Wednesday, December 31, 2008

If You Snooze...2/23


The Snooze came through--in their typical fashion. Hard-hitting journalism? Ah, well.... At least the site got a mention.

The Essent-PRMC lawsuit against the operator of the-paris-site.blogspot.com began in June 2007 when the hospital accused the anonymous blogger of wrongful conduct in publishing information detrimental to the hospital and violating patient confidentiality, and obtained a court order to force the blogger’s Internet service provider, Suddenlink, to reveal the name of its client.

Days before the end of 2007, the blogger’s attorney sought and was granted a writ from the Court of Appeals negating the previous court order. The Court of Appeals held there is no precedent in Texas to give the trial court the authority to issue such an order, and that several courts have noted that Internet anonymity serves a particularly vital role in the exchange of ideas and robust debate on matters of public concern. The Court also ruled that the hospital must first prove the statements are not true and then prove they are harmful to the hospital.

In March 2008, the two sides were back in court, and were given 14 days to present written arguments to the court.

Since that time there has been little movement in the case. In September of this year, Essent’s lawyers filed an affidavit stating a team of computer analysts hired by the hospital were unsuccessful in a forensic search for the blogger’s identity.

Could it be that the hospital is intent on stating to the court that they (the court) are its only resource in finding me?


It would seem that they ought to concentrate on the two stipulations of the appellate court: Truth of statements, and financial impact. But, then again, maybe they have...and come up short.


They know that I have some interesting sources--local and elsewhere. What's problematic is the anonimity of the comments. One of the things that was probably verified with the forensic group was that there is no track-back on the anonymous commenting. Speaking of 'in the dark,' the Snooze (with some prodding) even climbed on their case for keeping the community in the dark (Andy and Hud dismissals, holiday layoffs, and more....) And most (if not all) of the calls have been dead-on.


As to financials, with the recession 'officially' starting in 2007, what is their baseline? Sounds like global warming to me. (Something you really can't prove, but you know it exists!)



The biggest factor in fostering a poor image was the publicity created by the lawsuit itself. The number of hits jumped a hundred-fold.

Sooooo...stay tuned in the New Year.

Tuesday, December 23, 2008

Christmas Wishes....1/7

May the spirit of Christmas fill your life.

May you enjoy the rewards of an unselfish act.

May you remember and honor those that are serving in the military, far from their loved ones, and pray for their safe return.

Saturday, December 20, 2008

Looking Back....1/1




It's traditional to look back at this time of year. Did you realize that Hud has been gone over a year? And Knizley almost two? Both are still bringing in a significant number of hits from the search engines.

If you look back at the blog posts from November 2007, you'll see several things that are pertinant to today: Sub-prime loans (GE Capital), Dux's B.P.M., Essent's vision, receptiveness to suggestions, and contemplation about the move to the North--in April(--of '08). In December, the lawsuit was still open, and the possiblity of selling Essent was being bandied about.

The new year brought the touting of new radiologists--one leaving before he really started and the other out-going.

The RHCs imploding. From what I've heard, the non-affiliated RHCs in Bogata and Honey Grove are doing well. PRMC is still looking to fill the Cooper Clinic spot. (No longer, Cooper closed this week.)

Speculation about downsizing...




A listing of red ink for Essent. (A side note, the other hospitals are reporting for the fourth quarter of 2007, while PRMC is only listing the third. Wonder what changes will be displayed when they finally update?) (A director pay cut of 10%...)

And another article hit the media, this time from the Reporters Committee for Freedom of the Press. An excerpt from Guarding the unnamed writers of the Internet



"The blogger, using the pseudonym “Frank Pasquale,” was sued in 2007 for defamation when he posted critical remarks about a local hospital on his blog, The Paris-Site. The blog focuses on issues related to Paris Regional Medical Center, ranging from the hospital’s budget concerns to a broader debate over universal health care.

Essent Healthcare, Inc., the owner of the hospital, didn’t like what was being said on the site, so it sued Pasquale and nine other anonymous bloggers for defamation and breach of contract, among other claims.

The corporation sent a subpoena to the owner of the blog, SuddenLink Communications, seeking Pasquale’s true identity.

Pasquale fears that revealing his identity will cost him his job in the health care industry and he has been fighting to quash the subpoena ever since. The case is pending.

“In a small town, and dealing with what once was the largest employer, one has to be careful,” Pasquale said."


They did neglect to mention that the appellate court rejected the decision.

Sunday, December 14, 2008

30-50-80?....1/24

Well, I've heard the whispers...one person said 30 were being let go, another 50, and just now: 80. The hospital is rife with rumors...and all based on the point of view.

It's sort of like the economy: When it's your neighbor that's out of a job, it's a recession. When it's you without the job, it's a depression.

Somehow I don't think that I would get much of an answer if I called and asked for an exclusive. However, you'd think that instead of running a winter fluff piece, the Snooze would ask Essent for the real scoop. No one with eyes has any doubts that we've had slick conditions and freezing rain. Finding out what is in store for community health would seem to be more appropriate.

Possibly asking Dux as he returns from Valhalla...?

Thursday, December 11, 2008

Living Forever

The internet is a great resource, but one must filter some of the content. Part of the problem with the internet is the tendancy for information to outlast its usefullness. Or validity.

Case in point:
Christus St Joseph Foundation. Should you go to this site, your expectations would be considerably different than reality. And, had you depended on the calendar of events, you might have been trying to vote on the 6th of November.

The disturbing thing is that the date listed for "last updated" is 6/12/2006 (or is that a 8? Small print.) In either case, it would appear to be dated information.

When we see it on the net, we expect it to be current. That's the main reason the newspapers are having such a hard time: Yesterday's news printed today. And in some cases, tomorrow.

But, I digress. If you google a topic, you'll receive an example of what I mean. Almost anything you pick is going to have "cached" listed on some of the hits...meaning, not current.


Kind of the reason that I put a date after the post topic--it gives you a reference as to when the last comment was made.

But, the information from the posts and comments is going to be around for a long time. Far longer than Essent wants it to be, possibly far longer than I want it to be....

Monday, December 08, 2008

Speculation....12/11

I received a comment that was a bit convoluted, but the essence was: How do you pour a gallon of water into a pint jar?


The South Campus (St Jo, Holy House, whatever) has more beds, always did. The modifications to the North Campus (Big Mac) probably lost some beds. So how do you move a staff into a facility that is perpetually going to be low-censused without losing people? ...you don't, without a physical expansion of the hospital. I haven't seen a lot of dirt flying, have you?


They also pointed out that some of the equipment is fairly antiquated--the MRI, X-ray machines, Lab, and the like, and while some could be dis-assembled from South, and moved to North, those also have the age factor to deal with. That and moving such equipment is a significant cost in itself. Maybe GE Capital can get GE Medical to cut them a deal...hah!


I wonder if the old animosities will rear up again. That was a big spanner in the works when Essent purchased the hospital(s). Something that they discounted in the initial evaluation for purchase--much to their chagrin. The controversy over the "Women's Center" is what drove the hospital sale, that and the money pit the combination of the two hospitals had become.


And how is the St Joseph's Foundation going to take this? Big Mac wins? Seem like an ignoble end to the guilt trip laid on an order of nuns oh so many years ago. To quote from the Grateful Dead, "Lately it occurs to me What a long, strange trip it's been...."

Wednesday, November 26, 2008

All Hale....12/6

I have been pondering why and how a corporation can hang on with as much red ink as has been flowing...and came up with this next bailout: Obama healthcare. For you of skeptical leanings, float this one:

If everyone is insured, then hospitals will get what they bill for (probably with reductions in reimbursement, but nothing like what goes out for indigent care. So, even MVH would be breaking even, if not making money. But, if you thought healthcare costs are high now, wait for it....


Speaking of MVH, had this comment that had to be elevated:


Mis-management at MVH? How in the world could this be possible with the dedicated leadership staff there?

