Saturday, March 18, 2006

Management Strategies--3/25


You can catch the original comment (see Hud and bud), but this is the way things seem to be going.

"This is just the tip of the iceberg. This type of madness will continue and will affect all departments of the hospital. When Essent has finished its departmental cleansing, then we will really see the animal for what it is (We've had a small glimpse, so far). Money mongering at it's best. Healthcare here in Paris will be non-existent. The only way it will change is if the Doctors assemble and finally do something.....like another hospital. Again, we will be faced with a healthcare split, but perhaps it would be best. Sometimes ashes do present a better model by which to work with. And then, maybe,this community can begin to have effective healthcare, with employees that hold their heads, principles and profession high. Without pride in one's work and the employer they work for, it is an ever descending maelstrom of discontent, and ineffectiveness.

The bans have been hung by Essent, and they portend disaster. And NO ONE who currently works for them, OR the community can avert the inevitable end result. The powers that be in this town should be hanging their heads in shame, as they are as greedy as this corporation. For the sake of the almighty dollar, they too are as guilty as Essent in my opinion. So when our local people start the handshaking, and asking for votes, they need to be reminded of their actions. Somewhere, there has to be someone who, in a position of power, will take the forefront, and actively try to end this travesty. But, that too, is never a popular position to hold. It will take a person, or group of individuals with a great deal of wherewithal and courage to make a stand. But, should it ever begin to happen, I think it will be a heavily supported endeavor...much to the dismay of Essent. Money can only buy so much loyalty......and I don't believe Essent has deep enough pockets to take this to perpetuity. Let's hope not anyway!"

As to the money issue, this is probably under scrutiny. When investors show at a location, they're probably concerned--greatly concerned!

60 comments:

fac_p said...

A pretty perceptive question was asked: "I heard that the PRMC board of directors when under Christus got paid nothing, but under Essent are receiving a salary which may be why they seem so reluctant to change anything. Do you know if this is true? If so, how much are they being paid?"

Another had been funnelled to me, earlier, dealing with a board member. The "coach", after noticing that a RR billing notice was still (one or two days after the split) posted in radiology, threw a hissy-fit about it still being up. He wanted taken down immediately!

When someone reacts that badly, they generally have something to hide...and which group decided to accept a lower offer to keep their own positions? HCA's bid was higher, but the board would have gone bye-bye!

Anonymous said...

Sometimes, the only way to make a change is to fire all the happy people. I haven't got a thing to worry about!

Anonymous said...

Aah the "coach". If you could buy him for what he is worth and sell him for what he thinks he's worth you'd be able to retire and tell Essent to kyb.

Anonymous said...

Maybe a service was rendered: You vote for us, we'll pay you for your 'service'......how 'bout it, Gene? Like to keep your name up front?

Anonymous said...

so basically all the dr need to finally join together and build their own hospital or take over the north side and when essent looses all their business we can tear down that nasty south and build a hospital to suit the needs of the nurses such as the nurses station and to suit the patient b/c after all patient care is what we would be all about

Anonymous said...

It's going to have to be: build the hospital. And E$$ent would be kicking, screaming, and litigating to the bitter end. But, they are an ill that can ill be borne. This is a case of physicians healing the community, not just the individual. A pandemic has struck Paris, and greed, your name is E$$ent.

Anonymous said...

Advisory: Change to Texas State Law Affects Plan Sponsors
Posted on January 30, 2006

This is an advisory of new statutory requirements in Texas which require certain fully insured group health insurance contracts covering Texas residents to continue health insurance coverage through the end of the month in which notice of the termination is provided to the insurer. The employer plan sponsor is responsible for 100% of the premium payment from the time the employee loses coverage to the end of the month in which the employer provides notice to the insurer that coverage is no longer available.

--------------------------------------------------------------------------------

The Law applies to the Following Plans:
The Law DOES NOT apply to the Following Plans:
Self insured plans, and;
Indemnity dental plans
Effective Immediately
Clients of The McCart Group offering group health insurance to employees (and dependents) in Texas should be aware of a recently enacted law imposing notification and payment requirements on them. Recently signed into law by Governor Rick Perry, this new statute requires certain fully-insured group health insurance contracts covering Texas residents to continue health insurance coverage through the end of the month in which notice of the termination is provided to the insurer.

