When a first-of-its-kind report card of the state's hospitals is released this fall, Los Angeles County's four public general hospitals won't be represented -- making the system the largest in California to opt out.
In fact, the system's flagship, County-USC Medical Center, is the largest single hospital not participating in the voluntary effort, according to the California HealthCare Foundation, which is sponsoring the initiative.
"It's not because we don't want to provide data," said John R. Cochran III, chief deputy director of the county's Department of Health Services. "It's because it costs money to do this work and requires systems -- and we're still evaluating what we need to do to accomplish that."
Some of the information apparently is not being compiled now, nor is it easily available. Cochran said it would take valuable staff time to mine data from the charts of intensive care patients, for instance, in a system that barely has enough nurses.
More than 200 hospitals, which together care for 70% of the state's patients, have agreed to take part in the new report card, known as CHART, which stands for the California Hospital Assessment and Reporting Taskforce. All of the major chains have signed up, as have large public hospitals such as San Francisco General and Alameda County Medical Center.
L.A. County officials say the vast majority of the state's public hospitals are not participating. But most of the others are rural or considerably smaller than L.A. County's facilities, the healthcare foundation said.
County officials say they support the initiative's goals and intend to take part in the second report in 2007.
This won't be the first time the county has declined to take part in efforts to compare hospitals. It previously opted out of patient satisfaction surveys released by the healthcare foundation.
And more recently, county health officials denied a Public Records Act request by The Times for data on the quality of care provided at the troubled Martin Luther King Jr./Drew Medical Center.
Although some of the King/Drew quality statistics had been released previously on the county's website, the health department's new leaders said public release of the data could keep employees from reporting problems.
The new report card will include information on how well hospitals treat heart attacks, heart failure, pneumonia and surgical infections. It will also provide data on patient satisfaction, the rate of C-sections during childbirth, and deaths after coronary artery bypass surgery.
Some of the information -- including Los Angeles County's -- is currently reported to other agencies and on other websites, but the report card puts it all in one document, easily accessible to consumers.
Participating hospitals also are required to report data on intensive-care unit death rates, infection rates and patient falls, though this information will not be made public in the first year. The project's supporters say they first want to study how best to adjust the statistics to account for the severity of patients' illnesses.
Maribeth Shannon, head of the report card project for the California HealthCare Foundation, called L.A. County's decision not to participate unfortunate.
"We were hoping that they would choose to come in," said Shannon, director of the foundation's hospital and nursing home program. "At one point, they had indicated that they were likely to join. I don't know why they changed their mind."
Experts have estimated that it would cost each facility $40,000 to gather the data needed to participate, regardless of the hospital's size, Shannon said.
In addition to County-USC and King/Drew, L.A. County's public hospitals include Harbor-UCLA and Olive View-UCLA Medical Centers. Rancho Los Amigos National Rehabilitation Center in Downey would be unlikely to be included in the report card because it is not an acute-care facility, county officials say.
Under pressure from health plans, employers, lawmakers and consumer groups, U.S. hospitals have slowly been releasing additional information on the quality and cost of patient care. Minnesota, for example, releases an annual report detailing serious lapses in care, such as surgeries on the wrong part of a patient's body, for individual hospitals.
"Transparency is the wave of the future," said Debby Rogers, vice president of quality and emergency services for the California Hospital Assn., a strong supporter of the report card.
When the new report card comes out this fall, Rogers said, pressure will only grow for L.A. County and other hospitals that aren't participating as people ask, "What's the scoop? Why aren't you participating?"
An official at San Francisco General said the public hospital decided to take part because it was interested in how it compared with other medical centers and because it was already gathering much of the data for other initiatives.
"Why jump into this two years from now when everybody else has already gotten their feet wet?" asked Hiroshi Tokubo, the hospital's director of quality management. "It's much better to do it now."
Kaiser Permanente has also signed up all of its California hospitals, said Carolyn Days Mustille, the HMO's vice president for quality systems improvement. "We believe that public reporting does improve quality of care for everyone," she said.