''For those for whom the most important factor is low use of intensive care during the terminal phase of illness, Baptist Hospital may be a better choice,'' the report states.

Mount Sinai's spokeswoman said the hospital provides ``a level of treatment appropriate for each individual that is sensitive to their personal and religious requirements. . . . Mount Sinai accommodates all of its patients who seek hospice care.''

At Baptist Health South Florida, Chief Quality Officer Thinh Tran said he looks ''in depth'' at the Dartmouth data and that the five hospitals in the Baptist system work hard to practice evidence-based medicine. ''We work very closely with the families and patients'' to explain options for end-of-life care, he said, ``to provide the best outcome for the patient and also consider low costs.''

The Baptist chain includes Homestead, a hospital in which dying patients see a comparatively low number of specialists. ``We have [staff] coordinating care and, collaborating with patients, we try to bring in just the right patients at the right time.''

At the other end of the spectrum is South Beach Community Hospital, which ranked at 100 on the HCI index, putting it in the top rank nationally for intensity of care.

The hospital closed in February 2006 after running into repeated problems with Medicare over billing issues. After it filed for bankruptcy, federal officials took the extraordinary step of banning it from receiving Medicare payments for five years.

The record is more complicated at Jackson Memorial, where most services are provided by faculty of the UM medical school. Its intensity of care index ranks it near the very top of the nation's academic medical centers, next to programs such as UCLA Medical Center and New York-Presbyterian, and far above Johns Hopkins, Yale University and the Mayo Clinic's St. Mary's Hospital.

But within South Florida, Jackson ranks 26th of 33 hospitals listed by healthcare costs.

Pascal Goldschmidt, dean of the UM medical school, says he's paying special attention to the Dartmouth study and how UM's doctors practice.

MOVING JACKSON AHEAD

When he arrived in Miami two years ago, Goldschmidt said he noted that evidence-based care was ''definitely not as advanced here'' as at his previous school, Duke University, but he has been working hard to change that.

Dartmouth's Fisher believes medical schools and their teaching hospitals can lead the way in establishing evidence-based care, but he believes that there's a basic flaw with the nation's present healthcare system. ''The current system fosters entrepreneurial behavior,'' meaning the more procedures doctors and hospitals do, the more they get paid and that ''can be harmful to patients,'' he said.

SERVICES VS. PAYMENTS

Linda Quick, president of the South Florida Hospital and Healthcare Association, has been a longtime supporter of the Dartmouth work, but she notes the data is based on what Medicare paid out, which might be different than services rendered.

That could be significant because federal investigators have long considered South Florida a top spot for Medicare fraud, particularly in areas like durable medical equipment (DME).

Although Dartmouth doesn't attempt to analyze for fraud, the patients with the highest DME expenditures in South Florida were connected with Larkin ($8,081) and Westchester ($7,862), far above the two hospitals with the lowest DME expenses -- Holy Cross ($1,498) and Imperial Point ($1,472).

Jack Michel, chief executive of Larkin, said DME expenditures are ordered by doctors, not hospitals: ``Larkin doesn't have anything to do with that.''

Still, healthcare costs in South Florida continue to be undeniably high, and UM's Goldschmidt says that needs to change.

''The overuse of specialty care and procedures is in no way good for health. There is clearly no link between the cost of healthcare and the quality of healthcare,'' he said.

Changing physician practice habits won't be easy.

''I think it's going to take about 10 years to make a difference in healthcare in Miami,'' said Goldschmidt, ``but I'm very committed.''