Celebrating Doctor’s Day 2022

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Volume 3, Issue 20 | March 29, 2022

Highlights of Outreach and Collaborative Efforts of the

Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO)

The Livanta Compass. Supporting patients and families in their healthcare journey.

Celebrating Doctor's Day 2022

Doctor’s Day, March 30, is when the service and dedication of the nation’s doctors is honored. Although they represent only a fraction of the labor force in the American healthcare system, they are vitally important to the function of the healthcare industry through the leadership roles they fill. For Livanta, this Doctor’s Day is special, as we formally introduce our new Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) Medical Director, Dr. Matthew Stofferahn.

This week’s issue of The Livanta Compass introduces our readers to Dr. Stofferahn and explores the role physicians play in leadership and the BFCC-QIO program.

Livanta is grateful for all doctors who provide care for their patients and sincerely wishes each one a happy National Doctor’s Day.

The Importance of Physician Leadership

The healthcare industry is continuously evolving due to new research and evidence, discovery of new diseases, new developments in medical technology, incorporation of best practices for value-based care, and other advancements. Hospitals and other provider organizations are typically led by physicians, but many other sectors of the healthcare industry also employ physicians in leadership roles, including local, state, and federal government agencies, insurance companies, community service organizations, research and development businesses, and government contractors like Livanta.

Physicians in leadership positions offer a unique perspective to the workplace because they typically have a deep understanding of how other clinicians and provider teams work in the delivery of health care. They also understand how critical issues—such as access, equity, or patient safety—need to be prioritized along with an organization’s business needs. According to Harvard’s School of Public Health, it is important for physicians in leadership roles to demonstrate emotional intelligence, self-awareness, conflict management, decision-making skills, and influence.

Read more about physicians in leadership roles here: https://www.hsph.harvard.edu/ecpe/physician-leader-skills-success/

Livanta's Physician Leadership

At Livanta, two physicians lend their expertise and leadership perspectives to Livanta’s corporate and BFCC-QIO operations daily. Their expertise in the medical field, which stems from years of working directly with patients and delivering medical education, inform many of Livanta’s innovative projects, procedural structures, and publications. Livanta’s physician leaders are BFCC-QIO Medical Director Dr. Matthew Stofferahn and Chief Medical Officer Dr. Ellen R. Evans.

Introducing Dr. Matthew Stofferahn

As Livanta’s BFCC-QIO medical director, Matthew Stofferahn, MD, brings his experience as a physician reviewer for the QIO program and specialization in internal and emergency medicine and medical education. Dr. Stofferahn attended Johns Hopkins University School of Medicine and completed his residency in internal and emergency medicine in Newark, Delaware at Christiana Care Health System. In addition to his work for the QIO program, he is currently a teaching faculty member at the Valley Health System in Nevada. Dr. Stofferahn also regularly plays trombone and euphonium and loves to travel. He is deeply involved in the everyday work of Livanta’s physician reviewers and signs each determination letter that is sent out to Medicare patients or their appointed representatives.

Meet Livanta’s Chief Medical Officer: Dr. Ellen R. Evans

Ellen R. Evans, MD, FAAFP, Diplomate ABFM, CAQ Geriatric Medicine ABFM/ABIM, CHCQM (Diplomate ABQAURP), oversees clinical aspects of Livanta’s business development, company outreach, healthcare quality initiatives, and contract innovations. Dr. Evans has more than 30 years of active clinical practice, medical direction, and teaching experience across all areas of geriatric and primary care medicine, including family practice, skilled nursing facilities, rural emergency departments, inpatient and outpatient settings, homeless youth centers, and more. Dr. Evans provides medical guidance for Livanta’s corporate program development and medical oversight for various contracts.

Q & A with Dr. Matthew Stofferahn

Although many people are aware that Livanta retains the services of licensed physicians to review medical records, most are less familiar with exactly what these doctors do for Livanta and the BFCC-QIO Program. Livanta’s communications team met recently with Dr. Stofferahn to ask a few questions about the role of physician reviewers at Livanta.