The employer plan sponsor is responsible for 100% of the premium payment from the time the employee loses coverage to the end of the month in which the employer provides notice to the insurer that coverage is no longer available.
Under the new law, plan sponsors of fully-insured Preferred Provider Benefit Plans (PPO) and Health Maintenance Organizations (HMOs) with covered employees (and dependents) in Texas must:
Pay 100% of the cost the employee’s premium for the plan for coverage from the time the employee terminates from the plan (typically at employment termination) to the end of the month when the plan sponsor first informs the insurer of the employee termination from group coverage
Maintain coverage under the policy from the time of termination to the end of the month when the plan sponsor first informs the insurer of the termination
The McCart Group urges its clients with insured employees (and dependents) in Texas to:
Implement immediate steps to ensure prompt notification of coverage termination to their insurance carrier(s);
Work with legal counsel to amend plan documentation, including the plan’s summary plan description, to reflect the change, and
Issue a summary of material modification of the summary plan description advising all Texas participants of the change.
Clearly, the sooner employers notify insurers of coverage terminations the better. Under the new law, Texas employers are liable for 100% of premium payments until the end of the month in which the employer provides notice to the insurer that coverage is no longer available. Implementing procedures immediately to ensure notification to insurers within 24 hours of a coverage termination (including termination of employment) will result in health insurance savings.

EXAMPLE:
Assume an employee experiences a qualifying event on January 12, 2006. As a result, the employee’s group health benefits terminate on January 31, 2006. The HMO medical plan is subject to Senate Bill 51 while the indemnity dental plan is not. If the plan sponsor provides notification of the coverage termination on January 23, 2006, coverage under both the HMO medical plan and indemnity dental plan will terminate on January 31, 2006. However, if the carrier is notified of the coverage termination on February 3, 2006, the employee’s medical coverage must be extended through February 28, 2006, while the dental coverage will terminate on January 31, 2006.
You may review the new Texas law at http://www.capitol.state.tx.us/cgi-bin/tlo/textframe.cmd?LEG=79&SESS=R&CHAMBER=S&BILLTYPE=B&BILLSUFFIX=00051&VERSION=5&TYPE=B
This notice is offered as an advisory service to clients of The McCart Group and for information purposes only. It does not constitute, contain or convey legal advice. The information in this notice should not be used or relied upon as legal advice. Readers should consult counsel for specific advice.
Fully insured medical, dental and vision health maintenance organization (HMO) plans, and;
Fully insured medical and vision preferred provider organization (PPO) plans


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Anonymous said...

I can't see the Doc's taking a back seat to Essent after having built their practices over the years. Why would they consider flushing everything down the drain, simply because Essent is such a green beast? They have spent years servicing this community, and moving to Dallas may be incentive for some, but I think for the most part, not for all. Protection of your assets is inherent in all of us (even the "bad guys"). I truly believe, that behind the scenes, a movement has or will be started. Think about it, without the Doctors (let alone staff) how will THIS hosptial function? Not to mention, there aren't too many Doc's I know, that haven't got a true appreciation/care for their patients. It's all about relationships, and Essent can't even spell the word, let alone safeguard it!

Anonymous said...

I really don't see why the docs personally would want to take this on. I know they have a personal stake in this, but, it is a tremendous burden.

I mean think about it, they are all ready on call, and spending most of their day trying to run their practice, and take care of their patients with no time with their family. Taxes and malpractice insurance already eat their lunch. Why would they do it? I wouldn't.

Anonymous said...

MAYBE THEY ARE REAL DOCS AND CARE ABOUT THE PT!

Anonymous said...

Essent hasn't learned--or has forgotten: If your primary purpose is the money, the people, both patients and staff, get lost. If your purpose is the people, they can tell, and the money will come.

Right now, people in that hospital are terrified of saying the wrong thing. On pain of termination, the unwritten rules in an unwritten guide are their nemesis. And Andrew can't fathom why people throw rocks at him? I guess everyone is moral in their own mind, just not in that of others.

Anonymous said...

Anonymous 4:04,
Because they can treat the community, as well as the individual.

They are already involved to a large extent--how do you think they feel about the current situation? Increased post-op infections, spreading MRSA, poor nursing coverage, and an administration about as responsive as an anvil.

When you are hospitalized, what is the first question that's asked by your friends, "Who's your doctor?" The second is, "Why did he let that happen to you?"

Anonymous said...

Da--, look who was missing from x-ray this weekend--heard he got canned by AeroFit????

What the h_ll is going on here? No one is talking, everyone is scared, and temps rule supreme!!

Anonymous said...

Ok, I know we have some good docs that care about their patients.

That's not the point. The point is, alot of these good docs, voted out the trauma designation, because they didn't want to be overburdened with the extra call, not to mention the freebies they have to do from the pts without insurance, or that is my understanding.

Please correct me if I'm wrong. I really want to understand. That would have brought in an extra million to the hospital per year, not to mention sooooo much extra equiptment to the ER.

