The Italian count checked in unnoticed by the other guests. He settled into a two-room suite where he was served gourmet meals on the finest china and crystal. A pink rose arrived with breakfast. He called London frequently, and when he left he was whisked away in the private elevator.

In the midst of all that, the count was undergoing major surgery.

Luxury wings like One South in Bethesda's Suburban Hospital, where the count stayed, are one way Washington-area hospitals are trying to lure patients to their institutions.

Hospitals are also going to the airwaves and to glossy magazines to market their services to Washington consumers -- particularly the middle to upper-middle class professional.

They are offering low-cost office space to physicians and free "wellness clinics" to executives of major companies -- all in an effort to grab a share of a dwindling patient population and to remain solvent in the midst of tightening payment rates.

The changes are coming quickly:

* Hospital occupancy rates fell to 67 percent in 1984, down from 72 percent in 1983, according to the American Hospital Association (AHA). By contrast, patients filled 77 percent of the hospital beds in 1965. A decline in the length of stay and a small but steady increase in the number of hospital beds accounted for the drop in the occupancy rate, even though admission rates grew in the 1970s, according to Debbie Reczynski, an AHA economist. But even admission rates dropped last year -- by 4 percent, or 1.5 million fewer patients entering a hospital than in 1983.

Medicare now pays a fixed rate for each illness no matter how long the patient stays in the hospital (with occasional exceptions) or how many tests the doctor orders. City hospitals could lose $1,000 per Medicare patient in 1987, the last year of the phase-in to fixed rates, says the D.C. Hospital Association.

Employers are taking a close look at hospital bills as well. A 1984 survey of 1,100 companies showed that 39 percent of employers are offering employes higher reimbursement for having surgery done on an out-patient basis, according to Hewitt Associates, a consulting firm.

Marketing is one answer to the hospitals' woes.

Suburban Hospital surveyed residents of Montgomery County in October 1983 to see what features would attract them as patients. As a result, they opened a luxury wing last September aimed at the well-to-do, who are willing to pay $70 to $140 a day above the semiprivate room rate to maintain a low profile and convalesce in style.

Privacy is paramount to patients at One South. Affluent patients don't want their friends to know they are having a face lift. Executives may not want their companies -- or competitors -- to learn they are undergoing serious surgery.

"When the patient says he is self-employed," said Bettie Powell, head nurse of One South, "we know not to dig."

The 13-bed wing has been running at capacity since it opened.

Other hospitals are using a different approach. Greater Southeast Community Hospital spent $225,000 on radio advertising last year to create what one hospital official called a "warm and fuzzy" feeling about the institution. Barbara Cepuhar, director of marketing and communications at the hospital, said 30 percent of the listeners surveyed later had had a "positive change" in their feeling about the hospital.

Washington Hospital Center is underwriting a weekly half-hour public television series that focuses on topics like emergency medical services, high-risk pregnancy and organ donations.

Providence Hospital ran a full-page color advertisement in Washingtonian magazine this winter, featuring a rugged-looking fireman vouching for a new knee surgery technique offered there.

Local institutions are also starting to cater to busier, more demanding professional women who still are likely to make the health care decisions in their families. Gourmet meals, short-stay programs, liberal visiting hours and birthing centers are becoming standard in area hospital obstetric departments.

Leith Mullaly, director of the Matters on Maternity (MOM) program at Alexandria Hospital, said busy Washington executives expect more help from the hospital these days.

"One of the things we know we have to do," she says, "is get into some areas of parenting. The Washington metropolitan area tends to be an area where there is no extended family. The parents would really like the hospital to do more mother-support groups and classes on discipline."

The transient and fast-paced Washington life also means that many people do not have a private physician, so several hospitals have established physician referral lines. When someone calls to ask for names of doctors, the institution has a ready-made list -- naturally of those who use its facilities. Fairfax Hospital, which began its referral line last June, targeting new residents and patients in need of a second opinion, receives about 450 calls a month.

"What a lot of people are calling marketing," says Richard Wade, vice president of the Maryland Hospital Association, "are changes in how hospitals and the public view health care."

The fitness movement combined with higher employe copayments have fueled patient interest in controlling their health care when they go to the hospital, Wade said. Patients are asking doctors more questions about their treatment and demanding that hospitals cater to them with tasty food, flexible visiting hours and comfortable rooms.

Hospitals realize they are being scrutinized by patients and employers and must sell themselves as much on innovative services as on good medical care, Wade added.

As a result, hospitals are "loosening up," he says, and allowing children to be present in the delivery room and patients to have martinis before dinner.

"Why should their life style be altered dramatically when they are in the hospital?" he says, adding that if patients have more control over the stay in the hospital, "it may get them home faster."

The biggest payoff for hospitals, however, may be in an aggressive pitch to the gatekeepers who are largely responsible for selecting the hospital a patient enters -- physicians, employers and health maintenance organizations (HMOs).

"Advertising is name-recognition, but it doesn't necessarily bring you much in the way of direct results," says Tom Flynn, regional vice president for the three Adventist hospitals in the Washington area. "If you can develop linkages with HMOs in the Washington area, then they provide the patients."

Providence Hospital invites decision-makers of major companies and government agencies to their weekend "Wellness Institute" free of charge. The intensive course measures an individual's health and fitness through a number of tests and usually costs $225 per person.

When these decision-makers package their insurance plans, says program coordinator Beth Jaeger, "We would like the people who participate to think of Providence Hospital."

Hospitals also want to attract specialty and "high-admitter" doctors to their facilities.

Office space is an obvious draw. "If you have an office close to the hospital," says D.C. Medical Society president Dr. Robert Collins, "you tend to use the hospital. It cuts down on travel time."

Another way to attract patients is the joint venture agreement between hospitals and physicians, like PreferCare Inc. at Greater Southest.

Here, the hospital and 195 participating physicians offer a package of medical services to employers for a discounted fee. In turn, the doctors and the hospital receive a "captive audience" of patients when the employes need health care. Deductibles are low or waived altogether if the employe chooses the plan.

PreferCare, begun in 1983, is serving Greater Southeast employes and expects to market its plan to large employers this year.

What all this marketing means is more choice for consumers -- if they take the time to compare hospital services.

Also, hospitals will begin to take on "personalities," says Heidi Hunter of the American Hospital Association. "Hospitals will figure out which services they can provide well at a low cost to them and advertise those."

Flexible care plans, which allow the patient to choose the level of care he will receive in the hospital, may catch on. A patient could bring a family member in to stay with him free of charge and provide much of the care traditionally given by a nurse, lowering the cost of the stay.

The New York Unversity Medical Center began a flexible-care program in 1979 in part to cut nursing costs. Other hospitals, such as Greater Southeast, are offering similar plans as part of their marketing push.

Or the patient could choose to pay more for luxury accommodations. Washington Hospital Center provides a private nurse for each patient staying in its top-of-the-line rooms. Howard University Hospital features VCRs and portable tape decks for its luxury care patients.

Room wars, in which competing institutions try to undercut each other in their room rates, may surface. But George Barker of the Health Systems Agency in Northern Virginia warns that the room rate is only part of the price. It doesn't include the operating room and lab work.

In the end, however, quality of care will remain the bottom line. Hospital advertising, said Collins, is like "a circus barker -- it gets your attention and gets you inside, but if the hospitals don't give you good care, the results will be short-lived."

By Susan Parker, Special to the Washington Post