Funny Thing Happened....3/12

A lot of people wonder why the posts have dried up. It's not that there isn't anything to discuss or cuss, it's just that the discussion seems rather futile. It doesn't change.

The ER loses good staff, and they hire locums. Clinical or nursing loses staff, and locums replace them at twice or three times the cost.

The spread-out services continue to make it difficult for Essent's showplace to be truely functional.

The 401Ks go begging for a second year, but a new hospital is acquired.

When ever you ask someone that works here how things are, the first thing they do is look over their shoulder...that says a lot. (Try it sometime, you'll see what I mean.)

But, apparently the only thing we lose is customers. Paying customers, that is.

Maybe it's the wave of the future, but this is a future that doesn't float my boat. I think it's about time that I plot a different course. There are enough locum jobs that don't involve Essent and provide a safe way to evaluate an employer--and an area.

There are a number of former staff that have made the move--I'll probably have mates to commiserate with. I just hate the idea of the bad guys winning...by default.

Ya Wonder....2/11

By now most know that Essent is in the due-diligence phase of the Brown County General Hospital in Ohio. It is also noted that they didn't bring the commissioners to Paris....

I particularily liked the quote in The Ledger Independent:

"Essent will breathe new life into Brown County General Hospital," Edwards said.

And,

Essent will also provide capital for facility and equipment enhancements and
proposed to invest "significant amounts of capital over the next three years to
include the construction of two new floors with approximately 50 private
inpatient rooms," according to a press release.

Wonder how that plays in the new hospital in Ayer, MA--Oh yeah, they decided not to build that one. And when was that move to the North Campus taking place...let's see now...Oh yeah, in the beginning of the year. This year or last year?



Must be a real good price, and who in the organization is getting their raises and matching funds? Divide that rumored bonus by 2000 hours to find approximately what your actual hourly bonus is.


I'm just waiting for the naming contest. Bet Georgetown Regional Medical Center takes the prize.... Has a ring to it--like the Gong Show....

Half Better Than None?....10/30

Remember when Essent was negotiating for Nachez Regional Medical Center--and they backed out because the other hospital in town wasn't included in the deal? Well, for the first time in five years, NRMC is projecting a profit of approximately 3/4 of a million. Timing is everything, I'd say.

'Course they're also projecting $12.5 Million in bad debt--unpaid bills. Now, if Obama-care makes it through, would those debts be unpaid? That would suddenly transform these small, un-profitable hospitals into cash machines...or so it's touted.

A lot of folks don't remember, but one of Hud's (the original CEO of Essent) catch phrases was, "We want to make this 'the' hospital in the area..." Hud really meant, the only hospital in the area. They were actually going to try to repeat the Paris condition.

This is the one where patients are shuttled back and forth by ambulance from ER to ER, based on an initial diagnosis which may or may not be accurate? And where they are moved, again by ambulance, to the North to have an MRI, and then back to the South?

To heck with hospitals, I'm investing in ambulance services! That is the growth industry.

But, if either Obama-care, or the proposed Republican health care plan go through, the county hospitals that Essent has been scooping up will suddenly be gold--in 2010-13. Isn't that when the phase in goes into effect?

Local Impact....9/28

You might have wondered why I started covering the national health care issue, rather than more local problems. The latest poll that came through might be a reason. Currently 48% of the surveyed population are rating the health care system we have as good or excellent, as opposed to 29% last year. And, we're going into a congressional recess.

What does that mean, locally? With the announcement of the possibility of increased taxes on the "middle class", there is a real chance that the health care bill will stall, if not fail. Medicare cuts have already been projected. What are most of the Essent hospitals dependent on? Federal programs.

PRMC is currently, if I'm not mistaken, considered as part of the metroplex in Medicare reimbursement levels. The new cuts will leave the rural rates alone and cut into metro. So, a quandary: Will the new rates drop below the rural, equal them, or stay above? How much of a cut will PRMC take? Hmmm?

Quite possibly Nashville was sitting back, confident that a lot of the self-pay/no-pay would now be covered, pushing their revenue levels up. Now, the projection might not be so rosy...possibly equivalent to a lump of coal in their stocking.

Damned If You Do....9/3

Remember, years ago, when the Medicare renewal was let slip through the cracks and the reimbursement rates went to rural, rather than that of the metroplex? Well, under what is being cussed and discussed in Congress, that might be a good thing in the future.


Apparently, rural hospitals and physicians (medically under served areas) will not sustain the level of cuts that are being proposed to current Medicare levels. My take is that they are afraid of the egress of physicians from those areas to more profitable practices.


Understand, this is proposed, not a done deal.


So, PRMC and the other Essent hospitals might actually make out better. Who'da thunk it?


But, here is the kicker: While the percentage of insured would go up, the levels of reimbursement would still go down. The plan still doesn't cover everyone of those that are 'counted' in that 46, 47, or 50Million that is being bandied about.