As a leader/manager with a college degree and almost three decades of world wide experience that used to work at MVH my humble opinion is this:

As long as the “Hale-good-old-girl- system” (hereafter known in this blog as the HGOGS) is in place at MVH, that facility will remain the same. This means miserable working conditions and unhappy employees in some departments because of poor departmental leadership.

To define ‘HGOGS’; MVH was formerly named “The Hale Hospital”. It was a large employer and money-maker for the city of Haverhill. With a large cash-base at their disposal it seems the mentality in the department I worked in was to just get another ‘widget’ if one was broken or missing. This no-accountability mentality is still alive and well in some of the more expensive-to-operate departments of the hospital. A good-old-girl-system (GOGS) occurs when a senior person blindly supports an underling’s decisions because they’re buddies – even if the underling’s decisions may impact adversely on staff or patients.

Examples:

To flagrantly disregard a nursing standard of care or a recommendation from the infection control committee that could impact on the health and welfare of employees and guests and have the full (blind) support of the senior officer is the HGOGS at work.

Another example of the HGOGS that may be happening at MVH is the hiring of minimally or un-qualified personnel to work in areas under the control of a director because they are friends or acquaintances of the hiring director instead of going through the usual protocol for the hiring process.

Spending outrageous amounts of money on equipment repairs instead of addressing the real problem of employee negligence because the people damaging equipment have been long time employees and are ‘friends’ of those in charge - another example of the HGOGS at work.

Not permitting a department to rehire people due to attrition and insisting that a department operate short on personnel for extended periods of time (even though the department furnishes productivity data which would support new hires). Making false promises to staff departments regarding per-diem employees that may or may not be permitted to work in the short department might also be an example of the HGOGS at MVH.

I could go on but I believe I have captured the essence of the HGOGS.

I do realize (for you more critical readers) that I have a sentence fragment as the opening question of my blog – I did it to catch your eye. Grammatically wrong? Yes, but I spent my time in college working on my clinical skills – not English comp (which I still got an “A” in).

I would be remiss if I did not make a recommendation to change MVH for the better. Simply, get the good-old-girl-system the ‘Hale’ out of MVH. As long as senior leaders blindly support the poor decisions of their uninformed subordinates, morale will continue to wane away and good people will continue to leave. Ultimately, the HGOGS will be the only ones left…try to run a hospital on a staff like that!!

Friday, November 21, 2008

Essent Lenders....11/28

Now isn't GE Capital one of Essent's lenders?

From Barrons
November 19, 2008, 10:46 am

GE: Meaning
Well, If Not Always Doing Well

Posted by stockstowatchtoday_topeditor
GE SEES $2 BILLION CAPITAL FAT; RISK TO WIND?

General Electric (GE) has become the corporate embodiment of the description of a sometimes-wayward so-and-so in a Lyle Lovett song: not always good, but always possessed of good intentions. Two earnings warnings in a year. Insistence that it’s bedrock financial condition remained intact, even though it managed earnings by paying more than $30 a share in buybacks before raising new capital at $22 a share. Pointing to its triple-A credit rating as evidence of its ample liquidity before raising more capital from Warren Buffett, to whom it’s paying a 10% coupon.

The latest reposte from the company that Brings Good Things: Tuesday’s announcement of changes of its GE Capital unit. The move was aimed at saving $2billion. Again, well-intentioned. But, as Deutsche Bank asked in a research note Wednesday: where’s the savings coming from, exactly? Can the company demonstrate where it’s taking costs out of the structure to realize the savings? How does any manager cut risks in a credit crisis that’s fraught with risks?

The problems with financing aren’t limited to GE’s capital operation. There’s increasing chatter in the market, fanned by a Bloomberg report Wednesday, that some of the wind turbine installations that GE is selling into are being postponed because their operators can’t finance the projects. GE said it hasn’t seen any outright cancellations. But some of the anecdotes certainly raise questions. After all, T. Boone Pickens has made himself the populist leader of the wind-farm movement. But Pickens is an oil guy - at heart and in his investments. It’s not to say that he’s anything but sincere in his ambitions to spread the gospel of renewable power. But anybody seen what’s happened to the price of crude lately, and think that might have had some impact on someone like Boone Pickens’ ability to finance new projects?

There’s no crisis in the wind-farm projects, as yet. GE said that it has a ‘’strong” backlog of wind turbine equipment. But Theolia, the French maker of power plant equipment, earlier this week backed off its financial and operational forecasts. That not only validates concerns about the integrity of wind turbine budgets over the short term. On top of it, Theolia’s 80% decline in market valuation certainly suggested GE’s 17% stake in the French company is worth less than it paid for it, another investment that hasn’t worked out.

Meanwhile, GE has made the ”green” movement a big part of its corporate identity, including such messages in its marketing and corporate imaging efforts, as it moves away from its image as a merchant of appliances, an operation it’s selling. A failure in the wind turbine business - even though all power generation represents less than 20% of the company’s sales - would hurt. GE shares declined 3% Wednesday.

I never thought that GE would be just over 12.

Monday, November 10, 2008

Healthcare Alternatives....11/28

I went back in the draft status posts--ones in which I hadn't completed the thought process--and ran across this list of waiting periods for procedures under the Canadian healthcare system:

For Canada, waiting times:
General surgery: 14.3 weeks
Orthopedic
surgery: 40.3 weeks
Cardiovascular surgery: 8 weeks
Urology: 11.5 weeks
Internal medicine: 11.5 weeks
Radiation oncology: 5 weeks
Medical
oncology: 4.9 weeks.


Now in some cases, those are to get the initial evaluation, not treatment. Realize that we still have Canadians coming over the border to American facilities for diagnosis and treatment because it is so much faster. It might be cheaper in Canada, but if you die while waiting for an appointment, cost becomes less of a factor. (My caveat to the Obama healthcare initiatives.)

Wednesday, October 29, 2008

Landing On His Feet....11/13


Like a big cat, Hud has apparently landed on his feet...so to speak. I'm not talking about a large jungle cat, more like Garfield. Just less cuddly.

Those who can, do. Those who can't, consult. Hud is now apparently a CEO in Performance Management Institute (seminars), and consults under Stroudwater Associates, as well. If you follow the link, the bio seems to leave out significant parts of his career, but that's just Hud.

ARCON has disappeared, and various other head, er..milestones have been milled down, but it's Hud, just the same.

Saturday, October 11, 2008

How Does It Stay Afloat?....1/1


I have been remiss, and not checking the site American Hospital Directory (AHD.com). Some new figures have come in which make the Essent Healthcare Corporation's future a bit more uncertain. Only one hospital is listing a profit: Sharon Hospital. The rest are swimming in red ink. The rundowns are as such:


Sharon Hospital********78beds $1,889,467
PRMC*****************255beds -$508,231
NVMC******************57beds -$638,864
SWMC******************73beds -$2,411,841
MVH*******************138beds -$4,323,137

Total********************601beds -$6,001,606 net annual loss

The names of the hospitals are also links to the full listing for each under the free information section of AHD.com. Note: The information included is provided by Essent itself.

These figures do not reflect the current crisis. The disclaimers on the pages indicated that these are last year's figures, and in part 2006! So, it doesn't show the construction costs, the locums, the RHCs, and so on....

You would think that the various newspapers in these communities would have picked up on the downward trend, but, then again, they missed the firing of Hud (by almost a month!), and locally the Knizely dismissal. When I can scoop them, just using my limited resources, what are their reporters doing?

Sunday, October 05, 2008

Sub-lime or Sub-prime....2/26



Does the current credit crunch bode well for Essent? For PRMC alone, they borrow to pay their payroll, and with a half-million dollar loss/yr, how does this keep them out of sub-prime status?

With the last financing, Essent included a rolling line of credit, possibly against such an event. Otherwise, in the current financial situation, the money might not be available. Hopefully the institutions that offered that line of credit are still able to fulfill their commitment.

If not, meeting payroll for all the hospitals might be a financial nightmare. Essent borrows month-to-month to make payroll--a fairly common practice. But with credit tightening.....

One wonders how other hospital groups that are also in the same category are able to maintain?

