Sunday, June 28, 2009

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 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....

Friday, June 12, 2009

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....

Tuesday, June 02, 2009

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.