What will happen, is more taxes--tax the wealthy will descend to tax the working. And I'll foretell something additional: Both Social Security and Obamacare both become means tested. So, if you've been responsible, saved, and invested in your retirement--tough. We're giving it to the ones that overspent their income (you saw it in the home loans, why not here as well?) All others pay cash.


All I'm saying, is that those who ignore history are doomed to repeat it. We've seen the examples: Federal programs with spending 300% over their estimates. Bailouts for the poorly managed (corporations as well as family finances.) Earmarks attached to "essential" funding...and we're willing to turn our health care to those people (who aren't crazy enough to opt for the same program)?

The Ayer is a Bit Stale....2/23

Dr. Cerel has come to view, as of late. A few comments stored up directed me to two locations. The Mass Board of Registration, and "rateMDs".

The Mass Board of Registration had this to say:
Hospital Discipline:
This section contains several categories of disciplinary actions taken by Massachusetts hospitals during the past ten years which are specifically required by law to be released in the physician's profile.

1. Facility: Nashoba Valley Medical Center
Action Begin Date: 2/10/2005
Action End Date: 6/20/2005
Action: Other

Basis or Allegation:

• Failure to follow internal by-laws, rules, etc.


• Interpersonal skills/personal behavior


• Delay in treatment


• Lack of informed consent-surgery related


• Failure to prescribe

-
-------------------------------------------------------------------------------
2. Facility: Emerson Hospital
Action Begin Date: 2/17/2005
Action End Date: 3/16/2005
Action: Suspension of right or privilege

Basis or Allegation:

• Failure to follow internal by-laws, rules, etc.

--------------------------------------------------------------------------------
Board Discipline:
This section includes final disciplinary actions taken by the Massachusetts Board of Registration in Medicine during the past ten years.
--------------------------------------------------------------------------------

1. Date: 3/16/2005
Case #: 2007-024
Action: Practice Restrictions

I would say that he's on staff, with no restrictions, other than what was imposed by the Mass Board. Unless there's something current, the last action was three years ago. However, that put him on training wheels. Wonder when that ends?

RateMDs.com had this:

He has privleges in one hospital, and is rated 2.3 on a 5pt scale.

More From Emailings....8/5

Emailed to me, subject: Congressional Clout

This is an awful lot of reading. Some of us will just go with the flow. But, read some of the provisions and compare them to the language of the actual bill (attached). Or go through and pick the ones that piss you off—and verify them.

Then, write a letter (a real one, not an email, not an on-line petition—they get round-filed) to your congressman (the link will take you to where you find out who yours is.) You can say that you’re mad as hell and that mad is going to stay around through the next election. Cite the provisions that bother you. Get your spouse to sign as well.

Think about this: There hasn’t been a President elected from an independent party in recent history. Too much stacked against them. But, Congress is a different story. And the weight of the independents when the two major parties are deadlocked is significant. More actually than a long-term incumbent.

Maybe we do need to make a change, but I want to know that my representatives are aware of the provisions and can vote intelligently—like we supposedly did when we voted them in. Passing a bill with only the vaguest idea of what it contains is not responsible. Too many people respond to the “this won’t last long in this market” and “if you snooze, you lose.” ***

This is a bill that we have no idea as to what it is going to cost. No one does. Yet. The time to find out the cost is before it passes. This is the time for competitive bids.

Or don’t feel so superior when those people who bought houses for which the payments are more than their total income are paraded on TV. You’ll be one of them.

The included listings of specific hot-button items is in comments. The post would have been far too long. You can download the bill from the previous post's comments.


*** I would include, "And Congress responds to, "We have to pass this NOW!" Less reading."

And, another chipped in:

Yes, healthcare for the elderly will be seriously ... Yes, healthcare for the elderly will be seriously limited. Tests and surgeries deemed too expensive will not be allowed.
Can euthanasia clinics be far behind?
And yes one congressman did state that the healtcare bill was too long to read and he didn't need to read it anyway. Now I ask you, if someone handed you contract filled with fine print and clauses would you just sign it? Or would insist on reading it and having your lawyer read it too before you signed it? Yet that is what Obama is asking congress to do. Sign it into law without knowing what's in it. Obama has even admitted he hasn't read the damn thing. Who's driving the bus??
I urge everyone to email their congressmen and senators while they are on recess. Let them know this healthcare bill is not what you want!!!

I admit, if someone dropped a 1000+ page contract on my desk, I'd want some serious review done. Either by myself, or by someone with my interests at heart. We don't have that here.

An added inclusion, submitted in a comment, but since it doesn't display there, I thought I'd bring it forward.

Frank, check out Pg932-6 and see how this applies:

80% Believe....7/31

The latest figures indicate that Congress should come under whatever health care program that the citizens are being forced into. Is 'forced' the correct term? Possibly not, but there are reservations--from physicians, from health care workers, and from citizens, as well as Congress itself.

What are those reservations?

• Cost


• Ability to keep what some already have.


• Congress being lax in reading the 1000+ pages of the House bill.


• Congress's adamant refusal to come under the provisions of the bill.


• Taxing employer provided health care (didn't they criticize McCain for that proposal?)


