D. Hospital Services

One traditional measure of hospital utilization is the occupancy rate, or the ratio of patient days to available bed days. Table 6.7 shows that this ratio was .35 (35%) for all inpatient services at Lompoc District Hospital (LDH) in 1996. By today's standards, an occupancy rate this low is not unusual, as the shift from an inpatient services emphasis to an outpatient emphasis continues throughout the nation.

A partial explanation for this low occupancy rate is illustrated in Table 6.8 which shows that 42% of the Lompoc residents who were discharged from California hospitals in 1996 were discharged from hospitals located outside the Lompoc zip codes. While the majority, 58%, were discharged from LDH, this level of patient out-migration is relatively high.

Table 6.11 lists the most frequent DRGs for which Lompoc residents were hospitalized outside of Lompoc. The top two of these DRGs were for obstetric services, which were also the leading discharge DRGs at LDH as shown in Table 6.9. Other top out-of-market discharge DRGs were psychoses, back and neck procedures and percutaneous cardiovascular procedures; services for these conditions are not available in Lompoc. As illustrated in Table 6.12, almost 46% of these out-of-market hospitalizations were discharged from Santa Barbara Cottage Hospital.

Of the top twenty DRGs at LDH in 1996, nearly 40% of the discharges and 14% of the hospital's gross revenue were related to obstetric services. Significant non-obstetrical discharge DRGs included heart failure and shock and major joint and limb reattachment. As depicted in Table 6.10, the top five 1996 discharge DRGs closely paralleled hospital discharges throughout California.

Table 6.10: Top Twenty Lompoc 1996 In-Market Discharge DRGs by Rank

DRG Name & Code Lompoc Discharges Percentage of Total California Discharges Percentage of Total 373 Vaginal delivery w/o complications 496 16.1% 356,070 9.8% 391 Normal newborn 416 13.5% 388,224 10.7% 390 Neonate w/ other significant problems 141 4.6% 75,009 2.1% 127 Heart failure & shock 79 2.6% 80,353 2.2% 389 Full terms neonate w/ other significant problems 73 2.4% 43,307 1.2% 371 Cesarean section w/s CC 60 1.9% 81,187 2.2% 359 Uterine & adnexa for non-malignancy w/o CC 58 1.9% 42,068 1.2% 209 Major joint & limb reattachment process of low extremity 48 1.6% 46,394 1.3% 89 Simple pneumonia & pleurisy age >17 w/CC 45 1.5% 59,637 1.6% 88 Chronic obstructive pulmonary disease 36 1.2% 44,371 1.2% 174 G.I. Hemorrhage w/ CC 36 1.2% 36,676 1.0% 337 Transurethral prostratectomy w/o CC 35 1.1% 5,527 0.2% 296 Nutritional & misc metabolic disorders age >17 w/CC 34 1.1% 28,712 0.8% 167 Appendectomy w/o complicated prin dx w/o CC 33 1.1% 18,240 0.5% 14 Specific cerebrovascular disorders except TIA 33 1.1% 59,515 1.6% 223 Major shoulder/elbow proc or other upper extrem proc w/CC 32 1.0% 5,693 0.2% 374 Vaginal delivery w/ sterilization &/or D&C 31 1.0% 21,223 0.6% 148 Major small & large bowel procs w/ CC 31 1.0% 22,734 0.6% 372 Vaginal delivery w/ complicating diagnoses 29 0.9% 38,179 1.1% 336 Transurethral prostratectomy w/ CC 26 0.8% 6,748 0.2% All others 1,312 42.5% 2,172,300 59.8% Total 3,084   3,632,167

Source: OSHPD 1996 Patient Discharge Database

Table 6.11: Top Twenty Lompoc 1996 Out-of-Market Discharge DRGs by Rank

DRG Name & Code Discharges Percentage of Total Gross Revenue Percentage of Total 391 Normal newborn 211 9.6% 200,885 0.5% 373 Vaginal delivery w/o complicating diagnoses 161 7.3% 636,686 1.5% 430 Psychoses 142 6.5% 1,075,739 2.5% 215 Back & neck procedures w/o CC 102 4.6% 2,099,660 5.0% 112 Percutaneous cardiovascular procs 77 3.5% 1,979,091 4.7% 371 Cesarean section w/o CC 75 3.4% 776,914 1.8% 462 Rehabilitation 38 1.7% 367,909 0.9% 359 Uterine & adnexa proc for non-malignancy w/o CC 31 1.4% 376,478 0.9% 214 Back & neck procedures w/CC 29 1.3% 761,555 1.8% 494 Laparoscopic Cholecystectomy w/o C.D.E. w/o CC 28 1.3% 331,157 0.8% 209 Major joint & limb reattachment procs of lower extremity 27 1.2% 799,731 1.9% 14 Specific cerebrovascular disorders except TIA 25 1.1% 855,120 2.0% 435 Alcohol/drug abuse or depend, detox or other symp tx w/o CC 25 1.1% 105,546 0.2% 1 Craniotomy age >17 except for trauma 24 1.1% 861,324 2.0% 372 Vaginal delivery w/complicating diagnoses 22 1.0% 152,639 0.4% 388 Prematurity w/o major problems 21 1.0% 265,219 0.6% 389 Full term neonate w/ major problems 20 0.9% 168,838 0.4% 390 Normal newborn 20 0.9% 111,783 0.3% 478 Other vascular procs w/ CC 20 0.9% 691,789 1.6% 106 Coronary bypass w/ cardiac cath 19 0.9% 1,135,987 2.7% All others 1,084 49.3% 28,464,772 67.4% Total 2,201   42,218,822

Source: OSHPD 1996 Patient Discharge Database

Table 6.12: Lompoc Top Five 1996 Out-of-Market Discharge Destinations

Destination Discharges Percentage of Total Santa Barbara Cottage Hospital 1,006 45.7% Valley Community Hospital 320 14.5% Marian Medical Center 174 7.9% Goleta Valley Cottage Hospital 168 7.6% Vista Del Mar Hospital 80 3.6% All Others 453 20.6% Total 2,201

Source: OSHPD 1996 Patient Discharge Database

Although dwarfed by the inpatient out-migration statistics, Table 6.13 shows that LDH drew nearly 200 inpatients from outside the service area in 1996. Almost half of these patients were residents of the communities of Solvang and Buelton.

Several factors which may contribute to Lompoc's significant level of inpatient out-migration include perceived differences in the quality of care, the real or perceived unavailability of local services and the proximity of Santa Barbara to Lompoc residents. These are not unlike the factors that impact patient out-migration in rural areas throughout the nation.

As shown in table 6.14 and Exhibit 6.1, the 1996 inpatient payer mix at LDH was led by commercial payers at 40% of total discharges, followed by Medi-Cal at 26%, Medicare at 25% and Private/Other at 8%. This payer mix mimics the population distribution, in which you see a large percent of families with children or middle age adults having children. Most of these families would have commercial/ managed care insurance or if they are lower income they would be covered by Medi-Cal.

Exhibit 6.1: Lompoc 1996 Hospital Inpatient Payer Mix

The 1996 LDH outpatient statistics parallel the inpatient payer mix, with Commercial payers at 46%, Medicare at 24%, Medi-Cal at 16.0% and Private/Other at 14%, as illustrated in Table 6.15 and Exhibit 6.2.

Exhibit 6.2: Lompoc 1996 In-market Hospital Outpatient Encounters

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