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- [00:00]
A
This is Laura Dardo with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Marlon Levy, Chief Executive Officer at VCU Health System, as well as Senior Vice President of VCU Health Sciences. Dr. Levy, it's a pleasure to have you on the podcast today.
- [00:15]
B
Hi, Laura. How you doing?
- [00:16]
A
Well, I'm doing well. And, you know, I'm really excited to have you here because there's a lot happening in healthcare right now. It's a particularly unique time with different legislation coming down, as well as a lot of moving parts and dynamics in the industry and technology as well, bringing. Bringing in some. Some new and interesting opportunities. So I'm excited to speak with you. But before we begin, can you tell me a little bit more about yourself as well as VCU Health?
- [00:42]
B
Yeah, I'd be delighted. So VCU Health is an academic medical center, academic health system in central Virginia, headquartered in Richmond, the state's capital. We are primarily a large urban academic medical center, but also have a significant footprint out in the community and in rural Virginia, with two rural hospitals in Virginia, each about an hour to an hour and a half away from downtown Richmond. We have, as of a couple of years ago, a freestanding children's hospital, which is growing extremely quickly, and then a very large outpatient footprint with 48 different sites, clinic sites throughout Central Virginia, covering roughly 300 square miles of area in our service area, by the numbers, approximately 50,000 inpatient discharges every year, 1.2 million outpatient visits, and really trying to understand how best to meet the needs of our patients.
- [01:46]
A
Absolutely. That makes a lot of sense. And, you know, I know there's so many different academic systems across the country that are in a similar position, have similar questions, but I wanted to ask, what is a big win or success story from the last year that you want to share with us?
- [02:01]
B
Well, I'll tell you, this is really a very unusual situation that we faced in January in many of our downtown Richmond locations when the city water supply was lost for a period of five days. So try to run a major medical center, urban medical center, with an extensive trauma footprint, burn footprint, organ transplant footprint, without running water, not to mention the 800 inpatients that we had at the time and a significant number of patients coming through our emergency rooms and our clinics was really, really challenging. So for five days straight, we simply had no running water, which was compounded by the fact that our physical plant is heated by steam, as it is in many urban areas. And so we had no water to heat the buildings as well. So Very quickly you had to have an all hands on deck situation where multiple teams of various specialties, physical plant operations, it of course, clinical care, had to figure out what to do. And we, you know, trucked in many, many trucks with, for our water supply to keep our physical plant going. We had personnel going up and down the elevators with buckets so that we can flush toilets in the upper floors of our building. So the bucket brigade, we have to sterilize our surgical equipment and our endoscopy and other invasive equipment off site to some of our satellite facilities. And so had courier service running back and forth to sterilize hundreds and hundreds of trays. Our scheduling people had to cancel and reschedule Hundreds of surgeries, 20,000 clinic visits. It was really quite a, quite an enterprise. And amazingly the teams got through it really well. And the upside of this whole adventure, if you will, was how affirming it was that our teams could rally in a completely unprecedented event and still make it all work.
- [04:04]
A
Absolutely. What an amazing story. I can imagine the initial just feeling of panic when something like that happens when you lose your water supply or any type of vital resource and then having to figure it out just to really see the true heart and soul of the team coming together to make sure everything runs smoothly and you're able to continue to care for patients who really need that. So what an amazing time. And then like you mentioned, just a. I can imagine a culture builder for the team as well.
- [04:36]
B
It really was, you know, it's. It felt in so many ways like we were in a movie. And sadly, it was not somebody else's movie, it was our own movie. But I have a, you know, 30 year career as a transplant surgeon. I've worked in many very advanced medical centers across the country. And I have to say this is the first time that I've ever been confronted with, with such a situation and I don't know of anyone else who has either. So it's really pretty incredible in so many ways.
- [05:05]
A
Absolutely. Well, you know, I'm glad that it seems like you were able to come together and work through all of that. Now, what are the top two or three issues that you're focused on?