• Forcing out the commercial policies.


• Possible federal mandated restricted care (MRIs, CTs, and C-sections are what were touched on. Probably more to come.)


• Exaggeration of the numbers of the uninsured.


• Who is going to pay for it?


• If you are going to limit costs, are you going to enact tort reform (litigation is a major source of medical costs?)


• Limiting treatment to those with terminal diseases...like YOUR parents, or you.

Fewer applications to medical schools might be fortelling the future. One reason is the overwelming amount of paperwork mandated by the federal government. And you think it'll be less???? We've been depending on FMGs (Foreign Medical Graduates) covering the rural and inter-city areas. What happens to their incentive to stay if the Fed gets involved to this extent?

Change, But Can We Live With It?....7/26

Change...an interesting word. We've definitely had change in Paris.

But, we're talking about the Federal Government--managing 1/6 of our Gross National Product. This is the same government that has yet to come in under budget on almost anything?

This is the same administration that said they didn't understand the severity of the recession?

The same administration that let Billions in pork get attached to the stimulus package.

This is the same administration that wants to include 10+ MILLION illegals in the care process....because if they're citing the justification for 50 Million uninsured, they're part of that number.

Of course, that also includes those young adults that are not covered--by choice: those healthy enough to roll the dice, and mostly win. That's an extra latte a day.

That also includes those that are counting on the guaranteed access to emergency treatment, reguardless of ability to pay, that already exists. They are estimated at 18 Million, with many over the $50k income level.

So, what happens when the government runs hospitals? Take the VA...look at Walter Reed. One of the formost military hospitals...and what was it that they were having problems with? Oh yeah, patients falling through the cracks. Almost literally, since there were holes in the floors and walls.

So, if these patients are heroes, what's in store for the rest of us????

I'll consider making that change...when Congress makes the same one....

Ideas Wanted....7/26

From the comments:

OK,OK,OK, I get it........you have a situation with medical care in Paris,Texas.
I have been reading this blog for 2 years and HAVE NOT ONCE heard of a solution. This country is full of whiners and finger pointers. Come on people, step up and put some backbone in it and solve the problem. I am a physician and have watched things fall apart. I cannot agree more that the Big Boys snookered the "ownership" of the not-for-profits and sold you down the river.

OK, now for the solution....take back control of your destiny. It is too expensive to "buy back" the facilities that exist with dwindling profits and ownership is now private (not subject to oversight). You need a new facility with options for inpatient care and cooperation with a larger facility for transfers. You need a robust outpatient facility for the majority of ambulatory care. Allow the hospitals to carry on with their "for profit" management and they will soon learn that Paris no longer "needs them". Once this occurs, the doors to the meeting room will fly open.

10:03AM
Anonymous said...
"OK, now for the solution....take back control of your destiny. It is too expensive to "buy back" the facilities that exist with dwindling profits and ownership is now private (not subject to oversight). You need a new facility with options for inpatient care and cooperation with a larger facility for transfers. You need a robust outpatient facility for the majority of ambulatory care. Allow the hospitals to carry on with their "for profit" management and they will soon learn that Paris no longer "needs them". Once this occurs, the doors to the meeting room will fly open."

best idea i've heard yet, doc. how do we make this happen?

I'd like to say the county could come up with something at this point, but truth is, some of those physicians that have been "reading this blog for 2 years and HAVE NOT ONCE heard of a solution" need to step up and become players again. (The blog has been here for three, and there have been suggestions of that nature....)


Yes, I know your retirement investments have been sorely depleted. Yes, I know that Obama-care gives you chills. And, finally, I know that a struggle over the healthcare industry in this town is going to have some unpopular side-effects, but you know, sometimes the medicine just can't be sugarcoated.

Bemoaning The ER....7/20

Don't know if you caught the Snooze article on ERs.

Emergency room challenges

By Sally Boswell

Published July 12, 2009

We’ve all heard the horror stories.

A friend, a loved one, is injured or falls ill. They go to the emergency room at the local hospital and once there, are forced to wait — and suffer — an interminable length of time until they are seen and treated by a physician. In the most extreme versions of the story, the patient dies of neglect, sitting unattended in a chair in the emergency department waiting room, hours later.

Sadly, the story — at its base — is rooted in an undeniable truth: Emergency room wait times have gone up.

According to a report issued earlier this year from information gathered at more than 7,000 hospitals across the nation, the average wait time in emergency departments across the country went up to 4 hours and 3 minutes, an increase of 27 minutes since 2002. In Texas, wait times in 2008 averaged 4 hours and 8 minutes, putting Texas 31st in the nation in that ranking.

In August 2008, the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention and the National Center for Health Statistics, issued a report on the state of emergency departments nationally. The report linked patients’ inability to access a primary care provider in a timely fashion with the increasing frequency of ED visits. This was compounded by a decreasing number of EDs across the country as well as decreasing numbers of inpatient beds.

“EDs nationwide are under increasing pressure to provide care for more patients,” the report reads, “resulting in crowding and increased waiting times for minor illnesses.”

