#90 - Empowering Physicians: Dr. Busse on Transforming Healthcare with ViTelHealth

In this week's episode, get ready to dive into an exclusive interview with Dr. Brittany Busse, co-founder and CMO of ViTelHealth, Inc. Discover how her groundbreaking digital health platform and physician cooperative are revolutionizing independent practice management. 

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Transcript

 00:03
Speaker 1
Welcome to RevMD, the podcast all about medical billing. I'm your host, Doctor Heather Signorelli. Join us as we break down the ins and outs of medical billing, discuss the latest trends, and also share insights to help you and your practice navigate the world of healthcare finances. All right, welcome back to another week of the Rev MD podcast. I am so excited to have with you guys today with Doctor Bussy, who we are going to talk all about many different problems that we see with private practices and some solutions that are out there with a group of physicians who are coming together to help really band together and prepare other physicians for private practice. So with that, I will hand it over to Doctor Bussy to introduce herself and go from there. 

 01:00
Speaker 2
Thanks, Heather. I'm really excited to be here. I know we've been talking a lot since the cooperative launched and you joined us. And I'm really excited to share with your listeners about some of the things we're doing at vital health. It's a brief background on me. I graduated from University of Wisconsin School of Medicine in 2009. I moved here to Sacramento, where I was a surgical resident for a few years after having some medical difficulties and having surgery. Actually, for my vision, I had to separate from the program under some not so great circumstances. But it left me in the position of being non board certified and not even board eligible. So it was kind of difficult for me to navigate finding a job. 

 01:45
Speaker 2
So initially, I took a job at urgent care so that I could keep working with patients and learn some more clinical skills. But the urgent care life just wasn't for me. I didn't like being stuck there. Twelve hour shifts, four days a week. So I started looking in 2016 into telemedicine. It's kind of the birth period of telemedicine. It was still relatively unknown. Most of the companies at that time wanted you to carry all the costs, like your own licensing, your own malpractice, and then promised very few patient visits in return. So I thought maybe I could do better than that. I evaluated a few companies and eventually landed on a medical director position. 

 02:22
Speaker 2
But even in that position, I noticed that the CEO's of these companies, especially the one I was working for, tended not to value their physician, who was working for them, and really didn't understand that without their physician workforce, they didn't have a company even to the level of just not paying on time, not paying regularly, paying very low rates and reimbursements for the time that the physicians were providing. And I just didn't feel comfortable working in that environment anymore. And the physicians I was working with didn't see the same problems that I saw. So they kept working despite me trying to encourage them do otherwise. So I moved on to another position again, working as a medical director, starting up a telehealth company with a more established company. So they just wanted to start a telehealth arm. 

 03:08
Speaker 2
And then Covid happened, and I was working all the time, like, just constantly seeing patients, hundreds of patients a day for, like, five minutes at a time. Not even, I think I was timing the calls on my phone, and they were two and a half minutes long. And that was the most that I could fit in, because I had literally hundreds of these calls to do every day. And more and more would stack up on top of each other. I just felt I was drowning in patient calls, and I couldn't help anyone. I was just supposed to ask them five questions, get the yes or no answers, and the machine would spit out, can they return to work or not? And I was like, really? This is not a good use of physician time and resources. 

 03:47
Speaker 2
But the company liked it because they could charge more for physician time than they could just for a computer algorithm. So I was like, I can't take it anymore. I literally had a panic attack and, like, a nervous breakdown. And I told my partner, I'm like, I can't do this. 

 04:00
Speaker 1
I have to quit. 

 04:02
Speaker 2
I said, I don't know what I'm going to do. I think I'm going to start my own company that empowers physicians to start their own telehealth practices, because there's really nothing that difficult about what these CEO's are creating on the backs of the physician workforce. I said, really? They just need the structure and somebody to help them find patients and acquire low cost malpractice and a way to network with each other and learn from each other. That can't be that difficult for me to create that kind of structure with my background as a medical director. So we just started looking at different ways to be helpful, honestly. So we founded Vital health. My business partner and I, he has a technology background. He's a medical technologist, has worked in healthcare technology as well as technology more broadly for decades. 

