Several NAPH staff had the recent pleasure of meeting with one of our newest executive committee members, Sheldon M. Retchin, MD, MSPH, chief executive officer of Virginia Commonwealth University (VCU) Health System and vice president for health sciences at VCU. In a candid conversation, Retchin shared with us VCU’s successes and challenges as a safety net provider caring for the highest proportion of under- and uninsured patients in Virginia.

In 2011, VCU Health System, which provides primary care for the city of Richmond, routine specialty care throughout the region and special services statewide, celebrated 10 years in operation. The milestones the system has seen in that time are significant – and provide valuable lessons for the safety net.

For example, VCU launched Virginia Coordinated Care for the Uninsured, a managed care program that teams the VCU Medical Center with local, community-based physicians to provide access to care and coordinate services for the uninsured . This staggeringly successful program has nearly tripled in size since its inception and is continuing to provide evidence that access leads to improved health outcomes, better resource utilization and lower costs. A VCU study, which appears in the February 2012 edition of Health Affairs, showed that among VCC participants continuously enrolled during a 7-year period, emergency department visits declined sharply, primary care visits increased and inpatient costs fell year over year — reaching nearly 50 percent. In the current debate around the value of health insurance coverage, VCC statistics support the notion that costs associated with populations gaining coverage could be reduced by half. However, Dr. Retchin cautions about the need for patience when looking to these types of initiatives for results, noting, “The savings are not there in the first year.”

VCU Health System has also seen success in improving quality and workforce capacity. To do so, VCU modernized its medical campus and built the only hospital in the state dedicated to critical care. Quality care and patient and provider safety were the overarching goals of the hospital’s evidence-based design and architecture, and the entire building is digitally wired to accommodate the intense communications of critical care units, and environmentally constructed so help is just a step away.

In addition to improving the quality of care it delivers, upgrading its facilities helps VCU retain faculty and physicians who are always being wooed away from the inner-city. But, as Retchin notes, physician shortage is a serious challenge he sees on the horizon. As more and more newly trained doctors are choosing to practice in the suburbs versus the inner-city, a generation of physicians is being lost, and Retchin worries that the safety net won’t have the doctors to fill the tremendous need.

But VCU is doing what it can to fill the void, including investing heavily in medical academics to address class size and the physician shortage. And the organization is seeing results. VCU has become one of the fastest growing medical schools in the American Association of Medical Colleges and has seen a boost in research awards from the National Institutes of Health.

The organization has also seen strong fiscal health over the past few years. It is the second largest employer in Central Virginia and a major referral center for the region. In addition to the critical care hospital, which fills a tremendous need for highly specialized care that involves advanced and complex procedures and treatment for seriously ill and injured patients, VCU offers the only level 1 trauma center in Central Virginia, the only certified burn center in the region and the National Cancer Institute–designated Massey Cancer Center. VCU also recently merged with Children’s Hospital of Richmond, which offers the only pediatric beds in the city of Richmond.

The work done in these facilities is truly innovative, as evidenced by such triumphs as the separation of conjoined twins, which required the volunteer efforts of more than 45 physicians and pediatric specialists and gained additional support from VCU departments such as fashion design and merchandising and the department of sculpture.

But even with its recent success and relatively strong position, the future, Retchin warns, looks to be bumpy. In addition to the “doc deserts” he anticipates, the disproportionate share hospital (DSH) cuts and other hospital-related reductions in the Affordable Care Act will deeply burden the safety net. And while VCU is heavily focused on quality, certain improvements, such as those related to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey, present obstacles. “We’re improving,” Retchin says, “but so is everyone else.” And, like many safety net providers, he notes that the HCAHPS parameters don’t necessarily take into consideration the distinct challenges associated with serving low-income and vulnerable populations. Because of their particular patient mix, safety net HCAHPS scores do not necessarily accurately reflect the quality of care received.

Overall, Retchin’s comprehensive and engaging presentation offered us an important, firsthand glimpse into the realities – good and bad – our members face. Thank you, Dr. Retchin, for your time and your insights.