plan clients to accurately predict the costs on which their capitated payments are based. As he spoke, I felt myself becoming more frustrated by the minute because his claims seemed unfounded.

Immediately, I thought, this isn’t fair or accurate for a few reasons. First, PCPs are inappropriately being cut out of the financial and care loop. Second, it’s not in the patients’ best interest to be seen by a clinician with whom they have no relationship with and who does not have access to their complete medical record. Third, I wondered how non-PCP affiliated nurses were closing clinical and quality care gaps.

I went home and began to research the Medicare Advantage industry and quickly found that my concerns were justified—CMS also began to scrutinize the value of home assessments that failed to improve care and outcomes due to the lack of integration with the PCP.  

I had the proverbial light bulb moment. It struck me that we should empower physicians to use a simple interface to perform risk adjustment coding and capture quality of care data in a way that also improves their practice’s financial performance. I knew this could address an important pain point that most physicians feel—being overworked and underpaid. Plus, I knew that the treating physicians could do this work with greater efficiency and quality, leading to improved patient outcomes.

Fortunately, this insight, unlike many of my other entrepreneurial ideas, proved accurate, and nearly a decade later we have empowered thousands of PCPs to “take back” risk adjustment assessments. In doing so, we’ve helped improve outcomes and generated tens of millions of dollars for our provider network.

What makes Vatica’s solution different?

As a busy practicing physician for over two decades, I think I have a good sense of what frustrates providers—too many administrative burdens, not enough time, and declining income. We designed our solution with these frustrations in mind. We provide dedicated clinical support services to reduce administrative burdens, we negotiate health plan incentives to enhance PCP revenue, and improve quality by increasing the use of preventive services and helping to close care gaps. It’s a win-win-win—providers, health plans, and patients all benefit.

Why is it important to put PCPs at the center of risk adjustment?

I feel strongly that the PCP should be at the center of care. The treating PCP and their staff—not some randomly assigned clinician—is best suited to have the most efficient and effective face-to-face encounter with the patient. Given their relationship with the patient and access to all clinical information in their EMR, they are the most appropriate clinician to accurately document and code clinical conditions and close care gaps leading to better outcomes.

Talk to us about how Vatica helps PCPs succeed in value-based care.

Value-based care is about efficiently providing the highest quality of care to improve outcomes. There are a number of studies that demonstrate physicians in value-based care programs provide higher quality of care. Unfortunately, many PCPs lack the technology, expertise, staff, time, and other resources to thrive in value-based care. Vatica addresses this issue head-on. Unlike a lot of other solutions, Vatica is not here to make more work—we actually do 90% of the work for PCPs.

Vatica’s solution not only facilitates risk adjustment documentation and coding—but also enables PCPs to close gaps in care and increase the utilization of preventive services which are critical to improving outcomes. Powered by our technology platform, PCPs accurately capture all the active medical conditions with the associated documentation for clinical validation in the medical record. Vatica’s clinical consultants leverage all available data to create an accurate and complete view of the patient—the key to improving outcomes and performance in value-based care.

Why are risk adjustment and quality of care initiatives important to primary care providers?

Value-based care is designed to incentivize providers to improve outcomes in a cost-efficient manner.  Finances and quality of care are inextricably linked. Success in value-based care depends on accurately assessing the needs of your population so that your payments will be sufficient to deliver appropriate care. And for PCPs, this should be an urgent initiative since each year alternative payment models shift more risk to providers. I’ve heard providers say, “When value-based care comes, then I will pay attention to risk adjustment.” But, then it’s too late. The CMS data collection lags approximately three years, so your allocated resources for patient care in 2021 may be dependent on your coding and documentation in 2018. The time to focus on it is now.

What are the compliance risks for PCPs and health plans with other risk adjustment and quality of care solutions?  