 04:50
Speaker 2
Like, he just has a really great background in both technology and business. So he started companies and led companies that were very successful. So I felt like I could use a little bit of help from that standpoint. And we founded Vitel Health with the mission of empowering physicians, because we had the idea that if physicians were happier, that patients would be healthier. So that became our mission and our vision statement was happy physicians, healthy patients. And most of the time, yeah, most of the time I just spent talking to doctors, like, what can I do to help you? I mean, it really just became this, like, bespoke practice of, we think doctors want or need these services, and then actually talking to them and finding out that they needed other things. 

 05:36
Speaker 2
So while technology, of course, is important, there's hundreds of emrs, especially in the post Covid area. Sorry. And they just didn't need technology so much as they needed each other and patients, and to feel like they had a chance, I guess, of fighting for the wellbeing of themselves and their patients in this largely corporate dominated healthcare space that we find ourselves in. And they said, what can you do to make me feel like I'm going to be successful at this? And also, malpractice is really expensive. Did you know malpractice was so expensive? And I was like, I didn't know that. So what made sense for us at that time was that vital health, the technology company, continued to focus on technology. 

 06:26
Speaker 2
So we continue to focus on our proprietary electronic medical record, as well as remote patient monitoring and chronic care management, and delivering a really comprehensive, compliant, highly trusted, and patient focused service on that side, like I said, from a doctor's perspective, I felt like that's what it needed to be. And then moving our physician services into what we call the physician services cooperative. So for years, agriculture and farmers have seen that there was a corporate decimation of the agricultural business. So smaller farms started banding together in order to better afford services and goods, and they call this a services cooperative. And I found this really, like, obscure article that was published back in 2013 that was saying that, why don't doctors do this? 

 07:15
Speaker 2
And it was this law firm that had written this whole article about physician services cooperatives, what the potential legal pitfalls could be and how you get around them. And I was like, okay, this is not my business plan. The framework for the cooperative. And it took me a few months. I told a bunch of people, and eventually I just had to pull the trigger, and I went and formed a professional corporation here in California. So we are officially a medical group. That's really what differentiates us from other physician networking sites, right? Most of them are corporations of a sort, and they bring physicians together to network or provide certain services. 

 07:52
Speaker 2
But as a medical group, we really focus on the idea that physicians could be completely autonomous and independent within the group, but still work together to achieve the goal of having a financially stable, independent practice. So that's really the model that we're looking for, is just independent together. 

 08:13
Speaker 1
I like that. So sustainable. And what was the other word you used? Sustainable and affordable. 

 08:20
Speaker 2
Yeah, those would be two good words. 

 08:22
Speaker 1
I like that. I mean, because we hear we have so many people that reach out to us, right? I actually had two this with this past weekend that we're emailing with, and they're just branching out. They're starting their own independent practice. And it's those two words that keep coming up, like, how can I do this and it be sustainable? And I continue to build my practice and do it in an affordable way. And the things that come up are often what you talked about. Right. What technology vendor should I choose? And then number two is always, how do I manage my vendors? Right, as a billing company, right, we're considered a vendor. And so how do I manage my vendors and get good vendor discounts, but at the same time have a reliable service? 

 09:04
Speaker 1
And so it sounds like you're hearing that same thing, that it's because you can open up a practice, it just can be just you. But then how do you grow and start and be able to stay in business when it's just one physician all the way up to growing into your ten, 1112 physicians? 

 09:23
Speaker 2
Yeah, exactly. And I think so many physicians do start out from the standpoint of maybe doing too much too soon. Right? Like, I gotta go find a space, I gotta go rent this, I gotta go hire people. And like, maybe you do, depending on your type of practice, especially if you're an interventionalist or procedurally oriented kind of specialist, that might be the right place to start for you. But I think building a base and building an understanding of how to work with your patients from a digital health standpoint and then finding a way to work with other physicians around shared space, I've heard that from a lot of physicians. 