Friday, September 26, 2008

Is This What We Want in Healthcare?....10/7

Looking back at the sub-prime mortgage mess, you have to consider what the original 'intent' was, and what has happened in practice. There are considerable parallels that can be drawn between that and what the future of healthcare holds for us. Freddie and Fannie were pseudo governmental entities--sort of like the Post Office.


"1970: The U.S. Congress creates the Federal Home Loan Mortgage Corp., nicknamed Freddie Mac."
What may play out could possibly be foretelling the fate of healthcare in a foreseeable future.

Well, what do I mean by that? De-regulation is being slapped about as the cause of the problems, but was it de-regulated? There were several mandates that were placed on lenders to make sub-prime loans. They made them, but in order to minimize their exposure (risk), they would re-sell those mortgages. Those were repackaged and sold as securities by Freddie Mac. When the mortgages were defaulted, the securities were devalued...do we see where this is heading?


"Freddie Mac is a shareholder-owned corporation whose people are dedicated to improving the quality of life by making the American dream of decent, accessible housing a reality. We accomplish this mission by linking Main Street to Wall Street--purchasing, securitizing and investing in home mortgages, and ultimately providing homeowners and renters with lower housing costs and better access to home financing. Since our inception, Freddie Mac has achieved more than 30 consecutive years of profitability and financed one out of every six homes in America."
30 years of profitability---didn't quite make 40, did we? And, for the last several years, the CEO of Freddie Mac was stating that the reported figures were not accurate! Why isn't the former management team of the F.M.s coming under the same scrutiny as Enron? There is far more money and far more impact in the trickle-down effects.

Do we want this kind of management turned loose on healthcare? How about the politics? Speaking of politics, Senator Obama has the honor(?) of being the recipient of the second largest amount given to campaigns of elected officials by Freddie Mac/Fannie Mae ($126,349). McCain's campaign also received contributions, but far less substantial ($21,550). I'd say both would be better off returning the money. (Note: The Republican 'leader' that is being touted by the Democrats as having reached an agreement on the bailout was on the list--the most money taken in by a Republican campaign from the F.M.s.)


Current members of Congress have received a total of $4.8 million from Fannie Mae and Freddie Mac, with Democrats collecting 57 percent of that.
Can you say, "Deal Maker?"

We see the purpose as providing 'accessible' housing. Isn't that similar to the mantra of 'accessible' healthcare.



Can you see the writing on the wall?

Tuesday, September 09, 2008

I Understand....9/29



Yep, my attention has been diverted as well--the election looms in two months! Bet the decision on our case comes out within the week (after the election results.) Any takers?

But, let's go back to the election. It became a horse race in the middle of the Republican Convention...and with such a weak start, I was beginning to feel that it was all over.

Senator McCain took some advice, and brought in a ringer. She has to be. This was a conservative's wet dream: A working MOM, a member of the NRA, Pro-Life, happily married, active, a governor, and bucks the 'good ole boy' authority in the Republican party. And she can stand up before a record number of people and deliver a punchline. And a punch.


Salvation.


Maybe there are some fleas, but the Democrats are panicking. There are more PIs going through Sarah Palins life (and trash) than the number of times that Obama can say 'uh' in a speech. Their version of recycling is to hand the garbage to the next investigator in line.

And the more that the Democrats poke at non-issues, the more popular and the more of the sympathy vote the Republicans get. Kind of like the blog. When Essent was pursuing hot and heavy, they stirred up national attention. Now, the blog is barely hitting a thousand-fifteen hundred hits a week. (The record is about that in a day!)

But why bring the election up? Just trying to play on the Palin effect? Maybe, but Duc-boy's 'practice Scotish spending' reminds me of the Obama plea to fill your tires to solve the energy crisis. Far too little, Far too late

Thursday, August 28, 2008

Universal Healthcare....9/01

In case you haven't noticed, when the government owns a program, they really own it.

Healthcare. Something that we've taken for granted that we have some choice in. But, would that be true in a single payor environment? I ran across a blog post that casts some doubt towards that assumption.

It was mentioned in the Coyote Blog, which pulled it from Qando, which sourced the Jewish World Review. I went to the source. What it boils down to is the wishes of the patient, and his family were ignored.

"Golubchuk is an Orthodox Jew, as are his children. The latter have adamantly opposed his removal from the ventilator and feeding tube, on the grounds that Jewish law expressly forbids any action designed to shorten life, and that if their father could express his wishes, he would oppose the doctors acting to deliberately terminate his life."
One would think that a patient's religious beliefs would hold some weight, but not so:
In response, the director of the ICU informed Golubchuk's children that neither their father's wishes nor their own are relevant, and he would do whatever he decided was appropriate. Bill Olson, counsel for the ICU director, told the Canadian Broadcasting Company that physicians have the sole right to make decisions about treatment — even if it goes against a patient's religious beliefs — and that "there is no right to a continuation of treatment."

Notice, this was in Canada...not Russia, not a dictatatorship. But, in some ways it is. The moral of the story is, in bumper sticker logic: "Those who would trade freedom for security deserve neither" -- Benjamin Franklin


But, you say, I'm not Jewish. True, but does your faith have tenants that impact your healthcare? Say, against transfusions? Autopsies? Surgery, or other treatments? I can think of many that do. Separation of Church and State can have an interesting consequence in that situation.

When it happens to my neighbor, it's a shame. When it happens to me, it's a tragedy.

Sunday, August 24, 2008

And Then There Was One....8/25

West Paris RHC is the latest: Brandi Chadwick gave notice and will be working with Dr Cannon.

So, based on Essent's keen understanding, process improvement, financial management, and support of its employees, there will be only one semi-functional Essent run rural health clinic by mid-September.

So, what will be the impact? Maybe not that much. More likelihood of patients going to hospitals other than PRMC. Puckett can refer to Bonham, Higgins to ETMC. The West Paris crowd will probably jam the ER with low acuity. Unless Cooper gets quickly established, Commerce will pick up their patients.

What will it take to keep the RHCs operational? Recruiting new NPs/PAs (with associated fees.) Keeping the rest of the staff intact (less change for patients to absorb.) And be ready for the associated loss of income from the former employees, now competitors, taking their patients with them.

But, it's unlikely that Nashville gets it. They haven't so far....

Friday, August 22, 2008

Top 100....10/17


PRMC made the top 100 hospitals.... Wouldn't you just hate being in one below that? Realize, first off, that it was based on performance improvement, not position. The positional results were announced earlier in the year.


Now follow me, if you will, in a logical fashion: If you are at the bottom, and you move up 20 places in a field of 3000, you might be improving, but are you in the top? Not even close.


Realize too, that they only review data that is sent in from the hospital. And, theoretically, you could be most improved, but still file for bankruptcy....


"Lies, damn lies, and statistics" according to Mark Twain
Note: The graphic is from the math department at Vandy--Vanderbilt also made the list!

Thursday, August 14, 2008

Rural Health....9/18

Been by Honey Grove lately? The Puckett Family Clinic is the new game in town, and that has caused quite a stir with the hospital's other rural health clinics. It looks to be doing well, and is up to speed. Drop in some time.



Patricia Higgins was apparently planning something similar, but was informed on by her medical director, at the time, Dr. Green.

The next Friday, in their typical bulldozing fashion, the hospital DEMANDED that the NPs in the remaining clinics sign contracts complete with geographical non-compete clauses by 5PM or they would be summarily terminated. They could also not hold any outside employment to supplement their income.

So, Pat Higgins (Bogata) quit. Annie Patton (Cooper) gave her 30 days notice. Brandi Chadwick (West Paris) refused to sign, but the hospital backed down.

Now this is on top of what they pulled on Jane Tijerina a while back.


The hospital has done so well in providing healthcare to the community, wouldn't you agree? Can you say "Hello Emergency Room...."

...and goodbye to any sense of loyalty by their outlying patients....

Wednesday, August 13, 2008

Who Knows....8/25

Frank,
When is the decision about the blog's anonymity to be made? We haven't heard much of anything lately. Have you been given a deal to lay low, or what?