In a standard risk adjustment data validation audit for a health plan, a meaningful percentage of the submitted diagnosis codes will be unsubstantiated in the medical record. Most of the approaches to risk adjustment are not meeting the new standard, which requires clinical validation. As a physician, it was important for me to design a solution that improved efficiency and mitigated compliance risk for providers. To accomplish this goal, we aggregate all available clinical data from the EMR and present all active medical conditions and their associated documentation for clinical validation to the treating provider. The provider is then responsible for selecting an appropriate ICD-10 code and completing “TAMPER” documentation. Then, as a fail-safe, after the provider e-signs the visit, we ensure that 100% of the codes are reviewed for completeness and accuracy by our team of AAPC CRC™ certified nurses, prior to submitting the codes to the health plan. We also deliver comprehensive provider ICD-10 coding and documentation training, which I personally provide and oversee.

What keeps you up at night in the current situation, with all the changes and disruptions in care during the pandemic?

PCP practices, particularly those who serve seniors, have endured some serious challenges. Reimbursement models are changing, and the new models demand vigilant documentation, accurate coding, additional practice resources, and subject matter expertise lacking by most physicians. At the same time, health plans are struggling to maximize risk adjusted revenue to ensure that seniors, who are the most vulnerable and costly patients, are receiving quality care and improved outcomes. Fortunately, CMS approved telehealth for a variety of encounters, including risk adjustment, and in-office patient volume has also started to bounce back from the post-pandemic decline. I think CMS will have to continue to adapt and make changes to the Medicare Advantage HCC model to account for the missed outpatient care during the pandemic. I am concerned about the increasing demands and worries of the PCPs, but I am optimistic about our ability to be a true partner, and subject matter expert, to help them succeed in this everchanging environment.

To learn more about how Vatica helps providers, watch our quick overview video.

Telehealth-Enabled Risk Adjustment: A Solution to Closing Revenue and Care Gaps

Providers have exerted a herculean effort over the last few months to minimize the human cost of the COVID-19 pandemic. Yet, the unfortunate irony of these efforts, to keep patients and communities safe, is the negative impact on the group considered to be the linchpin of the healthcare ecosystem: primary care physicians (PCPs).

A recent Harvard study estimates visit cancellations due to the COVID-19 pandemic will cost practices, in 2020, an average of $67,000 in annual revenue per physician. Across the entire primary care system, the loss adds up to nearly $15 billion. Notably, the study estimates that the impact could more than double if COVID-19 telemedicine policies are not sustained.

PCPs and the primary care ecosystem can’t afford such a massive blow, which would threaten the viability of thousands of providers. When we emerge from the acute phase of the pandemic, it will be more essential than ever to have a robust primary care system to meet the pent up healthcare needs—especially among the aging population with multiple chronic conditions.

The study’s lead author, Dr. Bruce Landon, told the Boston Globe, “If we fail to pay attention to [PCPs], many of them are at risk for going away.” Paying attention, in this case, means continued legislative support for telehealth and care delivery flexibility. It also means giving providers the tools and solutions to maintain their quality of care and create new sources of revenue. It is particularly important for PCPs to keep their senior patients—the population at greatest risk for falling through the telemedicine cracks—engaged in ongoing routine and preventive care.

Starting in March, CMS took unprecedented action to expand telehealth services and benefits. Among the key changes has been CMS approval of audio and video telehealth as a means to gather diagnostic data for purposes of risk adjustment—a move that has been critical for Medicare Advantage (MA) plans to keep up with risk adjustment and quality of care initiatives.

For PCPs struggling to close revenue and care gaps, performing health-plan sponsored risk adjustment via telehealth represents a great opportunity. “The temporary expansion of telehealth is a tremendous opportunity—if it’s utilized,” said our CEO Hassan Rifaat, MD in an article authored for Fierce Healthcare. “Because telehealth is new for most providers and for much of the Medicare population…it is important to implement easy-to-use technology and efficient workflows,” he explained. “In these extraordinarily challenging times, it’s important to be creative and proactive to keep patients healthy and the system financially afloat.”

Participating in value-based arrangements, addressing gaps in care, and achieving strong clinical outcomes during this time is especially arduous for PCPs who are burdened with the operational, technical, resource, and practical challenges resulting from COVID-19. Vatica Health has developed a PCP-centric, workflow-agnostic solution that provides free clinical and administrative support, remote EMR access and connectivity, audio and video interface, member engagement, and other services to help providers thrive clinically and financially during these challenging times. Contact Vatica Health at info@vaticahealth.com to learn how we can support your practice.

