In Business Q and A

Jon Sewell, chief executive, Centennial Hills Hospital

Interviewed by Michelle Swafford / Staff Writer

Jon Sewell Photo by Steve Marcus

During late August and early September, Jon Sewell was responsible for overseeing the daily operations of Chalmette Medical Center in New Orleans during Hurricane Katrina, which swept water 14 feet high in parts of the hospital.

After surviving days without external communication and closing the hurricane-stricken hospital, Sewell moved to Las Vegas to run Centennial Hills Hospital Medical Center when it opens in 2007. Chalmette and Centennial Hills are owned by Universal Health Services, which also owns Valley, Desert Springs, Summerlin and Spring Valley hospitals in Las Vegas.

Sewell brings with him 25 years of health care experience. Prior to serving as chief executive of Chalmette Medical Center, he was chief executive of North Colorado Medical Center in Greeley, Colo., which is owned by Banner Health.

Sewell met recently with In Business Las Vegas to discuss hospital operations during a natural disaster, plans for Centennial Hills and challenges facing the Las Vegas Valley's health care industry.

Question: You were hired late last year as the chief executive of Centennial Hills Hospital after serving as chief executive of Chalmette Medical Center in New Orleans. What strengths do you bring to the Las Vegas Valley?

Answer: I've spent a lot of time in hospitals. I've been in hospitals in three states and worked in operations for about 25 years. I've been a CEO in Colorado and a CEO in Louisiana so I think I bring experience and ideas from a lot of different markets. Some have been adopted in the valley and some may be new to the area. I've had a lot of experience working with multi-state tertiary referral programs. I'm used to working in very large geographic areas. Looking at the valley and the large expanses that it has around it it will be something that will be beneficial to developing those referral patterns and pulling people into the Las Vegas area.

What was it like to operate a hospital during hurricanes and what, if anything, is done differently to survive hurricanes?

It was very different running a hospital during the hurricane. There's no manuals that really tell you what to do when every aspect of your operation breaks down. We had no communications with external sources. We really had no idea what was happening as a result of Katrina outside of what we could see from the roof of our hospital. It was a couple of days before we started getting news reports and really having an understanding of how long we were going to be there and who, if anyone, was going to help us move patients out. Our hospital was under about 14 feet of water so boats became the principal source of transportation. I think there'll be a lot of changes in how hospitals operate as a result of this, especially in the Gulf area. There will be moves to move back-up generators at least 15 feet off the ground because in some areas they received 15 feet of flooding. In all but one hospital, the emergency generators were flooded. Simple things like satellite phones will be required and that will probably be enacted nationally. This was an experience where all phone traffic died because the cell towers were knocked out (and) phones were down. The most difficult part of the whole experience was lack of communication. It affected everybody whether it was from a clinical standpoint or a personal standpoint. People didn't know whether their families were safely evacuated and families who evacuated weren't able to find out the status of their family members who stayed through the flood. You'll see a lot of changes at the state and federal level for how hospitals are built and how they're equipped.

What is your vision for Centennial Hills Hospital?

My personal vision is that it will be a hospital offering some tertiary services and that it will be the preferred provider for the northwest region. There are currently approximately 200,000 people living within five miles of that hospital. The closest other hospital for that population is nearly five miles away. There are a lot of people up there who don't have close access to care. We've calculated up to 2,000 babies that are being born out of that service area and well over 200 heart surgeries that come out of that area. It has a future to be a very full-service provider and serve a lot of people up to a couple hundred miles to the northwest; all down that 95 corridor.

How is Centennial Hills progressing and what is the timeline for completion?

It's progressing well. It's a little slower than the Valley Health's experience because there's so much construction going on; a lot of different projects competing for the trades. We're pleased with the progress. The foundation, the cement, is starting to show up above ground. The columns are being poured. We're looking at late second quarter of 2007 to open. We're hoping to have a medical office building with physicians in it three to four months prior to that. We've had interest from a wide range of physicians from family practice to neurosurgery. A lot of the physicians are interested in what programs we'll be offering from day one. We're still determining that. When the hospital was initially planned about three years ago it was envisioned to be more of a primary care hospital, not getting much more complicated than a level II NICU (neonatal intensive care unit) (and) not doing heart surgery or trauma. There seems to be a lot of interest on the part of the different constituents of investigating some more complex programs than had originally been planned.

What features will the hospital have that differ from its sister hospitals Valley, Desert Springs, Summerlin and Spring Valley?

We won't have any services that aren't offered at the other hospitals. If you look at the services at say Valley or Desert they have some very complex services there. Summerlin has a very comprehensive pediatric program there. We're trying not to offer redundant services that are already offered by a sister hospital but we may do that just because of the sheer number of people that live in that area who would prefer to stay closer to their home. With this road system, and I've only lived here four months, it's a long way from Centennial Hills to Desert or Valley where some of our more comprehensive services are.

You mentioned earlier that you're still figuring out which services to offer, but what are some of the considerations and what services will definitely be offered at Centennial Hills? What will it grow to be known for long term?

