There’s an old sports adage that also applies to hospitals – “the most important ability is availability.” If you have a medical emergency, get help as soon as possible. Unless you’re close to, or driving right by an emergency department, the fastest way is to call 911.
However, if you need non-emergency care, you have decisions to make; locally there are two choices, 62-bed Hazel Hawkins in Hollister or 75-bed Saint Louise in Gilroy. Those choices are only available if the hospitals remain open; if they close, then their critical hospital-level emergency rooms will likely close with them.
The debate about which is the better choice has gone on for decades. Neither operates for profit; HHH is a public agency, part of the San Benito Healthcare District while St. Louise is a nonprofit hospital.
Community Markets:
The Hospital Atlas uses a 5-mile radius to designate a facility’s primary “community area” population. The community for St. Louise Regional Hospital (SLH) had a 2013 estimated population of 54,249 while the community population for Hazel Hawkins Memorial Hospital’(HHH) was estimated at 21 percent less, 42,760. Both also serve larger, sparsely populated, so-called “core areas”; HHH is also designated a rural hospital.
Quality of Care:
The public can do head-to-head quality comparisons of up to three hospitals using https://www.medicare.gov/hospitalcompare, but the truth is that it is very difficult to differentiate the impact of small differences, especially for hospitals where the information is not statistically significant due to a limited number of cases.
Under the critical category “30-day unplanned readmissions and deaths” HHH and St. Louise had identical ratings – “No different than the National Rate” – in all 12 sub-categories under chronic obstructive pulmonary disease (COPD), heart attack, heart failure, pneumonia, stroke, hip/knee surgery and 30-day unplanned hospital-wide readmission.
When it came to a more subjective category, overall patient satisfaction, HHH received only a two-star rating while St. Louise garnered three-stars. Looking at the individual items, the difference appears to center on communications, especially patient confidence that they understood their home care instructions when they left the hospital. In that area, HHH rated only 39 percent while St. Louise rated 53 percent; the state average was 49 percent.
The overall patient experience rating was 59 percent for HHH versus 68 percent for St. Louise; this may also involve expectations as well as communications, but they are important.
Emergency Services:
Both HHH and St. Louise have emergency services and are licensed to the same treatment level: basic. St. Louise had eight emergency medical treatment stations while HHH had 18. HHH had zero ambulance diversions – the Emergency Department (ED) was available to accept patients 100 percent of the time while the St. Louise ED had some diversions every month totaling 262 hours for the year.
HHH also had a much higher count and percentage of “minor” visits to the ED. The reason may be the lack of other nearby facilities in Hollister to treat minor problems or the public’s overuse of the emergency department or some special program to divert minor complaints. If you go to the ED with a minor issue, you can usually expect to wait a while the staff treats those with more serious problems first.
Both EDs are busy; HHH had 19,548 visits and SLH had 25,807 visits. Admission percentages from the ED were within 2 percent of each other, 7.2 percent and 8.9 percent, respectively.
Since getting immediate care is, overwhelmingly, the first priority in a true emergency there is little difference between the hospitals in that respect because travel time is a factor.
2013/2014 Top Diagnoses and Charges:
The top 25 diagnoses data from each hospital includes the medical code and description, number of discharges, average length of stay, average charge per stay and average charge per day.
The largest difference was that HHH had extensive rehabilitation services listed in their top 25, but SLH did not.
To do an apples-to-apples comparison, I evaluated the 20 diagnoses and related charges of the top 25 that were common on both hospital lists; this excluded 15 percent of the HHH discharges (three quarters of which were rehabilitation services) and 10 percent of SLH discharges.
Comparison of the 20 identical diagnoses on both the HHH and St. Louise Top 25 Diagnosis lists:
Hospital / No. of Discharges / Avg. Stay (days) / Avg. $ per Stay / Avg. $ per Day
HHH…….. / 1,363 / 2.78 / $27,528 / $9,934
St. Louise / 1,730 / 2.56 / $38,908 / $15,187
The top two diagnoses in both hospitals were related and identical; NORMAL NEWBORN ranked No. 1 with 275 discharges at HHH and 489 at SLH and VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES ranked No. 2 with 203 discharges at HHH and 386 discharges at SLH.
Normal Newborn:
Hospital / No. of Discharges / Avg. Stay (days) / Avg. $ per Stay / Avg. $ per Day
HHH……… / 275 / 2.09 / $5,899 / $2,826
St. Louise / 489 / 1.81 / $7,792 / $4,296
Vaginal Delivery W/O Complicating Diagnoses:
Hospital / No. of Discharges / Avg. Stay (days) / Avg. $ per Stay / Avg. $ per Day
HHH……… / 203 / 2.05 / $20,571 / $10,014
St. Louise / 386 / 1.73 / $22,769 /$13,137
Birthing-related diagnoses were 48 percent of the discharges at HHH and 55 percent of the discharges at SLH. HHH had 39 discharges for Major Joint Replacements or Reattachments of a Lower Extremity while SLH had 46 discharges in that category.
On an average-cost-per-stay basis, HHH was less costly for all 20 common diagnoses on the lists — in half the cases, the cost savings exceeded 30 percent.
Financial Snapshot:
The last financial snapshot available was for 2013-2014 during which both hospitals had negative net total margins. HHH was in the lower 40 percent and SLH was in the lower 20 percent of state margins. HHH lost $5.9 million ($56 per adjusted patient day) from operations and SLH lost $11.9 million ($556 per adjusted patient day) from operations.
Summing Up:
Based on measurable results, the quality of care at HHH and St. Louise are, essentially, equal; however, patient perceptions of their overall experience (satisfaction level) at St. Louise exceeds that at HHH due, primarily, to better staff-patient communications.
When it comes to value, HHH is the clear winner averaging slightly longer stays and more than $11,300 less cost per stay for the 20 top common diagnoses to both hospitals. Normal newborns averaged $1,893 less per stay and vaginal deliveries $2,200 less per stay at HHH. The average charge per stay for joint replacement was a whopping $32,700 less per stay at HHH.
For the long term, HHH appears to be better managed financially; however, many public and nonprofit hospitals are currently experiencing significant net losses from operations.
Finally, there is another adage, “use it or lose it.” Health care is an expensive and limited service – if the population does not support the local public health care district by using Hazel Hawkins the district may be gone; at that time there may be no choices and no hospital-level emergency care in the county.