Downsizing.....6/8

Well, either Huddie sold his house, or it got repo'ed. No longer on the MLS, and the listing had a bit to go. Wonder where he and his bunk-buddie are headed? Heard that there are some good double-wides available--non-qualifying, even.
I imagine he was getting a bit strapped--dumping money down the drain does take a lot out of your bank account, and he seems to be doing that here and elsewhere.

But, 'sall good, huddie will land on his feet--wearing concrete overshoes, preferably.

You know, since I placed the pictures of his house on a nationally recognized blog, I wonder if I could get a cut of the commission?

We Won't Get Fooled Again.....6/13

Who? The daffy dux--"Meet the new boss, same as the old boss...."

This past week dux called a staff meeting and stated that there would be no "BMW" at prmc. That is B-itching, M-oaning, and W-hining. So much for giving this guy a chance.

It's obvious now that this guy is no different than any of his predecessors. All he wants to hear is how great this place is and how wonderful e$$ent's policies are.

Let me give you a little advice dux. If you want your staff to act like they are content; make them content. Try fully staffing your hospital and paying competitive wages for a change.

So, guess it's time to go dux hunting.

Patients? We Don' Need No Stinkin' Patients.....6/5

It isn't just the summer, although some might be attributed to that,but we are in serious hurt for patients. Low censusing is hurting everyone--those that had vacation time are dropping it into a big void, and more are quitting because they can't get the hours.

They did the big re-model a few years back on 6th (multi-million dollar), and now they don't have the patients (nor the nurses) to keep it open.

And the 'seen within 10 minutes' that they tout--yeah, seen by the screener. It might be hours before being roomed and seen by the doctor. Emails indicate in some cases 9+ hours from 'seen' to discharge for minor ailments.

Now they're sitting between the proverbial rock and hard place. This year has been rough here--going from $1.6M profit to $277k hasn't helped anyone's attitude, and I got an email yesterday that indicated the radiology department is a ghost town. That would be hard pressed to pay staff, much less depreciation.

The bottom line may be this year. If they can't be profitable, it could be what takes Essent down. Kind of the tail wagging the dog....but it's a tail that has half the beds of the dog.... And, if you read the Tennessean, or the Snooze, Dick is in charge of both of the company's dogs. That mean some over-the-shoulder time with Dux and Mikey? Or just being kicked upstairs to being a high-priced dog-walker?

Think Hud could get funding for another try?...frank

More From MVH.....5/25

Merrimack Valley Hospital partners with Lahey Clinic; Pact may bring Lahey doctors to MVH

Well, that's the story, let's look behind it. The Lahey Clinic has been aware of this blog for a long time. Sometimes three different logins simultaneously. So, after months, they offer to partner...I really don't think that the doctors will be going to MVH, more the patients going to the clinics for follow-up.


It's kind of like a hunter and a salt lick. You place the lick during the off season to get deer used to going there. When the season opens, you know where they'll be...in their comfort zone.

They can see when a hospital is on it's way down, and having a patient base comfortable with going to Burlington and other locations is a way to lock down your bid on the remnants.

Actually, it will probably do the patients a service, but the physicians on staff might have some problems with it.

Kind of funny in a way, a bean counter being beaten by another bean counter with some vision...and it isn't even that original: Advanced Heart has been doing it to PRMC for years.

Meet the radiologists for PRMC.....5/26

Meet the radiologists for PRMC? You might have to do some traveling, but here they are:

Bhojwani, Rajesh, MD
Casey, Sean, MD
Cho, Parina, MD
Davis, Steven, MD
Elsass, Kelcey D, MD
Evans, Gregory, MD
Farley, Faith, MD
Hande, Rashmi, MD
Liou, Wayne, MD
McDonnell, Kevin, M.D.
Melotti, Michele, MD
Narvaez, Gil, M.D.
Nicell, Donald, M.D.
Ozmun, Richard, M.D.
Packer, Jeffrey, M.D.
Parshad, Suleka, M.D.
Pendarvis, Raine, M.D.
Radanovich, Raymond, D.O.
Sauborn, Daniel, M.D.
Shaffrey, Julie, M.D.
Strong, Benjamin, M.D.
Theoharis, Jennifer, M.D.
Tobin, Katherine, M.D.
Turner, James, M.D.

When I say traveling, I do mean that literally. None live in Paris. A while back, someone commented that RR could be reading from Chile...could be, but the same radiologist could be reading from his office here. There is a world of difference.

