The-Paris-site

More Irony....

2011-05-18T06:20:00.002-05:00

If you caught 60 minutes Sunday, one of the segments mentioned that Gen. Musharraf, the former president of Pakistan was told that bin Laden was located near a town that turned out to be 12 miles from his compound. This would have taken place prior to his visit and check-up with Dr. A.J. Hashmi at PRMC. You wonder if his “meeting an old friend” would have brought that up.

A.J.'s recent venture into politics in Paris is noteable for at least one thing: When was the last time a cardiologist made housecalls???

Apparently there is to be a runoff, wonder if the General could drop in and lend support for his bff???

Irony....4/19

2011-04-05T17:30:00.001-05:00

What is the definition of Irony? When an "Account Dispute Resolution Expert" has to sue a client to collect.

More irony: The court disqualified the expert witnesses from Managed Care Solutions from testifying.

The final bit provided: Emails were destroyed 'per Essent's corporate policy' after they were enjoined from doing so...something like information that was sought by Essent in the case against Blogger 1-10.

SOLD....4/19

2010-12-13T23:32:00.009-06:00

BOSTON--(BUSINESS WIRE)--Today, Steward Health Care LLC (Steward) announced an agreement to acquire Essent Healthcare’s Merrimack Valley Hospital (MVH) and Nashoba Valley Medical Center (NVMC). The agreement calls for the assets of MVH and NVMC to be acquired by Steward Health Care to expand its community-based accountable care organization.

So, it would appear that Essent is divesting itself from the losing propositions. That leaves, what, three? Is that enough to have a building, a suite of offices, or a closet for a headquarters?

So with less going out, does that mean that there are new investments to be made in existing facilities, or are we back to buying?

Is it Fall Yet?....2/16

2010-11-02T16:18:00.006-05:00

The Nashville Post received a press release from Essent last year---almost a year ago---foretelling two events:

Essent consolidates Texas hospital campus
By Erin Lawley

Posted on November 24, 2009 at 8:10 am
Essent Healthcare will consolidate the acute-care services of Paris Regional Medical Center in Paris, Texas into a single campus by next fall. The move is designed to improve access for patients, strengthen the quality of care and provide for better coordinated services. Essent owns five hospitals and is in the process of acquiring its sixth.

Soooo, which proved to be true? Both? One? or, none (right answer)! So, does that mean that the access is poor, the quality of care needs strengthening, and the services are un-coordinated?

Hmmm.... I did say that it was a year ago, didn't I?

I wonder if that press release was from the same person that said Dux was leaving immediately, er ah, I mean, by October 1st. Probably going to announce that fall has been delayed.

Making Like a Tree....2/16

2010-09-02T07:55:00.006-05:00

Funny, as it was pointed out to me numerous times, how one day the Duck is being 'frog marched' to the door, with Essent saying the coup d'état was now...and the next day, he has a month to pack his pencils....

Now....

To ensure a smooth transition of the hospital’s leadership, Dux will remain at PRMC until Oct. 1. At that time, current chief operating officer Bill Porter will assume the position of interim CEO.

...and then....

“He is telling his employees now,” Fox told The Paris News shortly before 10 a.m. today.

Bill Porter, PRMC’s current chief operating officer, will begin serving as interim CEO immediately.

Whoever writes the releases ought to learn the meaning and value of consistency.... Of course we hicks can't remember one day to the next, so why bother???

My question would be: Why, with all that time and effort to build a reputation in health care would a CEO of a hospital bail? ...and for an undisclosed endeavor???

Cleaning Up??....9/6

2010-06-30T16:05:00.003-05:00

A different perspective:

You have to wonder what is going on. Apparently they are cleaning the place up in Paris (the fountain even works!), over-staffing in non-critical areas (2 nurses for 3 patients in some areas) and even Ducks and the Connster were seen roaming the halls "inspecting" everything this last week. Looks a whole lot like a potential buyer is looking to view the place or else they are expecting a "surprise" inspection from a state agency.
I think I would go with the former.

Cleaning up, or ride-sharing....

No News is Good News....7/4

2010-06-10T16:23:00.006-05:00

Is Essent for sale? Maybe pieces of it. The Lowell Sun's article left a bit to interpretation. "...possible joint purchase (of the hospital) of some kind." could mean anything, including a management deal, or a trade out for the newly acquired facilities. But wasn't the one facility pledged on that loan????

Since the fall through of the Brown deal (number 4, wasn't it?), Essent's stock is probably at a new low--or would be if it was a publicly traded company. A pay freeze for the third year doesn't indicate any good news, as well.

Time to use the motivational fairy....

Sorry Charlie....7/4

2010-05-28T16:00:00.003-05:00

Looks like Brown County General dodged the bullet...grapevine (rumours, not the town) has it that more guarantees were needed--by which party? Who knows.

But, that makes how many misses for Essent? There probably are only just so many fish in the sea. Ahh yes, but who's counting.... Just you...and me...and Charlie.

It Keeps On Rolling....5/28

2010-05-20T15:42:00.001-05:00

Been over to the ER lately? Recognize the staff? If you do, you're lucky, since the majority are temp service/agency nurses.

What's the harm, it infuses the hospital with new people??? Yeah, but when the location of the simplest things takes a question, and it pulls another nurse away from patients.....

But we can see if we like a nurse's work before we offer them a postion.... How many actually take an offer from here?

You really can't fault the nurses--the ones we had have a good chance of being agency in another hospital....

No truer words have been spoken than: Familiarity breeds contempt.

CHS has their problems

2010-03-19T06:33:00.001-05:00

I probably wouldn't have even mentioned it, but a memo was passed my way. Remember Bill Heburn? He was involved with the purchase of PRMC, I believe. He was bounced from Essent when he developed a case of foot-in-mouth disease, and mentioned that Crossroads, their hospital in MO, had only been profitable for one year in five. Huddie didn't like that after I kind of mentioned it (and at least two selection committees should have taken notice, because that was not the way that Essent was presented to Sharon nor Paris), so Bill was in the wind.

He's apparently redeemed himself over the years, with Trinity, and now CHS. Bill will be taking the reins of Northwest Health System on an interim basis. Apparently the CEO and CFO simultaneously resigned. That in itself is probably significant. Also significant is the fact that while writing this, the web page with Doug Arnold (CEO) is still up--but probably not for long. The memo went out on the 18th. Good luck Bill.

M E M O R A N D U M

TO: Northwest Health System
Members of the Board
Members of the Medical Staff
Employees
Volunteers

FROM: Michael Portacci
President – Division II Operations

DATE: March 18, 2010

SUBJECT: CEO Announcement
____________________________________________________________________________________
Doug Arnold, Chief Executive Officer, and Eddie Klein, Chief Financial Officer, have resigned their positions with Northwest Health System effective immediately.

Bill Heburn will lead the system as Interim Chief Executive Officer, providing operational oversight during the transition. Bill is a veteran hospital executive who has worked with CHS-affiliated hospitals, most recently as a chief executive of the 349-bed Trinity Medical Center in Birmingham, Alabama.

A national search for new officers has begun; board and medical staff leaders will be involved in identifying the best candidates to lead this system.

Through the strength of our medical staff and employees across the Northwest Health System, I am confident that your focus will remain on delivering quality patient care. Thank you for your commitment to being the healthcare resource in our communities.

MTP/gf

“Community Health Systems” is a registered trade name of
Community Health Systems Professional Services Corporation

Management by Proxy....5/20

2010-02-12T00:09:00.008-06:00

More commentary, seemed fairly poignant, so it gets its own post:
I'm not sure anyone reads this blog any more, but I'll give my last 2 cents worth of commentary.

Truism: A business exists to benefit the owner, not the employee. It is what it is. The sad fact is, it seems Essent only cares about corporate earnings statements and not the people who support the business; customers and employees.