If they don't want to take that on, why would they want to take on buying a hospital.

I'm not being negative, I'm being a realist.

Do the doctors really cooperate with each other well enough to pull it off anyway?

And, think about this----most of the doctors, I would love to have as an employer, but what about the abusive ones. Think of having them as your boss.

Ok, flog me if you must. Just my thoughts on the situation.

fac_p said...

Anonymous 4:12
I will leave the comment intact, but Essent is self-insured, with UMR administering. Does not apply.

fac_p said...

Anonymous 4:12
Essent is self-insured, doesn't apply, but good post, since this isn't just about the hospital.

fac_p said...

As to the physician owned hospital: I'm not saying that a physician has to administer the actual day-to-day, but more involvement would probably be good.

With any corporation, the administration serves at the pleasure of the stockholders, even Essent. A privately held corporation is fine--when you are part of the holders. We're just at the wrong end of the stick.

That's why an employee-owned facility might have more going for it. It would definitely change the tone.

Issue stock--fixed amount--based on the initial investments. But, also stock to employees. Use it for retention, initial hiring bonuses, as well as a buy-in for them. Don't do any dilution initially, until the value can support it, stay with using buy backs as folks retire, terminate, or investor buy-outs. But, to work, you have to be at least a minority stockholder.

Use the concept with a 'boutique' hospital initially. By the time you were in business a year, PRMC would be up for sale, if not sooner.

Welcome the competition, if someone actually tries it. It makes you stronger. If they don't, try for a purchase of the north campus in a break-up sale. Same concept implements there...everyone puts more into that which they hold an interest.

Obviously this is bare-bones. The submission is garnered from a couple emails and probably could (and should) be bumped into a post on its own.

Downside:
Time. It wouldn't be a quick fix, but in the long run it could be the best for Paris.
Money. It has to be attractive to investors, either private or corporate (Thomas Cressey, maybe?)
Dedication. It is going to take some visionaries that are willing to invest themselves in the project.


Upside:
Involvement. It eliminates the union involvement (split personality, anyone?) and it has the benefit of getting more people involved. Two opposing forces make less headway than when you're all going in the same direction.
Stability. Once in place, it eliminates the corporate see-saw that we've had.
Quality. How does one measure it? Everyone knows when they've experienced it. We don't have it now, and in healthcare, that's unacceptable. If this was implemented, you would be beating off prospective employees with a stick, rather than sticking it to the current survivors with temps.

We don't need complaints, we need solutions.

Anonymous said...

I have never really had a doc be abusive to me, I just tell them not to treat me that way, hang up or walk away. So far this has worked every time. They know they can not work w/ out us.

Anonymous said...

Kudos to you fac_p for the 11 AM post! Bonafide thoughts that get people to think about it and then keep the ball moving! If it takes the employees AND Doc's working in tandem, GO FOR IT! Any community (laypersons and professionals alike) who have a vested interest in something, will (yes slowly) progress. We already have the tools with which to work with both professionally and business wise. I would much rather fight these carpetbaggers with our OWN people than subject ourselves to another for-profit buy out, or a union! Granted, it may not be the fastest solution, but I think most of us in medical would welcome the chance to get this problem straightened out. I for one would be willing(due to investing in something like this) and more than happy to look at the long term, as opposed to NOT GETTING A RAISE FOR TWO FREAKING YEARS, and being told how crummy an employee I am. If I am part owner, you bet your bottom dollar I would strive to ensure it's success! From simple seeds, great oaks are sown!!!

Anonymous said...

Annonymous 11:05

I think abuse is a matter of opinion as well, but yelling at nurses in front of patients and staff, (and not for any wrong doing, just out of frustration for being woke up, or difference of opinion between the doctors), and throwing things, to me is abuse.

I may even understand their frustration, but I don't want to be a sounding board for it. I get to be sounding board enough for patients. Some of the doctors take out their frustration on the nurses on a daily basis.

As to incorperate the hospital, it sounds really good, but here are a few ideas to consider as well.

The stock holders/board members may expect triage, due to wealth and power instead of ABC. The wealthy, as always have the advantage.

The country club in this community is owned by the stock holders. It doesn't seem to get any more respect by the members for it. They have accumulated massive debts, no one ever gets a return on it. Some of the board members pull ranks on issues because they can.

I know I sound negative, and I'm not trying to. If Paris ever did incorperate the hospital, I just want people to think ahead on it, and put some safeguards in place prior to starting up.

I thought about this, a community insurance type of thing. I really don't know how to express what I'm thinking, other than a way for people to pay insurance to the hospital, in return for care. Dr. Wilkinson in the ER had shared this idea before, and maybe someone could get him to elaborate. It really sounded like a good idea.

