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.

Natchez on the Essent....3/9

It's been what, three years, since Essent has seriously gone after a hospital? Maybe not quite that long.

Anyway, Natchez Regional Medical Center, Natchez, MS, is in the sights this time. They lost $2M, so the company they keep won't awe them. 179 beds.

And, they might have a not-for-profit management team. Funny how that works out. They might have a better chance of making the black on their financial chart in that case. Or, it could be like Presby here.

It would appear that the after-hours clinic is on the same vein as Dr. Salas.

See, Greg, you jumped ship too soon. Essent might actually get one! Something about a blind squirrel....

Pay to Stay....3/21

The latest from the 'town meetings':

Well I heard that at the Town Hall Meeting everything is sunshine and roses--so good in fact that Ducky & Co are going to pay out a bonus to employees. (Apparently they 'set aside' some funds from the 2008 budget for this--could it be the matching funds for 401K?) Bonuses are expected to be between $200 and $4000 dollars based on full or part-time status and number of quarters worked. They may have to 'break up' some payments. The first installment is to be doled out on Friday, March 13th (how auspicious!)

Most employees are skeptical. Will it really happen? 4K seems like a lot to dole out to that many full time employees....

And is this bonus because Essent finally cares about its employees or is it an effort to stem the flood of exiting staff?

There must have been some serious doubts in Essent's retention figures, possibly voiced by a comment a bit ago:

I don't know if it even matters anymore...... Several nurses that I have spoken with are just waiting for the temporary, transition-related hiring freeze at Greenville and the other new Baylor facilities to end, then adios!

This makes sense when you put it in the context of what Christus tried, so many years back, but they labeled them retention bonuses. Now, that would be admitting to a problem. Hardly an Essent virtue.

Puffin' Up....3/7

Mike Browder (CEO, Essent) was interviewed for Hospitals & Health Networks recently:

Essent Healthcare’s Browder is also optimistic. Despite a drop in 2008 inpatient admissions and a 6 percent jump in bad debt, elective procedures have not yet declined, and the for-profit system’s regional diversification—with five hospitals spread between Texas and New England—has helped keep it on firmer financial ground than competitors, Browder says. In addition, Essent recently invested heavily in infrastructure, completing three major building projects. That means it won’t need to borrow large amounts of capital anytime soon.

So, being of an inquisitive nature, I wondered how the hospitals that were worried were doing. Since the only thing I can really pull from and have it publicly verifiable, I chose AHD.com. The president of Florida Hospitals in Orlando worried about donations, but they also posted a $137M profit during the same period that Essent lost $6M and PRMC lost $508,231.

OK, says I, how is ETMC-Clarksville doing, in the same period. Should be far worse than Paris--Clarksville has even a worse pay mix than here. ETMC made $902,309. Funny, it had the same profit level (percentage) as Florida Hospitals.

I'd look up Bonham, but with the physician group buying them, it's too new. Under the old management, it lost almost $1M. But, then again, it was sold....