That being said, what has happened to this community is a terrible thing. Many previous posters have talked about every issue possible, offered their solutions to many, many problems only for them to fall on deaf ears. Most didn't have Harvard MBA's but had experience a degree couldn't provide.

Although Essent is reading these comments, they are much like the current administration in Washington and that is; "Full speed ahead, damn the torpedos."

It's too bad that they didn't listen to the troops on the ground. After all, it wasn't their money and prestige they were squandering, it was other peoples.

I don't know of one single person, me included, that has left that place without bitterness in their heart. It used to be such a nice place to call home. And, it was home to thousands of people in Paris and surrounding areas. Not any more.

I believe the hospital will survive, but it will take many years to regain the trust of the people in Paris and NE Texas.

RIP

Funny Thing Happened....3/12

2009-12-21T22:10:00.004-06:00

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

2009-10-02T07:45:00.005-05:00

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

2009-09-28T16:00:00.004-05:00

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

2009-08-04T16:00:00.007-05:00

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

2009-08-03T16:00:00.003-05:00

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

2009-08-01T09:29:00.006-05:00

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

2009-07-30T11:49:00.004-05:00

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

2009-07-23T15:00:00.005-05:00

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

2009-07-18T06:28:00.008-05:00

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

2009-07-17T16:00:00.002-05:00

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

2009-07-17T03:54:00.003-05:00

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

2009-07-16T06:13:00.003-05:00

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

2009-06-28T08:15:00.008-05:00

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

2009-06-12T14:11:00.014-05:00

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

2009-06-02T13:51:00.010-05:00

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

2009-05-23T06:09:00.005-05:00

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

2009-05-12T12:02:00.006-05:00

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

2009-05-05T06:30:00.010-05:00

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

2009-04-27T15:58:00.003-05:00

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

2009-04-15T16:57:00.011-05:00

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

2009-04-13T06:00:00.002-05:00

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

2009-04-12T07:00:00.002-05:00

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

2009-04-07T12:06:00.003-05:00

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

2009-03-31T15:10:00.004-05:00

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

2009-03-27T02:50:00.001-05:00

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

2009-03-26T09:11:00.005-05:00

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

2009-03-23T00:25:00.002-05:00

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

2009-03-21T19:56:00.016-05:00

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

2009-03-12T01:46:00.001-05:00

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

2009-03-09T17:00:00.001-05:00

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

2009-03-07T04:33:00.006-06:00

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

2009-03-05T13:33:00.009-06:00

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

2009-03-02T12:40:00.004-06:00

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....

HIPAA Issue and Court....4/11

2009-02-22T15:42:00.006-06:00

One of the issues that the lawsuit against the blog (and me, by default) pressed was HIPAA. But, as a result of the lawsuit, the blog has been gone over systematically by numerous agencies and individuals, looking to prove (or disprove) the case. Since I haven't heard from the government (under whose purview that falls), nor any individual whose PI might have been identified, it would seem that dog don't hunt.... Any related information that I might have received that could have remotely been considered a disclosure seemed more from the individuals themselves, or family, and I've been fairly reluctant to even put that out if it was identifiable.

Comments themselves, without going through a fair amout of trouble (even then it comes to best guess), are anonymous, so justification of making me disclose the identity of the contributors becomes moot. I've only gone through the trouble once, and that was for that stalker I had for a while.

I wonder if a statment for the court could be procurred from the administration of blogger.com to that effect...sure would take some of the wind out of Essent's sails.

That leaves defamation causing financial loss. I liked the comment from another post: That I might have kept Essent from over-extending (kind of like what Hud did with ARCON, too big, too fast). I don't know that I like the idea that I, by default, kept Essent going, but it could be possible. Who's to say that it was just the economic down-turn that did it?

As to false statements, they really don't want someone going through those areas in their records. Especially emails. And, if they somehow lost some of the emails, I would imagine that there have been enough IT people dismissed that might be able to shed light in that area--like where the manditory backups are, or maybe a copy they kept of the email server log. Honor bright!

From The Front Lines....3/13

2009-02-19T22:05:00.015-06:00

These were pulled from anonymous comments submitted to the blog yesterday. Most deal with Essent's anti-blog policy.

Heard that last week on South Campus there were 30 patients and only three nurses to care for them. Heard the nurses filed a "safe haven".
And one of Ducky's "8 Points" is The Patient Comes First?
Rrrrrright....that goes along with "Employees are our most valuable resource"!

Safe Haven is a notification of a dangerous situation--in this case loading three nurses with 10 patients apiece. Some patients require a higher nursing to patient ratio. If this was the situation, it was appropriate. Just remember, we can't talk about being short-staffed....

So Essent sent out a memo that stated the following:
"It starts out with Happy New Year..
and in one of those small paragraphs it has a little note informing about the increasing number of complaints (anonymous on-line internet "blogging".) "This will not be tolerated and will lead to immediate termination of employment and is a violation of company policy and the Federal Law!" The Health Information Director at MVH posted a comment on the blog using her name and title. So is she still employed or is it just to scare the employees?

Quote from "Kathy DiPietro, RHIT said...
I am the Director of the Health Information Mangement Department at MVH and I am tired of being lied about by ex-employees"

But, is she really? I can't tell. And who would be stupid enough...need I say more?

The Federal Law the memo was citing was in regards to HIPAA info. Posting priviledged information is a violation of federal law. However, I hope he can prove it!!!

Mr. Fletcher is the source of all HIPAA in Essent, however he's been aware of several breaches (and not on this blog) that have quietly gone away.

Saw a memo sent out to all employees from Charles "Mr HIPAA" Fletcher that first congratulated employees on being mindful of HIPAA regs but then warned them that posting on blogs "even anonymously" was a violation of Essent policy and would be strictly enforced.

This was kind of a hold-over from Christus. They had two policies that chapped: You couldn't discuss anything of a detrimental nature outside the hospital, and actions of employees that brought discredit to the hospital, even if on their own time, were grounds for dismissal.

Recently, while wating to check out at WalMart, in response to my "how are you?" a complete stranger told me all about her recent surgery, the complications and the care she received at PRMC. As well as a similar surgery and complications her aunt had. For many people a surgery or even just a hospital stay is a life event and newsworthy. They tell everyone about it.

So how can Fletch be so sure that an anonymous post about a patient's experiences at PRMC are from an employee? The answer is he can't. It's just another excuse for a witch hunt. Already people have been fired from allegedly having something to do with this blog. Oh, wait. For going in a different direction from the hospital. Just another way to get rid of 'necessary terrorists'!

And there are whistle-blower statutes in place to protect those revealing actual situations that are criminal or dangerous. We use 'medical ethics' to justify non-disclosure of medical malfeasance. How can the truth be a violation when it corrects a dangerous situation?

I find it rather alarming that Essent's logo is very much like Enron's. Didn't that start with the CEO stealing the employee's pensions??

And lastly:

I hear another layoff is coming soon.
Please, dear Lord, let the rumor about ETMC be true!!!

Seriously???....3/2

2009-02-17T08:49:00.004-06:00

Received an interesting comment last night. You be the judge.

I overheard a conversation that wasn't for public consumption. The gist was that ETMC was currently engaged in talks to acquire PRMC.

I don't know how far it's gone, but it sounded serious.

The suprise is how long it took them to get to that point. Funny that ETMC could end up with a monopoly in Paris, so long after the original sale to Essent.

Maybe at a reduced price....

Caught In The Headlights....2/22

2009-02-15T07:30:00.008-06:00

You might remember when Hud left...(for those who don't, he was the CEO of Essent) and some of the rhetoric that was used when he was ousted. Possibly you might have missed a statement that was issued by David Jarrard, an Essent spokesperson to the Nashville Post:

According to Jarrard, discussions of a possible sale have been tabled for the time being noting that “every Essent hospital is profitable and growing in their markets."

