Tuesday, February 28, 2006


To let you know, I placed the counter around midnight on the first of Feb. That means that the current count is for one (short) month. Today, it will go over 12,000 hits. (Note: 13,000 by the 1st!)

This isn't rocket science, it means that:

a. Healthcare is an issue
b. The community is concerned
c. A LOT of folks have issues with Essent
d. Word of mouth advertising is the best or worst for a business

There are a significant number of comments as well. The comments that you see published are anonymous. Unless you directly email me, rather than click on comments, I have no idea who you are, and unless you want me to post any identifying data, neither will anyone else.

I have used several direct emails from sources, just placing them in a post or an anonymous comment myself. If you've received a reply, you know that the name that it is under is Frank Pasquale. That is not my name, and if you feel the need for an additional level of security, Yahoo mail and Hotmail both have the same option open to you.

Some of my sources I use to fact check. Some I just give a 'pre-release'. And some have given me some insights that I would not have normally had. It is enlightening, to say the least.

The warning about the PRMC computers is this: MIS has/will be installing 'spyware' to determine what sites are being logged to. I don't know if they installed a keystroke recorder.

What that means is since the logins are 'open', no one can tell WHO is actually using the computer, unless you are unlucky enough to be in front of a security camera at the time. If you are just looking at the site, it will register that the computer logged to it. If you comment, it may record the post.

Since a limited number of people have access to the computer, they can narrow it down to a few. If you are in a group that have to record timed activities, it can be narrowed further by excluding the ones that are doing other things.

The safest way is just to use your own computer, or a library's, or a friend's.

Note: See the comment from the former director of MIS

Monday, February 27, 2006

Back to the Cath Lab

This is a little bit technical for most, but not all of the readers. In this community, it is an issue of huge import. How many people have had, or know someone that has had a cardiac cath?

With the poor diet (when told they have to cut fried foods from their diet, the comment is "What can I cook?"), combined with the decreased physical activity levels, obesity, and smoking, this area is heart attack central.

Apparently, the entire staff of the Cath Lab threatened to walk out last week. I don't know their issues (besides staffing, call, and flexing), but I would certainly entertain them in this forum.

I don't know if the person that commented on this topic is a current employee, or former, just that he/she appears knowledgeable and is timely. Some of the earlier comments can be found here.

Ok, back to the 9fr holes. During any intervention in the cath lab, the pt. receives blood thinners, heparin etc... The sheath can't be pulled until the blood is thick enough to pull the sheath, as determined by the ACT. This is several hours after the intervention. Therefore, the sheaths are pulled by trained nurses. They are pulled in the cath lab by a nurse or a tech, if an intervention was not done.

Other variables come into play here as well. The patient has been given versed and fentanyl during the cath, to ease the pain and anxiety during this procedure.

They are told to lie flat for x amount of time, to hold pressure on the site if they cough, and other instructions to help prevent re-bleed from this site.

But wait a min. They have been given versed and fentanyl. It makes you forget and not care. They are forgetting to hold their head down, coughing, and not holding pressure on the site.

This is where it is so important to have good staffing. They are told to get on the call light if they the site starts bleeding, or if it starts swelling or hurting. The site is supposed to be checked on every 15 min.

So, if someone is not answering call lights, if the nurse is giving blood, or in a code etc... and there isn't another to check it, yes some one could bleed to death very easily. That is a big artery, with a big hole.

Staffing is so important. It is the most important issue related to the heart program, and if Essent is not going to take that seriously, then we should not have it.

I "think but don't know" for sure that the nurses and tech's pull sheaths pretty much everywhere. I think this is common practice.

Another problem along the lines of this same issue, is floating (staff). If you float a knowledgable ER nurse to the stepdown unit, or ICU, and they have a patient with a sheath, or a post cath. Do you think they are gonna have a clue what to do in case of a problem?

If things are so bad that they have to float ER staff to these areas, do you think that there is going to be someone with time to help that ER nurse deal with a sheath problem?

It spells death. It spells law suit. It spells eternal guilt for someone.

I'm telling you guys, staffing, and appropriate staffing, and acuity is a huge problem.

Friday, February 24, 2006

More Tapdancing 3/5 +

J.R. was there, we were there, where was Andrew? J.R. Lindsey, the current director of ???, made a pitch Tuesday night: Everything is better. Do you find it so?