That way the community could truly own the hospital.

Anonymous said...

Let's see, Joe Pinion V.P for E$$ent left several months ago... now Hal Andrews... You think somethings up? I guess waiting for the stock options for this sinking company isn't looking so good after all.

Cogent taps former Essent exec for corporate development posted 21 Feb 2006:
Hal Andrews, former vice president of development for hospital owner Essent Healthcare Inc. and attorney with law firm Waller Lansden Dortch & Davis has joined Cogent Healthcare as a senior vice president of corporate development.

nashvillesnews.net

fac_p said...

Hmmmm, Hal bailed before Sept05, because that's when Greg Schonert took his spot. Went with Heritage. Now he's back in his old position with a different company, Cogent. Either he mucked up (buying PRMC, for instance...), or was desperate to get out.

I can't find a reference for Joe since the beginning of last year.

Anonymous said...

Whant happened to Bill Heburn, executive vice-president, operations? Is he still with Essent? He was the first PRMC CEO.

Anonymous said...

What about if we could buy the North Campus, and have each doc buy thier spot, or each group of docs buy thier spot.

Say a group went in, and bought the ER. A group went in and bought peds, etc.

I wonder if that would work. It wouldn't feel like this massive undertaking. It would be one group working for thier needs, one step at a time.

Anonymous said...

I just posted, and I had a few other thoughts on buying up the North Campus bit by bit. Just brainstorming, I have no idea if it could even work.

But, the doctors could choose their own staff for their particular area.

Then their would be no floating. Good deal. The doctors and nurses would be choosing each other, and no robbing Peter to pay Paul on the staff.

I'm not sure how it would work for governing bodies though. I'm also not sure how it would work if ER had a group, and wanted to admit a patient, to another group etc... also, not sure how it would work for grants and monies given to a hospital body etc...

Anyway, just an idea, and who knows, Paris could actually be put on the cover of a magazine for trying something out of the box.

DamnGreatNurse said...

I've been following this blog for a while now, and repeatedly comments about "float" nurses come up that bug me!
I worked "float" or "flex" for years, starting when it was St. Joe's...I learned every floor, all the staff, every procedure needed to take care of my patients and keep them safe.
This made me very efficient, I didn't have to ask many questions or delay care while I tried to figure things out.
Floors that would be short-staffed WOULDN'T be, and you and your family member would be taken care of!
The group of nurses that chose to work float might get paid a bit more, but we EARNED it by all the extra things we had to know and do.
Now PRMC/ESSENT didn't "NEED" the float pool, and we've all moved on to other things...and PRMC is staffed with "loaner nurses" that don't know jack about PRMC and Paris, and couldn't care less.
Now I've had my say, and I'll be back when whoever decides to run this hospital well calls me back, because I want to treat Paris first!

Anonymous said...

To those physicians who continue to remain silent ... To those physicians who continue to remain silent about what is going on at PRMC... I say shame on you! E$$ent and folks like J.R. may have a Teflon coating, but you are just as liable and responsible for tolerating what is going on inside these walls as they are... if not more so.

This is precisely the time one must remember when you took the Hippocratic Oath:

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

…or were they just words to suit the moment?

Do you think that E$$ent will support you when the walls come crashing down? When the lawsuits start? Will they even be here? Ask Wentzville, MO.

The doctors in this community MUST put aside their trivial North/South differences. They might have had value prior to the merge, but at this point, the pathetic political tirade has gone on long enough! We all lost! Soon, none of us will have a place to practice medicine! Is that what you want...

Anonymous said...

If doctor groups took a piece of the North Campus, think about having it your way.

You could run your unit, the way that you want to, within your money constraints. The only limitations would be your partner decisions that you would have to agree on, and government regs.

The nurses that work for you, are the ones you hand picked, and are willing to work with you. They would know the way you wanted things done.

Anonymous said...

Hey Damn great nurse,

I'm not saying anything bad about float nurses. If that's what you want to do, more power to ya. I did it to when I was fresh out of school, and I did learn alot.

Now that I'm older, I don't want to. I have a couple of areas that I'm comfortable with, and I don't want to float anymore.

It can be a dangerous situation too, depending on the nurses background and experience. Sometimes not knowing that you don't know something can be killer.

Like I said, I'm not downgrading floaters, but most people don't want to float out of their comfort zone. I know I don't want to be forced into it. If you do it by choice, and feel comfortable with it I think that's great.

Anonymous said...

I don't think anyone is dogging float nurses.

Most nurses just don't want to be forced to float.