“What most people don’t realize is that the term ‘wait time’ is considered the total time spent in the ER,” said Chris Dux, CEO of Paris Regional Medical Center. “At this hospital, the total wait time is 3 hours and 10 minutes. The time from when a patient comes in the door until they are seen — not by a triage nurse, but by the nurse that is going to care for them — averages 42 minutes.”

“These numbers are just averages,” Dux continued. “Some waits will be much shorter, some longer.”

“The ER is not a primary care provider,” Dux said. “An ER is designed to treat medical emergencies. Patients with a true emergency will be seen right away. Non-emergencies, where there is no danger of loss of life or limb, no danger of bodily system failure, will wait while more critical patients are seen.”

“The reality is that the sicker a patient is, the faster they will get seen,” Dux said.

Many who complain about long wait times at the ER cite a lack of staff as part of the problem. Dux and other hospital officials dispute that claim.

“Our numbers show that our busiest days are Sundays and Mondays,” said Connie Murchison, CNO at PRMC. “and afternoon hours are the busiest. We try to anticipate the need and have appropriate staffing for known peak times, but there are never less than five nurses on duty at any time in the ER. And the nurses work overlapping shifts so there is no lack of coverage.”

“There are patients who get it into their minds that if they come by ambulance they automatically go to a room,” added Phyllis McDaniel, nurse manager of the ER. “That is not the case. Someone who comes in an ambulance goes through triage just like anyone else. They are assessed and if it is determined they do not have a true emergency, they get triaged back out to the waiting room just like everyone else.”

So what is the solution to increased wait times in hospital emergency rooms?

“To start off, every person, if they don’t already have one, needs to establish a relationship with a primary care physician,” Dux said. “If they have a chronic condition such as diabetes or a pulmonary or coronary condition, the physician will be familiar with their case. If problems arise, the patient should call their PCP first. The PCP can advise them if they need to go to the ER or if they can wait and come to the office the next day.”

“A physician’s office visit is also going to be infinitely less expensive than a visit to the ER,” Dux added. “It’s not cheap to staff an ER with physicians and nurses and therapists and lab techs 24 hours a day, seven days a week. People think, well, it’s the ER, it’s free.’ It’s not free. We’re going to bill you for it and we’re going to expect to get paid. Our doctors and nurses have to put food on their table as well.”

Calling a PCP first also has other benefits, according the Dux.

“The doctor may advise the patient to go to the ER,” Dux said. “He can call the ER and give them a heads up and instruction for the patients care when he arrives.”

“The PCP can also call the hospital and order the patient to be admitted directly into the hospital,” added McDaniel. “The patient can bypass the ER and all that expense.

Patients should bring an updated list of all medications when they come to the ER, Dux added, as well as a list of all allergies the patient may suffer. The patient should, if at all possible, never come to the ER alone.

“Bring someone with you who can see that you get home safely when you are released,” Dux said. “Someone who is in a position to act as your surrogate and can help the staff understand your condition and communicate for you. However, the patient should not be accompanied by a large group of people. There is a limited amount of space in the ER. There can be problems with issues of contagion and privacy if there are a lot of unnecessary people in the ER.”

PRMC is also implementing ways to help make wait times at the ER more bearable.

“We encourage people to make use of the hospital’s Wet Paris Clinic at 2224 Bonham St.,” Dux said. “We would like them to call for an appointment but if the show they will be seen. It’s also cheaper than a visit to the ER.”

“We are also making sure that our patients and their families are informed about the process,” he said. “If you know why you are waiting, it’s easier to wait, than if you are sitting there with no information.”

Dux noted that PRMC has formed an Emergency Department task force, consisting of Murchison, McDaniel and several staff physicians to examine process issues in the ED and look for ways to streamline the way patients are cared for. Hospital officials are also studying the use of rapid testing modalities, which can be done in the ER itself and make lab work faster.

“We want the people of this area to know that, according to the numbers, we are 20 percent better than most of the people out there,” Dux siad. “And we are working to get even better than that.”

I don't know, maybe their average is better than most...when you factor in the patients that arrive at 5AM....and in some hospitals, even 5AM is busy. Staffing needs to meet the needs of the customers, the patients...and when ER rooms are closed to patients because of staffing shortfalls, then one has to worry about management. And the West Paris Clinic isn't open on a lot of the peak times.

So pull up the intake statistics (that's what Meditech and computers are for, after all) and do some flexing. We'll get happier patients, and a happier staff, that's for sure.

And Who Was Spotted In Nashville?....7/28

He's bigger than a breadbox....

Ego especially....

................................................

Awwww, you guessed it. Yep, Huddy was back in his town.

Job-shopping, perhaps? Hey, Hud, hope you got some good leads.... (Probably even updated his Linked In profile.... I could have said, 'Monster.com', but that would have been typecasting.)

Bet he just tapped one of his buddies...you know, one of the ones he fired....and they got him right in. Networking at the highest level. Nothing personal, you understand.

Will There Be Cake?....9/2

It would appear that the candles for the second birthday of the lawsuit have come and gone.