 10:02
Speaker 2
Like, oh, I just rented a place in a physical therapy, or I talked to some other doctors near me and we actually came to an agreement and I could just use one of their rooms. I think it's really becoming more of a norm. Whereas in past years, doctors have been extremely competitive, and it's like, hey, can I work just within. No, this is my practice. You're going to steal my patients. And it's like, no, why can't we cooperate? That's the whole vision behind cooperative, is that were all so competitive through medical school and even in college, and there's so few spots and the residencies are competitive. We're going to have to fight each other for best jobs and more patients and more revenue. But we don't like, there's patients out there just begging for doctors to see them. 

 10:51
Speaker 2
And they just want that connection with a doctor again, with a healthcare worker again, because they're so disconnected from their bodies, from the healthcare system, from their doctor, and they are just really hungry for an alternative to these corporate practices. 

 11:09
Speaker 1
Yeah. And I think that people just feel lost. Like, what do I do first? Or if I get into a situation and this isn't working, like, who do I reach out to? Is there a community of folks that I can ask questions to? And having only been part of the co op for a short period of time, I already see, like, those discussions happening on your LinkedIn page and with the upcoming call that you've set up. So, I mean, I do think that this sort of structure is really going to allow folks that atmosphere to ask the question, to pivot when they need to pivot, and to be able to put together the analyses that need to invariably go on when you're building a practice, but allows you to be mentored and supported by others. 

 11:52
Speaker 2
Yeah, and that's what I love so far is that like many of our first adoptees, or like really early people who jumped on the Benwagen were those who are extremely passionate about independent medical practice, and they are educators. There are mentors. And then I also have doctors joining who are at various stages of starting a practice. So some of them had an independent practice for a year or less. Some of them are just launching now within the next couple months, and some of them have been practicing for a while. And so it's really great, like the atmosphere that's developing, like camaraderie, where if I have a new person who wants to join and they're like, I'm just not sure what I should do or where to start. 

 12:33
Speaker 2
And it's like I can immediately connect them to someone else who's already a member and just say, like, here, talk to this person. It sounds like you're having the same questions that they've already started to answer for themselves and they can guide you in what to do next. So having that ability to connect with each other and then to jump right into starting with malpractice when you need it at an affordable cost and having the process be really simple. I know when I was even looking for our practice to get malpractice, it's like I talked to three or four different brokers and, like, some of them would leave me hanging for weeks, like, hey, I said I needed malpractice and they just were, I don't know, overwhelmed by my requests or didn't find the right fit, so they just gave up. 

 13:18
Speaker 2
But I found like this one broker, and he's just always there. Like, he answers my questions right away. He's always helping improve our coverage, making sure that it fits the practices of the physicians who are joining. And it's just developed into this amazing relationship so that it's as simple as have a discussion with me if I think this is a good fit, which pretty much everybody who I've talked to has been a good fit, and you're not doing procedures or surgery or delivering babies, you're probably a good fit for our malpractice. If you're doing any of those things. You're probably still a good fit for the co op, just not for our particular malpractice policy. And then I run a quick check, make sure you are who you say you are and that you aren't under investigation, OIG or anything like that. 

 14:02
Speaker 2
And yeah, then you just can join and participate in our malpractice coverage. It's really straightforward and I like to make a quick and easy and effective for doctors because it traditionally hasn't been. 

 14:15
Speaker 1
And so help me understand. So if you're part of the co op, then you get access to the malpractice, or are they two separate things? 

 14:23
Speaker 2
No, it's for members only. So. 

 14:24
Speaker 1
Got it. Okay. 

 14:25
Speaker 2
Step one is join as a member. Got it done is let me know you want to start the process. And then it's literally a three step process of joining our malpractice. And it can be done as quickly or as lengthy as we'll process as you determinant to be. Cause I just send you the steps and once you've completed them, you are officially joined into the malpractice policy. But we do have members who aren't using the malpractice. We do have several members who have surgical based practices and they are not using the malpractice. And then there are other members who haven't started using it yet. So it's not a requisite to join that you have to want malpractice. I think some of the members are looking for educational opportunities, networking opportunities. So all of those things are coming in. 