I haven't worked the floors in 10 years, I've been in specialty areas. The last time I worked the nursery, the babies were laid on thier bellies. Do you want me to float to nursery?

What about the nurse that has been in the nursery for the last 10 years. Do you want her working your heart attack?

Anonymous said...

Regarding the 8:22 PM post:

I just don't understand blaming the doctors. The problem is NOT the doctors. The doctors usually know the solution, but the problem is that E$$ENT DOESN'T LISTEN. Why do you think this web site exists? If E$$ent listened and took actions based on listening to doctors and nurses do you think this web site would exist?

Go back and read the very first post from 3/10/05: "I tried to put in a suggestion when I was visiting, but there weren't any forms...guess they know everything...."

Has anything changed in a year?

Not only does E$$ent not listen, but if you speak your mind, you're fired!

From a doctor's perspective, you don't want to be considered "negative." Doctors have a responsibility to maintain hospital privileges to continue to be able to care for patients in the hospital setting. The truth is that anyone can be replaced and E$$ent knows it. PRMC lost their radiologists, they'll get new ones. Anyone at any level is replaceable.

I just don't believe there is a North/South mentality anymore. I truly believe that the doctors want what is best for Paris, Tx.

fac_p said...

E$$ent isn't going to piecemeal sell off anything that would generate its own competition. It would have to be an all or nothing.

The only possibility of an asset breakup would be a bankruptcy sale. Then properties would have a greater likelihood of
being split. But you have the creditors to deal with.

The greatest expectation of success would be the creation of the "boutique" hospital, with a local--or mostly local--capitalization. It would jumpstart a pull-out.

Leland Medical (Plano) has invested in several hospitals of this type in Texas and has a pretty good website (http://www.lelandmedical.com). I'm not saying that the interest would even be there, but it's an example.

Anonymous said...

Ok fac_p. Start fessing up. I went to the Leland site, and it shows that we were supposed to have a facility open up in Paris in 2004.

What's the scoop there? You must have some info about that, or you wouldn't have directed us to that site.

Why didn't the hospital go up, where was it supposed to have gone up?

Anonymous said...

8:22 post,

The person that was blaming a doctor, I think was obviously a doctor himself. Probably one that feels like he's fighting alone, or that some of the doctors are looking the other way, and not fighting for what's right.

It's just too much easier on yourself to not make waves.

I don't think they could take a doctors to loose his privledges away over differences in opinion. Essent does not have the stuff hanging over the doctors, that they have on the other employees. The doctors do have a voice, they could get something done if they took a stand.

The ortho docs could take a united stand, and Essent would have to do something. Who do you think would jump right over to Paris to replace them?

They could do something. The ortho docs, have got to be in an uproar with the pacs system.

Anonymous said...

If I'm not mistaken Texas has placed a moratorium on building new Dr. owned boutique hospitals.

fac_p said...

http://www.lelandmedical.com/overview/frame.htm
frame 10 of 71

Interesting, don't you think? This was prior to Essent.

Let's jump back to the north/south issue: The feelings are still there, and the passive/agressive behavior towards the medical community has to go away, as does Essent....I don't like to name names, but.....

Anonymous said...

fac_p, I'm starting to get frustrated with you. It's like trying to solve a puzzle with some pieces missing, AND YOU HAVE MY PUZZLE PIECES!

Ok, so Leland was going to buy us, but Essent got the bid. It almost looked too good to be true. If you had a hospital like that, and PRMC, people would be beating down their doors to get insurance so they could go to the Leland hospital.

Anyway, back to the puzzle of the North and South thing. I know the Pediatricians and OB's weren't crazy about having to go South.

The cath lab had to go south, because they couldn't do interventions North, because the lab was too small, and the interventional equiptment was south, and it was too delicate to move without some massive repercussions. (probably some of RRR's reason to stay as long as they did)

The OB's had to stay North, because they had the equiptment there, with no way to expand the South campus to manage that.

I also know that there were some power struggles, but I'm still missing something. Tell it fac_p. You know there is a way to do it without naming names.

fac_p said...

Leland was not trying (seriously) to buy PRMC. The cardiologists wanted to separate from Christus, to an extent understandable, based on billing, credentialing, and generally attention to detail. They aren’t here to lose money. They were going to build a new facility, Leland was involved. They just haven’t updated their site.

There is a moratorium (2004) on strictly boutique hospitals, but, as I said in an earlier post, it is based on the level of service. You can’t just skim, and notice that all the indicated facilities have an ER—but only 15 beds in the hospital in some cases.