So, it behooves me to refresh a few of the invited players list.

Hud Connery CEO, Performance Management Institute, and Stroudwater Associates, another consulting firm, but doesn't really appear on their web site anymore??? And the 'word' floating around is that he is gone. Four is a row is a real losing streak!

Andrew Knizley Still in that consulting firm. Still looks like a bad ad for Hair Club for Men.

David Kreye Back in Florida, CEO of Physicians Regional Healthcare System. (Taking it out in sunshine. How's the intangible tax treating you, Davy?)

Michael Davis Still Behavioral Centers of America CFO

Bill Heburn, Trinity Medical Center CEO (CHS). Bill was apparently dismissed from Essent when he gave an interview in which he admitted that Essent had lost money in all but one year at Crossroads. (updated)


Anna-Gene O'Neal Cogent Healthcare VP, Quality & Performance Improvement. She followed in the footsteps of another Hud protege, Hal Andrews. Small world.


C. Gregory Schonert is a Vice President at Health Care REIT --A real estate investment trust...in Dallas. But then, why have a VP of Development (Essent) when you aren't expanding?

Joe Pinion is a hospital CEO at Central Mississippi Medical Center in Jackson, MS.

Those who can, do. Those who can't, consult.

Those who can't do or consult, manage....

What We Have To Date....7/17

Dig back in your memory, and think of a time when we had two hospitals. I know, it's been awhile, but bear with me....

We had a religious based, non-profit, and a for-profit that had the women's center. The for-profit started losing ground and went under Presby management--which was essentially Dallas-based and not terribly in tune with the community. The jacking up of leases on medical offices was a prime example. The Catholic hospital had a different management problem: They thought that not-for-profit meant spend all you want, we have deep pockets. In both cases, assumptions were made, erroneous ones it turns out, and big losses occurred. Both were management derived.

So, we have a for-profit that suddenly becomes a no-profit. It would have been bought by a more driven competitor, but for the management of the not-for-profit being scared witless by the thought of real competition. So they bought it. Paid far too much.

So now we have duplicated services, a mounting debt, and no real competition to keep the management on their toes. And we still have the "deep pockets will keep us afloat" attitude. We also have an outpatient surgical center that is a white elephant, Health Solutions which would have been more aptly named Health Delusions, and a "women's center" under the umbrella of a Catholic diocese (the rumblings over that gave Christus an out.)

Christus becomes tired of dumping money into a rathole, Dr. Royer (Christus CEO) might have felt the tug on his compensation (the highest of any Catholic hospital group CEOs), and so on the block it goes.

The decision to sell to Essent was poorly thought out. They might have dazzled the board with the idea of the tail wagging the dog--being a 'showplace' of the group...and it helped that the other serious contender intended to disolve the board. They also had never heard of Crossroads, Essent's first hospital that was being unloaded because it was only profitable for one out of five years, after dumping in millions to update it, and ARCON, the Essent CEO's previous failure.

Essent thought that the mess we were in could be settled by the wave of a ledger sheet and a heavy hand. Their due diligence was rather poor diligence, not accessing several factors. The number of properties that were owned, the Hatfields vs McCoys attitude of the two campuses, and the physicians. It didn't help that the Christus management had let things go towards the end, in maintenance, and in many of the basics.

Turning the attitude of the staff has been one of the major challenges, and a somewhat tightened purse strings by lenders in wanting to fund predominately capital assets, something having a sale value--in case. The intention of breaking the radiology group had its own consequences, actually placing them in a more advantageous position. Anesthesia was broken, and ortho came into line with the renovation of the ortho floor. Cardio was tamed by bringing in their superstar, but since the Advanced Heart are based out of Dallas, it didn't have as much leverage on them as those only in Paris.

What has happened is that the draw of the former medical community to a population base of 125,000 has dwindled. What was serviced by two hospitals can almost be handled by one--and could, if they added on to one of them. The North Campus has always had the advantage of land--but if they do such a complete move, what happens to the value of the South and the surrounding properties?

So, the Peds move to South is an adventure in utilization. This becomes a Rubik’s Cube of sorts, juggling departments from one to another, trying to find the best fit, only bean counters don't have the same perspective as health professionals. Just wait for the Women's Center to be moved to the South....

Peds on Hold....6/13

Maybe, just maybe, someone is getting through to administration. Peds moving to South and sharing nurses with other patients? You're kidding, I hope.

Cross-contamination is the biggest issue, with patients on both sides of the mix becoming losers. Look how everything else travels on a floor and you begin to realize that no matter how much handwashing you do, your clothes retain some contamination. Brushing against a bed, touching a sleeve to a patient.... Why do you think a lot of healthcare workers take a shower when they get off work?

Just watch how one room posted as isolation on a floor, grows to two, three...sometimes a whole hallway.

Different age-groups have different resistances. What may affect one group minimally might be devastating to another. And realizing that pedi patients can turn on a dime can be a hard-learned lesson.

The last aspect is dealing with the patients. Not everyone can work peds by temperment. A good pedi nurse is gold.

