Wednesday, January 07, 2009

Magic Bullet....2/3

From the comments:

It is strange that the upper managment of Essent seems to think that the "Cardiac Center of Excellence" will provide the resources to make their investment payoff. Cardiac surgery does not pay its own way. The diagnostic caths are no longer the cash cows that they were earlier before the costly drug eleuding stents came out (they cost many times more than medicare will pay in the DRG.)

Meanwhile, the hospital continues its crazy scheme of cutting services to achieve profitability. They have hired yet another consultant to ask the staff what they feel are important goals of the hospital which might turn things around.

Any businessman knows that in a profit squeeze you can reduce costs some; but the way out is to grow goods and services. Hiring a consultant to tell you what needs to be done--while smart in some cases--is not in this case. What the hospital needs to do is get back to the basics of providing quality medical services to Paris.

The cardiac service is now a reality, so press ahead with a plan to get serious about basic services. FOR HEAVENS SAKE QUIT CUTTING RN'S WITH EXPERIENCE. If you must cut, cut some of the GN's who are barely able to find their A__ with both hands. The so- called Terrorists may have been your best asset--in that their terrorism might have been to disagree with your self-destructive behavior toward patient safety and basic patient needs. Sometimes listening to people who disagree with you can save your butt!

However; I doubt that The Duck has ever really lisned to anyone in his life. Even carrying on a conversation with him is an exercise in futility. Moving north is the answer to so much, but doing it without moving Psych and Dubois is nuts! Going from a total of 11 ORS between the two Campuses to 6 (counting Cysto ) will cause further loss of surgical cases and provide the impetus for someone building a short stay hospital (which would be the end of Essent in Paris.)
...and this is where I diverge...

(and , by my calculations be the wrong answer for the community, since a short stay hospital would take the cream off the top of reimbursement, forever dooming the chances of a viable General Hospital in Paris) Let us pray that by some Providencial miracle Essent can survive. Who knows, if they do, they may be able to sell out to an entity who dosn't depend on GE and GMAC financing to simply meet payroll month to month.
I think a general hospital is possible--assuming that in this climate that any hospital in this community can make it. One aspect of an Obama presidency might be an increased level of insured coverage. That will help all hospitals.

The Essent Problem is not the 'terrorists', necessary or otherwise, the problem is planning--or lack of. When you have the long arm of Essent directing this marionette show, confusion of purpose is inevitable. How well have they been in tune with the community so far????

(...and no one stays employed if Essent feels they aren't 'necessary', terrorist or not....)


Anonymous said...

What the Hale?

I see that upper management is up to their annual antics again with a recent lay-off at MVH - a bit late this year but more of the same. One from housekeeping, one from maintenance, one from the volunteers - the list goes on. I wonder how many of the aforementioned HGOGS group can drive a snow plow or operate a buffer...the writing is on the wall for MVH!

Anonymous said...

According to my experience, there are three constants of any successful small-town community general hospital.
The first is outpatient and elective surgery. If you can keep these dollars at home then you are on the right track. I agree with you 100%. DECREASING the OR's is a death knell IF anyone is paying close enough attention. Dux had better pray that they are not.
The second is cancer care. There are big bucks in cancer. It would seem to me that it might have been a profitable move to co-invest with Texas Oncology and help build a large regional cancer center (the unused pavilion would have been a perfect place to start)with state of the art offices and by giving them a designated floor with all the trimmings--including certified and qualified staff (one only need to go to any hospital in Tyler or Dallas to see the norm for cancer care). Given the opportunity to stay at home for cancer treatment, I think most people would elect to do so...but PRMC is NOT competitive in this area.
Look at Mount Pleasant. Their new cancer center is thriving.
Last of all is the mother/baby. You have a certain "built-in" clientele. They will come to PRMC regardless. The trick is updating the existing unit and NEVER cutting staff to those areas. Service...Service...Service.
If you cannot provide hotel-quality service in this area of healthcare--you will lose the cream of the crop insured patients.
There was a time when even the residents of Sulphur Springs would not use their facilities. Now, people from our area go part due to their newer facilities.
A cardiac center in this area is a boondoggle. Here again, I totally agree with your synopsis of it.
The hospital should have maximized their resources into boosting these three areas FIRST before diving off into a money pit like cardiac care. Successful cardiac centers rely heavily on reputation which can take YEARS to cultivate. I am NOT saying that they CANNOT attain a good reputation because I certainly believe that they can--but it is undoubtedly a shaky limb to stake the existence of the ENTIRE hospital on.

Anonymous said...

FUTILITY is the most accurate word to describe Essent management.

It is unbelievable to me that any business that has so much to lose (sorry investors!) would operate in a way guaranteed to lose money and experienced staff as quickly as possible, and ensuring people in these areas will not come for treatment.

The attitude that Essent management has that their problems stem from poor or defiant staff, poor paying or irresponsible patients, and generally anyone who irritates or doesn't agree with what they wish to believe is unbelievable!

It very much reminds me of a spoiled child who excuses his poor behavior by blaming everyone else.
Unfortunately this is a grown up world, and it would appear that some serious changes in behavior and thinking need to happen before Essent can succeed.

That would be a start, but also essential is Essent's willingness to undo the damage it has caused to its own reputation and to the communities it was created to serve.

Anonymous said...

Created to serve? Hud put Essent together to IPO it and make the 'big score'. Serving communities was an after thought, if given any thought...which truly explains all of those symptoms.

Anonymous said...

Rumor has it that Dr. Preston refused to come in and see a pt in the ER with a clogged shunt. Pt was in the ER for a total of 8 hours before EMS transported pt to WNJ in Sherman for evaluation due to Dr. Preston would not come in to evaluate. Rumor was that he was at a Paris Horse and Rodeo meeting. I guess meetings overtake patient care. Useless. Whats the point of him taking call if he is not going to respond to the ER.

Anonymous said...

Maybe Essent is one big tax shelter for some other company?

Anonymous said...

Maybe it's a case of good money after bad--you can't afford to let it go and write off the existing debt because of your investors, but you know it's going no where.

Vestar and GE Capital might be in that state, as well as Thoma Cressey.

Can you imagine the board meetings?

Can you imagine when they have to report back the current state?

Anonymous said...

Essent has an advantage: Being smaller, they can modify and change direction as needed, without overcoming inertia.

Essent also has a disadvantage: Lack of inertia. They're like a momentium invester who changes direction as the market does. One day he's going to zig when he should've zagged.

A larger corporation has more commitment to a course of action. That's where staying the course comes from. Essent's been changing direction--more likely chasing its tail--for the entire time they've been in Paris, and more so since Hud left.

Say what you will, he had a vision. Not ours, but it was a guide, a rudder. Now Essent is rudderless, and Browder just hasn't got it.

Think about all the changes, reversals, and reversals of the reversals. It has no internal compass. They won't know where they are when they get there.

Anonymous said...

"The attitude that Essent management has that their problems stem from poor or defiant staff, poor paying or irresponsible patients, and generally anyone who irritates or doesn't agree with what they wish to believe is unbelievable!"

google "narcissistic system".