Harris County Hospital District president and CEO David Lopez may be one of the few people in the nation to have read every word in the 2,000-page health care reform bill. "It took me four months to read it, and at the end, I thought, what did I just read? It's so confusing," he said.

But like a lot of hospital executives, Lopez sees a lot of opportunity in health care reform. More insured people will come into the system. Preventive medicine will take on a greater role. There will be fewer hospital stays and more clinic visits. All areas where the sprawling hospital district excels, Lopez said during a wide-ranging interview.

"With reform, a lot of our patients are going to get coverage. For us it's not a matter of attracting more funded patients. It's a matter of keeping the patients that we have who know what we do. They will stay with us if we do the right things," he said.

Lopez is proud of the quality of health care at publicly-funded district hospitals but realizes not everyone feels the same way. With the implementation of health care reform imminent, Lopez realizes the district has to be more aggressive in tooting its own horn.

"Volume (of patients) has never been our problem, so we never marketed ourselves," he said. "But we're going to have to change that. We have to inform the community who we are and what we're all about and the fact that we do outstanding work. It's a great opportunity because we have something to market."

Some excerpts from our interview:

CultureMap: You've been in the health care industry for nearly 30 years. What is the biggest change you've seen?

David Lopez: This industry is transforming itself from a sick care industry to a well-oriented business. Right now the providers don't get anything if people are well. They only get reimbursed when people are sick. That's the way it's been for many, many years. There was an adage in the Farmer's Almanac that said, "an ounce of prevention is worth a pound of cure.' We forgot about it, but it's true.

CM: What is the your greatest accomplishment?

DL: We are the poster child for what health care will look like in the future. We provide about 45,000 admissions every year at Ben Taub and LBJ. But we provide more than a million outpatient visits. So we're not a hospital-based system. We are an outpatient-based organization. If we admit people to the hospital, the average stay is between $2,500 and $8,000 a day. A wellness visit is $25. Because we get tax dollars, we want to make it stretch. We already have the culture in place for whatever is going to happen with reform. We went through this transformation years ago and now we are poised for whatever the future may bring.

CM: When did you go through that transformation?

DL: Honestly, we started building clinics in 1970, because that's how we figured out money would go further.

CM: What is the biggest misconception about the Harris County Hospital District?

DL: When people hear the word 'county,' they think it's substandard. But the same doctors that see patients at Methodist and St. Luke's and Hermann are the same doctors that we use. If you have a heart attack or a stroke or are involved in a major accident, you don't want to go to Methodist, you want to come here. We have a Level 1 trauma center. I have nothing against Methodist by the way, they're a great institution. We don't have fancy pianos in the lobbies or fancy bedsprings for the beds, but the quality of what we do here is absolutely the very best. And the community does not know that.

That's partly our fault for not telling our story. People don't know us. We're a well kept secret.

CM: You wanted to purchase Memorial Hermann Southwest. That didn't pan out. What is your vision now?

DL: In 1992, we had 975 licensed beds. In 2010, we have 975 licensed beds. This community has grown, but we have not kept pace. That (sale) didn't work out, but the issue hasn't gone away. There was a lot of opposition in the communities in that area. We met with them and I think they realize now that it would have been a good idea for them to have supported it. But all things happen for a reason.

CM: Do you have plans to build a new hospital?

DL: It's very expensive to build. It costs around one to one-and-a-half million dollars per bed. If we need 300 more beds, that costs $450 million minimum. With reform, there may be some options for us to lease beds or to buy beds or to maybe even build. We're open to all options. But at some point we are going to have to address that.

CM: When?

DL: Whenever our queues get so long or our acute care admissions (get out of hand). Right now we have a good handle on that. What gets in are the emergencies. But we're having some difficulties is getting in (elective procedures like) hernia operations. You won't die because of a hernia. But it can be painful. So how long are you willing to wait? If the community standard is seven to 10 days, are you willing to wait a month? Two months? What if it's your grandmother in dire pain? We're going to have to address that, because in the the future if they get funded (insured), they can go someplace else.

CM: If you were sick where would you go?

DL: Here, at our places.

CM: Why?

DL: Because I know the quality of our staff is outstanding. I know the outcome data that we show in comparison to everybody else. I would not even think twice. If I got taken someplace else, I would ask to be transferred back to the district, because I know what we do here.

CM: When was the last time you were treated there?

DL: A year ago I was coming back from Seattle and I got a kidney stone. I said, 'I'll suck it up.' I got on the plane for a four-hour plane ride. When I got back I went to Ben Taub and got it taken care of. I didn't want to go anywhere else.

CM: What kind of changes are we going to see with health care reform?

DL: Providers are going to be much more interested in keeping you healthy. Right now if somebody has an appointment and they don't keep it, it doesn't bother us. We just call the next person. But in the future it is going to bother us because if we're going to see them later on in the emergency room or they're going to be so much sicker, it will cost us more. You're going to see a big emphasis on prevention and wellness and a lot more emphasis on personal accountability. Smoking, drinking to excess, drug abuse and obesity are behavior modification-related. At some point there will be incentives for people to stay healthy.

CM: What about the issue of undocumented workers?

DL: That's the elephant in the room. We believe in strong borders and a strong immigration policy, and, yes, we need reform. But once they're here, when they show up at Ben Taub it's no longer an immigration issue; its a health care issue. What's interesting is the undocumented population is a lot healthier than the average citizen of Harris County. They're younger. They're working hard jobs. When they're in our hospitals or clinics, they're not getting paid. So it's not they're coming to this country for health care. They're out there working.

Eighty percent of the volume of our undocumented is women and children. When a young lady is pregnant, nine months later, something is going to happen. It's called nature.

(Lopez estimates that around 14 percent of patients in the district are undocumented. "Most of that is births," he said.)

CM: What do you do to stay healthy?

DL: I run six miles mornings every morning, six days a week. It's something I started doing 35 years ago. For me it's a stress reliever. And you have to practice what you preach. If I'm going to talk to my staff and the community about health, I wouldn't look good if I weighed 400 pounds.

CM:You have never smoked, had a drink of alcohol or a sip of coffee. Do you have any vices?

DL: I've got to have a Dr. Pepper once a day, preferably with nachos. But I work out hard, so I don't mind doing it.