Dr. Raul Vazquez had never visited Buffalo when he applied to the University at Buffalo’s medical school 30 years ago. Today he’s one of the area’s most active physician-entrepreneurs.
The Fordham University graduate grew up in the projects in the South Bronx, the son of parents from Puerto Rico. He was drawn to studying medicine after seeing his Uncle Joe Gonzalez, and their neighbors, struggle to get the proper care for their asthma and other ailments amid a language barrier, poverty and limited access to transportation.
Vazquez flew up to Buffalo on the old People Express airline – “You paid on the plane. Thirty-five dollars round-trip.” – and never left. “I was energized. I said, ‘This is where I want to go,’ ” he recalled.
He met his future wife, Toni, here, did his residency at Buffalo General Medical Center at the former Deaconess Hospital and took his first jobs at the former Columbus and Sheehan Memorial hospitals.
Vazquez in 1996 opened his own clinic, Urban Family Practice, which primarily serves Medicaid patients, on Niagara Street.
Vazquez and several partners later formed the Greater Buffalo United Accountable Healthcare Network.
The network is one of upstate New York’s largest minority-owned businesses and recently formed the first accountable care organization that serves Medicaid and commercial insurance patients in the state. ACOs seek to better coordinate the care provided to their patients, with the aim of avoiding unnecessary tests and procedures, improving outcomes and saving money.
The network is building a $5 million facility that it says is the largest commercial development in its West Side neighborhood in the past 25 years. The network has 170 employees at eight locations and will add 100 more when the new building opens.
“What I have today is owed to Buffalo, is owed to the West Side. I was a poor inner city kid who came up to Buffalo, and everything I am I owe to Buffalo and this community. It’s the best of all worlds,” said Vazquez, 53, who lives in Williamsville.
Q: Why family medicine?
A: I was always intrigued by “Marcus Welby” and “Star Trek.” I was a “Trekkie.” I had this idea of going into cardiothoracic surgery. That’s what I wanted. But then, at the time, I saw the way systems work. And surgery tends to be more, you’re a mechanic. And you’re really sometimes disconnected from the individual. And that turned me off. I did a rotation, and found myself in family practice for one year. And that ended up being the way I headed.
Q: You’ve used electronic health records since you opened your clinic. Has the ongoing investment in EHRs paid off?
A: Yes, absolutely. I think the problem that we have in medicine is that, physicians, while they’re genius-level individuals in a lot of areas, they’ve always, especially older providers, been scared of technology. And that’s been a hindrance. I think electronic records have gotten much better. But you have to know how to use them. You can’t depend on staff to develop the models you need. And I think that’s been the disconnect or the barrier. Where physicians just don’t feel that they can lead the charge. And in offices they have to be the champions. They have to be the population management guys. To really know what their population needs and how, from the data, to really learn and develop models around it that are going to help patient care.
Q: Do you feel pressure to move quickly through your patient appointments?
A: The fee-for-service world, the pressure’s there. I think with the Affordable Care Act changing reimbursement models to be more on value, than volume, it’s going to have a big impact. Because if you’re in a fee-for-service world, you only do the things you get paid for. You don’t think about going to the patient’s house, you don’t think about doing telehealth. So unless it’s bringing in revenue to pay for your expenses, you’re kind of caught. Now, in the value-based world, quality measures are important. Not just seeing the patient, but what happened in the encounter.
Q: Physicians and hospitals have built their operations around the old fee-for-service model. Are they buying into the new, value-based model?
A: No, and that’s where you have them often saying, this Affordable Care Act, it’s horrible, it’s killing health care, doctors, everyone’s unhappy with it. Because they haven’t taken the time to really analyze it. People don’t like change, and we can’t continue with this fee-for-service model. But it’s allowing systems to either evolve or disappear. I know that we’re building bigger hospitals and bigger insurance companies. Well, doctors have been isolated from that equation. But we’re hoping with the Affordable Care Act ACOs, to bring these guys together, so that we can help come through that process. Because by 2018, 90 percent of payments to doctors will be made by value-based payments.
Q: Surveys show doctors have grown unhappy in their practices. How do you feel?
A: My two daughters at Canisius College, one’s a third and (one’s a) fourth year, they’re both going to medical school. I want them to go. These are the best times for medicine. Because with all these problems, all these opportunities are coming up. We can reshape it. I would have told you, maybe before the Affordable Care Act, about seven years ago, I was tired, beating my head against the wall. All I had to do was see more and more patients. And I would have probably been out of practice three or four years ago. But the Affordable Care Act came up and it gave us so many different opportunities and possibilities that I love what I do.
Q: Why are you investing $5 million in the new building?
A: We’re at capacity. I can’t grow anymore. The Affordable Care Act is allowing us to evolve and provide other types of services that will improve your outcomes. I always wanted to have a bigger place to really do those other things. For example, nutritional classes. Exercise programs. Personal trainers. I don’t have the space here. In the same location, where I have some community health workers, we’re doing health coaching. That has a major impact on people. If you’re eating better, if you exercise, and you’re losing weight, and you feel good, everything gets better.