While the hospital juggles their facilities, spending money only to rip the changes out a year later, you understand why shortfalls occur. And why planning seems to be in short supply.

PRAYERS FOR OUR TROOPS ....5/29

What more can be said? Enjoy the holiday, but remember why there is one.

"If my people, which are called by my name, shall humble themselves, and pray, and seek my face, and turn from their wicked ways; then will I hear from heaven, and will forgive their sin, and will heal their land." 2 Chronicles 7:14 NIV

Please join us in our prayers for the men and women of the Armed Forces Of The United States Of America and other countries who are now in harm's way in Afghanistan, Iraq, and other parts of the world. We thank them and their families for their sacrifices.

We are grateful for the ultimate price of freedom paid by those fallen. We pray for strength and courage for the POWS and Missing In Action and those held hostage.

We pray for the protection and safety of selfless relief workers and missionaries who help those in need.

We pray for the protection of children and innocent civilians.

We pray for our nation and our leaders.

- The Howards, Over 22 Years Serving In The US Navy

Walkouts....5/30

A FYI link sent to me lead to an MSNBC article that highlighted a situation in healthcare. ER AMA (Against Medical Advice) walkouts because of the cost of medical care. I don't know what our percentage is, but I know I've been questioned about the costs of care, items, and tests...and I really don't know the answer.

We watch the medical shows on the television, Hopkins, Rescue Me, ER, and think of the lives they are saving--maybe we ought to think about the lives that we are ruining. It would be an eye-opener if they had a running tab on-screen of the cost of treatment.

We have those who are brought in by EMS, which decline treatment from the start, who didn't want to go to the hospital, but were told they just needed to be "checked out."

Some patients see the back-up in the waiting area and don't want to wait. (Now, if it was serious enough to come to the ER, wouldn't you think that waiting wouldn't be the issue???)

And some that get a sense of the costs when they enter--when the Dr orders a battery of tests, sees the costs mounting and their savings dwindling.

The average cost of an ER visit, nationally, is $1,000.

Sure we have the regulars, those that appear on the ER doorstep at the faintest indication of discomfort. They are the ones that have virtually no out-of-pocket expense, whether from assignment or self-pay (generally no-pay).

The Austin Statesman ran an article about ER abuse, 9 people used the ER 2,678 times in a 6 year period. Costs: approximately $3 million. They either had very good insurance, or the hospital was getting hosed. If it was like Parkland, then the whole county paid for it. If it was like the University Medical Center in Las Vegas, then the shortfalls cause closure of services.

So, where does that leave us? With $75 aspirin. With $200 walk-in-the-door charges. To make up for the shortfalls. And that's why people leave AMA.

What To Do With South?....5/30

With all the thoughts going towards the move north, you wonder about the plans for the South campus.... Maybe that's why Kevin Gross from RehabCare was appointed to the Essent board. RehabCare has ambitions of owning 17 rehab hospitals by the end of this year, according to its CEO, although the economy may have brought about a change in that timetable.

Or, maybe Kevin's appointment was a backstop in September, but with the uncertainty in the financial markets, it may be significantly longer, if that indeed, was the plan.

On the other hand, maybe he's there to scope out what Essent might have available should they not keep their head above water....

Pandemic....5/18

I certainly don't want to be a fear-monger, although some would place me in that category. The CDC has declared a national health emergency with the outbreak of swine-flu.

How does that impact us? Think of all the cases of flu, nausea, headaches, tiredness, and the like that filter through the ER. Think about the percentage of people that don't wash their hands, don't cover their mouth when they cough, and live in close quarters. Think of the high percentage of patients that have respiratory problems.

For our own little slice of heaven, the ER waiting areas, we might want to issue masks. Certainly to keep patients from contracting the flu from others, but also to keep the staff a little safer. I feel a run on barrier masks with face shields is in our future.

The one hundred-plus deaths attributed to the outbreak are mostly in poorer areas: Malnourishment, compromised immune systems, elderly, those with respiratory problems, and the very young would be thought to be susceptible. However, we are seeing a NY prep school closed, and cases in at least five states, with more to follow. The deaths in Mexico were comprised of patients that were atypically age-grouped (adolescents and adults).

During the avian flu scare not so long ago, it was anticipated that a pandemic of that nature would take less than six months to make its way through all but the most isolated regions of the world. I don't know how much was based on the vector including birds, but probably it was inconsequential. How many people end up with hystoplasmosis? (My little nagging voice is making an issue out of the report that the virus is a combination of human, avian, an pig viruses. It keeps focusing on the avian.)

It would seem that the third-world countries will be hardest hit, with African nations taking a high toll based on the HIV percentages. Likewise Thailand for the same reason. Any high-density, poor, populations. Israel has reported patients, can you imagine what this could do in Gaza?

So-o-o, handwashing, cover your mouth, and limit the handshakes, hugs, and kisses. They can wait until this is over.

Monetizing....5/4

If you're a blogger, that is one with a blog, you know that there is a certain amount of pressure to monetize your blog with ads. I've resisted, since this isn't about the money--but had a thought on the matter.