Mr. Lindsey has two projects, E$$ENTially, PACS and voice transcription. Hopefully, at least one will make it to fruition.

One locum (temp)radiologist that is unable/unwilling to use their PACS, would prefer to have his CTs on film, and is unable/unwilling to do interventional studies. (At least he recognises his limitations and doesn't attempt it with liquid courage.) The other rad apparantly has an aversion to reading plain films...the rumor is he's already been fired...everything is meshungina.

Radiology is a diagnostic tool that we cannot afford to minimize, which the administration apparently has. Studies that we need and that are unable to be performed on in-patients require one of two things: transfer to a facility that can do them, or bring in a radiologist that is qualified.

Reports were processed within an hour...but, having spent a million dollars on a PACS, hiring two additional transcriptionists, and pulling overtime restrictions, would you expect less? Would the results have been any different with the Red River group, given those resources? And, how long before the emphasis returns to normal with staff levels and overtime? (Tokhis oyfn tish, bubbala.)

But, radiology wasn't the only subject raised. The hospital is contracting for some services that are out of network for some of the largest insurers in the area. In one case, the very same lab was used by the urology clinic and the hospital. With the clinic, it was in-network, with the hospital, it was out. Go figure. The billing for the Emergency Room physician is listed as out of network for BC/BS, another major carrier in the area.

But, what strikes at the heart of the matter wasn't even brought up as an issue: The hospital apparently files liens against its patients, insured or not, dropping them only when the bill is paid. They might lose cars, property, and bank accounts. Only homes are exempted, as this is a homestead state. The hospital with a heart ...pickled in a jar ....their pound of flesh.

Wednesday, February 22, 2006

New Hospital?-- 3/8

"Surgeons have been stymied and frustrated by the loss of surgical services. Generalists and medical sub-specialists have been alarmed at poor nursing ratios, loss of morale among hospital staff, [and] sub-contracting out of ancillary services" such as physical therapy, with an attendant loss of availability of those services....
This was a quote, which some say describes PRMC to a "T", from an article dealing with "boutique hospitals". There are current limitations on such hospitals, but they, for the most part, are based on the limitations of service. A hospital with a more open scope of care might scrape under the wire.

We have physicians from the community requesting privileges at other area hospitals--because that's where their patients are going. Both hospitals in Clarksville and Bonham are planning expansions or updates because of the increased patient loads.

The original North Campus hospital was built from a disagreement in principle between administration of St Joseph's and the doctors. Some stayed, some left. Why should it be any different now?

Even under Christus, a new facility was planned. I haven't heard it mentioned very much lately except in questions. Maybe it's time physicians step up to the plate?

It would be essentially based on self-interest: With the plans in the works by the hospital for bringing in a cardiologist, possibly direct-referring cardio-vascular cutter and internists, (under contract?), the pool will certainly be diluted, with far less influence exerted by the physicians as a whole. Radiology has gotten a taste, who's next?

A split-practice between Dallas and here is far less impacted--they can just shift emphasis (generally they live in Dallas, anyway.) But those that are invested with the community are far more vulnerable, and who wants to go through the pains of re-establishing a practice?...with Dallas prices on the square footage ($.90 vs $14 /sqft, Arlington 'boutique' hospital $35/sqft)!

A new facility might actually bring in more specialties (neuro, plastics, and the like) which would tend to stem the outflow of referrals to Dallas, and keep revenues in the community.

Pie in the sky? Possibly, but it was a group years ago that made it a reality. Those with a problem with the North/South should see this as an opportunity. Those with an Essent problem should likewise be empowered. The rest might just like a facility that looks clean, new, and without roaches.

Monday, February 20, 2006

E$$ENT, CO$TS, and CARE--3/4

Some people in Paris have been sending in commentaries about the ER bills they have received.

$6000 for treatment (for a fall) from one ER visit!
$300+ for a chest x-ray (not including reading! The imaging center charges about $100 all inclusive!)
Blue Cross-Blue Shield showing billing for the ER docs as out of network.
Blue Cross-Blue Shield listing the Pathology Lab that a kidney stone was sent (by the hospital) to as being out of network.
For Medicare and other insurances, they do not pay that amount. Medicare determines what is fair and reasonable, and then pays their negotiated amount. However, if a patient's co-pay for insurance is a percentage, then 20% of $300 is a bit more than 20% of $100. If you only carry catastrophic insurance, or you are self insured, you pay the entire inflated bill.

