Thursday, November 23, 2006

Hard Questions...12/16

Last year, Merrimack Valley Hospital lost $87,205. They have been an Essent hospital for how long? Since 2001.

In retrospect, the first hospital (Crossroads) that Essent bought lost money for all but one year (out of five.) From the beginning, they put serious money into the hospital, but like the Titanic, it just kept going down.

Nashoba Valley made $537,676 last year, approximately the same percentage of return on their gross as PRMC. But, their Return On Investment (ROI) is far better, as the price was only $11M. They still have a little over a year to commit an additional $16M in improvements or a new structure. While ground-breaking for a physician's office building has occurred, we'll see how an actual replacement hospital shapes up in the next year. Kind of waiting until the last minute...maybe hoping for an exception to be granted? Or was the timeline on the new hospital completion left open--sort of like the lawsuit by the gay couple....

Sharon Hospital seems to be the cash cow of the organization: Approximately $3.7M from a gross of $98.5. And they got it at a price lower than that of NVMC ($16M outright and $8M more for improvements)! Guess it was worth waiting for--despite assuming liability for a toxic waste dumping problem in NY.

Paris had a total revenue of $363,370,383...yet only made $1.6M over costs. Maybe it's all those locums?

Southwest wasn't in the mix, but lost almost $2M. I imagine that there were some changes.

It should be interesting this year, since the cost reporting period is over and the figures should be posted soon. For those interested, is the website.

My questions are many, but here is the predominate one: Do they really expect to turn around a hospital with some paint and TVs? That isn't the problem, but let's see what happens....

Friday, November 17, 2006

Your Comments are Welcome...12/15

It's hard not to hear the comments when you mention that you work at PRMC. I've heard of more incidents involving patients in the last year than in the previous six. Some have been relatives, some have been the actual individuals. E-mail them or if you want it as a comment, just comment. This is one forum in which complaints are asked for, and not swept under the rug.

Additionally, if you have a complaint in general, this is seen by Essent corporate at least once a day, most days six or seven times. Some execs even check it after hours. Trust me on this one. They are very aware of this blog.

If you mention that you don't want any identifiable information included, but in order to make the point to me, there are certain 'tells', that's fine. I'll use what I can, and if it can't be told without identifying you, then I just add it to my understanding of what we are facing.

I was asked why radiology was a hot-button issue here? You go with the gold. The topics with radiology were producing more comments than anything else. One post got 77 comments (and the comments are the best part!) If nursing was commenting more, we'd probably have a broader mix. But with RRVR even making the Paris Snooze, you go with success. There has only been one other that has been better (104), and that was a physician lambasting the medical community for sitting on its hands. Got to admit, there aren't too many that draw that kind of attention.

I will have some financial data a bit later, dealing with Essent's balance sheets. We will see how those go over. Just a few of the basics. All public domain, or subscription, but immediately available to the public for verification.

Monday, November 13, 2006

For the Beancounter in You...11/29

I guess I was too harsh on the bean counters, since I did get several replies defending their honor. A few observations were made that need the light of day, as to why Essent and Paris weren't the right mix:

1. Essent didn't have the assets to be able to swing this large an endeavor. They were very exposed coming into this deal, partially because of a poor evaluation during the 'due diligence' period. They had no idea of the magnitude of what really needed fixing.

2. Short term goaling. Corporate put them on a fast-track schedule, with milestones in the monthly/quarterly timeframe, rather than planning for the long haul. Sort of the difference between Japanese and American corporations: Japanese take a longer approach, while American corporations are more instant gratification driven.

3. Lack of real understanding of the politics of the situation.
They had no real concept of the animosity between the "Holy House" and "Big Mac" crowds, and how it actually impacted Paris healthcare. (Note: the quoted descriptors were not mine, but they seemed to illustrate the point....) Additionally, the dynamics of the physician groups that had formed were foriegn as well.

4. Inability to adjust to the situation. Despite descrepancies in their conceptualize viewpoint and reality, they insisted on staying with the original plan and milestones, forgetting that feedback, adjustment, and re-evaluation are important steps in a project.

5. Mis-evaluation of the area's labor pool. In metro areas, there is always a supply of staff, due to the population base. But, in the Paris area, there are a couple of fallacies in that equation: There is a smaller population and limited draw to the area. The metroplex pays far better. Why drive the same distance to one and get paid less? It's like what put some of the nails in McCuistion's coffin: A Dallas-based management team that assumed the business climate was the same as the metroplex, and implemented policies that drove away their physician tenants.

And the result? Patients are leaving in droves. Shuttle bus services to Texarkana, Tyler/Longview, and Dallas are having to buy more vans. (Maybe Essent invested in those!) Services and procedures that we could previously count on are here no longer.

All we get in return is a visit from a military dictator, who meets with the hospital CEO--probably sharing tips....

Sunday, November 12, 2006

Turf War...1/9

What's happening in the so-called war between out-patient radiology and "Red River"? Seems as if the imaging center wins by default. This is not an exclusively Parisian situation, but it does impact the financial health of the hospital.

Typically, studies help spread the fixed costs of a department. When the number of studies for the hospital day shift is only 50 or 60, the result is a net loss per exam. Right now, they should be coming into their heavier census period, but if out-patient studies continue to go down, that won't help them.

What is the solution? For Essent, the automatic solution is to cut staff, one of the largest costs. How does that affect the new graduates appearing in December? It can cut in several direction: Hire the top guns in the new class, paying them entry level, and raise the performance bar to the existing technologists, hoping attrition would create openings and lose some of the higher paid staff? Or not hire any FTEs (Full-Time Employees), merely keep a supply of PRNs on tap to fill the peak periods through May. Or, just cut staff.

However, the solution may be taken away from them. The new class has been working in several different clinical settings, and has seen the differences in facilities. They might opt out of the PRMC setting for other markets, should that be viable for their situation.

Friday, November 03, 2006

Say AAAHHH....11/15

We're all healthcare professionals, aren't we? Okay, except for the beancounters, I mean. Which means we come to work, sick or not.

Personally, I hated going back to designated sick days--PTO was the best incentive to make it in no matter what...that way I could tack on a few extra days to a vacation that otherwise wouldn't be there. For Christus it was a good deal, they had less unplanned absences, which meant better staffing effiency.

Retrogressing to sick days opened the gates to people taking un-planned-for absences, rather than scheduling time off. Essent's new policy is slap in the face to anyone with children, an ill spouse, or chronic conditions which keep them from building up a surplus of sick days.

The policy (amended this month) is that in order to be paid for a sick day you have to have forty hours of sick time accrued at the time of the call in. To be paid on the second day if you are sick you have to have twenty hours accrued. So, if you have an extended period of illness, come back to work, and have a relapse--you won't get paid for the first day if you don't have a week's sick time banked! If you didn't have at least half a week, you wouldn't get paid for two.

I have plenty, but I know several people that this would knock to their knees. I would venture to say that the northeast doesn't have to put up with arbitrary B.S. like this--because of the union contract. I can feel myself drawn to the dark side....