No, no deals have been offered, or made. I'm suprised as anyone how long this has dragged out. 'pears that a pending decision won't chase away supporters prior to the election, so why give the legal blogs the chance to throw stones? Conversely, why piss off the largest employer (is it still? Figures, please...) in town?

As to why I've been absent as of late, well, that's a good question that I really can't answer yet.

We're all kind of in limbo until the 'big move' to the North Side. Just looking to see who goes north and who leaves...and how it's all going to fit into Essent's master plan.

Heck, maybe they'll be creating a specialty heart hospital, and sell the South to ETMC as acute care. The original population base would have sustained two of that nature, maybe with that mix it still might--unless the area turns vegetarian...Nahhh.... Not with the most popular eatery called The Fish Fry....

Saturday, July 19, 2008

Maxi--mum Support....7/29

I received an email quite off the theme, but worthy of publishing, just the same, from a Red Cross volunteer. It got to me a bit late, but since it indicates that it is the 'first', I have no doubt that there will be others.

Hello friends,

I make it a policy not to forward e-mails, but I ask you to please pass this on to all your Paris-area friends and family.

Tomorrow - Friday, July 18 - is the first donation collection event for our troops in training at Camp Maxey.

Please have a look at the list of needed supplies on this website: http://www.lamarcounty.redcross.org/ - click on "Camp Maxey" in the menu.

Drop items off between 10 a.m. and 4 p.m. at Ramseur Baptist Church gymnasium, 3400 Lamar Ave, Paris.

Anything you can give will be much appreciated and well deserved.

In case you haven't heard, several hundred troops are in the last stages of training at Camp Maxey before heading to Iraq. They will be there the rest of the summer and a community effort is underway (through our local Red Cross chapter) to make them feel welcome, encourage their spirits and show the true colors of Lamar County. More events are planned in the near future and will be publicized on East Texas Radio stations and in The Paris News. (And in the-paris-site....)

- Allan Hubbard
Communications Coordinator (volunteer)
Lamar County Chapter American Red Cross
Community + Camp Maxey
http://www.lamarcounty.redcross.org/ - click on "Camp Maxey" in the menu


I don't care what your politics are, where your leanings take you, if you had a son or a daughter being deployed over there, how you would wish that they were treated while in a different town/state/country. Time to check the list, and see what you can give. Undoubtedly you can donate at any time....frank

Wednesday, July 09, 2008

Cheap To Keep?....7/26


Back to the drawing board, I guess. I wonder what I cost to recruit the last guys and what the hospital will pay for the next bozos.

Well here's some interesting news....seems the Full Time Radiologist, of whom they were soooooooo pleased to have, has turned in his notice. Seems he doesn't like being the ONLY full time rad and, shucks, the money is too dern low to boot. Awwwww. Back to Ye Olde Locum Tenums.

Rio Rojas boys don't look so bad now, do they???



(Photo of Jim Mabe, also known as "Droopy Drawers".)


As an update, since we are talking about money: Paris remains the same, Sharon increased it's profit to $1.8M, Nashoba Valley stayed the same, Southwest dropped to $-2.4M and Merrimack Valley is certainly in the valley...$-4,323,137. What it comes down to is a loss of $-4.5M per year.

So, Essent needs to sell, but who would buy? Investment capital is getting tighter, and you could see that Vestar, GE, and T-C might want to lighten their load.

And, obviously, I must not have had an effect on the bottom line of PRMC...why it's been sitting at a half-million dollar loss for a while now.

Tuesday, July 01, 2008

Staying Out Of Politics?....7/19


Is this the same company that Hud Connery founded? Hud, who gave so much to political candidates? In checking the Essent PAC record, it would seem that this is the election that they're staying out of...a far cry from previous elections in which Hud personally gave thousands ($70K+, minus the $7,250 returned for over contributing) in campaign contributions. Likewise did top Essent executives. They even tried to have a fundraiser for a political 'friend of Sharon Hospital'...but, we're not trying to buy Sharon Hospital any more, are we? And, besides, the fundraiser was cancelled as being in violation of federal rules governing campaign finance. I still wonder why Hud donated $500 under Arcon Healthcare/COO, in 2004. Wasn't it defunct in '98? Ahhh, it must have been for old times sake....


But the current crew doesn't seem to be givers. Take that as it may....


Hey, speaking of the current crew, have you noticed that Dick Salerno is back with FTI? At least his name is on the website. He wasn't a big giver, either. $250 when he was with Healthtrust.

Sunday, June 22, 2008

How Low Can You Go?....8/25

If true (and only those actually at the hospital can confirm) this little snippet is pretty damning for Essent's profitability:


Last week Nashoba Valley Medical Center set a new record for their inpatient census. There was a grand total of FOUR INPATIENTS. Yes, I said FOUR INPATIENTS.


Essent should start thinking about changing from a FOR PROFIT status to NON-PROFIT status. Staff continues to be sent home daily and there aren't many elderly still choosing NVMC for their healthcare needs. The next generation knows to stay clear of NVMC and travel another 20 minutes to the next facility.


While census is usually lower during the summer, the depth of this low sends an obvious signal: Not viable in its current configuration.

Thursday, June 12, 2008

Reactions....8/16

Some people only read the posts--a mistake on their parts. I can kick a topic to life, but the people that are living it may have several different viewpoints on the subject matter. These were generated by the last post:


Tell Todd/Matt that if the blog has lost steam it's because some people are afraid to post lest they lose their jobs. The lawsuit has done more to damage Frank's rep and his business than the other way around!
I know what he means...fear is always a factor....

Todd/Matt/whoever this guy is writes (most likely on his company's time):

"Frak-a-rino:
I only check your blog every few weeks anymore.....You have run out of steam, bro'. Looks like despite your best efforts you have been singularly unsuccessful in bringing Essent to its knees.

This may be a good response in your court case.....you haven't caused a whit of damages, so why the h@#$ are they wasting their time and money suing you? "

Do your homework, Toddster- had you read some of the posts and did a little homweork (in between playing solitaire and tetris on your company's computer), you would have read this company is awash in red ink. From a heavily profitable year (50 grand- woofreakinhoo) to the 4.5 million loss recent reported.

Essent doesn't need Frank's help in FUBARing its facilities, swallowing up all that investment money. They're doing just fine all by themselves. All this humble blog is doing is reporting the truth, which in itself is a dangerous weapon. THAT is what Essent has their shorts in a wad over- people are paying attention to the man behind the curtain, and not the smoke-and-mirrors display run by Dud, dick and Duckboy.

Actually, I must give Essent a little credit- they're the perfect model of how NOT to run an allegedly for-profit company.

-The poster NOT known as Frank a/k/a John Doe number any
When it comes down to it, they are just trying to blanket all possiblities with the 1-10 thing. Even if it's determined that my comments were not libelous, they can say that the only way to find the 2-10 is through my account. Were it true, that would be one thing. Now, even with the settings set to forward, blogger doesn't and I haven't even a clue when comments are made.

"According to the latest American Hospital Directory (AHD.COM)data, when you add up the fiscal performance of all Essent hospitals for fiscal 2007, the company lost $4.5 million. Contrast that to fiscal 2006 when the combined operating profit was $55,000. How long are these idiots going to be able to keep their jobs with losses like these?"

Waitaminit...........this is a for-profit chain, right? Supposed to make some money, right? If I were pouring millions of dollars into a corporation, I'd expect them to make a little money, right?

This ain't a for-profit anything- it's a massive tax write-off, a money pit. Pouring good money after bad is not what I call a sound investment.

Matt/Todd/whatever the h___ his name is this week mocks this blog for "not bringing Essent to its knees". I'd say Essent and it's carload of circus clowns are doing a nice job of wrecking this company all by itself- what could this little ol' blog from Texas do, other than report on the train wreck taking place in Nashville, Paris, Ayer, Sharon and SW Pennsylvania.
And, finally:

Seems not much different than when the big mining companies ran the towns and the company store. Essent may be hoping that the Judge forgot that era, and the laws that prevent slavery....
So, you see, the posts aren't the fun part: the reactions are. You have to click a few times, but it's all there.

