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


Anonymous said...

If an agency nurse cost around 95 dollars an hour, as opposed to a regular staff nurse, costing around 20 dollars an hour----why do you suppose administration is so quick to oppose overtime, and threaten you with your job, when you complain about short staffing?

Who do you suppose actually approves the rent for these nurses?
I wonder if the big dog writing the check for this knows that some of their staff is running off nurses so they can pay this heafty price to replace them?

Do you have radiology temps? How much do they cost as opposed to regular salaried staff?

Anonymous said...

Respiratory and Radiology both have temps...big bucks, especially for the radiologists.

Anonymous said...

What is all this costing the community? Not just in care, but in the outflow of cash from the area?

With nurses leaving and temps based out of wherever, what does this have leaving the community? Money.

And, if a temp nurse costs $95 per hour, how much does a doc (Radiologist or Anesthesiologist) leave with?

Anonymous said...

The Agency nurse only gets about 30-40 dollars of that. The agency gets the rest.

ER docs are agency. That agency used to be Schumacher. They came in with nurse consultants a couple of years ago, teaching the ER how to run a tighter ship.

Anonymous said...

Maybe if you buy agency nurses in bulk you get them cheaper?

I'm not complaining about the agency nurses. Its not their fault. I would rather have them, than do without by far.

What bothers me is why. Is someone getting kick back for using these agencies or what? Does it make someones job just so much easier if they don't have to listen to someone about staffing?

Try an ER nurses job for a while. Do you think its easy. I mean even when staffing is good? Do you think bus loads full of mangled up kids don't haunt you at night. What about dying babies.

Anonymous said...

Burns---burns are in the top nightmares that I have. Combine it with trauma....

Anonymous said...

Not only is there an issue with patient care, let's address employee issues. I've decided to post this comment as fair warning to ALL employees who've decided to end their tenure with this joke of a company. Heads up ya'll

1.In checking with the appropriate agencies with regards to giving notice to your employer you are leaving............YOU ARE NOT REQUIRED TO DO SO BY STATE LAW.

2.If you give Essent the benefit of the doubt and do it simply because you are a good person, DON'T........you will not be able to use ANY of the sick time you've accrued OR vacation time as well. USE it and blow 'em off, utilize the same attitude they have towards us. Fighting fair does not exist for these jerks!

3.The last day you work is the LAST day you will be covered by their crummy insurance......and to quote an HR rep, "I hope you can afford the Cobra premiums." Nothing like compassion here folks. If you have a family w/children, you basically are screwed until you find employment elsewhere. So have a job lined up already!!

4. There will be no refund of healthcare premiums should your last day of employment fall in between pay periods, as a matter of fact, you've lost that money, period!

........AND whenever I hear ANYTHING about Jay R, my teeth automatically start grinding. He who was FIRED, then magically WELCOMED BACK into the bosom of management. A classic example of management taking care of management without regards or an inkling of care/concern for the employees that ensure their crummy salaries and positions. And they wonder why their bleeding out employees??? Essent knew the score a LONG time ago, they knew the blocks holding this place together were crumbling and quickly. Agency techs, where do you think that that money is coming from, robbing Peter to pay Paul. And we as employees are funding that business maneuver. Another salt rub into a wound that is showing purulent exudate already.

Moral of the story, if leaving their employ, take them before they have a chance to take you. Trust me, if you leave, do you honestly think you'll get a "Rehire" on your record???? Don't think so!

Anonymous said...

Since the hospital is a "for" profit facility, here are some of the complaints I have as a former patient.
1. Having to pay for tests up front, before your test will be run. My doc had the same complaint.
2. Pricing ridiculously high. Costs for a Holter monitor almost $1500 higher than Advanced Heart Care.
3. Getting threatening collection letters before balance is paid.
Baylor Plano
1. Everyone is treated like someone.
2. Pre-admit is just that. Walk in and your taken care of.
3. They file insurance, bill you later.
4. Nurses and staff out the wazoo.
5. Staff is happy to be there, and why not, its a Five Star facility.
Essent needs to take a look at other hospitals that do it right.

Anonymous said...