If you note the timeframe, that was in November of 2007--exactly the period that is displayed on the American Hospital Directory's site right now, showing the losses of what, $5 Million? So much for Essent's veraciousness.

If we take that, and Essent's backing out of the retirement match, you might have some serious doubts about the present and future health of Essent as a viable entity. And how can you trust what they say?

An Issue of Trust....2/20

2009-02-11T14:22:00.011-06:00

I have to say, not telling staff that there wouldn't be matching funds for their retirement was a stroke of genius. It must have saved millions...okay, hundreds of thousands. And it shored things up for this year, while keeping the contribution level higher.

And it showed that Essent is still in charge, under whom backdating has become an artform.

What the heck, already contributed? Tough. So what if you lost 40% of your investment last year. Essent had its fingers crossed when they made that promise.

They could have mentioned this year before last, when they lost--what, $5 Million? If there was that much of a difference, I can't wait to see the results for '08.

Wonder if Browder took the 10% management cut, or the matching funds cut....

Where Ever You Go, That's Where You Are....2/15

2009-02-04T14:30:00.006-06:00

From the comments:

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.

Note: The title came from a second one.

NP Walking....2/6

2009-01-31T02:39:00.004-06:00

Would appear that the pay cut "administration" took hit the trenches. Rumour has it that Vurlinda, the nurse practicioner that was hired for Honey Grove, then bounced to West Paris RHC, was hit with the 10% cut--and quit.

One would think that: (a) She was bounced around initially. Has a longer drive to go to work. (b) She's a provider, and actually works for a living.

She probably had a contract. Have you heard of an ER group taking a paycut during their contract period? How about a hospitalist? They aren't given a "take it or leave it" ultimatium.

Wonder what it cost to recruit Vurlinda? Maybe they needed the additional numbers in the ER?

Look at your big toe----Ready? Aim...fire!

Discretion....2/1

2009-01-24T07:39:00.009-06:00

Because our nation is experiencing difficult economic times and 2008 was a very challenging year for all hospital operators—the company has determined to forego the discretionary employer matching contribution under the 401k plan for 2008 for all employees.

Sincerely,

C. Therrien and M. Browder
NEW: See and answer the Poll (left.)

Letters To The Snooze....1/20

2009-01-08T13:57:00.004-06:00

I saw this in the letters from readers, and thought: This has to go mainstream...

I agree in part with the editorial in a recent issue of the News regarding the future of your local hospital. I worked for the former McCusition Regional Medical Center in the 1990s, and until I left for Colorado in 1999, I was proud to be an employee at that facility, and promoted it as best I could.

I also worked for Christus St. Joseph amid the Essent-run PRMC for a short while, and could readily tell the difference between the two. I was not then, nor am I now, impressed with the Essent way of doing things, nor how they treat employees and communicate with the community.

I also disagree strongly with PRMC CEO Chris Dux’s statement about how much black ink the hospital has. A quick search at the ahd.com website would show that PRMC was in the red as recently as last year, as was every Essent facility save one. Perhaps the layoffs and other financial cutbacks will help the so-called bottom line, but only time will tell. One could also make the excuse that decreased Medicare and Medicaid payments are the root cause — they’re part of the problem, but not all of it. It takes two to tango, and in my opinion Essent is out of step here.

I am not the “anonymous blogger” Essent is looking for, but I am a former Paris resident who feels that the community deserves better than the facility Essent has running now. I am 100 percent for a decent medical center for my former neighbors and friends, but I don’t think Essent is the one to provide it.

Amen, brother....

Magic Bullet....2/3

2009-01-07T16:27:00.007-06:00

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....)

If You Snooze...2/23

2008-12-31T17:51:00.006-06:00

The Snooze came through--in their typical fashion. Hard-hitting journalism? Ah, well.... At least the site got a mention.

The Essent-PRMC lawsuit against the operator of the-paris-site.blogspot.com began in June 2007 when the hospital accused the anonymous blogger of wrongful conduct in publishing information detrimental to the hospital and violating patient confidentiality, and obtained a court order to force the blogger’s Internet service provider, Suddenlink, to reveal the name of its client.

Days before the end of 2007, the blogger’s attorney sought and was granted a writ from the Court of Appeals negating the previous court order. The Court of Appeals held there is no precedent in Texas to give the trial court the authority to issue such an order, and that several courts have noted that Internet anonymity serves a particularly vital role in the exchange of ideas and robust debate on matters of public concern. The Court also ruled that the hospital must first prove the statements are not true and then prove they are harmful to the hospital.

In March 2008, the two sides were back in court, and were given 14 days to present written arguments to the court.

Since that time there has been little movement in the case. In September of this year, Essent’s lawyers filed an affidavit stating a team of computer analysts hired by the hospital were unsuccessful in a forensic search for the blogger’s identity.

Could it be that the hospital is intent on stating to the court that they (the court) are its only resource in finding me?

It would seem that they ought to concentrate on the two stipulations of the appellate court: Truth of statements, and financial impact. But, then again, maybe they have...and come up short.

They know that I have some interesting sources--local and elsewhere. What's problematic is the anonimity of the comments. One of the things that was probably verified with the forensic group was that there is no track-back on the anonymous commenting. Speaking of 'in the dark,' the Snooze (with some prodding) even climbed on their case for keeping the community in the dark (Andy and Hud dismissals, holiday layoffs, and more....) And most (if not all) of the calls have been dead-on.

As to financials, with the recession 'officially' starting in 2007, what is their baseline? Sounds like global warming to me. (Something you really can't prove, but you know it exists!)

The biggest factor in fostering a poor image was the publicity created by the lawsuit itself. The number of hits jumped a hundred-fold.

Sooooo...stay tuned in the New Year.

Christmas Wishes....1/7

2008-12-23T11:08:00.015-06:00

May the spirit of Christmas fill your life.

May you enjoy the rewards of an unselfish act.

May you remember and honor those that are serving in the military, far from their loved ones, and pray for their safe return.

Looking Back....1/1

2008-12-20T21:37:00.008-06:00

It's traditional to look back at this time of year. Did you realize that Hud has been gone over a year? And Knizley almost two? Both are still bringing in a significant number of hits from the search engines.

If you look back at the blog posts from November 2007, you'll see several things that are pertinant to today: Sub-prime loans (GE Capital), Dux's B.P.M., Essent's vision, receptiveness to suggestions, and contemplation about the move to the North--in April(--of '08). In December, the lawsuit was still open, and the possiblity of selling Essent was being bandied about.

The new year brought the touting of new radiologists--one leaving before he really started and the other out-going.

The RHCs imploding. From what I've heard, the non-affiliated RHCs in Bogata and Honey Grove are doing well. PRMC is still looking to fill the Cooper Clinic spot. (No longer, Cooper closed this week.)

Speculation about downsizing...

A listing of red ink for Essent. (A side note, the other hospitals are reporting for the fourth quarter of 2007, while PRMC is only listing the third. Wonder what changes will be displayed when they finally update?) (A director pay cut of 10%...)

And another article hit the media, this time from the Reporters Committee for Freedom of the Press. An excerpt from Guarding the unnamed writers of the Internet

"The blogger, using the pseudonym “Frank Pasquale,” was sued in 2007 for defamation when he posted critical remarks about a local hospital on his blog, The Paris-Site. The blog focuses on issues related to Paris Regional Medical Center, ranging from the hospital’s budget concerns to a broader debate over universal health care.

Essent Healthcare, Inc., the owner of the hospital, didn’t like what was being said on the site, so it sued Pasquale and nine other anonymous bloggers for defamation and breach of contract, among other claims.

The corporation sent a subpoena to the owner of the blog, SuddenLink Communications, seeking Pasquale’s true identity.

Pasquale fears that revealing his identity will cost him his job in the health care industry and he has been fighting to quash the subpoena ever since. The case is pending.