If I do it, it will be only at the side panel, not in the body. The proceeds are either going to legal defense if the lawsuit continues, or to a local charity, should it not. With the recession, they can use all the help they can get. In any case, the funds should be held in abeyance until the situation plays out.

I'm going to put up a survey, letting the readers contribute, and we'll see what shakes loose. So think about it.

It might not be possible to do it anonymously, but it's worth a try. If I can, I will, if I can't I won't.

Bailout--Four Degrees of Separation....4/23

Were you aware that Essent is a bennificiary of the bailout? In kind of a round-about way. Remember the Six Degrees of Kevin Bacon? Well, GM is accepting a bailout, GMAC is 49% owned by GM, GMAC-RFC is totally owned by GMAC, and GMAC-RFC loaned Essent $75 Million to buy PRMC.

Since GMAC owns a bank, the degrees of separation might decrease, if it gets bailed out directly.

The Snooze: No News

I don't really know if precedent-setting fits, but enough people do...at the legal blogs that reviewed the initial filing and the appeal...that whatever decision is handed down will be studied, picked apart, and judged on its merits. It has almost the same feeling as the Scopes Monkey trial as portrayed in "Inherit The Wind": The judge was damned if he did and damned if he didn't.


The solution that was given in the play/movie however, won't play in this instance. The reality equivalent was that of the appeals court when it sent the case back. They emulated the (movie) judge (a non-decision decision) in bumping it to the previous court, thereby placing the hot potato back in Judge McDowell's lap. Hence, the spotlight on McDowell.

Lawsuit still on hold
By Bill Hankins
The Paris News
Published April 9, 2009

In what could be one of the most precedent-setting lawsuits involving bloggers, First Amendment rights and Paris Regional Medical Center, movement in the case seems to be on hold.

Attorneys for Essent, the parent company of Paris Regional Medical Center in its last request to 62nd District Court Judge Scott McDowell asked McDowell to order the release of information about the blogger or bloggers, whom they say have damaged the hospital’s reputation.

Attorney James Rodgers, defending one of the unknown bloggers, said today nothing has changed in the suit since the 6th Court of Appeals ruled the hospital must first meet the threshhold of proof the statements damaged the hospital before proceeding with the case.

“They have made another run at getting information, but we do not think they have complied with the appeal court ruling, and we expect the district court will agree,” Rodgers said. “As far as I am concerned, until the judge finds Essent has complied, no movement will happen in the case, and it does not appear the hospital is taking any steps to comply.”

Rodgers said no hearings are scheduled and no decisions expected.

“No news is good news.” Rodgers said.

The 6th Court of Appeals in Texarkana ruled the hospital first must prove the statements damaged the hospital before seeking the identity of the blogger or bloggers.

The lawsuit by Essent was filed June 19, 2007, when the hospital accused 1 to 10 unknown bloggers of wrongful conduct in publishing “false and misleading” information detrimental to the hospital and asking the bloggers be silenced.

After the appeals court ruling turning the burden of proof of damage back on the hospital, attorneys for the hospital issued a statement that said: “We appreciate how carefully the court is proceeding with this important issue. We understand the rules surrounding the Internet are new and evolving and that the court wants to proceed deliberately. That said, we are very confident in our ability to meet the standards articulated by the court. We intend to pursue all available legal options.”

No movement has been made in the case since.

Is The Heart on Life-Support?....4/22

New rumor from Dallas--the Paris Heart program may be having its own problems. Specifically volume. For a hospital that is 'dedicated' as a heart center, the patient load isn't there.

When the majority of the insured patients go to Dallas or Tyler for treatment, and the remainder are high mix of self-pay/no-pay and have poor health and diet, we can see why.

What's even more confounding is that the hospital gives privleges to physicians that are referring patients right out the door to other hospitals.

Obviously, the emergency patients generally don't have a choice, but Advanced funnels a significant number of insured away.

Marketing....4/9

FROM:Charlie Therrien
TO:Staff
SUBJECT:Common questions
March 30, 2009

As I meet with departments and individuals there are a few questions that come up that I thought I would respond to across the hospital.
Will DTO continue?
We will continue to make sure that we maintain the correct level of staff for the fluctuating level ofpatients in both the inpatient and outpatient areas, clinical and non-clinical. I understand that this creates anxiety and financial pressure during difficult times; however we are trying to reduce our expenses and avoid the elimination of positions.
Why spend money on Studer at this time?
The investment in Studer is an investment in the training and development of our people. It is consistent with our educational assistance program, CME, and other training that are all investments in the employees. The measurable outcome from all of these initiatives is to improve employee satisfaction, which drives patient satisfaction, which drives volume growth.
What is the hospital doing to increase business?
National trends indicate that people are putting off elective and non-urgent healthcare services due to the economic issues that we all are facing. In order to offset these trends we are actively pursuing strategies to grow new business. For example, we are actively working on a plan to open an urgent care center in New York, we are in the process of developing a coordinated women's health program, we have hired nurse practitioners and physician assistants to improve access to primary care services, and we continue to actively recruit more physicians to the area.
Please don't hesitate to contact me with any additional questions. Thank you very
much.