The only reason that the north was purchased was that an efficient, for-profit organization would have dusted south off the map. They overbid to keep out competition because of that. As to why they have things arranged the way they do, it’s not through planning. Heck, south didn’t even really have a planning department (north did, but don’t think they planned for this!)

Everyone came to the same conclusion: A new facility. Doesn’t mean they were right, just means that on that one point they agreed. But, the way this place was losing money, it wasn’t going to happen. Cardiology had a good idea: setup, from the ground up, a new outpatient/surgical facility. For profit, not like Health Solutions (which was only there to juggle out the losses.) (Can you believe they actually charged to manage anything?) But, it might have been the last contribution of straw to the camel’s (Christus’s) back. The threat of losing more insured patients was the headstone on the grave.

A lot of physicians opposed the boutique idea, because of the loyalty to the idea of non-profit facilities—and the nuns. That’s changed. E$$ent is for-profit; and it could use some competition. A new facility could be a mend to the medical community, after sinking Essent.

Anonymous said...

Well, I know the cardiologist from the North Campus--at one time were sending all of the bypasses to Dallas. (I don't know if that is still the case now)

So when a couple of the South campus cardiologist left, there were very few bypasses done at the hospital.

I know some of this caused some tension between some of the doctors. I don't think any of them were too happy at that point due to lack of communication and lack of cooperation.

Is all of that still going on?

Cardiology, and the heart program, is a big money maker. It could pretty much make or break the hospital by itself.

Anonymous said...

I wonder how much was loyalty, and how much was fear of change.

Change is here, we've either got to get it under control, or its going to control us.

Anonymous said...

The struggles for the heart program, I guess in E$$ent lies some of the problem.

If the cardiologist form their own cath lab with a vascular surgeon, it is very possible that PRMC would go bankrupt.
(its probably inevitable anyway)

If the cardiologist aren't cooperating with bringing people to PRMC, there lies the issues. If they are shuttling these people to Dallas for bypasses and interventions then we are loosing money.

So what came first the chicken or the egg?

Did the short staffing, and poor management, make the cardiologist afraid to let the bypasses be done here, Or did the money losses from the lack of interventions, and bypasses cause some of the short staffing?

I guess regardless of the cause, we have got to get over it and fix it.

Anonymous said...

I was at the Leland presentation a few years ago. A Leland facility will not get off the ground (nor will any other physician owned hospital in Paris) for a number of reasons.
Financially, Paris and Lamar county is one of the least profitable places in the State of Texas to run a medical business (whether a hospital or a medical practice).
It takes little research on the U.S. Census Bureau web site to realize that Paris is growing slower than the rest of the state (1.3% population growth vs 22.8%: 1990-2000; has an older population, 18% over 65y/o vs.9.9%, meaning more medicare patients; and is poorer, median income $27,438 vs. $39,927 and persons below poverty 20.6% vs. 15.4%.
All of these factors lead to lower profit margins, greater financial risk and greater difficulty in attracting investors.
Why would Leland, the physicians, or any other investors accept a greater risk for lower return on investment dollars when there are more favorable places in the State to put their money?
The doctors also were less than enthusiastic about Lelands proposal (or in the general concept of owning their own facility) for the good of the city and county as it would inevitably lead to a two tier health care system in the town: any patients with insurance and/or money would want to be treated at the private facility, and would receive top- notch care; all those without money or good insurance (including medicare patients) would be treated at the public hospital (with an abysmal standard of care).

Anonymous said...

I know the cardiologist want to make money, but here is another issue as well.

Would they go to extreme measures to make money? Would they stent occlusions less than 75%?

Here in may lie some of the issues as well. If a manager questioned the diameter of the luman, an arument might occur.

I'm not questioning ability, but there might be a question of ethics, and if there is no one to question the need for the stent, highway robbery might occur.

Looking at motives for actions here, not accusing.

Anonymous said...

Just a question, considering the situation regarding healthcare now in Paris. How would this moratorium affect the possibilities of a boutique hospital for us. We already have patients that are going to other facilities in Dallas, Winnsboro (wound care), Texarkana, etc. AND, these folks are the Medicare/Medicaid patients. Our insureds gravitated a long time ago.

Just a ?, not too clear on the moratorium issue.

Anonymous said...

I feel like I've just tapped into the Pelican Brief. I have a theory here, just a theory laced with some facts, and I will differentiate between the two.

Ok, a while back, there were questions in the cath lab, as to whether or not unnecessary stents were being placed. The director of the cath lab, the one that everybody is dogging now, questioned that doctor about the necessity of the stent.

You are not supposed to stent if the artery is not 75% occluded. The questions of ethics and saftey for the patient came into question, and the director was advocating for the patient.