Wednesday, June 11, 2008

Vote, and Vote Often (Part Deux....7/4

A question has been asked:

Any news yet? Or is the ozone cloud that is emanating from the judge's brain still hanging over the courthouse, as he ponders this decision.......

Watch it come down to a coin flip: heads, guilty; tails, innocent.....

......and Essent provides a two-headed coin.
Actually, I'd hate to be in his spot. Basic liberties vs the largest single employer in town (might not be any more with the outsourcing, but for argument's sake let's say it is)...and with an election coming up. The dissection of his decision will be in the legal reviews as well as the boardroom.

But, I'm not wild about mine, either. Legal representation is not free, and I'm going to hate being back in the state court of appeals. As Todd (formerly known as Matt) comments:
Frak-a-rino:
I only check your blog every few weeks anymore.....You have run out of steam, bro'. Looks like despite your best efforts you have been singularly unsuccessful in bringing Essent to its knees.

This may be a good response in your court case.....you haven't caused a whit of damages, so why the h@#$ are they wasting their time and money suing you?
That's a question for the ages. Hud's ego, initially. Now, probably the point is moot. They want my name, but probably not for an actual trial. It wouldn't gain them anything, and more than likely hurt them--I do have enough to prove what I say. They can impose economic sanctions without that--just look back at Holly and her family. Come to think of it, it probably is still ego. These are still Hud's picked cronies. Dick is still at Essent. Browder was picked by Hud. Dickie picked Duckie.

Thursday, June 05, 2008

Smoke Gets the Ayes!....8/25

In roughly two months the entire campus will be smoke-free. Finally, something I agree with! I never could understand why a patient that was sooo sick that they had to use a bedside commode--that was unable to bear the pain of sitting up on their own--could beat a street racer to the door to go out and puff. Besides, it takes a surgical patient about 20% longer to recover if they smoke after surgery. Oxygenation of tissue....



The excuse that was used: It's the norm for Dallas hospitals. Yeah, right. Since when has Duc-boy been concerned with what was done in Dallas--unless the advent was in his favor. One thing it will get rid of--smokers.



If you have to go off campus to smoke, then you have to punch out to smoke. Anyone who doesn't---off with their head! And, last I heard, only two breaks were allowed plus lunch, per shift. So when they're Jonesing over that smoke, and they either find a place to blow it out the window, or punch out so many times they have to pay the hospital to work here....gotcha!



And you wondered how they were going to thin out ranks before transitioning to the North? Meet the new boss...same as the old boss....

Sunday, June 01, 2008

News From Connecticut....11/26

An interesting tidbit from the CT branch of Essent. Sharon hospital had seemed detatched from the problems plaguing the rest of the hospitals. However the article does refer to the nursing ratio concerns, as well as the all-consuming debt that Essent carries.

From TCExtra.com

Lakeville Journal
Sharon Hospital opens its books
By TERRY COWGILL
05/29

SHARON — It’s been six years since the first hospital conversion in Connecticut from nonprofit to for-profit.

When Sharon Hospital was under nonprofit ownership, its operations were essentially an open book. Its tax-exempt status required it to reveal much of its finances to the Internal Revenue Service and to state officials.

Essent Healthcare, the privately held company that acquired the nearly 100-year-old hospital in 2002, is required to report less to those authorities. Now Essent executives such as new Chief Executive Officer Michael Browder have decided to disclose unusual amounts of data regarding the hospital’s operations, finances, patient care and comparisons with competitor facilities.

“We want to be more connected to the general public,” said Ben Heller, a member of the hospital’s governing board. “For so long it’s been this mysterious entity.”

Aggressive investing

Heller, Browder and Sharon Hospital CEO Charlie Therrien spoke with this reporter and Lakeville Journal Company publisher Janet Manko last week in the hospital’s board room.

In a four-page insert purchased for insertion into this week’s Journal, hospital officials also revealed that Essent is carrying a significant debt load, which has funded the company’s aggressive expansion. When Essent was founded in 1999 by venture capital firm Thoma-Cressey, Essent’s board of directors and then-CEO Hudson W. Connery saw the firm invest $120 million right away. Since then, Essent has taken on $115 million in debt — borrowed mostly from GE Capital. Essent hopes to retire that debt, or refinance to lower its obligations, by 2013.

“Sharon Hospital today is strong and so is Essent,” said Browder, who replaced Connery last year after the founding CEO was reportedly forced out. “We are comfortable with the debt load. By pure market standards, we are underleveraged.”

From a high of $3.6 million three years after Essent acquired it, the 78-bed hospital’s net income declined to $1.734 million last year. During that time, interest expenses have risen more than 18 percent to $1.729 million, eating into the hospital’s operating profits. However, under nonprofit ownership, the hospital had lost about $16 million in the six years before Essent bought it. Essent owns four other hospitals: two in nearby Massachusetts and one each in Texas and Pennsylvania.

Decline in patient volume

The three men said that Sharon Hospital’s challenges are quite simple. Increasing patient volume remains a priority. From 2004 to 2006, for example, Sharon’s discharges went down 5.3 percent and emergency room visits declined by 5.4 percent. Browder and Therrien said patient volume is down at Sharon’s principal competitors (New Milford, and Torrington’s Charlotte Hungerford) by a similar percentage.

Many hospitals across the nation are experiencing similar declines since mid-2006, owing perhaps to the alternatives including walk-in clinics, outpatient surgical centers, hospices, home therapy and visiting nurses. Browder said he believes that recent improvements in pharmaceuticals and a declining economy have also kept would-be patients away from hospitals. In acquiring new facilities, Essent has always looked for hospitals that do not have a proximity to outpatient surgical centers, Browder said.

The physicians associated with Sharon Hospital, most of whom work as outside contractors to the hospital, are also vying for patients’ attention.

“Doctors are trying to plug the hole and do more in their offices, so they are also our competitors,” Browder explained.

Births at the hospital, however, have been a bright spot. They’ve increased about 10 percent since Essent acquired Sharon. A new 11,000-square-foot women’s services center finished last year could have something to do with that.

Financial advances, stability

In the six years it has owned Sharon, Essent says it has retired the hospital’s previous debt, financed an $8-million renovation project, helped fund a locally controlled community health foundation worth between $16 million and $20 million, and restored the hospital’s long-term fiscal health — all without a reduction in patient services.

And there was last year’s $17 million capital improvement project, which included not only the birthing center, but a new emergency department, an addition to the radiology department and a new 1,200-square-foot facility to house the magnetic resonance imaging equipment.

Through its first five-and-a-half years of ownership, Essent says it has spent more than $34 million in additions and improvements to Sharon Hospital’s physical plant and equipment. That amount is greater than the hospital’s net annual revenue when it was purchased.

Response to community concerns

Still, in the statements put out by its governing board in this week’s Journal, Essent officials concede that patient “volume has not yet sufficiently increased Essent’s significant investments [and] the debt created to increase business is large.”

In a letter to the editor in The Lakeville Journal earlier this year, Victor Germack, a financial analyst and member of the Community Association To Save Sharon Hospital (CASSH), a group that opposed the sale to Essent, raised what he called “several troubling issues.” Therrien acknowledged that today’s insert in The Journal is, in part, a response to Germack’s letter.

Germack went to Hartford to the headquarters of the state Office of Health Care Access, whose approval was critical to the Essent sale. He reported that of Essent’s five hospitals, “only Sharon Hospital was marginally profitable. The four others showed net losses for fiscal 2006.” Germack raised questions about Essent’s debt load, its overall financial condition and was particularly concerned about staffing levels and the degree of charitable care given at Sharon.

Indeed, The Lakeville Journal received a letter last April complaining that “as a result of the spending on the physical appearance of the hospital, the nursing staff has had considerable changes to their working conditions.”

The letter, which was signed only as “a group of concerned employees at Sharon Hospital wanting quality healthcare,” said nurses are “being forced to work” under a lower staff-to-patient ratio and that often “nursing personnel are being canceled and told to stay home.” Complaints to the administration fall on deaf ears, the letter claimed, so there have been some discussions about “joining a healthcare union.” Therrien said those employees’ concerns have been addressed.