Just to let you know in regards to MIS, in 1998 & 1999 OmniQuad Desktop Surveillance was installed on all Compaq Deskpros in the hospital on all main nursing floors. I am sure it was installed on the newer systems as well. This allows MIS employees to set in the MIS Dept and view what you are doing on your PC, and take "screen shots". It also utilizes a desktop key recorder.

I wanted to let you know that MIS has had this technology for years. I was the one who installed it.

Dawn E. Lambert
Former MIS Director

fac_p said...

Apparently, MIS fell a bit behind, and had to play catch-up with whatever they are using currently. But, that explains blocked sites and other discontinuities that pop up on the computers.

With the shortage of MIS folks, I doubt they had time to do the monitoring that the software allows, they probably just ran the stats periodically.

However, for those that bank on-line: can we say Identity Theft? If anyone has been using a hospital computer for their on-line transactions, and their accounts have had a discrepancy, I would propose that the hospital has a liability in that they provided an avenue in which an unscrupulous individual could make use of passwords obtained on hospital systems.

Since no warnings were made public, the personnel capable of monitoring such data should be not only screened, but bonded and polygraphed periodically.

Anonymous said...

Was there an 'expectation of privacy'? We all knew the phones can be monitored, but that little lock on the bottom of the screen indicated a secure transaction. I'm changing my passwords, and reverifying my accounts.

What about all the emails that have been 'monitored'? What a##holes! Who watches the watchers??? MIS, 2004=1984.

Anonymous said...

Can anyone say George Orwell here? As this site continues, more and more of Essents' business practices surface, from not only the patient side but the employee side as well. Sure, by law Essent is able to monitor their computers and employees, but when it gets to the point of affecting someones life through possible identity theft....come on, it is one of the most debilitating experiences a person can go through. As evidenced by some of the articles in the papers/television news reports. Not to mention taking a great deal of money on the individuals part to clear it all up. First, we found out about Essents' lien policies, now we are being subjected to something that is even more horrendous!!! I am surprised with this type of invasive attitude, that they don't offer the patients internet capabilities from their rooms, I mean if you're gonna screw somebody why the heck not include ALL the residents of Paris. AND LETS not just overbill 'em, put 'em at risk to lose all they've worked for in their lifetime!

Anonymous said...

Wonder if all the directors knew about the keystroke monitoring? Guess JR will have to limit his chat room time. You know, the one devoted to workplace romances....

Anonymous said...

I swear, if I stayed 2 weeks extra, and they gave me no rehire, I'm going to go postal!

Oh well, they are hiring back no rehires anyway. The only thing it does is make it look bad when you go to interviews. Almost seems illegal doesn't it. Its almost like they are preventing you from getting a job somewhere else, but they will take you back.

Anonymous said...

The death spiral of losing local people for costly temporary replacements has been going on for years. This seems to be the Official AHA Hinterland Hospital Playbook, seeing as it has been the policy for whoever was running a hospital in Paris for most of the last decade.

What do you expect when the payor mix is 70% Medicare/Medicaid/No Pay? Hate to tell you, but there is no solution to a bleeding hospital system in a town the size of Paris with a lousy payor mix. It just costs more to run than you can possibly make, for-profit or not-for-profit. Separate management teams at McC and StJ both ran their hospitals into the ground, Essent was stupid to buy the hospital and equally stupid to claim that they could turn things around. Unlikely, unless they brought several thousand more indemnity insurance jobs to town with them.

RRVR is no more delicate a touch with its employees than Essent. The ace in their hand has always been that working for them was marginally preferable to working for the hospitals in town. Dismissals to cover MQSA discrepancies and threats to never rehire good employees who voluntarily separate are not unheard of over there. They may be a family-owned business, but then again, so were the Gambinos.

Anonymous said...

TAKE YOU BACK!!!............bwahahahaha, oh yeah they will, less money,and about three different jobs you're responsible for as well. Pound of flesh, oh no, definitely more like your first born and twelve pints of blood!!!

Anonymous said...

The payor mix is about right, yet Christus probably could have made it, had there not been so many dropped balls, and if the physicians in the community had just sucked it up and got over the purchase. With them slowing discharges and referring out the insured population, can you say, "death spiral"?

Essent got saddled with twice the property that was needed, and didn't dump what they needed to when they had the chance. They're paying taxes on inflated values, and just can't figure out which foot goes where.

