Executive Summary/mike1st/mark2nd

While the number of licensed beds in L.A. County's 25 largest hospitals remained essentially flat from the past year (16,281 from 16,268), the number of beds actually available fell by almost 1,000 (14,318 last year vs. 13,460 today).

The State Department of Health Services determines the actual number of licensed beds that a hospital is permitted to have, but that number is rarely made available. Only three of the hospitals on this year's list have the full number of licensed beds available for use.

Meanwhile, most L.A.-area hospitals continue to reduce the number of beds available for patient care. Among the reasons are managed care, technological advances and financial difficulties at some local hospitals.

If a hospital cannot afford enough staff to meet the required patient/staff ratio, it will reduce its number of available beds to the point where that required ratio is met.

Meanwhile, demand has been reduced by managed care insurance plans stipulating that patients be hospitalized for shorter periods of time following various procedures.

In addition, managed care plans have been pushing for procedures once performed in hospitals to be done at outpatient clinics. Patients who do require hospitalization are being released sooner, and many patients with chronic ailments are being treated in their homes by home health care agencies.

Pacesetter

L.A. County-USC Medical Center is the largest public hospital not only in the county but the world.

With a workforce of 8,000 and an annual budget exceeding $700 million, the medical center treats hundreds of thousands of patients each year, many of them for free.

The long-anticipated construction of a replacement hospital is still in the design-and-development phase, with the county Board of Supervisors tentatively giving their approval for a 600-bed replacement facility. A smaller satellite facility on a nearby site is also being contemplated. The cost of the replacement facility or facilities has yet to be determined, but a capital budget (for construction and high-tech equipment) of $657.3 million has been set by the Board of Supervisors. Opening of the main replacement facility originally had been scheduled for 2006, but hospital officials now are putting the actual opening date closer to 2008.

As for its management, County-USC has a new executive director, Roberto Rodriguez, who says he is intent on keeping patient care a priority even as the facility struggles with financial troubles and redirects its focus to outpatient care.

In April, County-USC, as a part of a four-hospital cluster known as LAC/USC Healthcare Network, became the first public system to be accredited as a network. Its position as a member of this network allows the county to assign primary-care physicians from other member hospitals to treat county patients. Rodriguez said the network will help streamline its operations by spreading patients among many facilities.

County-USC was founded in 1878, and its current facility was originally completed in 1933. It is the primary teaching facility of the USC School of Medicine.

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