Patients out faster, pay more at Southland hospitals; local prevalence of HMOs spells short stays, study finds.

A patient's chances of swift recovery in a Los Angeles-area hospital are better than in the rest of the country -- but so is the likelihood of paying a fatter bill at discharge time, data from a recent study suggested.

The results, which are based on 1993 statistics, came from a recently released survey that chose the top 100 hospitals in the United States. It was compiled by two health care consulting firms, Baltimore-based HCIA Inc. and New York-based Mercer Management Consulting Inc.

HCIA and Mercer's statistics for Los Angeles-area hospitals tended to be supported by separate data compiled by the Hospital Council of Southern California, a regional trade group that has criticized other parts of the study.

Although the survey cited the 100 best hospitals, it analyzed data from more than 4,000 institutions to tabulate its results, officials said.

According to the survey, the median mortality rates in Los Angeles-area hospitals are about 9 percent below the national median -- that's the point where half the hospitals have higher rates, and half are lower.

Fewer complications arise

Medical complications among Los Angeles-area hospital patients are about 3 percent below the national median.

More striking was the average length of hospital stay -- 5.04 days was the median for a Los Angeles hospital, compared to 5.78 days nationwide.

Ed Susank, a Mercer partner based in Los Angeles, attributed the shorter lengths of stay locally to the higher penetration of managed care health plans, particularly health maintenance organizations, which control costs by working to keep patients out of hospitals as much as possible, preferring treatment in doctors offices or outpatient clinics and surgery centers.

"This goes to how medicine is practiced differently in Southern California," he said. "More procedures are done on an outpatient basis, and if you have a higher preponderance of ... managed care, there is a higher tendency to treat (outside of a hospital) whenever possible."

David Langness, spokesman for the Hospital Council, said his organization's studies also tend to confirm that local citizenry is relatively healthy.

Hospital stays decline

"The length of stay at hospitals continues to decrease," Langness said.

Costs for local institutions are higher than nationwide, however, the Mercer survey found. Expenses per patient were $4,001, compared to $3,871 nationwide. Charges were even greater -- $11,690 per patient stay for a Los Angeles hospital, compared to $8,688 nationwide.

Susank did not have a definitive explanation for the cost disparity, but he noted that the influence of managed care may also be coming into play.

"The people who do go to the hospital in Southern California tend to have more acute conditions (compared to the rest of the country)," he said, due to the trend toward de-emphasizing hospitalization. Such implications makes a hospital stay more treatment-intensive, driving up the cost.

Capital outlays differ

Indeed, Susank suggested this was tied into investment in capital assets. Nationwide, hospitals invest a median $95,431 per bed, according to the study. In Los Angeles, it's $101,576.

"Hospitals have to prepare to treat more acute patients by investing in more sophisticated equipment," he said.

Langness was not surprised by the costs. He noted they were not out of line for an area like Los Angeles.

"Hospital costs are directly pegged to the labor market and real estate market because hospitals take up a lot of real estate and are very staff-intensive," he said. "When you consider that real estate and labor tends to cost more here than in other parts of the country, our costs here are actually pretty low."