Marketing ideas, hmmmmm:

• They've tried suing me, that really helped publicize Essent.
• They've tried putting a happy employee's face on TV, extolling Essent's virtues--while laying off more staff.
• They start the bidding for another hospital, at the same time cutting managers' salaries by 10%
• They give a bonus...and pull matching retirement contributions. (Oh, yeah, that wasn't a bonus, that was retention.)

So rather than pay what they promised, they'll promise to pay.... Looks like Ducky and Charlie have been talking....

Federal Inroads....3/28

The new announcement of the additional powers for the treasury are interesting in the extreme. Being able to determine that a business is under-capitalized---and dissolve them if it would be in the public interest. Kind of an eminent domain for business.

Now we've seen over the years how eminent domain has been abused. What makes us feel safe in our own little communities when a large developer wants our land? Never the concept of fairness.

But, let's put another spin on this ball. The Feds want inroads into healthcare. What healthcare organizations are truly financially sound? Could the Feds walk into Columbia and say, "You're insolvent, you belong to US...."? What about Essent?

Those hospitals that Essent owns impact their communities drastically if something occurs...and three hospitals are marginal. This could be a back way into healthcare.

On-line IP Tagging....3/30

The neat little trick that Essent used to pick up my IP address is the same one that can bite your butt.



If you go from this site to the Essent site to check your paystub without totally dumping out of your browser, it will show up that you were 'logged to the blog.' And, they'll have your IP along with your employee number.



Can we spell pink-slip?



Also, if you've been cruzin' through their websites looking for neat quotes and stuff, they already have your IP, just matching it to a name is what they want to do.



So, how does one find anonymity? Laptops from a hotspot, check your stub at work, or from the library. There are also ways to shed that nasty IP. More on that, later.



And, if they really push the issue, how secure is your computer? Who has access to it? I'd imagine several people, so it might not have been you at all.

What Does Essent Want?....3/30

So, Essent is bucking the trend. They're back in a buying mode? They have free capital to invest, or their backers are so enamored with what they've done so far that they're willing to advance more money?



Someone has done some fast talking.



So, what should they look for? A hospital that has just completed major renovation, facility and equipment. One that has a monopoly in an area that has a heavy percentage of insured patients. One that is concentrated in one location (campus) with room to expand. One that is in a right-to-work state. And, last but not least, one whose finances are in the toilet.



They keep trying to buy publicly owned hospitals, but that's because they can off-load the debt to the community. (Look at previous purchases.)



Natchez was probably a less than optimal choice. There were two campuses. (They wanted to buy two hospitals there, two sellers.) Jackson would have been a better area, but neither area is great.



Could it be that the role of Essent was going to be merely that of landlord? The vaunted management skills not put to use? That would be rather telling as well. Maybe the tenant was directing this one.

Feathers....5/29

Heard some dept managers were urging their folks to send Ducks a thank you card "as they didn't have to do this." Did they or didn't they??

Send him a cookie. Being "urged" to send a thank-you card is classless at best. Ooops, I forgot, it's Duckers here.

Show some love to da Duck, lest ye find thy head on the chopping block next time. Kiss the Duck's butt, and never mind the feathers in your mouth.

News from Natchez....3/13

From the Natchez Democrat:

Potential buyer backs out of deal to buy Natchez Regional
By Julie Cooper (Contact) The Natchez Democrat

Originally published 11:32 a.m., March 11, 2009
Updated 11:37 p.m., March 11, 2009

NATCHEZ — Natchez Regional Medical Center’s would-be buyer has backed out of the deal, reportedly citing poor economic conditions.

Essent Healthcare of Tennessee has been in negotiations with NRMC since November but told CEO Scott Phillips late Tuesday night that the deal was off.

Phillips said, ultimately, Essent was concerned with the risks of taking on a new property in the current economy.

The company reportedly wanted to purchase Natchez Community Hospital and partner with Oschner Health System of New Orleans to manage both facilities. Essent was unable purchase Community, a factor that also hurt the NRMC deal, Phillips said....

In The Black....3/13

Interesting that for the year that they make $3.8M plus, they pull the matching 'discretionary' funds.

PRMC*****************255beds $3,824,649
SWMC******************73beds -$464,815

SWMC is the only other hospital that's been updated, so far, but it's had some significant improvement.

So, it might take some wind out of my sails, but my questions are these:

• What were the results on MVH and NVMC?



• While a profit is important (keeping the doors open is very important), was the pain that the community--patients as well as staff--worth it?



• We noted that several functions were not moving. Are they now? Psych, Wound Care?



• Are the cuts in matching funds now going to be made up?



• Are there going to be more staff cuts when the move happens?



• Are the other upgrades in equipment needed at the North Campus going to be made on a timely basis?

Or is the negotiation for Nachez Community and Natchez Regional going to slow things a bit. Only time will tell.