- [05:15]
B
Well, nowadays, of course, like I think all of our peers across the country, we're really trying to understand what's the landscape of healthcare delivery. What's the landscape of institutions like ours that are not only safety net hospitals, but research intensive enterprises with very strong academic footprint. You know, we have a thousand physicians under roof and many of whom do research and rely on extramural funding, both for their career as well as to keep their teams going. And so I would say the number one issue that we're all thinking about is how is all of this going to work, given the changes in federal legislation? Virginia is a state that expanded Medicaid in 2019. And in Virginia, there's approximately 1 million Medicaid patients, 1 million Medicaid dependents, if you will. And of course, as the largest safety net in the Commonwealth of Virginia, VCU Health is keenly interested in understanding what the impact of legislation and Medicaid changes may or may not have to our patient population and to our ability to deliver care. We have a very large footprint in pediatric services, many of which are Medicaid dependent. We were not thinking that's going to be hugely affected, but certainly the adult side of the house is. And so I would say that's what we do think about all the time. A close second is what, again, I think many academic medical centers across the country are wrestling with, which is how to provide access. We have patients who are asking us to take care of them, and we're sadly not always able to say yes or we say yes, but can you wait a little while before we can get you a hospital bed? So we don't like ed boarding. No one does. But we have to try to solve for that. We have to try to solve for access to our specialists and our clinics that often are booked many weeks or sometimes months ahead of time. So I would say those are the two big drivers of what we think about how to continue to be financially responsible and good stewards of the resources and deliver, you know, high quality care at the lowest cost possible, how to understand what the funding landscape is going to look like and how to continue to fulfill our mission, which is to take care of patients and make sure their health is as robust as possible.
- [07:37]
A
Absolutely. I know that's, you know, such a huge and very real and big challenges, you know, for the healthcare organization in general in the system, trying to think through, you know, how you can expand that access and then, like you said, be good stewards of resources. And when you're thinking about trying to continue to operate in understanding, you know, whether it's the legislation, expansion of Medicaid or some other things that could come into play, how do you fortify the organization or the culture just to meet any challenges that arise and then, you know, find ways to keep the resources coming into the organization, even if, you know, some of the traditional ways that they have been start to dry up.
- [08:23]
B
Well, you know, it probably starts, and if I think about it, it probably ends with effective communication with our teams internally, you know, complete transparency about what are some of the barriers that we face or think we're facing and what we think some of the solutions are. And, you know, vetting those solutions with our team, understanding that they're subject matter experts throughout the enterprise. And it's not always the administrator. In fact, it's often not the administrator. It's the. It's the nurse, the physician, the technician. There's lots of different ways to deliver care, and there's. Our folks have many innovative and thoughtful ways to do it efficiently and safely with the least possible cost. And so I think we have to be humble enough to listen to our team members that when they give us guidance, I think we have to keep an eye again on what's going on on the outside at the federal level or with insurance companies and reimbursement programs, and continue to ask ourselves, are we doing it optimally? And if not, what are ways that we can improve?
- [09:28]
A
Absolutely. That makes a lot of sense. And it is really strong and steady way to move forward. And I appreciate that. Now, I think when you look into the future, too, I was curious about growth. Where do you see some of the big opportunities you're looking at growth in development over the next few years?