Right now they're in a power play, and it's costing them. Temps are bleeding them, Dallas referrals the same (two pt vans Tuesday), and they're feeling the noose tighten...and they still have this silly north/south campus thing going on.

How much of their office space is rented? And, they're kicking out RR?????? Meshungina!!!!

Anonymous said...

The trauma designation would have given the hospital an extra million a year. Not to mention better care. Who didn't want that?

Anonymous said...

I can imagine RR doing a happy dance when they pulled out of the hospital. They had to take the low pay/no pays and count on the hospital successfully completing their end of the coding for the insured...Yeah, R-I-G-H-T....

Now, the hospital has to hire locums, by the hour or by the reading, and the hospital bills both sides...and gets butkis x2 if they don't pay (but has to pay the locums)...after laying out a million for a slow PACS.

Don't throw me in the briar-patch....

Now, RR gets to build its own facility, in a better location, deal with an insured patient base, and do the billing that they are so good at.

They probably would have stayed in the same location that they had leased from the hospital for years. The road to change is hard to start. I would imagine that they might say, "Thanks, E$$ent!" for the reason to improve, in the years to come. 'course, Essent will probably not be here....

Anonymous said...

RRVR (a.k.a. the Cliffords) are not the angels this blog has portrayed them to be. Good businessmen they are. They have managed to skim as much of the cream out of the Lamar county imaging cow for the last 40 years, leaving the hospital (St. Joe's,Christus, and now Essent) all the skim it can drink.

Thirsty anyone?

Anonymous said...

Hey, no one said RRR were angels, far from it, but they are business minded. They too know the community and the percentages of pay -vs- no pay. So if they've made a successful business stand without castrating the masses, what was Christus/McQuistion/Essents' problem..........management, and a severe lack of vision that only went as far as managements paychecks and positions. Someone once said, grads that had a BA or Masters in business management, the top 5% were quickly plucked up by Fortune 500 companies, the other 95% wound up in positions that........well, like Andrew has!! GEE go figure! One thing Paris is NOT known for is it's metropolitan bend. Heck, we can't even get decent eateries here. But could we at least try for a reputable, well run healthcare organization folks???

fac_p said...

No one ever said that RR should be nominated for sainthood. Gail Parkhill is a shrewd businesswoman. Here is the down and dirty: RR has been helping the hospital for years. Radiology coding has never been the hospital's strong suite. RR has been doing the hospital's job for it, with verification of appropriate justification.

Sure, it's self-interest, but it has always been their contention that the hospital should be doing a better job on their own. (It's nice to have a variety of sources.)

The ChargeMaster, the codes and charges that the hospital uses to bill, is a problem with Radiology and Cath Lab. They do procedures that are not listed, and need to be added. If they aren't, they can't be billed.

RR kept the hospital updated on charges that needed to be entered for Radiology. Additionally, they bumped back inappropriate reasons for x-rays (abdominal pain for a chest x-ray doesn't cut it) which helped the hospital. The dirty little secret is that the reason has to match the procedure, or neither get paid. Meaning that (without the crosscheck) the ward clerk is probably the most important person in the mix, next to the doctor (and the lowest paid), since they enter the order. Can you spell R A I S E?

But, not doing it correctly costs the hospital revenue for services performed. (Can you spell F I R E D?) (It's a crib, but a good one, I thought.)

We will see if the hospital can handle the pressure, and derive the revenue. If it can't, more rants will be heard by all.

fac_p said...
This comment has been removed by a blog administrator.
fac_p said...

Wednesday 1st Mar 2006 969hits
Tuesday 28th Feb 2006 915hits
Monday 27th Feb 2006 940hits

Heaviest hitters so far!

Anonymous said...

I find it curious that some believe that CSJ would have done any better long-term than Essent. I suppose that's true if they could continue to find more PCPs they could recruit and then claim the retirement benefits and last 90 days of AR from, but that seems unlikely. If you can't make two hospitals pay on Paris' lousy payor mix, why will one do any better even without some of the administrative overhead? Maybe it was mostly depreciation, but the cash burn rate actually increased after the union of the two hospitals, and the McC patients by and large weren't going to go to CSJ in any event, and vice-versa. There was no possibility for a winner in the deal, a percentage of the economically mobile patients were headed out of town no matter who bought whom, leaving an even worse payor mix afterward. This was clear before the merger, it's a pipe dream to believe otherwise and events since have proven the truth of this.