“We follow national standards and our own determinations. I feel confident that our staffing levels are appropriate,” Therrien said. “There will always be people who disagree, but we have worked with nursing leadership to make sure they have the right support and resources.”

Finding quality doctors

Another significant challenge for Sharon Hospital is recruiting doctors. Shortages exist in adult and pediatric primary care, where Therrien said he would like to have four more physicians; and in endocrinology/diabetes, where the hospital could use one more.

The ranks of medical school graduates have been declining nationwide, Therrien noted, in part because of increased demands on physicians’ time and resources in order to comply with regulatory burdens and insurance. Combined with the cost of living in the Northwest Corner and an ailing national economy, the climate for finding qualified physicians leaves a lot to be desired.

“Recruiting doctors is hard,” said Heller. “Stop to think what it costs to buy a house here.”

Therrien has had less trouble recruiting qualified nurses, but was quick to “knock on wood.” He also insisted that Sharon Hospital fulfills its legal obligation to care for those who cannot afford care.

“We do not screen for financial ability,” Therrien explained. “We do go through a process to see what people can pay. Whether you have insurance or not is not necessarily the determining factor.” He added that Sharon Hospital has financial counselors who work with patients and direct them to local services that can help them further, if needed.

But all three men emphasized the importance of the concluding sentence of this week’s insert: “Finally, we are faced with the largest problem of all: How can the nation’s 2,000 small community hospitals survive in today’s atmosphere of intense governmental, economic and medical pressures?”


© Copyright 2008 by TCExtra.com


Just remember: Sharon Hospital is profitable. One of two in the Essent chain. They are talking about retiring Sharon's debt in that time frame, not Essent's.

Tuesday, May 13, 2008

Speculation....5/28

A comment caught my eye, and I thought it was worth sharing:

What's going to happen to all the loyal employees when the consolidation takes place? I don't see tons of earth being moved, and the reason for the main business of the hospital being at the South Campus was the facility's size: More OR suites, more rooms, larger ER. If we all move to the North, how is everyone going to fit, especially after redesignating part of it to the "Heart Center"?
Probably the same way they handled 'right-sizing' before. So, you will see less agency personnel and the rest will come out of staff.

What will they do to accomidate the ER traffic? Rack 'em and Stack 'em. An ER is a losing proposition anyway. Why make them want to come? You want the insured for high billable procedures, not self-pay/no-pay ER visits. Hence, the Cardiac Center for Excellence .

As the Snooze might say, "Don't you worry your little head about such things...." Or, in their own words:
The Paris News also pledges to continue to worry out the details, and to bring our readers all the news of these changes.

This is a Six Sigma innovation which they might take a hint from:

Friday, May 02, 2008

Questions from the Top....5/4

I almost said from administration, but it's just the cousin formerly known as Matt:

I need a quick primer.....on the one hand Essent is criticized for being money grubbers, putting the almighty dollar ahead of patient care. Then, when the hospitals show losses, they are criticized for not making a profit.

I am quite sure you can reconcile these apparently opposing conclusions.



Guess they're doing a poor job of money-grubbing?


Actually, the two opinions are not mutually exclusive. A hospital can be fiscally responsible, without covertly spying on staff. It's all in the how.


It can monitor the orders so as to have justification for tests run, rather than rejections. It can set specific goals...rather than wavering in the wind...and invest its employees in the process.

Essent jumped in with both feet, not just discounting suggestions, but ignoring them entirely. "We're from Nashville, and you poor hicks ought to worship at our feet." Well, the feet have been proven to be of clay.

Obviously, strategic plans have to change, with the change in the top. But, beware boys and girls: the shifting sands might get you...or possibly the red ink....

Wednesday, April 30, 2008

Press Ganey and Vestar....4/31


While surfing not too long ago, I ran into an article that just clicked. Vestar bought a controlling interest in Press Ganey. (You remember Press Ganey, don't you? They measure patient satisfaction. Ironic, isn't it?!?)


Now for those in Rio Linda (one of Hud's expressions), Vestar is heavily invested in Essent. One would hope that the crossover would have a positive effect on Essent...Hah!

Monday, April 28, 2008

More Red Ink....5/2



If you go to http://www.ahd.com/ and key in for Paris Regional Medical Center, you will notice that the bottom line says it all: $508,231 in red ink.

Sharon Hospital, while having a gross of less than 1/3 of PRMC, produces $1,467,558.

Merrimack Valley Hospital has a gross slightly ahead of Sharon, but out does PRMC: $1,498,033

Nashoba Valley Medical Center nets $860,296.

Southwest Regional Medical Center produces the lowest gross, yet rounds out the company with the greatest losses: $2,411,841.

So, one would hope they have some deep pockets, 'cause if they don't, someone sometime is going to say: Enough!



Disclaimer: The figures published at AHD.com are not current year. Please see the time periods shown on each hospital's sheet. Amounts could be greater or less for the current fiscal year.

Friday, April 25, 2008

New Radiologists....3/12/10

Well, the Snooze has announced the arrival of two new radiologists. Emphasis on 'new'. The first, LUCHO LOISEAU ROSSMAN has been practicing for three years, after an eleven month fellowship. You wonder how much of that was as an assistant professor?

MICHAEL SCOTT ALLEN, the second radiologist, has practiced for 18 years, with only a small misunderstanding on his renewal--delinquent/non-payment--and an 'active-not-in-practice' during 2002. Maybe it was during his mini-fellowships....(the information on Hopkins and Emory has mini-fellowships listed from less than a week to three months....) Worldwide Imaging sounds like a radiologist reading from his home in a bathrobe...with little to no patient contact.

One good thing, he ought to be able to keep up with dictation! Hopefully he can get past the generalization trap of the on-call services and make definitive statements.

But, here is the story, you be the judge:



A (64) slice of life

Staff reports
Special to The Paris News

Published April 23, 2008

Two board-certified, fellowship-trained radiologists — Michael Scott Allen, M.D. and Lucho Rossman, M.D — are new additions to the Paris medical center.

Their arrival in the community coincides with the arrival of a Toshiba Aquilion 64 Slice CT Scanner on the North Campus where work continues on new cardiology facilities.

The Toshiba Aquilion can perform a whole body trauma in ten seconds, more than twice as fast as conventional multi-slice CT scanners. This speed is especially helpful in shortening breath holds for geriatric patients, patients who are on ventilators and pediatric patients.

In a single rotation, the scanner creates 64 high-resolution anatomical image “slices” as thin as a credit card. These images are combined to form a three-dimensional view of the patient's anatomy for the physicians at Paris Regional Medical Center to analyze. From these images, physicians can view such things as blockages in the coronary arteries, as well as the motion and pumping action of a patient's heart.

Both Allen and Rossman bring extensive experience and knowledge to the hospital’s radiology department, Paris Regional Medical Center CEO Chris Dux said.

“We are thrilled to have them here,” Dux said.

Allen, who is to serve as Medical Director of Radiology, specializes in neuroradiology, muscle skeletal radiology, virtual colonoscopies, magnetic resonance imaging (MRI) and Coronary Computed Tomography Angiograms (Coronary CTA). He joins the staff from a private practice at Worldwide Imaging Technologies in the Dallas area.

Allen received his Doctor of Medicine from the University of Texas Southwestern Medical Center at Dallas and fulfilled his residency at the University of Missouri Medical Center. He has completed mini-fellowships at Emory University, New York University, University of California at San Francisco and Johns Hopkins University.

“Paris Regional Medical Center made me feel at home right away. It has a great group of physicians and the best radiology department that I’ve ever worked in,” Allen said. “I am honored to be part of such a top-notch organization.”

Rossman, the area’s only fellowship-trained interventional radiologist, joins the staff after most recently serving as assistant professor of Vascular Interventional Radiology at the University of Texas at Houston and as a clinical interventional radiologist at Memorial Hermann Hospital and Lyndon Baines Johnson Hospital in Houston.

