The Valley Health System - made up of Desert Springs, Spring Valley, Summerlin and Valley hospitals - is also building a hospital, Centennial Hills.

Extra hospitals require additional doctors and nurses, who are already in short supply in the Las Vegas Valley.

As group director of the Valley Health System, it is David Bussone's responsibility to help his hospitals overcome those challenges and meet the financial expectations of Universal Health Services, parent company of the Valley Health System.

Bussone recently talked with In Business Las Vegas about solutions to some of those health care concerns and operating challenges.

Question: You were hired last spring as the group director of Desert Springs, Valley, Summerlin and Spring Valley hospitals - known as the Valley Health System. What strengths do you bring to this community and the company?

Answer: As it relates to my strengths to the company, I have a long career. I have held a lot of different experiences throughout that career including running a variety of different of types of hospitals and hospital systems whether they're for profit, not-for-profit or academic medical centers. As far as how the community goes, you have to look beyond my career background to my personal interests, which have related in the past to things like working with United Way and other organizations that have the best interests of the community at their heart. I've begun to get involved with some of those organizations here. I believe that I will bring focus related to health care and hospitals, but also a background that can benefit the community in other ways.

What is your vision for the system?

My vision for the Valley Health System is one in which a coordinated group of hospitals go beyond assisting and meeting the needs of the local community and surrounding areas for health care. We have the opportunity to really set the bar in terms of the quality of health care that's provided in Nevada as well as work with the community on issues that are health care-related but may not focus on acute care hospitals. (For example), the mental health issue in this state in terms of the numbers of patients who are being inappropriately cared for in EDs (emergency departments).

The Valley Health System consists of four hospitals and has a fifth hospital under construction in the northwest part of the valley. How are those hospitals distinguishing themselves from each other?

If you look at the hospitals in the Valley Health System you'll see that depending on their age and location in the community they are attempting to meet the needs of the population for which that individual hospital is the focal point. For example, Valley, which is the oldest hospital in the system, is a tertiary referral center - specialty services and subspecialty services. At Desert Springs you'll see that they are also an older facility and have many specialized services but they also are looking to the local Hispanic community and its needs so that in March you'll see a specific focal point around the medical needs of that population through the opening of a Hispanic medical center. Summerlin Hospital is meeting the needs of the population it serves through an increasing number of cardiac programs. We have an older population in the Summerlin area in addition to the younger population, which is why we've seen a focus on pediatrics. Spring Valley Hospital is the youngest hospital in the system - just open for two years - and they are still growing various programs but are primarily oriented toward a community-based hospital in the sense that they don't have an open-heart program. Centennial Hills Hospital will be much like Spring Valley Hospital when it opens because that's what the growing population in that area requires.

How are they distinguishing themselves from their competition?

Look at the niche programs. For example, the Hispanic medicine program at Desert Springs - that is certainly something that is unique to the hospital community in the Las Vegas area. You'll see shortly that Valley has a couple of hospital programs it's instituting that are related to the needs of specific population groups that aren't being served right now. Another way we try to differentiate ourselves is through our focus on quality and process improvement. I have hired a system-wide director of performance improvement so that all of our hospitals are moving forward in terms of the quality we offer patients and patient safety.

Each of the Valley Health System's hospitals has been expanding and restructuring to better serve their respective communities. What do you want Universal's hospitals to be known for and how important is this market to the overall company?

We are a very significant portion of Universal Health Services as a company and certainly as a market. I don't know off the top of my head what percent of the company's income we represent, but I think it's irrelevant anyway and the reason is because health care is really a local issue. The second part of that relates to Nevada and the Las Vegas market. We are the No. 1 provider of hospital care at this point throughout the state. We are obviously critical to everything that is going on to meet the health care needs of a population that is growing very rapidly. With our focus on quality and process improvement, we can also be a force in helping to guide the health care system meet the needs of the state and its population in a way that's very appropriate.

Are there plans to build additional hospitals in the Las Vegas Valley and if so, what areas are being considered?