“In a small town, and dealing with what once was the largest employer, one has to be careful,” Pasquale said."

They did neglect to mention that the appellate court rejected the decision.

30-50-80?....1/24

2008-12-14T17:53:00.026-06:00

Well, I've heard the whispers...one person said 30 were being let go, another 50, and just now: 80. The hospital is rife with rumors...and all based on the point of view.

It's sort of like the economy: When it's your neighbor that's out of a job, it's a recession. When it's you without the job, it's a depression.

Somehow I don't think that I would get much of an answer if I called and asked for an exclusive. However, you'd think that instead of running a winter fluff piece, the Snooze would ask Essent for the real scoop. No one with eyes has any doubts that we've had slick conditions and freezing rain. Finding out what is in store for community health would seem to be more appropriate.

Possibly asking Dux as he returns from Valhalla...?

Living Forever

2008-12-11T15:27:00.001-06:00

The internet is a great resource, but one must filter some of the content. Part of the problem with the internet is the tendancy for information to outlast its usefullness. Or validity.

Case in point: Christus St Joseph Foundation. Should you go to this site, your expectations would be considerably different than reality. And, had you depended on the calendar of events, you might have been trying to vote on the 6th of November.

The disturbing thing is that the date listed for "last updated" is 6/12/2006 (or is that a 8? Small print.) In either case, it would appear to be dated information.

When we see it on the net, we expect it to be current. That's the main reason the newspapers are having such a hard time: Yesterday's news printed today. And in some cases, tomorrow.

But, I digress. If you google a topic, you'll receive an example of what I mean. Almost anything you pick is going to have "cached" listed on some of the hits...meaning, not current.

Kind of the reason that I put a date after the post topic--it gives you a reference as to when the last comment was made.

But, the information from the posts and comments is going to be around for a long time. Far longer than Essent wants it to be, possibly far longer than I want it to be....

Speculation....12/11

2008-12-08T15:03:00.002-06:00

I received a comment that was a bit convoluted, but the essence was: How do you pour a gallon of water into a pint jar?

The South Campus (St Jo, Holy House, whatever) has more beds, always did. The modifications to the North Campus (Big Mac) probably lost some beds. So how do you move a staff into a facility that is perpetually going to be low-censused without losing people? ...you don't, without a physical expansion of the hospital. I haven't seen a lot of dirt flying, have you?

They also pointed out that some of the equipment is fairly antiquated--the MRI, X-ray machines, Lab, and the like, and while some could be dis-assembled from South, and moved to North, those also have the age factor to deal with. That and moving such equipment is a significant cost in itself. Maybe GE Capital can get GE Medical to cut them a deal...hah!

I wonder if the old animosities will rear up again. That was a big spanner in the works when Essent purchased the hospital(s). Something that they discounted in the initial evaluation for purchase--much to their chagrin. The controversy over the "Women's Center" is what drove the hospital sale, that and the money pit the combination of the two hospitals had become.

And how is the St Joseph's Foundation going to take this? Big Mac wins? Seem like an ignoble end to the guilt trip laid on an order of nuns oh so many years ago. To quote from the Grateful Dead, "Lately it occurs to me What a long, strange trip it's been...."

All Hale....12/6

2008-11-26T15:22:00.002-06:00

I have been pondering why and how a corporation can hang on with as much red ink as has been flowing...and came up with this next bailout: Obama healthcare. For you of skeptical leanings, float this one:

If everyone is insured, then hospitals will get what they bill for (probably with reductions in reimbursement, but nothing like what goes out for indigent care. So, even MVH would be breaking even, if not making money. But, if you thought healthcare costs are high now, wait for it....

Speaking of MVH, had this comment that had to be elevated:

Mis-management at MVH? How in the world could this be possible with the dedicated leadership staff there?

As a leader/manager with a college degree and almost three decades of world wide experience that used to work at MVH my humble opinion is this:

As long as the “Hale-good-old-girl- system” (hereafter known in this blog as the HGOGS) is in place at MVH, that facility will remain the same. This means miserable working conditions and unhappy employees in some departments because of poor departmental leadership.

To define ‘HGOGS’; MVH was formerly named “The Hale Hospital”. It was a large employer and money-maker for the city of Haverhill. With a large cash-base at their disposal it seems the mentality in the department I worked in was to just get another ‘widget’ if one was broken or missing. This no-accountability mentality is still alive and well in some of the more expensive-to-operate departments of the hospital. A good-old-girl-system (GOGS) occurs when a senior person blindly supports an underling’s decisions because they’re buddies – even if the underling’s decisions may impact adversely on staff or patients.

Examples:

To flagrantly disregard a nursing standard of care or a recommendation from the infection control committee that could impact on the health and welfare of employees and guests and have the full (blind) support of the senior officer is the HGOGS at work.

Another example of the HGOGS that may be happening at MVH is the hiring of minimally or un-qualified personnel to work in areas under the control of a director because they are friends or acquaintances of the hiring director instead of going through the usual protocol for the hiring process.

Spending outrageous amounts of money on equipment repairs instead of addressing the real problem of employee negligence because the people damaging equipment have been long time employees and are ‘friends’ of those in charge - another example of the HGOGS at work.

Not permitting a department to rehire people due to attrition and insisting that a department operate short on personnel for extended periods of time (even though the department furnishes productivity data which would support new hires). Making false promises to staff departments regarding per-diem employees that may or may not be permitted to work in the short department might also be an example of the HGOGS at MVH.

I could go on but I believe I have captured the essence of the HGOGS.

I do realize (for you more critical readers) that I have a sentence fragment as the opening question of my blog – I did it to catch your eye. Grammatically wrong? Yes, but I spent my time in college working on my clinical skills – not English comp (which I still got an “A” in).

I would be remiss if I did not make a recommendation to change MVH for the better. Simply, get the good-old-girl-system the ‘Hale’ out of MVH. As long as senior leaders blindly support the poor decisions of their uninformed subordinates, morale will continue to wane away and good people will continue to leave. Ultimately, the HGOGS will be the only ones left…try to run a hospital on a staff like that!!

Essent Lenders....11/28

2008-11-21T11:05:00.002-06:00

Now isn't GE Capital one of Essent's lenders?

From Barrons
November 19, 2008, 10:46 am
GE: Meaning
Well, If Not Always Doing Well
Posted by stockstowatchtoday_topeditor
GE SEES $2 BILLION CAPITAL FAT; RISK TO WIND?

General Electric (GE) has become the corporate embodiment of the description of a sometimes-wayward so-and-so in a Lyle Lovett song: not always good, but always possessed of good intentions. Two earnings warnings in a year. Insistence that it’s bedrock financial condition remained intact, even though it managed earnings by paying more than $30 a share in buybacks before raising new capital at $22 a share. Pointing to its triple-A credit rating as evidence of its ample liquidity before raising more capital from Warren Buffett, to whom it’s paying a 10% coupon.

The latest reposte from the company that Brings Good Things: Tuesday’s announcement of changes of its GE Capital unit. The move was aimed at saving $2billion. Again, well-intentioned. But, as Deutsche Bank asked in a research note Wednesday: where’s the savings coming from, exactly? Can the company demonstrate where it’s taking costs out of the structure to realize the savings? How does any manager cut risks in a credit crisis that’s fraught with risks?

The problems with financing aren’t limited to GE’s capital operation. There’s increasing chatter in the market, fanned by a Bloomberg report Wednesday, that some of the wind turbine installations that GE is selling into are being postponed because their operators can’t finance the projects. GE said it hasn’t seen any outright cancellations. But some of the anecdotes certainly raise questions. After all, T. Boone Pickens has made himself the populist leader of the wind-farm movement. But Pickens is an oil guy - at heart and in his investments. It’s not to say that he’s anything but sincere in his ambitions to spread the gospel of renewable power. But anybody seen what’s happened to the price of crude lately, and think that might have had some impact on someone like Boone Pickens’ ability to finance new projects?