He knows his techs, knows the equipment, and has the background for knowing which way to step off in a questionable call (if it is pathology, machine characteristics, or operator.) All the on-line folks just error to the "questionable, recomend additional tests...." dictation. And their in-house locums do the same thing.

I think that it is interesting that PRMC would pad their physician list with "virtual" radiologists who have never set foot in our hospital and have probably never heard of Paris, Texas. Yet here they are listed as proud members of the medical staff....frank

SA Data Center.....5/19

It would seem that Christus is doing fine. With the Essent data center moving to MA, it would seem that there are a few TX IT guys that could use the work....

Hospital chain to build $21 million data center
Another data center is coming to San Antonio.

Christus Health bought 10 acres in Westover Hills near San Antonio and plans to build a $21 million, 43,000-square-foot data center, which will have 50 employees. It also plans to expand the data center in 25,000-square-foot increments as necessary in the coming years.

"We did evaluate other locations in Texas, but we felt one of the things San Antonio offered to us was an increasingly high-tech-friendly environment," said George Conklin, Christus Health's senior vice president and chief information officer, based in Houston.

Microsoft Corp.'s decision to put a $550 million data center in Westover Hills also influenced Christus, Conklin said.

Christus is the fourth new data center this year to announce it will come to San Antonio. A few weeks ago, the National Security Agency announced plans to put a data center in the former Sony Corp. microchip plant.

The others include Microsoft's planned 470,000-square-foot data center and Stream Realty's proposed 150,000-square-foot data center on 33 acres. Lowe's Corp. also is building a $60 million, 100,000-square-foot facility, which it announced last year.

Taking a Page From The Snooze.....5/27

Sounds like there's still thorns on the Essent rose.

Dear 6:03... The snooze isn't the only paper Hud has close to his heart (which must be somewhere around his backside.)

The Lowell Sun hasn't told the whole story here in Massachusetts either. They have had people write them to give them the real scoop on this dump but won't acknowlege they even received the tips. I guess they don't believe in investigative reporting. Where is Geraldo when you need him!!!

The only time they report anything even remotely bad connected to the hospital is when a Doctor gets slammed by the Board of Registration of Medicine. The hospital administration is barely mentioned when all along they have condoned such bad behaviors by not actively coming down on the people who are truely ruining the place's reputation.

When you consider that 5 doctors at Nashoba were reprimanded by the Board, Merrimack Valley is being sued by the Nurses Assoc. and ACLU, the Department of Public Health is investigating Nashoba for the fiasco in Radiology, Nashoba asks for a tax abatement (and by the way is approved for it) because they can't afford them though Essent is supposedly so solvent, Essent and the town of Ayer are being sued to halt construction of a new hospital by the citizens, and both have had multiple CEO's, one would think any reporter would begin to put 2 and 2 together and come up with Essent has serious issues...but noooooo. It's all roses here too.

Just because it isn't reported fellas doesn't mean it isn't so. The community knows and is staying away from both Nashoba and Merrimack Valley. I'm surprised the CEO'S here haven't taken a page from the Paris book of PR and announced their wait times are non-existent as well. To me that just means the place is so bad no one wants to be treated there.

There are no wait times here because the patients are all in a non-Essent ER.

Emerson Hospital ought to thank Essent for their increased census, as Clarksville and others are thanking their stars here. They haven't seen this kind of influx of patients ever!

Well, The Dux Are Really Out Of Line.....5/18

You'll find the following comment elsewhere in the blog, but it really highlights a problem. Someone totally unaware of the dynamics of a hospital has just been put in charge of one.

Well, strike one for Dux! Seems the big man wandered into Radiology during the 3-11 shift and saw 2 employees sitting down. He immediately let their boss know, via email, that there were too many employees on 3-11 shift.

Dux, did you take the time to ask them what was going on? It could be the first time they sat down all night!

Did you know that Rad employees know that if the shift turns deadly dull someone is s'posed to "flex time" (i.e., clock out and go home).

Do you even realize that in hospitals it's always a case of feast or famine--and that it can change from one to the other in the wink of an eye? You can be bored out of your mind and then suddenly get blitzed with a dozen stat exams/critical patients. If you send folks home at the first sign of a slow night you can get bit in the backside when that suddenly changes and your other person has clocked out and left and there's no one to call in.

Before you make assinine comments like that you should take the time to get to know the employees, the dept and the shift! Seems Dux is good at counting beans but has no clue how a real hospital works!