None of this excuses Essent for whatever missteps that have followed, but there is no corporate force that can prevent Paris from becoming a healthcare money sink. The paying procedures had been balkanized, the trenches dug and battle commenced long before Essent arrived. RRVR had wanted to be rid of the hospital for years, Essent just helped by creating an environment for RRVR to be perceived as the 'victim'.

Anonymous said...

If Christus had actually started the north campus expansion, it probably would have partially assuaged the situation. Now, the trickle of Dallas/Tyler referrals is turning into a stream.

But, with Monty's little band of mauraders, there would have been too much skimmed. If one administrator has half a crew that is supposed to be working on a project at the north side working on his house, what would have happened in an expansion?

This place needs a fresh start.

Anonymous said...

In regards to Ms. Lambert's comments. She was director of MIS inm 1998. That's almost six years of technology that has come and gone. Yes, there is a internet appliance that monitors all internet traffic and filters what content you can and can not see. That's evident from the pop ups you get that say the site was blocked by St. Bernard. A simple lookup on the internet and you'll see that St. Bernard is a company that deals with internet security.

Guys..bottom line is.. The internet at the hospital is there as a tool to be used for business and patient care. Don't be balancing your bank account, looking at your credit card statements or anything that isn't business related.

Fact is, most likely you're using a computer that is easily accessable to others and is able to get on the internet. You have no idea what that other person did when they used it and could have went somewhere on the internet that installed spyware or a trojan that could log all your information. Use some common sense here. Do you really think the hospital supplies the internet so you can set around and play games on MSN all day long?

fac_p said...

Come on, of course they do. And why were those MIS folks running around so busily about two weeks ago?

If they were installing keystroke loggers before, I can imagine that the thought had crossed their minds lately.

Group policies would have taken care of unlimited access, and the novell desktop limits you unless you explore the "T" drive. Then you can essentially run any program on the computer.

Anonymous said...

There's more to having the proper diagnosis for an x-ray in regards to billing. If you do a chest x-ray with a diagnosis of "earache" that is considered fraud by Medicare/Medicaid and the hospital/clinic is liable for fines. The techs also have to check the diagnosis before doing any films. This is true for lab work as well.
It is important to have the proper diagnosis codes as well. If you code wrong not only are you possibly entering the fraud angle you may also get less payment. Having knowledgeable DRG coders is imperative if you want to get proper reimbursement.
Most of the unit clerks are thrown into their jobs with no training or orientation at all. Many of them have no clue about medical terminology so it's really up to the techs to make sure the diagnosis fits the procedure.

The main problem with the whole North/South-McC vs StJoe’s thing goes back to the mentality of NE Texas. For 50 years it was grudge match between these two hospitals (can you say Hatfields & McCoys?) so when they theoretically became one, instead of consolidating by moving into the newer, better located North campus it became “Let’s destroy McC!” I watched in amazement as they drove North campus into the ground and drove off a lot of regular patients. It made no sense to any one especially the patients—for many of them volunteered this opinion to me. It still would be better to combine into one hospital but I doubt that will happen with finances the way they are.

Anonymous said...

True, there are multiple ways of getting on the internet at the hospital if you're creative and smart enough to figure it out. But that's not my point. Wether there's keylogging going on or not bottom line is you should not be going to sites that are not business related. PERIOD. If you do, you're asking for trouble. IMHO. BTW, their internet filtering appliance does log every site visited so it would be real easy for them to look at the log of most visited sites and just simply block any of them that aren't business related.

Also, I started laughing when I read the part about phone monitoring. With their current phone system that's in place it's not possible to do it. Also, if I'm not mistaken, it would be a crime to record employees converstations without them knowing about it.

Anonymous said...

Obviously, the phone system is not your forte. As for recording and legality? since when did e$$ent care about legality, I'm sure just like NIXON, It's ok as long as you don't get caught..

Anonymous said...

It is possible to record conversations on that telephone system. You can go to radio shack and get that equiptment.

I know. I've done it.