He graduated from the Baylor College of Medicine in Houston and performed his residency and internship at the University of Texas at Houston. He completed a fellowship in vascular interventional radiology at MD Anderson Cancer Center.

“I have been impressed with the significant investment Paris Regional Medical Center has made in the latest diagnostic and interventional radiology equipment,” Rossman said.

“What we have here compares favorably to what is available in most major cities — like Dallas and Houston — and far beyond what you would normally find in a community this size,” he said.

What is a Radiologist?

Nearly all physicians examine patients, obtain medical histories, diagnose illnesses or prescribe and administer treatment for people suffering from injury or disease.

Generally, a radiologist is different from other physicians because he or she diagnoses diseases by obtaining and interpreting medical images. Some images are obtained by using X-rays or radioactive substances, others by means of sound waves or the body’s natural magnetism.

A radiologist correlates medical image findings with other examinations and tests, recommends further examinations or treatments and confers with the referring physician. Radiologists also treat some diseases by means of radiation (radiation oncology) or minimally invasive, image-guided surgery (interventional radiology).

Thursday, April 03, 2008

...With Baited Breath....6/11

It's back in the hands of the judge, again. Arguments have been made, answered, and now it's under consideration.

My contention is that it is a SLAPP suit, but Texas has no provisions against such suits. What is a SLAPP?

Generally, a "SLAPP" is a (1) civil complaint or counterclaim; (2) filed against individuals or organizations; (3) arising from their communications to government or speech on an issue of public interest or concern. SLAPPs are often brought by corporations, real estate developers, government officials and others against individuals and community groups who oppose them on issues of public concern. SLAPP filers frequently use lawsuits based on ordinary civil claims such as defamation, conspiracy, malicious prosecution, nuisance, interference with contract and/or economic advantage, as a means of transforming public debate into lawsuits.

Most SLAPPs are ultimately legally unsuccessful. While most SLAPPs lose in court, they "succeed" in the public arena. This is because defending a SLAPP, even when the legal defense is strong, requires a substantial investment of money, time, and resources. The resulting effect is a "chill" on public participation in, and open debate on, important public issues. This "chilling" effect is not limited to the SLAPP target(s): fearful of being the target of future litigation, others refrain from speaking on, or participating in, issues of public concern.
What is the harm in a SLAPP? Again, it curtails free speech, unless you have the money and time to fight it. While there should be an accountability factor, it shouldn't be dependent on one's bank account...and how much justice you can buy.

Thursday, March 27, 2008

New CEO....4/9

Essent confirmed Mike Browder as the permanent CEO. He had been the interim top dog since November when Hud Connery stepped down (or was stepped on...!)

One could wonder if the long and hard search they made uncovered any other possibilities, but Browder had the advantage of being current in the corporation. Another thought is, most of those about, in the various companies are like Hud--products of HCA/Columbia--with very little difference in style.

Had a comment that I had filed away for future use that might put things in context. Remember Muskogee? Essent bid on it and withdrew when Hud was invited to a question-and-answer session?

Apparently, the new owners (Capella) waited a bit and then drug-tested all the employees...using hair. Hair is a record farther into the past...3-6 months...and 200 of the staff were terminated. I can imagine a new look here...bald nurses and techs! (Remember, scalp hair isn't the only source! Eyebrows might not grow back!) (This is uncomfirmed, but an interesting contrast. How much would it cost to test everyone at that level, anyway???)

The employment pool is larger there, and they're relying on agency personnel heavily. Same story, different company and town.

Sunday, March 23, 2008

Did I?....5/11

Essent has stated that I defamed them. That since the blog came out, I have been mis-representing them to the public. But, have you noticed the changes in their operation?

Let's take this election year. Actually, please take it. I'm not wild about the choices, and it certainly looks like the Democrats are trying to eat their young--okay, Hillary isn't quite in that category, but you get the picture....

In election years 2000 and 2004, Essent employees contributed $13,250 and $16,250, respectively. Even in off-year elections 2002 and 2004, they gave $11,250 and $9,800 (mostly Hud). So far this election, the total is Zero!

Now, I don't mean to say that contributions have stopped, but large contributions have been turned off.

Raises are back in vogue. Several other programs have been changed. Cameras were pulled from the smoke alarms. And Essent has plowed bucks back into the local economy--(how much do TV ads cost, anyway?)

Remember when the hospital was being bought, and everyone thought that the change would be good? Change can be for the better or worse. When someone's campaign's mantra is 'change', be careful what you wish for....

Saturday, March 22, 2008

Integrity, Integrity....3/24

From the Boston Globe:

Emerson Hospital misstated financials

Investigation finds senior executives created documents
By Jeffrey Krasner, Globe Staff March 21, 2008


Two senior executives of Emerson Hospital in Concord created documents that misstated the hospital's financial condition over parts of its last three fiscal years, the hospital found after an investigation and audit that concluded last week.

The misstatements made the hospital's performance appear better than it actually was, at a time when it was seeking donations for a major expansion that is now nearing completion.

As a result, Emerson violated some promises it made to lenders. That, in turn, forced the hospital to reclassify some of its borrowing as short-term debt, a technical measure that could limit its borrowing ability.

Emerson has not missed any payments and officials said it is not in danger of defaulting on its bonds. The audit completes an inquiry that began last August when a midlevel manager noticed billing irregularities and told a supervisor, said chief executive Christine Schuster.

In all, the hospital had to wipe out $7.1 million in improperly recorded revenue. Because of accounting rules, however, it only had to formally restate its books for fiscal 2006.

The two senior executives - Dana P. Diggins, Emerson's chief financial officer, and Michael Collins, its controller - left Emerson last year. Officials declined to say whether they resigned or were fired. A third financial executive, who the hospital would not name, was let go.

The matter has been referred to the office of Attorney General Martha Coakley, said John M. Lowe III, chairman of the hospital's board of directors.

John O. Wilhelm Jr., interim chief financial officer, said the misstatements were accidental.

"They weren't aware they were misstating it - they thought they were correctly stating it, but they were wrong," said Wilhelm. "People make mistakes and they move on. That's life. They were big mistakes."

Diggins is now chief financial officer at Harrington Memorial Hospital in Southbridge. Collins is chief executive at Merrimack Valley Hospital in Haverhill. Neither responded to calls seeking comment.

Schuster said the former employees manipulated the hospital's earnings by misusing contractual allowances - a term that describes the discounts hospitals give to insurance companies on the "official" prices they charge for services and procedures. Each month, the hospital must adjust the amount of money it expects to receive to account for such discounts.

"The controller at the time overrode the estimates that the contractual allowance model was generating," said Schuster. "That resulted in an overstatement of revenue."

The restatement is particularly sensitive because the hospital is required to keep its lenders and bondholders informed of any changes in its financial condition. A failure to file audited statements can constitute a technical violation of the many promises and ongoing commitments lenders require of borrowers.

Footnotes to the restated financial results, by the accounting firm PricewaterhouseCoopers, state Emerson was "not in compliance with certain debt covenants" for a $3.9 million loan from Bank of America.

In addition, the footnotes state Emerson was not in compliance with covenants for a $63 million bond offering conducted in 2005 by the Massachusetts Health and Educational Facilities Authority, a quasi-public agency that facilitates borrowing for smaller institutions.

Wilhelm said that after the audit was completed, the hospital was able to forge a new agreement with Bank of America that waives the violations. He said that contrary to what PricewaterhouseCoopers reported, there was no violation of loan agreements with the Massachusetts authority.

"This was a fluid issue going back and forth with the auditors," said Wilhelm. "There were a lot of rewrites (to the footnote) and there was a little hurry-up at the end. We are not, and have not, been in violation of any of our bond covenants."

The facilities authority, which arranged the bond offering, declined to comment.

The restatement also comes at a difficult time for Emerson. The hospital made a small profit, $1.7 million, on its healthcare operations in fiscal year 2006. But in fiscal year 2007, it lost $8.1 million on healthcare operations. Some of the losses were offset by investment income, yielding a loss of $4.7 million for the most recent year.