There’s no crisis in the wind-farm projects, as yet. GE said that it has a ‘’strong” backlog of wind turbine equipment. But Theolia, the French maker of power plant equipment, earlier this week backed off its financial and operational forecasts. That not only validates concerns about the integrity of wind turbine budgets over the short term. On top of it, Theolia’s 80% decline in market valuation certainly suggested GE’s 17% stake in the French company is worth less than it paid for it, another investment that hasn’t worked out.

Meanwhile, GE has made the ”green” movement a big part of its corporate identity, including such messages in its marketing and corporate imaging efforts, as it moves away from its image as a merchant of appliances, an operation it’s selling. A failure in the wind turbine business - even though all power generation represents less than 20% of the company’s sales - would hurt. GE shares declined 3% Wednesday.

I never thought that GE would be just over 12.

Healthcare Alternatives....11/28

2008-11-10T16:53:00.004-06:00

I went back in the draft status posts--ones in which I hadn't completed the thought process--and ran across this list of waiting periods for procedures under the Canadian healthcare system:

For Canada, waiting times:
General surgery: 14.3 weeks
Orthopedic
surgery: 40.3 weeks
Cardiovascular surgery: 8 weeks
Urology: 11.5 weeks
Internal medicine: 11.5 weeks
Radiation oncology: 5 weeks
Medical
oncology: 4.9 weeks.

Now in some cases, those are to get the initial evaluation, not treatment. Realize that we still have Canadians coming over the border to American facilities for diagnosis and treatment because it is so much faster. It might be cheaper in Canada, but if you die while waiting for an appointment, cost becomes less of a factor. (My caveat to the Obama healthcare initiatives.)

Landing On His Feet....11/13

2008-10-29T09:18:00.006-05:00

Like a big cat, Hud has apparently landed on his feet...so to speak. I'm not talking about a large jungle cat, more like Garfield. Just less cuddly.

Those who can, do. Those who can't, consult. Hud is now apparently a CEO in Performance Management Institute (seminars), and consults under Stroudwater Associates, as well. If you follow the link, the bio seems to leave out significant parts of his career, but that's just Hud.

ARCON has disappeared, and various other head, er..milestones have been milled down, but it's Hud, just the same.

How Does It Stay Afloat?....1/1

2008-10-11T18:20:00.018-05:00

I have been remiss, and not checking the site American Hospital Directory (AHD.com). Some new figures have come in which make the Essent Healthcare Corporation's future a bit more uncertain. Only one hospital is listing a profit: Sharon Hospital. The rest are swimming in red ink. The rundowns are as such:

Sharon Hospital********78beds $1,889,467
PRMC*****************255beds -$508,231
NVMC******************57beds -$638,864
SWMC******************73beds -$2,411,841
MVH*******************138beds -$4,323,137

Total********************601beds -$6,001,606 net annual loss

The names of the hospitals are also links to the full listing for each under the free information section of AHD.com. Note: The information included is provided by Essent itself.

These figures do not reflect the current crisis. The disclaimers on the pages indicated that these are last year's figures, and in part 2006! So, it doesn't show the construction costs, the locums, the RHCs, and so on....

You would think that the various newspapers in these communities would have picked up on the downward trend, but, then again, they missed the firing of Hud (by almost a month!), and locally the Knizely dismissal. When I can scoop them, just using my limited resources, what are their reporters doing?

Sub-lime or Sub-prime....2/26

2008-10-05T08:09:00.023-05:00

Does the current credit crunch bode well for Essent? For PRMC alone, they borrow to pay their payroll, and with a half-million dollar loss/yr, how does this keep them out of sub-prime status?

With the last financing, Essent included a rolling line of credit, possibly against such an event. Otherwise, in the current financial situation, the money might not be available. Hopefully the institutions that offered that line of credit are still able to fulfill their commitment.

If not, meeting payroll for all the hospitals might be a financial nightmare. Essent borrows month-to-month to make payroll--a fairly common practice. But with credit tightening.....

One wonders how other hospital groups that are also in the same category are able to maintain?

Is This What We Want in Healthcare?....10/7

2008-09-26T14:40:00.004-05:00

Looking back at the sub-prime mortgage mess, you have to consider what the original 'intent' was, and what has happened in practice. There are considerable parallels that can be drawn between that and what the future of healthcare holds for us. Freddie and Fannie were pseudo governmental entities--sort of like the Post Office.

"1970: The U.S. Congress creates the Federal Home Loan Mortgage Corp., nicknamed Freddie Mac."

What may play out could possibly be foretelling the fate of healthcare in a foreseeable future.

Well, what do I mean by that? De-regulation is being slapped about as the cause of the problems, but was it de-regulated? There were several mandates that were placed on lenders to make sub-prime loans. They made them, but in order to minimize their exposure (risk), they would re-sell those mortgages. Those were repackaged and sold as securities by Freddie Mac. When the mortgages were defaulted, the securities were devalued...do we see where this is heading?

"Freddie Mac is a shareholder-owned corporation whose people are dedicated to improving the quality of life by making the American dream of decent, accessible housing a reality. We accomplish this mission by linking Main Street to Wall Street--purchasing, securitizing and investing in home mortgages, and ultimately providing homeowners and renters with lower housing costs and better access to home financing. Since our inception, Freddie Mac has achieved more than 30 consecutive years of profitability and financed one out of every six homes in America."

30 years of profitability---didn't quite make 40, did we? And, for the last several years, the CEO of Freddie Mac was stating that the reported figures were not accurate! Why isn't the former management team of the F.M.s coming under the same scrutiny as Enron? There is far more money and far more impact in the trickle-down effects.

Do we want this kind of management turned loose on healthcare? How about the politics? Speaking of politics, Senator Obama has the honor(?) of being the recipient of the second largest amount given to campaigns of elected officials by Freddie Mac/Fannie Mae ($126,349). McCain's campaign also received contributions, but far less substantial ($21,550). I'd say both would be better off returning the money. (Note: The Republican 'leader' that is being touted by the Democrats as having reached an agreement on the bailout was on the list--the most money taken in by a Republican campaign from the F.M.s.)

Current members of Congress have received a total of $4.8 million from Fannie Mae and Freddie Mac, with Democrats collecting 57 percent of that.

Can you say, "Deal Maker?"

We see the purpose as providing 'accessible' housing. Isn't that similar to the mantra of 'accessible' healthcare.

Can you see the writing on the wall?

I Understand....9/29

2008-09-09T16:00:00.006-05:00

Yep, my attention has been diverted as well--the election looms in two months! Bet the decision on our case comes out within the week (after the election results.) Any takers?

But, let's go back to the election. It became a horse race in the middle of the Republican Convention...and with such a weak start, I was beginning to feel that it was all over.

Senator McCain took some advice, and brought in a ringer. She has to be. This was a conservative's wet dream: A working MOM, a member of the NRA, Pro-Life, happily married, active, a governor, and bucks the 'good ole boy' authority in the Republican party. And she can stand up before a record number of people and deliver a punchline. And a punch.

Salvation.

Maybe there are some fleas, but the Democrats are panicking. There are more PIs going through Sarah Palins life (and trash) than the number of times that Obama can say 'uh' in a speech. Their version of recycling is to hand the garbage to the next investigator in line.

And the more that the Democrats poke at non-issues, the more popular and the more of the sympathy vote the Republicans get. Kind of like the blog. When Essent was pursuing hot and heavy, they stirred up national attention. Now, the blog is barely hitting a thousand-fifteen hundred hits a week. (The record is about that in a day!)