If you go to a real efficiency expert, he'll tell you that there are some jobs you can't measure in the traditional manner. You have to either staff for the peak periods, or you have waiting times like Parkland does....but better build a bigger waiting area. (And maybe you can set up a shuttle to Salas's Clinic for the insured/monied patients, 'cause that's the only way you'll see any of their cash.)

You have the option of randomly sampling as well, which will give you a better picture, but that doesn't account for seasonal variations. (Summer is usually slow for inpatient census.) However, this isn't like picking oranges: You can't just hire for the season. Traumas, cold and flu season, pre- and post-holidays, as well as a whole slew of factors effect your staffing needs.

I think we just found why he's bounced around so much on his resume. He doesn't understand.

Meditech has all sorts of trending and historical tools for working out staffing needs. Too bad he's either unwilling or unable to use them. In either case he shouldn't be determining staffing levels that require their use.

It would appear that the Peter Priciple has once again reared its ugly head at PRMC.

These guys make it soooo easy to throw rocks. Stay tuned for the never-before-seen ending....

A Message from the Essent Senior VP of Operations.....5/31

frankie boy,

" this is not an anti essent site it is an alternative to the current business model........ "

what business model? you offer nothing. you are just a sick, sorry and disgruntled individual who does nothing, i repeat nothing for the health and well being of the community.

do you even know what a business model is?

why don't you come out from your hole you call the blog? scared huh?
you and the people that support you are just chicken shit....plain and simply. no balls no guts.

post this you fool.

dick

Possibly a larger preoccupation with the blog than I should, but actually I feel that I am very concerned with the health and well-being of the community, a community that could use some defending...from Essent.

And, yes I am familiar with business models.

As for the 'hole you call the blog', it has apparently touched a nerve.... An office door rattling, incoherent rant, is what it has been described as.

But, let's explore why I want to be anonymous--an example: What you did to Holly's family was reprehensible. When power is controlled by small, mean-spirited egomaniacs, then sometimes discretion is the better part of valor. (One could say you were over-qualified there.)

Additionally, I have access to more sources of information, in both personas.


So, to verify the comment, I emailed a copy to Dick. No response. Expected, and here is my take: He mailed it with the hope that I would publish it, blindly, and he would have deniability, just attempting to make him look bad. When I emailed it back, it now has a trail. Simplest solution would have been to deny having sent it...and I wouldn't have published. By not acknowledging, he was attempting to distance himself. Sorry, Dick, your work precedes you....

NPs in the Wind.....6/4

What is it about West Paris RHC? First Jane T. is gone, now Brandi Chadwick has given notice. Is it anticipating the arrival of Dux?

If she doesn't vanish, she'll be pulling her patients with her, at least the insured ones! Gee, maybe Jane would come back....nahhh....

Rumors are flying about other NPs making moves as well. Will mid-levels start to outnumber the physicians? Stay tuned, it could get rough!

MVH Gets a Beancounter....5/14

Michael F. Collins is the new CEO at MVH. He's not a stranger to the area, being the head beancounter at Emerson in Concord, MA. Considering he is coming from a system that pulled a net of $5M, from a gross of $384M (translates to 1.3%), and going into a hospital with a -$87k (-0.1% return) net, everyone hopes some of that will rub off.

Let's hope that he avoids the predictable, short-term cost-cutting measures: Staff reductions. It's easy to say, "Cut 10% across the board." But reality starts to sink in. Housekeeping cleans the same amount of square footage in halls and other public areas no matter if the census is full, or only one patient. Security patrols the same buildings, empty or full. And, as another example, the health centers here may have an increased utilization during the same period--should we short staff/shorten hours? It would seem to have an even more negative effect on returns.

But, consider this: Back when I was hiring (Yeah, I know, a tell....), replacing any employee was at a minimum cost of $2-5 thousand. Now, with all the OSHA, state, and JCAHO requirements, the recruiting fees, advertising, bonuses, relocation, orientation, and such, it's far, far more. Cuts might help this quarter, what about next??

My drive would be to increase the gross, and take a smart look at the overhead. Keep the staff you have, with certain exceptions. Switch from quarterly goals to a longer view. Take a closer look at CPT codes, justifications, and repeat mistakes. "I don't have time to do it right" is not an excuse, it's a reason to leave.

Why do I post advise? Because if they follow it, it will change Essent. If they don't, well, there's always, "I told you so....."

Getting Your Dux in Order...5/29

When Joe Lieberman was announced for the VP, I thought that, "Gee, maybe there could be some hope for the ticket. The senator seems to be a fairly straight shooter...for a democrat..." But, suddenly, he was preaching the party line, with most if not all of what we considered his own views evaporating before our eyes. Once the election was over, he returned to pretty much his previous stance. Is this the route of all politicians and execs?