No, we're consumed enough with Centennial Hills. It's very difficult because of all the construction going on elsewhere in the county and in the city to get the resources you need to put something like that together. We had difficulty getting some subcontractors to bid on the project. Those who did decline typically used the fact that they're too busy elsewhere to have taken on that project.

When Spring Valley Hospital opened in October 2003, Universal executives said it cannibalized its sister hospitals. How have patient admissions improved since then and what must be done to spread the patients around?

I'm not sure what they meant when they said that. One aspect involved the number of employees that Spring Valley in essence borrowed from other facilities within our system. Obviously when you open a hospital and there are other hospitals in the area then you're initially going to lose some patients at the existing facilities. That happened to some extent at the Valley Health System hospitals. The fact that that hospital was the first in a rapidly growing area meant that the growing population soon took over as the primary source of patients.

State financial reports show that hospitals were less profitable at the end of 2004 than in 2003, which is the most recent data available. Summerlin Hospital was the only Valley Health System hospital to post a profit and even it was down from the year before. What is your company doing to improve hospital profitability so that it can continue to invest in the community?

I haven't seen that data. We continue to focus on meeting the needs of the population that the hospital serves. If we do our job well and we do our job right - taking care of patients - we'll ensure that we are able to save sufficient funds that we can continue our mission. Among the ways you do that is by implementing programs that the patient population needs. At Summerlin the open heart and pediatrics would be very good examples. They've been very well received and assist in providing needed services to the community.

What role do outpatient procedures play in the Valley Health System's hospitals and is that role likely to increase given that many outpatient procedures are profitable?

Las Vegas is an interesting market when you talk about outpatient services because so many of those services - that in other parts of the country are typically provided by hospitals - we see in non-hospital settings whether it's a diagnostic imaging center or an ambulatory surgery center. We would certainly like to see more outpatient work done at hospitals because that helps defray costs associated with that very expensive asset. (Las Vegas is) certainly below the national average when you look at the utilization of outpatient services in other facilities.

What are the Valley Health System's policies for assisting patients who cannot afford their hospital bills?

We abide by Nevada law, which requires that we discount services for those who couldn't otherwise afford them. We certainly abide by federal law, which requires that we provide care to patients who need care on an emergency basis without any ability to pay. We're in the process of working with an organization that is sponsored by Clark County Health Access Consortium in developing a pricing model that is available to folks who would qualify for that program.

Also, what procedures are in place to collect from those who can afford to pay their bills but opt not to?

We use fairly typical processes to ensure that we're collecting funds from those who can. From what I've seen elsewhere in the country, certainly the use of collection agencies is the primary methodology for folks who ought to be able to pay but for whatever reason elect not to initially.

Hospitals are continuously complaining about inadequate Medicare, Medicaid and insurance reimbursements. Is the situation improving and how is the Valley Health System coping with its rates?

Certainly we struggle at times when the federal government and the state change reimbursement policies. We have to adapt to those changes in polices as other facilities do. From what I've seen during the time I've been here, the Valley Health System hospitals have certainly adapted well and we try to be proactive when it comes to reading the tea leaves of reimbursement to see what's in the future. I'd say it's more status quo than improving at least from everything I can see from my vantage point.

What do you see as the solution to decreasing the number of uninsured patients?

To some extent it's ensuring that people have access to insurance, not necessarily in the sense of mandating it like we've recently seen Maryland do with Wal-Mart. There likely could be some programs at the state level that help individuals who have access to insurance through their employer to be able to expand that coverage to include their families. If you have health insurance through your employer and you have three other people in your family you may be able to afford the insurance that your employer offers for you personally but you may not have enough to spend money on insurance for those other family members. There are some things we can do - not just governmentally although that would be helpful - to help those folks be able to afford that type of insurance.

Hospitals won some tough battles in the legislature last year with several bills that would have dramatically altered how they operate. What is the likelihood that similar bills will resurface in the 2007 session? What, if anything, is the Valley Health System doing to address concerns such as community reinvestment, mandated discounts and other issues?