So, you might want to check out your options prior to an ER visit. In the off-hours, the Salas Clinic might not be able to treat a heart attack (if suspected, go straight to the ER), and they will freely admit it. If you go there and it is not in their scope of what they can handle, they will send you to the ER. But, if it is not a life-threatening emergency, it will be a more cost effective solution.

During regular business hours, your regular provider is obviously your best option. They have your history, and are not likely to be repeating tests which they have already explored with negative results. If they do send you to the hospital, they can give them a complete history.

The ER is starting from a blank slate, and only know what you or someone that is with you can provide. Do you trust your memory in a crisis?

Your best preparation for an ER visit is documentation. Have all your medications written down, with dosages. Have a full list of providers that you have seen and what for. If you have a living will, keep that with the lists. The least amount of guessing that the staff has to do makes care quicker and more effective. The time to do this is not as you are leaving the house--it's NOW. You are on your computer--pop up your word processor and list the items that you can remember. Then print it out and cross-check it with your medicine cabinet and your list of appointments. It's far more productive than blogging!

Saturday, February 18, 2006

Essent Unpublished

If the federal government kept us this much in the dark, heads would roll and outrage would be heard from all media outlets. In the federal system, there are protections for whistle-blowers. There are also protections for the rights of individuals. Not here. Apparently:

Should you say that you are understaffed, you are liable for a three day suspension.
If you contribute to this blog, you can be suspended or fired.
If you have the misfortune to not recognize Andrew and complain in his presence, you can be fired.

The soon-to-be-published (real-soon-now) personnel manual is nebulous in its scope. One would assume that the manual would have been transposed from one of their other hospitals, which would have made it appear upon the purchase. But despite its absence, it is used to justify almost anything, as is the lack of a cohesive policy and procedure manual.

So I will do my part...my part in creating a forum that allows the expression of an unimpeded dissenting opinion.
I will not release personal information.
I may alter some comments to change identifying characteristics, but not the context nor the intent.
I will continue this forum as a part of this community.

Friday, February 17, 2006

...three...two...one...zero! They're Gone!

At approximately 4PM, the review stations, digitizer, and the remainder of the equipment that made life easier for the medical staff started leaving the premises...Oh, and the radiologists....Hopefully, Paris, the transition won't be as tramatic as the ER.

Thursday, February 16, 2006

Counting Down...

Tomorrow, one of the longest running relationships in Paris healthcare ends. The radiology group is divorcing itself from PRMC. It is going to be an interesting change.

The new locums will have no real stake in Paris, nor any direct financial incentive other than that of a temporary employee. The radiology group had the need to ensure that the coding was correct for both themselves and the hospital and caught a multitude of mistakes.

The radiology group has experienced coders, in fact they do coding and billing for other practices. The hospital will be playing catch-up.

The radiology group had a PACS that had all the bugs worked out of it, the hospital has one yet to be installed.

But Hud says that he can do it faster and better. So while Nashville calls the tune, the hospital and the community have to get on their dancing shoes. We'll see how fast they can tap dance tomorrow.

Monday, February 13, 2006

Nurse, Nurse, who's got the Nurse. 2/25

Another shell game is in play, one might think. Balancing what nurses can be pulled from ER to the floor before the ER disolves into pandamonium. Neat trick: pull nurses from ER to cover floor vacancies, so you don't have to close beds. However, you just shifted the bottleneck to the ER. Patients certainly notice when they have waited hours to be put in a room, and they are taken past empty rooms that they don't have nurses to cover!

The agency nurses that they procure might be fine--or not. They are certainly being paid more than the staff (some of which got a nickel raise this last evaluation. Supposedly the rate is determined by the director, not HR.) But it takes time to find anything in a new environment.

So now we will have temp nurses, respiratory techs, radiology techs, and radiologists--all being paid more than the regular staff which was capped. Is there any doubt as to why the other hospitals (Bonham, Clarksville, as well as Dallas) are being flooded with applications from PRMC staff?

If you have the email address and websites of recruiters and HRs that have been helpful to you, post them as a comment, which it certainly will be. The hospital might need some new recruiters, but we definitely do.

