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

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
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 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.

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.

Friday, March 07, 2008

Another Court Date....5/1

Well, we're back on the docket. Arguments in about two weeks...a little over a week after the election. One might say that this was to have the time to devote to the contemplation...or, maybe not to have the firestorm prior to the election. The new case has been filed since before Christmas.

The last decision raised the eyebrows of every law review that took it up...and ultimately overturned by the appellate court. This one will be thought out and referenced with far greater detail, I have no doubt.

Obviously, I have my preference of verdicts, as does Essent. But please note: 'blogging' is not a new phenomena, at least in what I do. Benjamin Franklin wrote under several pseudonyms, as did several other writers the years prior to the American Revolution because of the possibility of repercussions and retaliation. It was just in a different medium.

I am hopefully not looking at a hanging, but the other side probably has a different hope and expectation. Speaking of expectation, I've heard, over the months, many that said should the case go against me, they were dropping Suddenlink like a hot potato. Something about an expectation of their privacy. Could be (might be just talk,) but I'm going to explore the Suddenlink involvement in the case in later posts, so don't drop that 'tater just yet.

This case has written a footnote into Texas law already. It should be interesting if it becomes a paragraph.

Monday, March 03, 2008

More Creativity!....4/27

Remember how Essent was going to build a new hospital in Ayer, MA? They said the current one was unable to be renovated and they would have to build new, instead? Ennnnnh, wrong again. The Lowell Sun had an article recently:

Hospital abandons new-facility plans, to renovate instead
By Jack Minch,
Article Last Updated: 02/29/2008 11:32:12 AM EST

AYER -- Nashoba Valley Medical Center announced yesterday it is abandoning plans to build a new hospital at a cost of $50 million to $60 million, and will instead renovate the existing facility.

Chief Executive Officer Steve Roach said he'll meet with town officials to determine if the change affects a tax-increment financing agreement approved at Town Meeting last May. However, the hospital still plans to add 30 new jobs to its staff as agreed to under the deal.

"The commitment to 30 jobs is still there," Roach said. "We have to grow the staff. You can't do it without staff."

The cost savings for renovations can be used to pay for new equipment, which benefits patient care and also works as a recruiting tool for new doctors, Roach said.

Officials say the decision to renovate reflects a trend in the medical industry that places emphasis on more outpatient care and shorter inpatient stays when hospitalization is required.

"Most of what we used to keep people in the hospital for three, four days or a week we do in a day now," said Dr. Kenneth Janes, a surgeon at the hospital for 30 years.

The hospital was built in the late 1960s and early 1970s as a 100-bed facility with little outpatient capacity, Roach said. Now, with clinical work, about 85 percent of the care is on an outpatient level.

The cost of the renovation hasn't been set, but it will be less than $50 million, Roach said.

The timeline for work won't be determined until the scope of renovations is decided. The work isn't expected to shut down the hospital.

The hospital originally planned to start construction in 2009 on a facility with 60 private rooms.

Instead, hospital doctors and staff members will work with a design-build team to determine what renovation work needs to be done, Roach said.

"We would get what we call a new hospital within a hospital," Roach said.

Town Administrator Shaun Suhoski and Planning and Development Director Christopher Ryan met Wednesday with Roach and Richard Salerno, the senior vice president of operations for Nashoba Valley's parent company, Essent Healthcare LLC of Nashville, Tenn. The meeting didn't delve deeply into details.

"From what I can gather, it would still represent substantial growth and investment at the facility," Suhoski said.

The current hospital has about 104,000 square feet, and renovation plans could include some new construction, Roach said.

The hospital is licensed for 57 beds but effectively uses about 35, Roach said.

There are about 116 doctors on staff, but only about 65 or 70 are active.

Note: This is after they mortgaged the hospital to GE Capital.

Now, take Paris. Should they build a new facility on the North Campus? What's going to happen to the old one? What about the property values around the South Campus? What about all the property that Essent owns around that facility? You wonder if Essent announced that 'exploration' to drop property values and get a tax-break on all the properties they hold.

You would have thought that the medical supply building directly across the street would have been a hot commodity, but it's still posted for sale. If the hospital wasn't active, how many doctors would stay in the old Brookshire's or the old Sears buildings?

One indicator would be how long it takes to lease Dr. Wilson's office when she leaves this summer. Directly across from the hospital, one would think prime location.

Sunday, March 02, 2008

Just an Observation....3/5

This is just an observation from a person who has used both hospitals recently, for pre op and then op I saw such things as unsanitary conditions in both places, inconsiderate staff, and what appears as inept or untrained personal.

Maybe it is the attitude of the staff "I will do what I have to do to keep the job but not one thing more," “patients don’t matter,” and “it is not my job” attitudes prevail. If my Aunt was still there and was head nurse again, I assure you those nurses would take care of the patients or they would be gone. Should she have caught one looking at a surgery wound without gloves on that nurse would be gone right then. There would not be trash left on the floor, patients would be made as comfortable as possible, and the staff would use a pleasant tone of voice at all times.

In the three days that I spent in the hospital I can say that there were only 2 nurses who showed me that they were true nurses. The rest were there for the pay check and did nothing more than what was required by the chart. On the third day I told the Doctor to release me I could get better care at home.

I have no knowledge of the Quint Studer group or what they really do, however, if it is that patients should be treated with respect, dignity, and compassion I am all for it.

When nurses and staff dictate to the Doctors and patients what will be done and how it is to be done or ignore doctors orders you don’t have a hospital, you have a first aid station. A poor one at that. This is why patients go else where to go to a hospital. Patients have rights, and the first one is where to spend the money for health care. If I have to have someone in the room taking care of me while sick I don’t need a hospital or their nurse.

I see a bunch of passing the buck and no one taking the responsibility of making changes. I guess if you cover it up deep enough with layers of management the problem will go away. And this is why most people go elsewhere for their Medical care.

I really can't add much to this. The end result is the patients and their perception of our hospital.