The Healthcare Association of Southern California has endorsed construction of a 675-750-bed replacement facility for Los Angeles County-USC Medical Center.

The endorsement, which the group delivered to the L.A. County Board of Supervisors last week, comes in the wake of release of a study HASC commissioned from the National Health Foundation.

The study looked at the effect different replacement facilities, ranging from 391 to 946 beds, would have on in-patient and emergency services in the county.

The model determined that even the smallest option (391 beds) would mean the area around County-USC would have an oversupply of in-patient hospital beds now and into the future.

Despite the surplus, HASC sees a need to replace County-USC's in-patient beds, as it primarily serves indigent patients people without insurance.

Private hospitals tend to treat as few of those patients as possible. Advocates of a smaller replacement facility say the county should contract with those private hospitals to absorb more of that indigent in-patient load.

While the study identified a surplus of private in-patient beds, it determined that 42 percent of existing emergency room capacity in the area surrounding County-USC is at risk of closing.

What that means is that a big replacement facility, say a 750-bed hospital, would add to the in-patient bed surplus, while a small facility (391 beds), would aggravate an already precarious emergency services situation.

For that reason, "we tied into (the recommendation) the absolute requirement that L.A. County enter into joint planning with private hospitals serving that region and others throughout the county for future sizing," said Jim Lott, HASC vice president for government affairs. "We can no longer plan independently of one another. All of our survival, public and private, depends on it."

The endorsement by HASC, whose constituency is area hospitals, is in line with an earlier endorsement for 750 beds by the L.A. County Medical Association. The LACMA, which represents physicians, is not a natural ally of the HASC.

"I think the supervisors ought to take great comfort that they've got the same recommendation from two expert organizations, albeit for different reasons," Lott said. "We're in the health care business. They (the supervisors) are not."

The study was conducted by the Lewin Group, a San Francisco-based health care consulting firm, to help local officials assess the health facilities needs of Los Angeles in the coming years.

The Lewin Group essentially updated a model first developed in 1995, taking into consideration new data on demographics, utilization of health care facilities and hospital beds, to predict future demand for emergency and in-patient services through 2005.

The Los Angeles County Board of Supervisors is expected to address the issue of a replacement facility for County-USC in the coming months, but awaits a further study looking at operating expenses for various replacement facilities being considered.

Salick keeps growing

Dr. Bernard Salick has hired another top gun to help staff his nascent Bentley Health Care Inc., signing up former Cedars-Sinai Medical Center chief financial officer Joseph Luevanos.

Luevanos will hold the same position at Bentley, the company Salick founded in April after being ousted from the chain of cancer and kidney disease treatment centers he founded in the 1980s. When the British pharmaceutical firm Zeneca Group PLC bought the remaining half of Salick Health Care it didn't already own, the company fired Salick from his post as CEO.

The hiring of Luevanos, who served as Cedars-Sinai CFO since 1982, comes on the heels of several other high-profile staffing announcements. Salick first attracted Ron Wise, former spokesman for Cedars-Sinai. Then in quick succession he announced the hiring of Luc Montagnier co-discoverer of the AIDS virus to head a molecular biology institute he was helping fund in New York, and AIDS researcher/Time magazine man of the year David Ho, to serve as Bentley's top AIDS advisor.

Bentley Health Care aims to open a string of AIDS treatment centers, along with centers to treat kidney disease and other catastrophic illnesses, much the way Salick Health Care targeted cancer.

Salick described Luevanos as "one of the most knowledgeable and effective financial executives in health care." Those qualities will be key as Bentley seeks hundreds of millions of dollars in backing for the venture.

L.A. youth at risk

Data compiled by Childrens Hospital of Los Angeles paints a grim picture of the health of local youth.

The data, contained in the hospital's recently released study "Applied Health Research with Children, Youth and Families," found:

- Violence is the leading cause of death among Angelenos aged 11-18.

- L.A. is home to about 5,000 homeless adolescents.

- 85 percent of those homeless youth have some symptoms of mental illness, and an estimated one-third of have been sexually abused.

The study is aimed at identifying factors that lead to death among the county's children and adolescents and at devising more effective intervention programs.

"Those in the trenches physicians, public agencies and funders have learned that most existing programs don't work well enough," said Michelle Kipke, who oversaw the study.

Eye surgery lower among HMO patients

Medicare patients in managed care plans are far less likely to undergo cataract surgery than patients in fee-for-service plans. Cataract operations are the biggest single expenditure for Medicare, with nearly 1.5 million such operations being performed annually at a cost of $3.4 million.

A team of researchers from UCLA, USC and the Rand Corp. studied 43,000 Medicare patients in a large Southern California HMO, and 19,000 Medicare patients in an affiliated independent practice association. The HMO was not identified.

The researchers compared these patients to 47,000 Medicare patients in fee-for-service plans. What emerged was that in the fee-for-service pool, there were 35 cataract surgeries per 1,000 patients annually, compared with 22 per 1,000 in the IPA and 17 per 1,000 in the HMO.

The researchers said the study was not meant to determine whether managed care patients are underserved or if fee-for-service patients are getting too much surgery.

What the study shows is that there is a significant difference in the likelihood that patients will receive surgery depending on where they are treated, Dr. Caroline Lubick Goldzweig of UCLA said in an interview last week.

Ben Sullivan is a reporter for the Los Angeles Business Journal who covers the health care industry.

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