Learn more about Vatica Health’s PCP-centric solution for risk adjustment to improve practice performance and patient experience.

Hope for a New Normal in PCP Practices Post-COVID-19

More than three months after the COVID-19 outbreak was declared a global pandemic states are now beginning to ease stay-at-home orders and lift restrictions. Plans to reopen introduce behavioral changes that ultimately create a “new normal,” or a new way of going about daily life, work, travel, and even healthcare routines.

Like other services deemed “essential,” primary care practices remained open for business during the COVID-19 pandemic, but business looked drastically different for healthcare providers. Many practices adopted telehealth, with exceptions for critical in-person care. We recently discussed the challenges PCPs faced due to COVID-19, which included a massive decline in patient volume, revenue, and a reduction in staff. We were hopeful this perfect storm would pass, and it is beginning to: primary care practices have largely resumed their standard hours of operation and are able to see patients for routine and preventive care. Even CMS Administrator, Seema Verma, is championing a return to routine care and recently penned an op-ed urging people to “get back to non-COVID healthcare.” Yet, to maintain volume and extend preventive care, it’s essential for PCPs to continue offering telehealth and other flexible workflows.


Patients, especially seniors, want to go back

Though it won’t happen overnight, the primary care setting is poised to rebound due to pent up demand. Patients need preventive and routine healthcare, and many prefer to be seen in person. This is especially true among older populations. A June 2020 William Blair Equity Research survey found that 80% of the patient visits cancelled or postponed due to COVID-19 are still needed and likely to be rescheduled. Surprisingly, the number of cancellations driven by fear of in-office COVID-19 exposure was lower in older populations than in younger ones. For the majority (63%) of seniors aged 65+, cancellations were driven by the logistical challenges of office closures and stay-at-home orders, among other reasons. Seniors generally have greater care needs and may be willing to return for care sooner, with the proper protocols to protect patient safety.


Continued telehealth usage

While this data provides some hope about the improvement in patient volume, the reality is, some patients will remain cautious about visiting their PCPs. Fortunately, many providers focused on developing and strengthening their telehealth infrastructure during the pandemic which will continue to serve them well in a post-pandemic world. Analysts expect heightened telehealth use to continue as new pockets of the coronavirus bubble up across the U.S.

With telehealth, providers can recoup lost revenue and bridge the gap between their “new normal” in-office volume and their pre-COVID-19 volume. Additionally, though some patients may be returning to the practice, some employees may not. Telehealth can also help equip practices that may be short-staffed with the tools and technology to provide quality care on a larger scale.

New federal legislation also signals that telehealth is being prioritized and will be permanent. Since April, the COVID-19 Telehealth Program, created by The Federal Communications Commission (FCC), has doled out more than half of its allotted funding to help healthcare providers build or bolster their telehealth infrastructure and services. Additionally, CMS and commercial payers alike have responded favorably by making sweeping changes to telehealth restrictions, requirements, and reimbursement policies, including in the area of risk adjustment.

Adjusting to this “new normal” will require patience, but for PCPs that have weathered the COVID-19 pandemic, there is a light at the end of the tunnel. Whether patients are in the office or on the screen, PCPs can continue to leverage telehealth to generate revenue, help patients stay on track, and keep their practices financially stable in a post-pandemic environment.

To hear more from our team and Vatica Health PCPs using telehealth to improve their practice performance and patient experience, watch the on-demand webinar.

Optimizing Real-Time Audio-Video Telehealth to Boost Your PCP Practice in the Pandemic

We’ve said it before: primary care providers are facing the perfect storm sparked by COVID-19. There are fewer routine and preventive visits, revenue is down, and offices are short-staffed. Fortunately, there is a path forward.

Telehealth has skyrocketed and is becoming the most practical way of providing primary care during these uncertain times. However, despite the surge in telehealth popularity, PCPs are having trouble taking full advantage of the benefits that telehealth offers to boost their practices – especially among seniors.