For the first four months of the current fiscal year, the hospital has broken even. But officials said the results were dragged down by a series of one-time charges, some associated with the accounting problems.

In particular, the hospital paid $490,000 to FTI Consulting Inc. - a healthcare consulting firm hired to improve the hospital's financial operations - and about $100,000 to the law firm of Wilmer Cutler Pickering Hale and Dorr LLP, which conducted the investigation.

"The board was concerned when this came to light, but because Chris (Schuster) had kept us informed all along, we were comfortable we were taking the right steps," said Lowe, the chairman. "We're now focusing on regaining our financial strength."

Jeffrey Krasner can be reached at krasner@globe.com.

This might be a non-story, except for two names that we're familiar with: FTI Consulting, and Michael Collins. Wonder if the GE Capital mortgage will be the next subject for Mr. Krasner's reporting skills?

Tuesday, March 18, 2008

So, Is an In-flight Lunch Included?....3/20


A new form of outsourcing is hitting the medical field. Radiology has been one of the first, but surgical procedures are now being targeted by the insurance companies. The hospital has been quick to use the over-night readings from Austrailia, wonder if TN BC/BS will be buying the tickets if the hospital can't meet the prices in Thailand? Or Costa Rica, India, or Ireland?

Business Week

Outsourcing the Patients
More U.S. health insurers are slashing costs by sending policyholders overseas for pricey procedures
by
Bruce Einhorn
For years, Americans have been traveling abroad to save money on elective procedures or dental work. David Boucher, 49, doesn't fit the usual profile for such medical tourists. An assistant vice-president of health-care services at Blue Cross & Blue Shield of South Carolina, he has ample health benefits. But Boucher recently chose to have a colonoscopy at Bumrungrad International Hospital in Bangkok, mainly to make a point about the expanding options available to Blue Cross customers. And his company happily picked up the $640 tab—a bargain by U.S. standards.

Blue Cross and other insurers would like to see more policyholders traveling abroad for medical care. Since the start of the year, Boucher has signed alliances with seven overseas hospitals and hopes to add five more by yearend, including them all in coverage for his company's 1.5 million members. As health-care costs continue to rise in the U.S., "medical travel is going to be part of the solution," he says.

Yes, just like manufacturing facilities and call centers, health care is moving offshore. "All of the largest U.S. insurers are starting to educate themselves or are putting [offshore] programs in place," says Jonathan Edelheit, president of the Medical Tourism Assn., an industry group formed just last year. Companies that self-insure are also bombarding Edelheit's group with requests for information.

Getting covered employees to leave the U.S. won't be that hard, says Edelheit. An insurance company could waive all deductibles and co-pays, offer to cover travel costs for the patient and family members, even throw in a cash incentive, and still save tens of thousands of dollars. After all, a heart procedure that costs $100,000 in the U.S. runs only $10,000 to $20,000 at some of the best private hospitals in Asia. And the quality of care? Foreign hospitals in such arrangements are typically approved by Joint Commission International, part of the same nonprofit organization that accredits American hospitals.

Blue Cross took the lead in medical offshoring when it formed its first partnership, with Bumrungrad Hospital, in February. Since then the insurer has signed similar pacts with the Parkway Group Healthcare, owner of three hospitals in Singapore, and hospitals in Turkey, Ireland, and Costa Rica. Three members of India's Apollo Hospitals Group are also joining the network. And another large Indian chain, Wockhardt Hospitals, is talking with U.S. insurers as well. "Americans haven't come to grips with having their heart surgery in Thailand," says Curtis Schroeder, the American CEO of Bumrungrad. "But that will change."

The shift is sure to leave some policyholders disgruntled, of course. Offering international coverage might make it easier for employers to limit benefits at home, for instance, by raising the deductibles on U.S.-based procedures. It's also extremely difficult for patients to sue for malpractice in most Asian countries. Bumrungrad has offices for marketing and promotion in 20 countries, but not the U.S.—in part because having a U.S. office would open the door to potential liability, hospital officials say. So it will take a while for the trickle of insured U.S. patients in Asia to become a torrent. But over time, for policyholders and payers alike, the price may be hard to resist.


With Catherine Arnst

Friday, March 14, 2008

When Our Eyes Meet....4/3

Sign the paper, old man.... Let me preface, when I read the comment, all I could think of was Marty Feldman....

A lot of the problems stem from poor employee morale. The bully tactics used by administration do little to empower or encourage the staff. The forced signing of the "Nursing Standards of Excellence" if not signed by 3/10 it was considered termination (or voluntary resignation). A lot over a signature on something that some people may or may not have agreed with.

Especially with an already understaffed facility that is doing nothing to correct this critical problem - travelers, agency, etc.... Personally some of it was so trivial and more of it was just plain common sense/courtesy (let people off the elevator before boarding) or my favorite will make eye contact within 15 feet and again within 10 feet smile and speak...how creepy can this get...eyeballing me walking down the hallway.

Does it mean that someone will be fired for running down the hallway in an urgent situation and failing to speak the the other people in the hallway? If going on prmc history...that very well may be the case... you've voluntarily resigned by "not meeting the standards of excellence...see you signed the paper...." blow me prmc

Tuesday, March 11, 2008

Where Are They Now?....3/16


"Hud" Connery...Rumored to be 'considering offers.'

Andrew Knizley...You've got to see this. If you note, PRMC didn't even show as a blip on his resume, other than size of staff--which under him was reduced significantly. A 'risk-taker'....



"Profit oriented focus
We help rebuild core businesses with a focus on the bottom line. We work with clients to develop new product lines and cull unprofitable product lines. We have multiple awards for enhancing shareholder value.

Analytics
Our team has a high-level ability to conceptualize and prioritize. We have a track record of transferring ideas into tangible results.

Quality centered management
We help our clients to achieve lasting, long-term results through intense focus on quality improvement. We have earned multiple national quality awards achieved in short time frames at turn-around facilities. We are fluent in the use of “best practices” and quality improvement methods to enhance performance and customer satisfaction."
Ahh yes, shareholder value. Tangible results? Enhance customer satisfaction? Anyone with a subscription to American Hospital Directory can verify the 'tangible results' that Andy created for PRMC during his tenure. But, resumes are selling tools, and should be taken with a grain (or shaker) of salt.

'Dick' Salerno...Still with Essent. Wouldn't be suprised if he was the guiding light for the Ayer mortgage and 'downsizing of their commitments.' Something about a submission of a certificate of need at a previous position just has that ring....


Anna Gene O'Neal...Vice President for Quality and Performance Improvement for Cogent Healthcare. A new position in a 350 person company, seemingly a bit of a drop from Essent's Vice President of Hospital Operations and Clinical Quality. But, she did survive the wrath of Hud.


Bill Heburn...Joined CHS two years ago. Long time to get over a Hud dismissal.


Michael Davis...CFO to the original Essent start-up, bailed in 2002 to CHS (right about the time of the Sharon purchase.) Currently Behavioral Centers of America CFO.


David Kreye...COO at Baptist Hospital North Central in San Antonio. Has been very low key, one would almost think he's not there. Far from Paris and Greene Co.

Notice that none of these folks and, I would venture to say, none of the current Essent crew has been in a single company for over 10 years. They have little in common with the poor schlubs that are trying to retire from a company. Twenty or thirty years? Hah! They can't understand what would motivate a person to be in one place that long. Not just move up or move out, but move out to move up. So, if you're feeling chummy with administration...don't. They won't be here that long. By choice.

I liked a comment that came through after this last round of non-performance-raises:

What makes it more of a disconnect is the current bastardization of TQM (Total Quality Management for those of you from Rio Linda). About the only characteristic that has emerged is the evaluation by peers. Which, by itself, has the tendancy to homogenize the workforce. It recognizes both ends of the bell curve: Those that do a poor job, those that make the others look bad...and those that make them feel uncomfortable. Performace is irrelevant, it's a Survivor or Big Brother social club. Who's next to be voted off the island?

Mediocrity is king.