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Friday, Sep 29, 2023

Health Column

Los Angeles County has 44 hospitals’ worth of excess beds, according to a new study just completed for the Los Angeles Department of Water and Power.

The DWP? Yes, the DWP, which faces deregulation next year and is trying to better understand its customer base to prepare for competition. A large customer group for the DWP is hospitals.

The DWP commissioned the study from L.A.-based Analysis Group Economics and UC Irvine professor Paul Feldstein, who holds the school’s chair in health care management.

The research team looked at demographic changes, health insurance trends and employer purchasing strategies to project the likely operational health of the county’s 145 public and private hospitals in coming years.

Leading the study’s findings, not surprisingly, is that demand for inpatient services is falling precipitously, while outpatient care is on the rise. That means, while the number of hospitals in L.A. County has dropped by 14 percent in the 1990s, far more downsizing is likely on the way.

“There remains a large surplus of beds in Los Angeles compared to other parts of the state,” the report states. “Other Southern California counties had 80 fewer hospital beds per 100,000 population than did Los Angeles County.”

Assuming a cost-minimizing occupancy rate of 70 percent for the hospitals, the county needs a total of about 25,400 acute care hospital beds to serve its 6.5 million inpatient days per year, the report concludes.

“Comparing 25,400 required beds with the county’s current actual bed count of 36,320 indicates some 10,900 excess hospital beds in the county. This is the equivalent of 44 average-size hospitals,” the report states.

L.A. is seeing faster reductions in the number of acute-care inpatient days, and slower growth in outpatient days than the rest of the state, according to the report. Inpatient days in L.A. County dropped 15 percent from 1990 to 1995, compared to a 10-percent drop statewide, while outpatient visits increased 13 percent, compared to a statewide increase of 29 percent.

That doesn’t necessarily mean Angelenos are getting healthier, said Dr. Alyssa Lutz, one of the study’s co-authors. Rather, the L.A. area has a higher concentration of stand-alone outpatient treatment centers, whose statistics were not included in the sampling. Much of L.A.’s growth in outpatient treatment has occured in those facilities, said Lutz.

Other findings of the study:

– 70 percent of all L.A. hospital beds, including those at county-owned facilities, are now operated by multi-hospital systems such as Kaiser Permanente, Tenet Healthcare Corp. and Catholic Healthcare West.

– Safety-net hospitals are in danger of losing vital Medi-Cal funding as managed care plays a growing role in serving these patients.

– With managed care pressuring hospitals to keep prices low, hospitals in turn will be unable to subsidize their treatment of uninsured patients by raising rates for the insured. That means the burden of treating the uninsured will increasingly fall on county hospitals and the few private facilities still willing to treat them.

– Pressured by managed care to keep costs down, physicians will be hospitalizing fewer patients.

FDA Green Light

The UCLA School of Medicine and Micro Therapeutics Inc. of San Clemente have gotten the go-ahead from the Food and Drug Administration to begin human testing of a liquid polymer to be used to fill in and intentionally clog abnormal blood vessels in the brain.

In a healthy person, blood flows from arteries to veins through zillions of small blood vessels called capillaries. In a person with AVM, or arteriovenous malformations, the flow through the capillaries is cut short by the development of larger vessels connecting directly from arteries to the veins. But because of the greater blood pressure on the artery side, the vessels tend to burst at some point, causing a stroke.

What UCLA and Micro Therapeutics will be testing is a liquid that is delivered to the abnormal blood vessels through an ultra-small catheter, and which upon arrival turns into a solid mass. That mass effectively blocks the further flow of blood through the vessel. Sounds risky, but in fact the reduced flow forces the capillaries to reassume responsibility for the job, which is how it should be.

Clinic opens

Cedars-Sinai Medical Center and CITA Americas Inc. jointly opened a rapid-detoxification center for treating opiate addiction at Cedars-Sinai last month. CITA is one of a handful of companies in the United States that uses a rapid chemical detoxification program to help drug addicts kick their habits.

An addict is put under general anesthesia and his body is flushed with chemicals that remove any remnants of heroin or whatever other opiate drugs are in his system. The chemicals also help turn off the cells in the brain that crave the drug. The process takes about eight hours. After that, the patient gets six months of psychological counseling. The process isn’t cheap, costing upwards of $10,000. But given Cedars’ location and long-tradition of treating rich and famous fast-lane types, it shouldn’t have much trouble finding patients.

Prostate cancer drug

Researchers at John Wayne Cancer Center in Santa Monica say they’ve developed the first pill to treat prostate cancer. The center’s Dr. John Boasberg presented the news at the annual meeting of the American Society of Clinical Oncology in May.

The drug, called marimastat, is still being tested, but Boasberg said early test findings are promising. Marimastat is designed to stop tumors from growing and spreading, as opposed to other medications already available which aim to shrink a tumor’s size.

A study of 88 patients who had failed to respond to other medicines found that taking marimastat pills halted a rise in the patients’ blood levels of prostate specific antigen (PSA), a protein that physicians measure as a warning sign for prostate disease. Patients who responded to the drug lived an average of 200 days longer than those who didn’t respond.

Prostate cancer strikes about 335,000 men in the United States each year, and kills about 42,000.


State Attorney General Dan Lungren endorsed a Senate bill that would require his office to review proposed HMO mergers in the state. The bill was sponsored by Sen. Herschel Rosenthal, D-Los Angeles Two dozen AFL-CIO union locals in Southern California, the Bay Area, Sacramento and Fresno approved a new labor-management agreement with Kaiser Permanente. The unions represent about 50,000 Kaiser employees. The agreement specifies that the unions and management work together to improve patient care, and gives unions more say in decision-making at Kaiser facilities.

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

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