I arrived here virtually at the end of the session so I've had a lot of catching up to do by way of legislative education. I think we're doing a number of things. No. 1, we're examining how those specific bills would have impacted us. We need to make certain we understand what would have happened had those bills gone through. I do think there will be continuing efforts to make some of those things happen. Once we understand them we've begun sitting down with legislators to understand things from their perspective. What do they think the impact of the bill would be and why do they think it's either appropriate or inappropriate to see that bill passed. Then we have the ability to discuss with them our perspective on that particular bill.

How is the Valley Health System coping with the shortage of physicians and what is being done to recruit them to the valley?

We have pretty extensive programs at our four existing hospitals and are creating a program at Centennial Hills because without physicians you can't provide care to patients. We have extensive efforts to recruit physicians in specific specialties as well as generalist physicians. We have a physician recruiter who helps us recruit physicians nationally from places where there are more physicians than are required by the patient population or from medical schools. The recruitment program at Summerlin Hospital for pediatric physicians is a good example. We've been successful in helping other physicians in recruiting to their practices and in recruiting new solo practitioners. We certainly have a concern about the number of physicians. If you look at federal data we are consistently below the number that we need overall and in various specialties. As a result, we have difficulty getting physicians to the patient population that requires them.

Let's talk about the nursing shortage. What is the Valley Health System doing to recruit and retain nurses?

There are a number of things we're doing. We are trying to recruit nurses from other parts of the country. There are places in the United States where nurses are being laid off. Wisconsin for example - states that are losing population. The second thing that we're doing is we're certainly supporting efforts to home grow our own nurses. We offer nursing scholarships virtually on an unlimited basis to nurses in the local nursing programs. We've applied for a grant with UNLV and their School of Nursing to develop an internship program for nurses in order to stabilize that group of new graduates when they first go to work for a hospital. Going from the educational environment to the real world work environment can be very difficult, particularly when you're taking care of sick people. In some hospitals, we're also looking internationally in terms of nursing staff.

The Service Employees International Union Local 1107 now represents the majority of the nurses in the Las Vegas Valley although Summerlin's and Spring Valley's nurses are not among them. Is the relationship with the union improving and how does union representation affect nurse retention at Desert Springs and Valley hospitals?

I haven't been here that long to be able to tell you how the relationship with the union has been in the past. Based on what I've seen, I would have to say it's status quo. I don't know that I can answer the question about retention.

In 2006, most of the SEIU's contracts expire with the Valley Health System and other local hospitals. Is there concern about a nursing strike that could cripple the local hospitals? What is being done to avoid such a scenario?

You would probably need to ask the folks at the SEIU about the nursing strike part of it. I would hope not because it would have a pretty significant negative effect on the ability of any valley hospital that was struck. It would obviously impair our ability to take care of patients to some extent. It would also have a pretty devastating effect on the local economy. I would be concerned if I were a tourist getting ready to go to Las Vegas and were to read in the newspaper that a bunch of the hospitals were impacted by a strike.

Desert Springs partnered with Kindred Healthcare to open a long-term acute-care hospital and it is said to being doing well. What is the likelihood other Valley Health System hospitals will enter partnerships?

I think you'll see that there will probably be partnerships in facilities although they may not be of that variety. For example, Summerlin Hospital is in a partnership with the Nevada Cancer Institute. Heather Murren and I are working together to see if there might be other things that we could do that would not only be a benefit to the community in terms of patient care activities but also be helpful in terms of their role in research and related activities.

What is the Valley Health System doing to reduce medication errors?

We have a company initiative under way to upgrade that capability. One of our hospitals - not here in the valley - is currently a beta site for testing our new and improved medication administration record. The system validates that the right patient is getting the right medication at the right time. It's a series of barcodes and handheld sensors to check medications and patients' identifications to minimize drug errors. It's rolling out to Northern Nevada Medical Center, which is one of our sister facilities, in February and before the end of 2006 it will have been rolled out here.