One might contemplate Hud possibly being a caring, considerate individual...until he became CEO.... Then his head snapped around and pea soup shot out of his mouth. Kind of the reverse of Joe L.



So, how will Dux fare? He's been here there and everywhere, which means the 'fit' might not have been there, or maybe he doesn't play the game, and what you see is what you get. If so, don't buy for the long term, Chris.



His seven tenets would seem to be hopeful, but we've been given lip service before. Pea Soup, Anyone?

Is There a Better Hospital Model???...5/16

Ironic, isn't it? Hud giving the keynote presentation for the GLALI..."Is There a Better Hospital Model? Trust me, Hud, there is. Merely take Essent out of the mix. A much better model. Better patient care, better relations with the community.

They must have been really desperate for a speaker. Looking at Essent's financials, it must have been a paid gig. You just wonder who paid...Essent or the GLALI....

Most if not all of the hospitals have recently suffered 'right sizing'. Most are running with extremely low census.

One actually might think the title appropriate...it's the question he's asking....

Another Kick in the Pocket...5/11

CMS* is also transitioning from basing DRG weights on hospital charges to estimated hospital costs. Studies by the Medicare Payment Advisory Commission have indicated that hospitals charge significantly more than their costs for some types of services, such as medical supplies and radiology. As a result, certain services are relatively more profitable, potentially contributing to the development of specialty hospitals which focus on high margin conditions. By basing DRG weights on estimated costs, rather than hospital charges, hospital payments will be more closely aligned with the actual costs of patient care, and the incentive for hospitals to take higher margin cases will be reduced. In October 2006, CMS began to phase in the new cost-based weights. The phase-in will take three years.

*Centers for Medicare & Medicaid Services

Remember the link to the comparison of procedure and treatments for Texas hospitals? Well, Paris came out higher than many, in some cases higher than most. This might just pull that rug out from under Hud.

It might give Open Imaging more of a run for their money, since they charge significantly less for procedures than the hospital...however, they(OI) still have newer equipment, and reports are usually available that day, rather than that month....

It might even slow some of the Dallas flight, but where would you rather have treatment: Baylor, or here? They are lower in cost than PRMC in a lot of things, and if all costs were equal....

There are some that think that the blog is aimed at the employees of the hospital. No, it is aimed to those employees that are trapped by circumstances in a poor situation. We don't blame you for having to stay here (...boy, can we relate...) but, we either want to generate a change in attitude, or a change in ownership.

Dick's last hospital, you know, the one that went bankrupt, was bought by a physician consortium...and no more Dicky. We got him. Maybe we could follow their lead? ...hint, hint....

Why Monopoly images? Just remember the quote from Essent: "We hope to make this 'the' hospital in the region...."

Just Sitting Back...5/11

Sometimes a quote gives you a chance to let other people do your job:

With all the changes in executive personnel, the cashflow picture from the vast Essent empire (all of 5 hospitals), turnovers in facility CEOs, the sale of one property after they couldn't do anything with it but watch it bleed, the refusal by three communities whose boards actually did their due diligence and didn't let greed, hubris, and outright stupidity rule their thought processes......why in the world would anyone with enough cash to burn a wet mule (and hopefully an IQ above that of a Boston fern) invest in this sorry excuse of a company? If this was the same picture in all of corporate America, we'd all be in rags on the street in months.

Essent isn't a company, it's a shipwreck looking for a place to sink. It's an old man who died, but doesn't have the decency to fall down anywhere. Hud isn't a great executive- he's a blithering idiot in nice clothes. Even the other for-profit chains (including HCA, his onetime employer) are better run than this mob. Essent's situation, as well as the situation here at PRMC, can be described in one word, but I can only use the first two syllables for decency's sake- cluster.

And Jo Sparkman is being complimented for this? I want whatever she's having, but make mine a double.

Wonder what light Anna Jean could shed on things?????

What's hilarious is that corporate is paying good money to mask the fact that they're tracking the blog...come'n guys, Hughes and Dolphini??? Get a grip.

We'd have even more serious doubts regarding your intelligence if you weren't keeping an eye on it....

"Holy sh#t, these people are in it up to their eyeballs. I get a morbid pleasure thinking of how tight Hud's sphincter is each morning as he checks the blog to see if the flashlight is shining on any more of his dirty dealings. Don't you just wonder what's out there that hasn't been discovered yet?"