In a recent on-demand webinar, Dr. Hassan Rifaat (Vatica Health’s CEO) and Daphney Vick (Vatica Health’s EVP, Operations) were joined by two primary care physicians that use Vatica Health’s solution. They shared their insights on how providers can leverage telehealth (especially real-time audio+video) to generate revenue, help patients stay on track with routine and preventive care, and keep their practices productive and financially viable. Below are a few highlights from the webinar.


Telehealth is here to stay

Providers have been quick to adapt to telehealth and, thanks to recent rulings, many PCPs plan to keep telehealth as an option post-pandemic after seeing the value that it can provide for routine care and reimbursable visits. Many health plans are also moving toward the permanent expansion of telehealth services.

But there is an important distinction between providing care using audio only – and more comprehensive telehealth as defined by CMS which requires real-time audio and video. While telephone-only may be satisfactory in certain circumstances, the key to maximizing telehealth is to ensure that it can also be used for risk adjustment, value-based care and other performance optimizing programs. For HCC coding in support of risk adjustment, CMS guidance states that PCPs’ telehealth options must be real-time audio-visual, and not just telephonic.

Real-time audio+video telehealth is not just better for the practice, it’s also better for patients. Imagine watching a movie versus just listening to it—there’s much more information to absorb, and it’s also more engaging. Patients agree: 62% of patients at MGH reported in a survey that the quality of care via video visits was the same as in-person visits.


Patients are already set up for success

While patient adoption of telehealth has been a hurdle for PCPs, some data shows that it’s catching on. Fifty-two percent of senior patients are willing to try telehealth, and many of them already have. Additionally, when asked about switching PCPs based on telehealth offerings, or lack thereof, the vast majority of seniors would rather stay with their own PCP. This is good news because there is a proliferation of telehealth service providers that are aggressively targeting your patients, making telehealth an important initiative to retain your patients.

In our webinar, family physician, Monica Ranaletta, DO, shared that the learning curve for video telehealth has been quick and easy. Once her patients have one video telehealth visit, even with another provider, the process becomes intuitive.

Also, on the webinar, Shanthi Rajendran, MD, and her colleague Sarah Boyer, PA, shared that they have been surprised at how equipped their senior patients have been for telehealth. Keeping up with the times and with their younger family members, many seniors already had the basic video tools in place to do audio-visual telehealth.


Taking the next steps with audio-video telehealth

Though patient adoption of telehealth is growing, it doesn’t just happen overnight and can take some time for providers to get the ball rolling and the process optimized.

On the webinar, the Vatica Health team, joined by Dr. Rajendran, Boyer, and Dr. Ranaletta, shared some key steps that providers can take to improve the use of telehealth for their patients and their practices, including:


  • Member engagement to drive participation and utilization
  • Educating patients about your practice’s telehealth options and use cases
  • Administrative functions to make telehealth an easy option for patients
  • Pre-visit tasks that help ensure patients are ready for appointments and show up for them
  • User experience and platform tips that help make telehealth clear and enjoyable
  • In-visit best practices for keeping patients engaged and improving their overall experience

Boyer shared that though this may seem like a lot to think about, she and Dr. Rajendran have found a rhythm and have successfully integrated telehealth into their operations. The experience is similar for Dr. Ranaletta, who estimates that 80% of her appointments are now via telehealth.

To hear more from our team and Vatica Health’s PCPs using telehealth to improve their practice performance and patient experience, watch the on-demand webinar.

COVID-19 Primary Care Challenges and Opportunities

The coronavirus has created a unique and challenging dichotomy in healthcare—some physicians in acute care settings are overwhelmed with urgent patient needs and other providers in outpatient settings are experiencing a massive decrease in volume.

Understandably, much of the public attention is on the busiest parts of healthcare, and to those frontline caregivers at hospitals, urgent care centers, and nursing homes, we simply say, thank you.