Hardhitting Commentary

After reading the Paris News'article about the lawsuits, I was not really clear about a couple things:

How many lawyers were mentioned (one)
Who he represented (it wasn't Essent)
Who was suing whom (Suit, counter-suit)

But, are they really going to wiz in the Wheaties of Paris's largest employer? Heck, when Christus owned it, they did not publish a peep when they laid off over a hundred folks from Lamar Medical--despite assurances that Christus gave just two months previous to the layoff. There was nothing published when the suits were flying between Health Solutions (for profit, owned by the hospital) and the docs over the practices that were purchased and the Rabbi Trusts that were lost when they bankrupted HS. One doc had been putting all her earnings into it. Bet she didn't intend on working for free....

So now the gloves are off, one would assume. The hospital is trying to evict two entities based on a lawsuit against one. Since they are being evicted, and all the miscellaneous mis-representations and outright falsehoods that have been handed around like lobby popcorn, the radiologists are pulling out of the hospital, not the community. They are still offering all the services that they did at the hospital, but on an outpatient basis. And, it is cheaper to go there, than the hospital!

As to the million dollars that Essent is putting into the radiology department (Essent ad, Sunday in the Paris Snooze), two years ago they said that they would be putting six million in, almost immediately. Their timeline and reality have some serious disconnects.

Thursday, February 09, 2006

Smoke II

Well, this time PRMC came out of the closet. The Paris News put out a somewhat confusing article today. What it seems to boil down to: Essent wanted an audit. Their auditors conducted a partial one. When they wanted to come back, the Radiology Center said they had to pay, up front, for the costs associated with the audit (personnel, overtime, etc.) They were not willing to do so, in turn, they issued findings based on an incomplete audit and commenced a lawsuit.

What is funny about this: they are suing themselves. They own a partial interest in the MRI. What is not so funny: it eats up time, and money.
Do you think that the money for both sides appears out of thin air? If so, it disappeared from our pockets. I am sure that Essent, out of the goodness of their heart, will absorb the costs, and "Hud" will just apply the normal $5,000 he donates to candidates and Political Action Committees (yep, "PACs". See why this gets confusing?) per year, to the lawsuit. Likewise, I am sure that "T" and the co-defendants are going to pull out pocket change and handle it. Yeah, r-i-g-h-t.

It hurts the community, because we all pay for it. The only ones that are getting rich off of this are the lawyers.

You have to follow the money, however, and Essent has never claimed altruism as a fault. It still comes back to the imaging money and getting rid of competition. I still think they want to be the last man standing, and the smoke has yet to clear....


The situation that has evolved between PRMC and RRVR has been simmering for some time. The Special Procedures Room issue (contractual exclusivity,) which was violated by PRMC was, in retrospect, a shot across the bows. Dismantalling the line-of-site antenna on top of the hospital, which allowed the images from the North Campus to be transmitted to the South for reading was a second.

A PACS (a means of digitally storing and transmitting images,) was coming, it was just a matter of time. RRVR wanted to review vendors and have the hospital sit in, back when Christus was here, but they had sale on their minds, and weren't buying. The radiology group bought theirs and offered to carry support if the hospital bought into the system. Again, no sale.

PRMC put together an advisory team to evaluate PACS systems, but look: the radiologists (the ones that would actually read the finished product and utilize the greatest amount of the capabilities)...weren't included, despite having just gone through the implementation of a working PACS.

A voice-recognition system for dictation was attempted and shelved for later because of problems (it didn't recognize voices.)

In the meantime, PRMC tries to evict RRVR. (The group is moving, but not until March.)

Now comes the rollout of both the new PACS and the recognition system--exactly what would be needed for a off-site radiology group to start...and the current group would have to work out the bugs...not likely! Making things simpler for the competition isn't going to happen.

But, this last episode probably shouldn't be a complete suprise. "Hud" Connery's prevous company (not Health Trust, but Arcon Healthcare, which went bankrupt in 1998) was based on the Virtual Hospital concept, similar to that which was implemented successfully by the University of Iowa.

In that episode, the little guys got hurt, like New World Printing, an office supply company that was owed $340.62 for June and August of 1998--and lost it to the bankruptcy in which the company left a handwritten note stuck in the door of the court saying they were too broke to re-organize. And the staffs of nine facilities that went under with minimal notice.