This is a fact. I saw it with my own two eyes, and heard it with my ears. This is why I have been advocating for this particular director, because he did advocate for the patient, and stood his ground. Now, whether or not the artery was occluded 75% or not, I don't know. I'm not a judger of that fact.

Now here is where my theories come into play. If a doctor were to place stents without a 75% blockage and wanted to do it routinely, he would have to have some cooperation from people who would be willing to let him do that. People who wanted to make more money.

Maybe this is why the director of the cath lab got fired at one point. And maybe this director now, lets things happen that shouldn't be happening because he got into a piss fight with a skunk and lost. Money is the bottom line right? Advancement is given to those who do what the owner wants, and who makes the hospital more money.

So if they had there own facility, couldn't the doctors more easily get by with unecessary procedures, more billing from insurance? Who would be there to question it, if you hired the staff.

Ok, so the entire cath is recoreded on DVD. How would they keep from being found out that they were performing unnecessary procedures? Well its sometimes hard to tell from the cath, so they use an IVUS. I have been told, but am not sure, that they can make the vessles look as occluded as they want to with technique. I'm not sure of that fact. I'm not a cardiologist.

So if you did a cath in Paris and scheduled the intervention, or part of the intervention in Dallas, could that possibly be a motive for that?

If a patient has to have bypass, do the doctors even tell the patient that they can have it done in Paris, or do they tell them they have to go to Dallas. Is the choice being offered?

Anyway, just a theory, don't put any weight on it. It could make a good book.

Anonymous said...

6:57 comment,

I totally understand if the doctors are not interested in being owners of a hospital. It's not my life goal for sure. I'm just here to take care of patients.

Statistically speaking, you may be right. But, I see hospitals, in areas of extreme poverty, doing much better than Paris.

Look at the houses off of 195. There are people with money here. The people with money, don't come to our facility. The ones with insurance goes elsewhere. Why is that?

Anonymous said...

Well we can't blame E$$ent for the fact that the Paris City Council routinely refuses to make changes that will encourage big businesses to build here. I understand that they have had several "lookers" wanting to build manufacturing plants here and were refused. I don't know the whole story, so the refusals may have been for very good reasons, but something tells me they weren't. We need more businesses if this area is to grow at all and having an good healthcare facility is one of the things prospective builders look for. Since we have established that this area is economically challenged, wouldn't it behoove the City Council to start courting some businesses and try to get Paris up to snuff? (Which includes the hospital)
I'd also like to know about the PRMC board of directors getting a salary...have we ascertained the validity of that?

Anonymous said...

8:59 post,

I agree. I do think the Paris city council needs to be looked at. I mean where do they go to the hospital? Are they supporting Paris? Do they go out of town to buy goods? Do they at least try to keep the money here.

When was the last time that they needed an ambulance, or firemen, or help from the PD? Do they understand the importance of saftey and healthcare?

Until these services are needed by you or your family, you don't understand their importance.

Just one more reason that we have to get involved. The powers that be need to be challenged.

Anonymous said...

Didn't see anything on the HIPAA training x-ray just went through. Guess the dancing twins (Mock-Neal) must have been having a cow with the attention generated....

Nothing like having an embarassing part of your medical records displayed for public consumption, is there?

Anonymous said...

Hahaha, yeah, wonder if that infamous teaching file is going to be gone through, patients contacted to get their permission for THEIR films to be in it, so on and so on. ORRRRR, if it will simply be destroyed as it would be proof, AGAIN, that the Director of Radiology doesn't know her foot from a hole in the ground!!! My, my, my, seems as though she is following JR's methods of operation. If you can't dazzle 'em with brilliance, baffle 'em with BS!!

Wonder if the file would be proof positive that MANGEMENT is the major violator of HIPPA laws and regulations. This "don't do as I do, do as I say." stuff is really gonna cost Essent one of these days, and it can't happen soon enough in my opinion. That Ivory Tower needs to be brought down to its foundations, along with all of its henchmen/women!!

Blanco said...

Please tell the rest of us who are out of the loop about the HIPAA training that x-ray just went through?

Also, what about getting people to address the situation with Essent at the next city council meeting? I'm talking having alot of people show up kind of thing...it that possible?

Anonymous said...

Apparently a tech decided to make a copy of a patient's x-ray, a very personal x-ray with a foriegn object visible, for her own personal teaching file (to show to her mother....) She got suspended for a HIPAA violation. Apparently the director, who teaches at PJC during the day (HUH?), asked techs to copy films for her teaching file...and who got the suspension???

Anonymous said...