 15:11
Speaker 2
Like you said, vendor management is really important. So I have the ability to go and talk to vendors and ask for better rates for our group because it's like, well, we're a group. We're not just a single physician. So we intend to put through more requests than just a single physician group would do on their own. And that same will go when and if we decide to contract with either employers who have the need for a larger physician group. So a lot of DPC doctors connect directly to small employers, but they don't have the ability to connect to large national employers. And I had a lot of experience working with those employers when I was in telehealth because I did workers comp for them. So I can't go to them and be like, I have three doctors. They need a more comprehensive physician base. 

 15:58
Speaker 2
But then we're able to negotiate for per employee, per month rates and those kind of things that we can't necessarily do as one offs on our own. So I think the ability to come together and to create the sharing arrangement will lead to more opportunities for our doctors. And even as we've grown just from five doctors to almost 20 doctors, I have more and more people approaching me and saying, like, hey, I have opportunities. Do you have doctors? It's like, yes. And so I've already had two of these opportunities presented to us, and we're able to evaluate that as a group. It's really why I founded the company this way. I think when people come to me, they're like, oh, man, like you. A company can be a lot of work, but as the cooperative, I don't see myself as, quote unquote, running it. 

 16:42
Speaker 2
Like, I am kind of the filter through which opportunity comes to us. Or like, I can have an idea of, okay, I think we want to set it up this way, but it's really going back to the members who are going to use the service and saying, like, does this work for you? Like, if the company wants to pay you this amount per visit or this amount per patient per month, like, does that work for you? Or should we pass? Because it's at the end of the day, like, we have to value ourselves and our experience and what we can provide for patients. And the only person who should be putting the price tag on our services are the doctors who are providing the services. And like I said, I won't even say us because it might not be me. 

 17:22
Speaker 2
Like, if the service is in a state where I'm not licensed, I'm not the one providing the service. So I'm not going to say how much the consult is worth. I want to ask the doctors who would potentially be doing the work. So that's the way we have to look at it, is that we are all independent. We have a voice, and we are autonomous. And I do not intend for this to be any kind of like a dictatorship where I'm the medical director and I'm saying, you have to do things this way or else you'll get kicked out of the group. That's not the point. I think that was what I hated the most about being a medical director in the past. Like, oh, now you're the authority figure? I'm like, no, please don't make me an authority figure. I hate authority. 

 18:01
Speaker 1
Like, no, I want to cooperate. 

 18:03
Speaker 2
Literally the last thing I want to do is tell other people what to do because I hate being told what to do. 

 18:09
Speaker 1
Yeah, no, I hear you on that one. I mean, I think that's the beauty of it though, right? It's the sharing of resources. It's the sharing of knowledge. Okay, so we talked a little bit about the co op, we've talked a little bit about the other things that vital health offers. Maybe just in a few sentences talk about, like, the CCM and RPM versus the co op, and how both of those are connected. 

 18:36
Speaker 2
Part of what vital health was doing as a technology company was helping existing physician practices. And all of our practices that we've worked with so far are all physician owned and operated. Some are single physician practices and some are multi physician groups. But they were looking for, especially in primary care, additional revenue streams. Again, we talked about how do we make primary care sustainable? We can't do it with e m codes. Everybody knows those don't pay that well. And if you're only seeing your patient every six months or every twelve months at the most, you're just not making recurring revenue on those patients. So how do you know if you can keep your doors open? 

 19:20
Speaker 2
And we wanted to look at these codes, especially in Medicare, and there's a few private insurers that cover them as well, that provide these services to patients who are chronically ill. And you can get reimbursement on a recurring monthly schedule for keeping these patients in your care, essentially. And so when my partner first started talking to me about this, he had an experience where he's lost two of his brothers to complications from cardiovascular disease and diabetes. And he just felt like if they were more connected to themselves and to the healthcare system and to their own health, that this wouldn't have happened. And we looked at RPM and CCM, and what I was seeing was this was mostly just like something that people would look at, like, oh, it's, look at that. It's nice, it's, there's a high blood pressure. Look at this. 