Wednesday, February 08, 2006

Famous Quotes

"...We are committed first and foremost to providing high quality health care services for everyone in Paris and the surrounding communities." Joe Pinion, Essent COO
"We hope to make this 'the' hospital in the region...." W. Hudson Connery, CEO/President of Essent Healthcare
"We believe that the company simply needs more time to allow its concept to mature and to grow its market share and revenue base," Hud Connery, one month prior to closing Arcon Healthcare.
"We have determined it is impossible for the debtors in
these cases to reorganize under Chapter 11." ...note left in the door prior to a scheduled meeting with Arcon creditors.

I'm not the director...." Beverly Mock, director of Radiology, PRMC
Diese Frau wird niemals verstehen -- This woman will never understand

Monday, February 06, 2006

Sound Familiar?

"It was a combination of things that made the hospital start sinking -- shaky management, a declining reputation, the close proximity of competitors and the way doctors started moving patients and practices to other facilities.

Sound familiar? This was the formula for failure at Crossroads Regional Hospital in Wentzville, Mo., before it was bought by Essent Healthcare...."

So goes the story of Essent's first plunge into hospital ownership...ending with the sale of Crossroads in October of last year.

Since Crossroads, Essent's first acquisition, the business model has changed--the hospitals are at the verge of closing their doors, and they are the sole facility in a community. Why did they modify their plan with PRMC?

Probably it was the size of the hospital. On paper, it looked good, and these boys are bean-counters if anything. The number of beds in their system would double!

The problem was two physical plants and all the baggage they got with it. So many things had been bandaided for so long that needed immediate outlays of cash. Big Mac's property management had gone Dallas, pissed off the docs, and unintentionally lost many tenants that built their own offices. Middle management had infused the staff with the philosophy of Monty--we don't have to worry about money, we're non-profit!
This was the philosophy of: the Gibraltar Hotel, not being able to bill for anesthesia because provider numbers were never obtained, not billing services for a year for the Minor Care Clinic (and wondering why it wasn't making money), not getting insurance pre-approval for some surgeries, mis-billing the Out-Patient Surgical Center, Health Solutions' inflated management bills, and the big one--not keeping the existing Medicare/Medicaid rates by renewing on time.

All these problems came from the top down, and, despite the initial chaos, it might have been better to totally replace from the mid-levels on up.

Currently, patients are leaving, staff are leaving, and the ones that still flock to the ER are the true emergencies (few), and the self-pay (no-pay, for the most part) that can't go anywhere else because they have no money and use the ER for an outpatient clinic and drug store. These are also the most likely to sue.

Hopefully we won't be another Crossroads, but then again, it can not stay the way it has been....

Wednesday, February 01, 2006

Blowing smoke and sunshine

Has anyone heard a lot of good things said by patients in this hospital? Certainly not as to response to call buttons, IV bag changes, bed changes, and the like. (All pointing to short-staffing.) So much for the Essent COO's statement:

"...We are committed first and foremost to providing high quality health care services for everyone in Paris and the surrounding communities."

But, remember the days prior to and heralding the purchase. Everything was roses. The Paris News was happy--their advertising income was probably going to stay the same, so they ran their typical hard-hitting fluff piece.

Right after the purchase, Jenks Healthcare Business Report said:
Although additional hospitals are in the pipeline, it is unlikely the company will close on any for at least the next six months while it digests St. Joseph’s and returns it to profitability. But as operations improve, and profits rise, Essent will continue its growth and may do one more venture capital round before it entertains an IPO.

Well, the reason for Essent's existence comes out: IPO. The magic drug to satisfy the craving of any management type. No wonder Hud came out of retirement.

It's also interesting how most of the Essent acquisitions have been in areas with no alternatives for care. Essentially, a monopoly. So, they can set the wage, they can evict Red River, and they can play the tune that everyone dances to in healthcare.

Someone mentioned that the doctors were being sued. Yep, all those that were in partnership for the MRI (Essentially the entire medical staff.) So was the hospital (a partner, 20%, I believe.)

Why are they hitting so hard on their imaging competition? Certain aspects of a hospital make money, enough to offset the losses sustained by other areas, and then some. Imaging is one of them. The hospital charges significantly more than RRVR does for exams. If they effectively took RRVR out of play, they not only absorb their business, but they can employ a radiologist to interpret and bill for the professional services as well.

So back to the initial quote, which might read:
"...We are committed first and foremost to providing the only health care services for everyone in Paris and the surrounding communities."