But why bring the election up? Just trying to play on the Palin effect? Maybe, but Duc-boy's 'practice Scotish spending' reminds me of the Obama plea to fill your tires to solve the energy crisis. Far too little, Far too late

Universal Healthcare....9/01

2008-08-28T01:00:00.002-05:00

In case you haven't noticed, when the government owns a program, they really own it.

Healthcare. Something that we've taken for granted that we have some choice in. But, would that be true in a single payor environment? I ran across a blog post that casts some doubt towards that assumption.

It was mentioned in the Coyote Blog, which pulled it from Qando, which sourced the Jewish World Review. I went to the source. What it boils down to is the wishes of the patient, and his family were ignored.

"Golubchuk is an Orthodox Jew, as are his children. The latter have adamantly opposed his removal from the ventilator and feeding tube, on the grounds that Jewish law expressly forbids any action designed to shorten life, and that if their father could express his wishes, he would oppose the doctors acting to deliberately terminate his life."

One would think that a patient's religious beliefs would hold some weight, but not so:

In response, the director of the ICU informed Golubchuk's children that neither their father's wishes nor their own are relevant, and he would do whatever he decided was appropriate. Bill Olson, counsel for the ICU director, told the Canadian Broadcasting Company that physicians have the sole right to make decisions about treatment — even if it goes against a patient's religious beliefs — and that "there is no right to a continuation of treatment."

Notice, this was in Canada...not Russia, not a dictatatorship. But, in some ways it is. The moral of the story is, in bumper sticker logic: "Those who would trade freedom for security deserve neither" -- Benjamin Franklin

But, you say, I'm not Jewish. True, but does your faith have tenants that impact your healthcare? Say, against transfusions? Autopsies? Surgery, or other treatments? I can think of many that do. Separation of Church and State can have an interesting consequence in that situation.

When it happens to my neighbor, it's a shame. When it happens to me, it's a tragedy.

And Then There Was One....8/25

2008-08-24T00:34:00.003-05:00

West Paris RHC is the latest: Brandi Chadwick gave notice and will be working with Dr Cannon.

So, based on Essent's keen understanding, process improvement, financial management, and support of its employees, there will be only one semi-functional Essent run rural health clinic by mid-September.

So, what will be the impact? Maybe not that much. More likelihood of patients going to hospitals other than PRMC. Puckett can refer to Bonham, Higgins to ETMC. The West Paris crowd will probably jam the ER with low acuity. Unless Cooper gets quickly established, Commerce will pick up their patients.

What will it take to keep the RHCs operational? Recruiting new NPs/PAs (with associated fees.) Keeping the rest of the staff intact (less change for patients to absorb.) And be ready for the associated loss of income from the former employees, now competitors, taking their patients with them.

But, it's unlikely that Nashville gets it. They haven't so far....

Top 100....10/17

2008-08-22T11:39:00.007-05:00

PRMC made the top 100 hospitals.... Wouldn't you just hate being in one below that? Realize, first off, that it was based on performance improvement, not position. The positional results were announced earlier in the year.

Now follow me, if you will, in a logical fashion: If you are at the bottom, and you move up 20 places in a field of 3000, you might be improving, but are you in the top? Not even close.

Realize too, that they only review data that is sent in from the hospital. And, theoretically, you could be most improved, but still file for bankruptcy....

"Lies, damn lies, and statistics" according to Mark Twain

Note: The graphic is from the math department at Vandy--Vanderbilt also made the list!

Rural Health....9/18

2008-08-14T13:34:00.011-05:00

Been by Honey Grove lately? The Puckett Family Clinic is the new game in town, and that has caused quite a stir with the hospital's other rural health clinics. It looks to be doing well, and is up to speed. Drop in some time.

Patricia Higgins was apparently planning something similar, but was informed on by her medical director, at the time, Dr. Green.

The next Friday, in their typical bulldozing fashion, the hospital DEMANDED that the NPs in the remaining clinics sign contracts complete with geographical non-compete clauses by 5PM or they would be summarily terminated. They could also not hold any outside employment to supplement their income.

So, Pat Higgins (Bogata) quit. Annie Patton (Cooper) gave her 30 days notice. Brandi Chadwick (West Paris) refused to sign, but the hospital backed down.

Now this is on top of what they pulled on Jane Tijerina a while back.

The hospital has done so well in providing healthcare to the community, wouldn't you agree? Can you say "Hello Emergency Room...."

...and goodbye to any sense of loyalty by their outlying patients....

Who Knows....8/25

2008-08-13T15:23:00.004-05:00

Frank,
When is the decision about the blog's anonymity to be made? We haven't heard much of anything lately. Have you been given a deal to lay low, or what?

No, no deals have been offered, or made. I'm suprised as anyone how long this has dragged out. 'pears that a pending decision won't chase away supporters prior to the election, so why give the legal blogs the chance to throw stones? Conversely, why piss off the largest employer (is it still? Figures, please...) in town?

As to why I've been absent as of late, well, that's a good question that I really can't answer yet.

We're all kind of in limbo until the 'big move' to the North Side. Just looking to see who goes north and who leaves...and how it's all going to fit into Essent's master plan.

Heck, maybe they'll be creating a specialty heart hospital, and sell the South to ETMC as acute care. The original population base would have sustained two of that nature, maybe with that mix it still might--unless the area turns vegetarian...Nahhh.... Not with the most popular eatery called The Fish Fry....

Maxi--mum Support....7/29

2008-07-19T19:50:00.007-05:00

I received an email quite off the theme, but worthy of publishing, just the same, from a Red Cross volunteer. It got to me a bit late, but since it indicates that it is the 'first', I have no doubt that there will be others.

Hello friends,

I make it a policy not to forward e-mails, but I ask you to please pass this on to all your Paris-area friends and family.

Tomorrow - Friday, July 18 - is the first donation collection event for our troops in training at Camp Maxey.

Please have a look at the list of needed supplies on this website: http://www.lamarcounty.redcross.org/ - click on "Camp Maxey" in the menu.

Drop items off between 10 a.m. and 4 p.m. at Ramseur Baptist Church gymnasium, 3400 Lamar Ave, Paris.

Anything you can give will be much appreciated and well deserved.

In case you haven't heard, several hundred troops are in the last stages of training at Camp Maxey before heading to Iraq. They will be there the rest of the summer and a community effort is underway (through our local Red Cross chapter) to make them feel welcome, encourage their spirits and show the true colors of Lamar County. More events are planned in the near future and will be publicized on East Texas Radio stations and in The Paris News. (And in the-paris-site....)
- Allan Hubbard
Communications Coordinator (volunteer)
Lamar County Chapter American Red Cross
Community + Camp Maxey
http://www.lamarcounty.redcross.org/ - click on "Camp Maxey" in the menu

I don't care what your politics are, where your leanings take you, if you had a son or a daughter being deployed over there, how you would wish that they were treated while in a different town/state/country. Time to check the list, and see what you can give. Undoubtedly you can donate at any time....frank

Cheap To Keep?....7/26

2008-07-09T14:38:00.011-05:00

Back to the drawing board, I guess. I wonder what I cost to recruit the last guys and what the hospital will pay for the next bozos.

Well here's some interesting news....seems the Full Time Radiologist, of whom they were soooooooo pleased to have, has turned in his notice. Seems he doesn't like being the ONLY full time rad and, shucks, the money is too dern low to boot. Awwwww. Back to Ye Olde Locum Tenums.
Rio Rojas boys don't look so bad now, do they???

(Photo of Jim Mabe, also known as "Droopy Drawers".)

As an update, since we are talking about money: Paris remains the same, Sharon increased it's profit to $1.8M, Nashoba Valley stayed the same, Southwest dropped to $-2.4M and Merrimack Valley is certainly in the valley...$-4,323,137. What it comes down to is a loss of $-4.5M per year.

So, Essent needs to sell, but who would buy? Investment capital is getting tighter, and you could see that Vestar, GE, and T-C might want to lighten their load.

