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.


Anonymous said...

How 'bout a community hospital owned by the community. I know that I'd treat it better if I owned a stake in it.

Anonymous said...

But would Lamar County step up to the plate?????? Doubtful at best, we still have too many "old schoolers" that would prefer to keep the money in the county coffers and NOT pay their fair share. It will take a much more PROGRESSIVE group of individuals to ensure that a community hospital would be to our benefit and would effectually deal with the needs of our community. Progressive being the key word here! No Bubbas, no good 'ol boys, no Pinkie's!!!! Professional,progressive and VERY adept at business!

Anonymous said...

Not a "city", or "county" facility, but one that is owned by individual investors (spelled e-m-p-l-o-y-e-e-s and p-h-y-s-i-c-i-a-n-s) and those who wouldn't mind investing in the community of Paris. It would still have a responsibility to make money, but if your money is at stake, you would probably take more interest in the efficient running of the hospital.

Yes, if indigent care is offered, the county would have to dig out some of those dollars, but I think that a different functional structure of treatment could mitigate the number of non-emergency ER visits, which suck money out of any hospital.

Anonymous said...

Businesses relocate to areas because of the infrastructure, one part being the availability of medical care. They also take it into account when they consider leaving.

Why not let them invest in that portion on the basis of self-interest? A move has a heck of a price tag associated with it. And if they can profit from altruism, more power to them.

They also supply more than just money--how many times have you talked to someone who had rotated through Paris as management that is retiring back here because of what they experienced as a member of the community?

We have untapped resources for a board that might have the business sense to keep us lean and in the black.

Anonymous said...

I don't think a for profit hospital is what we need or want. I may be showing my age here, but does anyone remember when doctors were doctors, and not business men? I miss that. Do you remember when nurses were nurses and not business men? It seems like we have lost touch with what is important.

Even if we had a non-profit hospital, and the CEO gets bonuses, it still hurts staff and patients, because they spend all of their time on how to save a buck, instead of what's important. Giving back, and making improvements.

Even if we take back the hospital, and make it community owned, there will still be greed. I'm not sure what the answer is, but I do know, that I did not choose nursing to get rich. I chose it because I like helping people, and I can make an honest living doing that.

I don't want to come to work everyday, killing myself for 8-12-16 hours, and still feel like I've done a bad job, because I have had too many patients to take care of. It's demoralizing. It's depressing.

Is there any hospital out there anymore, where you come away knowing that you have done a good job?

Anonymous said...

A not-for-profit might be able to take over in a purchase situation, but, the attitude that was prevalent under Christus was that of waste. That attitude made it so unprofitable that they had no recourse other than shed us. And, if the attitude returned, it would happen once again.

A good for-profit in which the administration is local, rather than out of city/state can be far more responsive and be talked to directly. No more 'up-channel'ing requests.

If the employees are vested in the entity, there is more attention to detail by all concerned.

Medicine changed in the '80s, with DRGs. We have no choice but to change as well, unless you are independently wealthy.

But, it has been done, and, with the proper commitment, we could make it happen here.

It couldn't have happened two years ago, but now we've experienced what a true MBO (Management by Objective/stick) corporate team is like, I'd say that there is far more motivation.

Anonymous said...

I know a neuro-surgeon that was actually thinking that opening an office here might be a good thing. He has enough referrals from Paris to make it worthwhile. ...but not while Essent is here....

Anonymous said...

Quote: A good for-profit in which the administration is local, rather than out of city/state can be far more responsive and be talked to directly. No more 'up-channel'ing requests. End Quote.

Well we had a local Good Ol'Boy and he ran it into the ground and didn't listen to anyone but his cronies. Obviously, having out-town-management isn't any good either (especially as one person commented to me--in Tenn. it's still legal for brothers and sisters to marry!)
But we do need an Admin that will listen and does care and is right here, a part of the community. But please no more Good Ol'Boys.

fac_p said...

When an administrator is collecting $600,000+ per year, one would expect a better class of administrator. Monty's most flagrant forays seemed to occur under Christus. Larger organization, less control....

If the entire hospital is vested in the operation, not just the retirement, wouldn't you expect that the "Customer" might have a bit more meaning? Same with the community?

I've seen organizations in which unprofitable divisions were taken private and were totally turned around. Not here, obviously. But, it has been done. But, it takes a 'leader', not a 'manager'.

Anonymous said...

The good ole boy system won't work.
The out of town system won't work.

If the local doctors took control think about this,

The local doctors voted out the Trauma designation due to the increase in call, and the money, or that is my understanding, please correct me if I'm wrong, I don't understand.

It was also my understanding that it would bring a million dollars a year to the hospital, + training for doctors and nurses, and you must maintain a certain level of education to keep your trauma designation.

To me its better for the hospital and the community. I had heard from one doctor, that we could not be a trauma designated facility because we didn't have enough money.

But ETMC Clarksville is a trauma designated facility, and that is a much poorer community than we are, But they do have a good system backing them.

I'm curious to know the politics surrounding this issue.

Anonymous said...

Talking about a community owned hospital, are there any out there still surviving the Medicare/medicaid crunches. I wonder what the stats are on that. I'm not being negative, just curious.

I know Red River General in Clarksville could not survive it and sold to ETMC.

fac_p said...

There is a difference in a city/county facility, and one that is owned by the community.

A city/county facility has no real incentive to do better. The employees are employees only.

A facility that is owned by the community has employees that truely associates--vested with self-interest in the course of the enterprise. When the hospital does better, so do they.

It is a business plan that is injected with humanity. The current environment seems to be attacking that like a virus.

Anonymous said...

It would be nice to have 2 hospitals again. It would be nice to have one for profit, and one not for profit.

Maybe if we had a nice one, and one that was not so nice, more people would have incintive to get insurance.

This was posted onto an archive--I thought that it might be appropriate for this as well.

Anonymous said...

I think until the inevitability of having NO HOSPITAL hits, will something be done. Until then, we can cuss and discuss all we like. We are seeing this situation with Essent become more grave on a daily basis. They will take it to the bitter end. We truly have concerned, skilled and professional individuals here in Paris, but it will take a great deal of courage and intestinal fortitude to get the masses moving on this issue. That,in and of itself, is a monumental task. Again, I know I'm being redundant here, it will take a GREAT deal of LEADERSHIP to motivate this community. Fear is a great motivator, when we are on the verge of having NO HOSPITAL, then I think, wheels will start to turn and quickly.