We're building it to eventually be a 400-bed hospital. If you look at the ground floor, some of the ancillary services — pharmacy, radiology or our surgical department — they're built for a 400-bed hospital even though we're opening with 170 beds. We're opening with a 30-bed emergency department. We'll have over 30 ICU (intensive care unit) beds, about a 25-bed obstetrics unit. We're opening with two patient care floors that are shelled. One is below our ICU so that if our ICU business ends up being larger than we thought we can expand it below our other floor. The other shelled floor is above our obstetrics unit and it's there because there's already 2,000 babies coming out of that area. We would expect that OB unit to grow. I hope it would be known for the general quality of care and the attentiveness that we have to that population. There's a good chance that (the hospital)would grow into having a significant cardiac program.

What are the population demographics for the northwest area and how are they expected to grow in the next five years?

There are 200,000 people living within five miles and that's expected to grow by about 23 or 24 percent over the next five years. I think that's conservative. I purchased a house out there so I spent a lot of time driving around looking at that area. I'm amazed at how many developments are concurrently being constructed.

When Spring Valley Hospital opened in October 2003, Universal executives said it cannibalized its sister hospitals. What is the likelihood Centennial Hills will have the same effect when it opens?

It will. If you look at the patients up there, they pretty much go to MountainView (and) Summerlin. We see a lot still going to Valley. You can't help but draw some patients from every hospital in the valley when you offer an alternative. It's something that not only happened when they opened Spring Valley (but also) it happened when they opened Summerlin and Summerlin just started an open-heart program in the past few weeks. That's going to be cannibalizing patients that are currently going to Valley and Desert. It's somewhat of a consideration when we're considering opening new programs, but we try to operate these hospitals so that they're providing the best scope of services and the best care for the patients that live in that community.

How will Centennial Hills Hospital go about recruiting and retaining physicians?

I'm spending the majority of my time — 70 to 80 percent of my time the first six months or so — meeting with local physicians and trying to bring a sense of awareness to the community about what our vision is for Centennial Hills. I've been impressed by how much anticipation there is for the opening of this hospital in the medical community. What I'm hoping to do is align with groups that are already in the valley and have been pulling patients out of that area and assist them in recruiting physicians into their groups. In the end we'll look outside of Nevada because we're going to need to bring more physicians into the state.

What is Centennial Hills doing to recruit nurses and retain them long term?

Valley Health has been working very aggressively to recruit nurses over the years into the valley hospitals. We'll start to put Centennial's name out there towards the end of this year or at the beginning of next year and work with Valley Health to recruit nurses into the community. There are a lot of nurses who are living in that part of the valley. There are a lot of people out there who will be interested in working at Centennial Hills because it's so close to home.

Have you hired any employees?

No, I haven't. I'll be bringing on my first employee that will help me with physician relations and physician recruiting. We'll start to build our management team towards the end of this year and start bringing on the general staff and employees the first or second quarter of next year.

What do you see as the biggest challenges that Centennial Hills Hospital will face?

Opening a hospital is very difficult. In the end it's your best guess as to how many employees you bring on, how much equipment you purchase. In the case of Spring Valley, Summerlin and Southern Hills they've been slower starts than projected. With Centennial Hills I'm almost afraid that we will err on the other side. There are many more people up there and potentially more demand than the original projections. We'll be spending a lot of time making sure that we are the right size and that we grow as the demand grows so we continue to offer good service from the day we open.

How do those challenges compare to ones you've faced at other hospitals in Colorado and Louisiana?

They're very similar in some respects. I've built a lot of projects over 25 years. I've never started a hospital from scratch. In Colorado we had a $130 million project that basically doubled the size of the hospital so I've dealt with the challenges of opening new hospitals. I've never been in a situation where we had such unprecedented growth. That's a nice problem to have compared to most other areas of the country where they're dealing with stagnant or declining populations.

What do you see as a viable solution to the growing number of uninsured patients?

That's a question the entire country is grappling with. As health care prices go up and insurance plans charge more, companies begin to make that health insurance more and more elective for employees. You run into a lot of younger couples that may be thinking they're bulletproof and they need a new car more that year than they need health insurance. They may opt out of it or underinsure and then end up having a baby or some other unexpected event occur. I wish I could give you the answer for that problem. There's obviously a state and federal dialogue between the hospitals and the insurance companies.

As a new hospital how do you determine your pricing to be competitive with the marketplace given that you're starting at a loss?

Having four hospitals already in the area we have a good idea of what kind of revenue we're going to get based on our projections. At the end we have to decide what our volumes are going to be for those various programs. Obviously we know what the costs are going to be for the programs we're going to start. We know who the payers are and we take all of that into consideration to determine what our rate structure is going to be and we hope we get it right.

The Centers for Medicare & Medicaid Services is now posting information on its Web site about whether hospitals meet industry standards for treating heart attacks, heart failure, pneumonia and surgery. How does that affect the way a hospital operates, knowing that the public is observing and comparing hospitals?

It's very good and hospitals can use that as an opportunity to promulgate the quality of care they're delivering. We strive to deliver high quality products and welcome an opportunity to have an objective indicator that's the same for every hospital that the public can go to. In the past, in the health care field, it's been very easy to say we're a leading provider of quality care and not have to worry about showing evidence that you really are. I welcome the opportunity to back up statements with objective indicators that say why we're a leading quality provider.

Are those measures enough to improve health care quality?

They'll continue to offer more and more indicators and that's a good thing. It will improve the quality. Evidence-based medicine has been relatively new in the last five to 10 years. It will guarantee each patient will travel down a consistent pathway; you get drugs at the same time and get the same types of tests by doing it in a more scientific manner than we've done in the past.

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