On the other hand, primary care providers are at a standstill. For PCP practices, particularly those who serve seniors, the virus presents some daunting challenges: preventive and routine care is simply not taking place, volume and revenue have plummeted, and offices are short-staffed. These factors are creating a perfect storm that is literally jeopardizing the survival of PCP practices and putting the lives of patients suffering from chronic diseases at greater risk.

Fortunately, there is a path forward. Unlike much of the doom and gloom circulating the web, we won’t just focus on the magnitude of the problems – we’ll provide a creative solution.


Declining Patient Volume

Across the country, in-person clinical visits—the foundation of primary and preventive care—have decreased at an alarming rate. In a mid-April survey, PCPs reported that their volumes had plummeted by 65%, with seniors showing the sharpest drop in visits. Office closures and decreased volume are threatening the financial viability of PCPs, especially smaller and independent practices.


Declining Practice Revenue

With the rapid decrease in patient volume, practices are now facing a severe financial strain as their revenue follows a similar trajectory. While telehealth has helped PCPs replace some in-person visits, these interactions have not led to significant, reimbursable revenue yet. Though 96% of primary care visits authorized for Medicare beneficiaries are now eligible for telehealth reimbursement, inconsistent guidelines and poor member engagement have made it challenging for providers to take full advantage of telehealth. All of this is creating a stark new reality – only one third of PCPs feel confident that their practice has enough cash to continue operating for the next month.


Declining Member Engagement

The disparity between reimbursable telehealth visits and the PCPs’ ability to take advantage of them boils down to engagement. Telehealth appointments, unfortunately, are not being adopted at the same rate that in-person is being abandoned. Additionally, many of the Medicare telehealth waivers require real-time audio and video communication, and providers are finding it difficult to identify easy-to-use platforms for seniors that also integrate into their practices’ workflows.


Practices are Short-Staffed

During this time, PCPs are facing unprecedented business and staffing decisions. Four out of 10 PCPs recently reported having to reduce their staff headcount. Many others are on rotations to keep staff healthy or are accommodating whatever situations employees may be facing in their own families. This has led to a precarious situation. The PCPs, who were already overworked pre-pandemic, are now left to do the back-office work—scheduling, follow-up, billing, technology, and more—on top of visiting with the patients they can get through the virtual doors.


Increasing Risk for Seniors

Given seniors’ increased risk of developing more serious complications from COVID-19 illness, it is especially important to keep them physically isolated. The Catch-22 is that as the months tick by without proactively managing existing chronic conditions, their long-term risks of serious illness rise significantly. Furthermore, social isolation has been linked to decreased cognitive function, depression, cardiovascular disease, and many other health risks.


The Solution: A Risk Adjustment and Quality of Care Solution at the Point of Care

For many years, PCPs were led to believe that HCC coding in support of risk adjustment was best left to home assessment or other vendors not connected to the treating provider. Despite the many shortcomings of this approach—patient abrasion, no access to EMR or medical records, lack of follow-up care—PCPs reluctantly accepted these inferior methods because they lacked the tools, resources, and time to do this work themselves.

All that changed when Vatica Health pioneered a PCP-centric risk adjustment and quality of care solution supported by expert clinical teams with cutting-edge technology at the point of care. Vatica Health empowered PCPs to “take back” risk adjustment assessments, helping thousands of PCPs dramatically improve care and their financial performance. Then COVID-19 happened.

While CMS significantly expanded telehealth benefits in early March, it did not address the face-to-face requirement for risk adjustment. Fortunately, on April 10, the healthcare ecosystem exhaled a collective sigh of relief when CMS officially approved telehealth as a means of gathering risk adjustment data. And while that’s good news for providers and health plans, rolling out telehealth isn’t as simple as flipping a switch.

With all the challenges PCPs are facing, the last thing they need is another burden. PCPs need turnkey solutions to keep their practices running and their patients healthy. Vatica Health is here to help. We are proud to support your practice by offering clinical and administrative support to get patients back through your virtual doors, and to efficiently perform health plan sponsored risk adjustment and quality of care documentation, via telehealth.

We are a PCP-centric partner, and we are here to help you get through these challenging times.