COME ON I THOUGHT YOU PEOPLE HAD A BRAIN, THIS IS TO BE EXPECTED OF THE DIRECTOR. THIS IS WHAT WE HAVE BEEN DISCUSSING ALL ALONG. HOW CAN ONE BE HELD ACCOUNTABLE FOR SOMETHING WHEN OTHERS (SELECT) EMPLOYEES HAVE NO BOUNDERIES.
IS THIS WHAT THEY PREACH AND TEACH AT PJC?
IS THIS THE WAY THE STUDENTS SHOULD BE TRAINED, IS THIS WHO YOU WANT YOUR NEXT TECH TAKING X-RAYS TO BE TAUGHT, ( MAKES YOU WONDER WERE YOUR FILMS WILL END UP,( ON THE INTERNET), NO STANDARDS NO MORALS.... GO ADMIN. ACCEPTING THIS BEHAVIOR, YOU CONTINUE TO MAKE US SICK.

Anonymous said...

EXCUSE ME, I'M READING BETWEEN THE LINES HERE. YOU HAVE A DIRECTOR, FULL TIME ETC.ETC, WHO IS TEACHING AT THE COLLEGE DURING THE DAY.
DOES THIS DIRECTOR, DIRECT(ANYBODY) AT NIGHT? SORRY, I HAVE NEVER HEARD OF SUCH A THING. DOES HE/SHE GET PAID BY THE COLLEGE?
DOES UPPER MGMT KNOW AND APPROVE OF THIS?
I HAVE A FEW FRIENDS THAT WILL TAKE THAT JOB.

Anonymous said...

What can the city council do? Pass a resolution? Are issues brought up from the floor in all sessions?

It is a private corporation. The only value might be in having it on the agenda--and covered by the Snooze.

Publicity is the only weapon. Public opinion. The only way is to put it out there for everyone. The blog puts it in an anonymous (non-suspension, no-fire) venue that has a continuous message with multiple examples. The only thing that might get as much play is outdoor advertising, but you are limited in the scope of what you can deliver.

Other things might be: calling in dedications on the radio, ads on channel 2, display ads in the advertiser tabloids, bumper stickers, balloons, and T-shirts....

All are relatively cheap, and a mix would give the biggest bang for the buck...but, it still is bucks.

The best is word of mouth, but if you are a PRMC employee, you're fired, so non-employees: spread the word.

Anonymous said...

We sure missed are buddy Scott this weekend.

Anonymous said...

The HIPPA training was NOT for all departments, ONLY for Xray. Due to the film copying that was a DIRECT violation of HIPPA laws and regs. You see, even in a teaching file (the Director teaching at PJC, for the new Xray students) is it mandated that even if the patient info is blacked out at the top of the film. The patient still has to agree and give their consent for these particular films to be placed in a "teaching file". Apparently the "know all, see all" Director of Radiology didn't have a clue as to these rules and regs. Again, a clear case of "dont do as I do, do as I SAY!" Pretty sad when you think of it, management is NOT trained in the sensitive issues with regards to FEDERAL regulations that can cost the hospital major bucks for infractions such as these, but also puts the employee (under threat of being fired for NOT following orders) at risk for fines, imprisonment and loss of licensure.

My question would be, if an employee is given time off for this, why the heck wasn't the Director ADMONISHED in a similar way. Of course, again, this hospital is making major bucks,in the form of kickbacks, from the folks who make Teflon!!

Anonymous said...

What floors me is the fact that Admin as it stands, thinks that by threats of being fired, sent home without pay, and the "We own you, heart, body and soul" attitude will succeed. The hospital grapevine is probably the most active it has EVER been, and with the inception of this blogsite, ANYTHING, that transpires at the hospital will be addressed in open forum on this site. Admin truely thinks that by clamping down on the remaining employees that any and all "bad" press will be averted. Not so, sorry to say. Their proclivity for stupidity merely sets them up under the microscope for inspection by all. We as humans may be slow to learn from our mistakes, but eventually we get it right. But I swear, these folks are REALLY getting boring in their maneuvers........for pity's sake, try doing it right for a change, you might find the rewards are much, much better. And you might save your OWN butts in the process! That is as opposed to being tarred, feathered, run out of town like a stray dog!! But hey, that might be fun too!

Anonymous said...

Well the employee to violated HIPPA is not being punished that much--she is now being trained in CT which is the closest you get to a promotion in radiology.
Eva Braun O'Hara, the director of radiology, has three jobs: director(PRMC), teacher(PJC), and her own little business in Tyler on weekends. No wonder she has no time to do her job at PRMC.

Anonymous said...

Guess that's why she has the support person have her beeper on the weekends--she can't afford not to...