- [09:49]
B
Yeah, I think there's. I think there's. In my mind anyway, there's two large categories of growth. One is geographically. So where do the patients expect us to take care of them? We happen to be, at least at VCU and here in Richmond, heavily focused on a large downtown medical center. The reality is not every patient can or wants to come to a downtown, whether it's Richmond or otherwise, because of traffic congestion, costs, no help to get them there, that sort of thing. So I think it's really important to understand for us as a team, where do patients live? Where do they want to receive their care? What services should we offer to patients in the areas where they live? It'd be difficult, for example, to export our solid organ transplant program across all of the hospitals that we serve. But other work that we do, perhaps less complex than an organ transplant or advanced burn care, I think can be delivered in other locations besides the downtown medical center. And so, you know, the proverbial right care at the right place at the right time, and of course, for the right cost, I think is an absolute truism. So one area of growth that we pay attention to is geographic growth. Where should we be and what should we be doing in the places that we are. I would say the other, the second important category on the growth conversation is what should we be doing? And how are healthcare delivery services evolving? As I'm sure you know and your audience knows, so much of healthcare delivery is now being pushed to the outpatient setting. And so we do have outpatient sites, surgery centers, and what can we do that, you know, perhaps 10 years ago could only be done in an inpatient setting, or five years ago can only be done in an inpatient setting? And now, because of advances in surgical techniques or anesthesia or just simply approaches to the care that's delivered now, that could commonly be done in an outpatient setting at lower cost and with more convenience to the patient. So that's, if you will, a question that we're constantly asking ourselves, as are many of our peers across the country.
- [12:09]
A
Absolutely no. And that's a huge, huge area of challenge. Both the complexity looking at care going to the outpatient setting. I know anesthesia, too, just anesthesiologist shortage across the country makes it challenging to bring those services in and has a ripple effect, it seems like, across the broader spectrum of, you know, providing care, being able to do surgeries in other types of interventions in a meaningful way, which I can imagine really makes a big difference, especially in some of the more rural settings as well.
- [12:42]
B
It really does. So, for example, you know, a field that I'm not in, which is, for example, orthopedic surgery, but the idea that you get now, do, you know, certain joint replacement surgeries completely in outpatient, at the beginning of my career, that would have been unthinkable or even ten years ago, I think that would have been unthinkable or very little considered, but now is rapidly becoming commonplace, as one example.
- [13:08]
A
Absolutely. And it's amazing to see how that technology has been moving and can bring patients into a quicker recovery time and in the outpatient space. But I know that also too changes the economics and just how hospitals are thinking about some of these procedures, since I know they're reimbursed less in the outpatient setting than in the inpatient setting.
- [13:32]
B
That's right. But, you know, I think that it's an important consideration. Site of service. Without question. It's important. I think I'm. I'm old school in the, in the sense that I think if you do the. The right thing by the patient for the right reason, then the financial situation sorts itself out. So in the case of, you know, surgery that can be safely done in an outpatient with the same high quality outcomes as it would be on an inpatient, then that's absolutely what should be done, regardless of, you know, the financial reimbursement model.
- [14:05]
A
That makes a lot of sense and it's, you know, a great way to think about it and certainly keeping the patient first. Now, before we wrap up here, I'm curious, what do you think it will take to lead a thriving organization over the next five years or so, knowing the challenges we talked today about, as well as the very real opportunities ahead?
- [14:23]
B
Yeah, that's an interesting question. And I'm sure all of us are asking that, you know, non stop. Fundamentally, I think a healthy dose of humility around understanding what we know and don't know. What are the unknown? Unknowns, if you will, how quickly, quickly the landscape is changing. Not just the financial reimbursement model, but the care delivery models. You know, what's the best way to apply some of the technology? What's going to be the impact of artificial intelligence in diagnostics, therapeutics, decision trees, algorithms, things of that nature? What are, how are we going to solve some of the workforce shortages that we have? I think being alert to all of these, all of these topics is going to be critical. I think speed of reaction is going to be critical. I think being too slow to react is potentially very problematic given how quickly things are changing across all of these areas.
- [15:24]
A
This is a great point. And, you know, having that reaction time, being able to, you know, be quick to make adjustments and then move on from any challenges, it makes a lot of sense. Dr. Levy, thank you so much for joining us on the podcast today. This has been such a fascinating conversation and I look forward to connecting with you again soon.
- [15:42]
B
It's my pleasure, Laura. Thank you.