 20:08
Speaker 2
But nobody was really doing anything about it. Like, there were no behavioral modifications being made. And on top of that, the compliance is really complicated. The doctors have to hire additional staff. And so in the long run, it wasn't as sustainable as they would have hoped. So our goal was to bring everything in house in our corporation to partner with the doctors to sign their patients up for the program. So run the eligibilities, provide them with the equipment, provide them with the personnel, do the billing on their behalf. Like really a turnkey program that was trustworthy. Again, that's something that so many of these corporations out there running these programs. I've heard horror stories from doctors where these companies are just not compliant, they are not trustworthy, they are not reliable, and they're not helping people. So we employ health coaches. 

 21:04
Speaker 2
So they have a health coaching background, a health coaching certification. A lot of them are also nurses or nutritionists or other clinical personnel. And they review the numbers with the patients and they have meetings with them once or twice a month to talk about what behavioral health goals these patients should have in order to improve their daily life. And it's just amazing to me the relationships that develop between the coaches and the patients and sticky the program is like, we have patients who have left a doctor's office that were working with, gone to a different doctor's office that didn't have the program, and a few months later come back to their other doctor because they missed spending time with their. 

 21:46
Speaker 1
Yeah, they found it valuable. 

 21:48
Speaker 2
Yeah. And so they just. They love it. And the number one feedback that we get from patients is just like, thank you for spending the time. Like, we hear about this epidemic of loneliness in our country and is disproportionately affecting our elderly patients. Like, so many of them just have lost their social connections. Either they're widows or widowers or their friends have passed away. And it's just really hard for them to connect with people. And it's nice for them to know that they can call their health coach anytime, that the coach will be calling them and reaching out to them. And somebody in the healthcare system actually sees them as a human being. So we just absolutely love the program and the results that we're seeing with patients and the way it improves their lives. 

 22:34
Speaker 2
I think that's something that I'm really proud of with vital health and then improving the lives of the doctors. Like I said, the administrative burdens of this program can be enormous. We take care of all of that. We track the documentation. We track the time that's spent. We make sure that the billing goes out every month and we just make sure that the program is seamless for the doctors, that it's not overwhelming for them and they can every month hear the positive comments that their patients are making. So it's really rewarding from that standpoint as well. 

 23:02
Speaker 1
That's great. And is there a revenue sharing component if you can share for the physician? 

 23:08
Speaker 2
Of course, we share revenue 60 40, the practice takes 40 and we take 60. And honestly, that's really just covering our costs. Like because we are purchasing the equipment upfront, we have the staff that we need to pay the billing that gets paid for which we split with the practice. So essentially once you generate the revenue, if it's dollar 100, a certain percentage goes to the billing company. In this case we have 6%. So dollar six comes out and then we split the dollar 94. That's remaining 60 40 with the practice to cover our costs of running the program. 

 23:42
Speaker 1
Great. I mean that's such a benefit and it's an easy way for docs to get that started if they don't have that today. And I know the benefits there from a patient perspective as well as a practice perspective, helping support the care of the patient is critical. So I love that. And if folks were wanting to find you and check out either the co op or the CCM program, how would they do that? Where would they go? 

 24:07
Speaker 2
Yeah, so if you are interested in the cooperative, I mean honestly the best place to reach me is LinkedIn. Just da like hey, I want to set up a time to talk and I will send you a link to talk with me. You can also go to our website which is www dot physician cooperative.com and then you can also do the contact me through there and I'll get an email and I'll send you a link to schedule some time to chat. The other place to find more information about our RPM CCM program would be vitalhealth.com dot then if you use the contact us button on there, that will send a note to our business development team and they would be able to provide you with more information about RPM CCm. 

 24:53
Speaker 2
But obviously if you just have questions like LinkedIn is the best place to find me, I'm always there. I always answer my DM's as quickly as possible and I just love connecting with people well, I love it. 

 25:05
Speaker 1
Well, I've enjoyed getting to know folks in your group and I've had a few people dm me as well, so appreciate you connecting me with others and just excited to see like all the activity that's already going on amongst people and excited to see your co op grow and be a part of it as well. So I'm looking forward to seeing how things transform over the next twelve to 24 months. And again, anything we can do to help physicians who are wanting to stay independent be successful at that, I think is the key. And with that, for our listeners, I will have her links down in the show notes. So just take a look at those. And we look forward to chatting with you guys next week. Thanks so much. 

 25:50
Speaker 2
Thanks, Heather.