And, obviously, I must not have had an effect on the bottom line of PRMC...why it's been sitting at a half-million dollar loss for a while now.

Staying Out Of Politics?....7/19

2008-07-01T13:22:00.006-05:00

Is this the same company that Hud Connery founded? Hud, who gave so much to political candidates? In checking the Essent PAC record, it would seem that this is the election that they're staying out of...a far cry from previous elections in which Hud personally gave thousands ($70K+, minus the $7,250 returned for over contributing) in campaign contributions. Likewise did top Essent executives. They even tried to have a fundraiser for a political 'friend of Sharon Hospital'...but, we're not trying to buy Sharon Hospital any more, are we? And, besides, the fundraiser was cancelled as being in violation of federal rules governing campaign finance. I still wonder why Hud donated $500 under Arcon Healthcare/COO, in 2004. Wasn't it defunct in '98? Ahhh, it must have been for old times sake....

But the current crew doesn't seem to be givers. Take that as it may....

Hey, speaking of the current crew, have you noticed that Dick Salerno is back with FTI? At least his name is on the website. He wasn't a big giver, either. $250 when he was with Healthtrust.

How Low Can You Go?....8/25

2008-06-22T05:47:00.011-05:00

If true (and only those actually at the hospital can confirm) this little snippet is pretty damning for Essent's profitability:

Last week Nashoba Valley Medical Center set a new record for their inpatient census. There was a grand total of FOUR INPATIENTS. Yes, I said FOUR INPATIENTS.

Essent should start thinking about changing from a FOR PROFIT status to NON-PROFIT status. Staff continues to be sent home daily and there aren't many elderly still choosing NVMC for their healthcare needs. The next generation knows to stay clear of NVMC and travel another 20 minutes to the next facility.

While census is usually lower during the summer, the depth of this low sends an obvious signal: Not viable in its current configuration.

Reactions....8/16

2008-06-12T20:07:00.015-05:00

Some people only read the posts--a mistake on their parts. I can kick a topic to life, but the people that are living it may have several different viewpoints on the subject matter. These were generated by the last post:

Tell Todd/Matt that if the blog has lost steam it's because some people are afraid to post lest they lose their jobs. The lawsuit has done more to damage Frank's rep and his business than the other way around!

I know what he means...fear is always a factor....

Todd/Matt/whoever this guy is writes (most likely on his company's time):

"Frak-a-rino:
I only check your blog every few weeks anymore.....You have run out of steam, bro'. Looks like despite your best efforts you have been singularly unsuccessful in bringing Essent to its knees.

This may be a good response in your court case.....you haven't caused a whit of damages, so why the h@#$ are they wasting their time and money suing you? "

Do your homework, Toddster- had you read some of the posts and did a little homweork (in between playing solitaire and tetris on your company's computer), you would have read this company is awash in red ink. From a heavily profitable year (50 grand- woofreakinhoo) to the 4.5 million loss recent reported.

Essent doesn't need Frank's help in FUBARing its facilities, swallowing up all that investment money. They're doing just fine all by themselves. All this humble blog is doing is reporting the truth, which in itself is a dangerous weapon. THAT is what Essent has their shorts in a wad over- people are paying attention to the man behind the curtain, and not the smoke-and-mirrors display run by Dud, dick and Duckboy.

Actually, I must give Essent a little credit- they're the perfect model of how NOT to run an allegedly for-profit company.

-The poster NOT known as Frank a/k/a John Doe number any

When it comes down to it, they are just trying to blanket all possiblities with the 1-10 thing. Even if it's determined that my comments were not libelous, they can say that the only way to find the 2-10 is through my account. Were it true, that would be one thing. Now, even with the settings set to forward, blogger doesn't and I haven't even a clue when comments are made.

"According to the latest American Hospital Directory (AHD.COM)data, when you add up the fiscal performance of all Essent hospitals for fiscal 2007, the company lost $4.5 million. Contrast that to fiscal 2006 when the combined operating profit was $55,000. How long are these idiots going to be able to keep their jobs with losses like these?"

Waitaminit...........this is a for-profit chain, right? Supposed to make some money, right? If I were pouring millions of dollars into a corporation, I'd expect them to make a little money, right?

This ain't a for-profit anything- it's a massive tax write-off, a money pit. Pouring good money after bad is not what I call a sound investment.

Matt/Todd/whatever the h___ his name is this week mocks this blog for "not bringing Essent to its knees". I'd say Essent and it's carload of circus clowns are doing a nice job of wrecking this company all by itself- what could this little ol' blog from Texas do, other than report on the train wreck taking place in Nashville, Paris, Ayer, Sharon and SW Pennsylvania.

And, finally:

Seems not much different than when the big mining companies ran the towns and the company store. Essent may be hoping that the Judge forgot that era, and the laws that prevent slavery....

So, you see, the posts aren't the fun part: the reactions are. You have to click a few times, but it's all there.

Vote, and Vote Often (Part Deux....7/4

2008-06-11T10:04:00.006-05:00

A question has been asked:

Any news yet? Or is the ozone cloud that is emanating from the judge's brain still hanging over the courthouse, as he ponders this decision.......

Watch it come down to a coin flip: heads, guilty; tails, innocent.....

......and Essent provides a two-headed coin.

Actually, I'd hate to be in his spot. Basic liberties vs the largest single employer in town (might not be any more with the outsourcing, but for argument's sake let's say it is)...and with an election coming up. The dissection of his decision will be in the legal reviews as well as the boardroom.

But, I'm not wild about mine, either. Legal representation is not free, and I'm going to hate being back in the state court of appeals. As Todd (formerly known as Matt) comments:

Frak-a-rino:
I only check your blog every few weeks anymore.....You have run out of steam, bro'. Looks like despite your best efforts you have been singularly unsuccessful in bringing Essent to its knees.

This may be a good response in your court case.....you haven't caused a whit of damages, so why the h@#$ are they wasting their time and money suing you?

That's a question for the ages. Hud's ego, initially. Now, probably the point is moot. They want my name, but probably not for an actual trial. It wouldn't gain them anything, and more than likely hurt them--I do have enough to prove what I say. They can impose economic sanctions without that--just look back at Holly and her family. Come to think of it, it probably is still ego. These are still Hud's picked cronies. Dick is still at Essent. Browder was picked by Hud. Dickie picked Duckie.

Smoke Gets the Ayes!....8/25

2008-06-05T20:27:00.005-05:00

In roughly two months the entire campus will be smoke-free. Finally, something I agree with! I never could understand why a patient that was sooo sick that they had to use a bedside commode--that was unable to bear the pain of sitting up on their own--could beat a street racer to the door to go out and puff. Besides, it takes a surgical patient about 20% longer to recover if they smoke after surgery. Oxygenation of tissue....

The excuse that was used: It's the norm for Dallas hospitals. Yeah, right. Since when has Duc-boy been concerned with what was done in Dallas--unless the advent was in his favor. One thing it will get rid of--smokers.

If you have to go off campus to smoke, then you have to punch out to smoke. Anyone who doesn't---off with their head! And, last I heard, only two breaks were allowed plus lunch, per shift. So when they're Jonesing over that smoke, and they either find a place to blow it out the window, or punch out so many times they have to pay the hospital to work here....gotcha!

And you wondered how they were going to thin out ranks before transitioning to the North? Meet the new boss...same as the old boss....

News From Connecticut....11/26

2008-06-01T00:38:00.007-05:00

An interesting tidbit from the CT branch of Essent. Sharon hospital had seemed detatched from the problems plaguing the rest of the hospitals. However the article does refer to the nursing ratio concerns, as well as the all-consuming debt that Essent carries.

From TCExtra.com

Lakeville Journal
Sharon Hospital opens its books
By TERRY COWGILL
05/29

SHARON — It’s been six years since the first hospital conversion in Connecticut from nonprofit to for-profit.