Communications Team: In its BFCC-QIO work, Livanta employs dozens of nurses, social workers, and other healthcare professionals, but also contracts with more than 200 physician reviewers. Why does the BFCC-QIO Program use physicians to review beneficiary cases?

Dr. Stofferahn: Although many elements of medical care can be standardized, modern medicine is a complex, multidisciplinary profession that must individually tailor its interventions to each specific patient. The optimal way to do so can only be determined through special consideration of each patient's unique medical history and subjective experiences, objective findings discovered through physical exam and diagnostic studies, specialized assessment from other clinicians, and contextual factors. Physicians are the most highly trained members of the healthcare workforce, and as such, they have the necessary expertise to consider the totality of all these aspects of a beneficiary's case when assessing the quality of care that the beneficiary received or whether discontinuation of services is appropriate.

Communications Team: Beneficiary appeals to the BFCC-QIO can be very complex. What do physician reviewers consider when reviewing a beneficiary appeal?

Dr. Stofferahn: The Centers for Medicare & Medicaid Services (CMS) provides specific criteria that must be met for applicable services to be covered. For instance, in appeals cases related to skilled nursing facility services, physician reviewers are looking to see if the documentation provides sufficient evidence that the beneficiary no longer reasonably requires daily, skilled, inpatient therapy or nursing services to maintain their current level of function or prevent deterioration. For hospital reviews, the physician reviewer must ensure that the documentation supports that the beneficiary no longer requires the intensity of monitoring and treatment that can only be provided in a hospital.

Communications Team: What do physician reviewers look for when reviewing records for quality of care complaints? When it comes to quality healthcare, there is so much to consider in each situation.

Dr. Stofferahn: Physician reviewers primarily base their decisions on the information found in the medical record because medical record documentation is typically completed as the episode of care is occurring and because the medical record is written by medical professionals who have the requisite training and experience to make a clinical assessment. Livanta’s physician reviewers search the medical record for details that specifically relate to the care in question to ensure that the beneficiary received appropriate evaluation, monitoring, and treatment for his or her condition. If the medical record documentation contains discrepancies or is inadequate to support that the patient received appropriate care, the physician reviewer can then suggest ways in which the provider can improve the care they provide to future patients or refer the provider for higher-level remediation.

Communications Team: How do Livanta’s physician reviewers determine which standards of care apply to each case?

Dr. Stofferahn: Our physician reviewers and nurse review coordinators collaborate to determine the most appropriate standard(s) of care to apply to each quality of care concern. Livanta’s physician reviewers cite the highest level of evidence possible to fit each clinical scenario. Nevertheless, in most cases, a written standard of care is only a start. The physician reviewer must then use his or her training and expertise to modify and apply that standard of care to fit the beneficiary's specific situation.

Communications Team: What would you like people to know about the role of physician reviewers for the BFCC-QIO Program at Livanta?

Dr. Stofferahn: Beneficiaries or their representatives who file an appeal or quality of care concern with Livanta can be assured that their case is analyzed by a board-certified physician who actively practices in a similar setting as the one in which they received care. This is critically important to ensure that the physician reviewer has a complete understanding of the day-to-day complexities of the healthcare system and can consider the totality of the beneficiary's case when making determinations about the quality or necessity of care that the beneficiary received.

Physician Reviewers at Livanta

Every Medicare patient has the right to file an appeal or request a review of care that he or she feels did not meet the standard of care. Livanta receives these requests directly from beneficiaries or their representatives, and immediately begins to coordinate a review of the medical record by one of its independent physician reviewers. Livanta relies on physician reviewers who have a specialty match to the case and who live or work in the same geographic region as the beneficiary.

The name of the physician reviewer remains confidential throughout the process, and Livanta provides compensation to these doctors for their case review services. To qualify as a physician reviewer, a physician must be board-certified and actively practicing, have hospital privileges, and have no formal actions against his or her medical license.

Interested in learning more about the BFCC-QIO program and Medicare appeals and quality of care reviews at Livanta? Email Communications@Livanta.com.