When Sharon Hospital was under nonprofit ownership, its operations were essentially an open book. Its tax-exempt status required it to reveal much of its finances to the Internal Revenue Service and to state officials.

Essent Healthcare, the privately held company that acquired the nearly 100-year-old hospital in 2002, is required to report less to those authorities. Now Essent executives such as new Chief Executive Officer Michael Browder have decided to disclose unusual amounts of data regarding the hospital’s operations, finances, patient care and comparisons with competitor facilities.

“We want to be more connected to the general public,” said Ben Heller, a member of the hospital’s governing board. “For so long it’s been this mysterious entity.”

Aggressive investing

Heller, Browder and Sharon Hospital CEO Charlie Therrien spoke with this reporter and Lakeville Journal Company publisher Janet Manko last week in the hospital’s board room.

In a four-page insert purchased for insertion into this week’s Journal, hospital officials also revealed that Essent is carrying a significant debt load, which has funded the company’s aggressive expansion. When Essent was founded in 1999 by venture capital firm Thoma-Cressey, Essent’s board of directors and then-CEO Hudson W. Connery saw the firm invest $120 million right away. Since then, Essent has taken on $115 million in debt — borrowed mostly from GE Capital. Essent hopes to retire that debt, or refinance to lower its obligations, by 2013.

“Sharon Hospital today is strong and so is Essent,” said Browder, who replaced Connery last year after the founding CEO was reportedly forced out. “We are comfortable with the debt load. By pure market standards, we are underleveraged.”

From a high of $3.6 million three years after Essent acquired it, the 78-bed hospital’s net income declined to $1.734 million last year. During that time, interest expenses have risen more than 18 percent to $1.729 million, eating into the hospital’s operating profits. However, under nonprofit ownership, the hospital had lost about $16 million in the six years before Essent bought it. Essent owns four other hospitals: two in nearby Massachusetts and one each in Texas and Pennsylvania.

Decline in patient volume

The three men said that Sharon Hospital’s challenges are quite simple. Increasing patient volume remains a priority. From 2004 to 2006, for example, Sharon’s discharges went down 5.3 percent and emergency room visits declined by 5.4 percent. Browder and Therrien said patient volume is down at Sharon’s principal competitors (New Milford, and Torrington’s Charlotte Hungerford) by a similar percentage.

Many hospitals across the nation are experiencing similar declines since mid-2006, owing perhaps to the alternatives including walk-in clinics, outpatient surgical centers, hospices, home therapy and visiting nurses. Browder said he believes that recent improvements in pharmaceuticals and a declining economy have also kept would-be patients away from hospitals. In acquiring new facilities, Essent has always looked for hospitals that do not have a proximity to outpatient surgical centers, Browder said.

The physicians associated with Sharon Hospital, most of whom work as outside contractors to the hospital, are also vying for patients’ attention.

“Doctors are trying to plug the hole and do more in their offices, so they are also our competitors,” Browder explained.

Births at the hospital, however, have been a bright spot. They’ve increased about 10 percent since Essent acquired Sharon. A new 11,000-square-foot women’s services center finished last year could have something to do with that.

Financial advances, stability

In the six years it has owned Sharon, Essent says it has retired the hospital’s previous debt, financed an $8-million renovation project, helped fund a locally controlled community health foundation worth between $16 million and $20 million, and restored the hospital’s long-term fiscal health — all without a reduction in patient services.

And there was last year’s $17 million capital improvement project, which included not only the birthing center, but a new emergency department, an addition to the radiology department and a new 1,200-square-foot facility to house the magnetic resonance imaging equipment.

Through its first five-and-a-half years of ownership, Essent says it has spent more than $34 million in additions and improvements to Sharon Hospital’s physical plant and equipment. That amount is greater than the hospital’s net annual revenue when it was purchased.

Response to community concerns

Still, in the statements put out by its governing board in this week’s Journal, Essent officials concede that patient “volume has not yet sufficiently increased Essent’s significant investments [and] the debt created to increase business is large.”

In a letter to the editor in The Lakeville Journal earlier this year, Victor Germack, a financial analyst and member of the Community Association To Save Sharon Hospital (CASSH), a group that opposed the sale to Essent, raised what he called “several troubling issues.” Therrien acknowledged that today’s insert in The Journal is, in part, a response to Germack’s letter.

Germack went to Hartford to the headquarters of the state Office of Health Care Access, whose approval was critical to the Essent sale. He reported that of Essent’s five hospitals, “only Sharon Hospital was marginally profitable. The four others showed net losses for fiscal 2006.” Germack raised questions about Essent’s debt load, its overall financial condition and was particularly concerned about staffing levels and the degree of charitable care given at Sharon.

Indeed, The Lakeville Journal received a letter last April complaining that “as a result of the spending on the physical appearance of the hospital, the nursing staff has had considerable changes to their working conditions.”

The letter, which was signed only as “a group of concerned employees at Sharon Hospital wanting quality healthcare,” said nurses are “being forced to work” under a lower staff-to-patient ratio and that often “nursing personnel are being canceled and told to stay home.” Complaints to the administration fall on deaf ears, the letter claimed, so there have been some discussions about “joining a healthcare union.” Therrien said those employees’ concerns have been addressed.

“We follow national standards and our own determinations. I feel confident that our staffing levels are appropriate,” Therrien said. “There will always be people who disagree, but we have worked with nursing leadership to make sure they have the right support and resources.”

Finding quality doctors

Another significant challenge for Sharon Hospital is recruiting doctors. Shortages exist in adult and pediatric primary care, where Therrien said he would like to have four more physicians; and in endocrinology/diabetes, where the hospital could use one more.

The ranks of medical school graduates have been declining nationwide, Therrien noted, in part because of increased demands on physicians’ time and resources in order to comply with regulatory burdens and insurance. Combined with the cost of living in the Northwest Corner and an ailing national economy, the climate for finding qualified physicians leaves a lot to be desired.

“Recruiting doctors is hard,” said Heller. “Stop to think what it costs to buy a house here.”

Therrien has had less trouble recruiting qualified nurses, but was quick to “knock on wood.” He also insisted that Sharon Hospital fulfills its legal obligation to care for those who cannot afford care.

“We do not screen for financial ability,” Therrien explained. “We do go through a process to see what people can pay. Whether you have insurance or not is not necessarily the determining factor.” He added that Sharon Hospital has financial counselors who work with patients and direct them to local services that can help them further, if needed.

But all three men emphasized the importance of the concluding sentence of this week’s insert: “Finally, we are faced with the largest problem of all: How can the nation’s 2,000 small community hospitals survive in today’s atmosphere of intense governmental, economic and medical pressures?”

© Copyright 2008 by TCExtra.com

Just remember: Sharon Hospital is profitable. One of two in the Essent chain. They are talking about retiring Sharon's debt in that time frame, not Essent's.

Speculation....5/28

2008-05-13T15:30:00.003-05:00

A comment caught my eye, and I thought it was worth sharing:

What's going to happen to all the loyal employees when the consolidation takes place? I don't see tons of earth being moved, and the reason for the main business of the hospital being at the South Campus was the facility's size: More OR suites, more rooms, larger ER. If we all move to the North, how is everyone going to fit, especially after redesignating part of it to the "Heart Center"?

Probably the same way they handled 'right-sizing' before. So, you will see less agency personnel and the rest will come out of staff.

What will they do to accomidate the ER traffic? Rack 'em and Stack 'em. An ER is a losing proposition anyway. Why make them want to come? You want the insured for high billable procedures, not self-pay/no-pay ER visits. Hence, the Cardiac Center for Excellence .

As the Snooze might say, "Don't you worry your little head about such things...." Or, in their own words:

The Paris News also pledges to continue to worry out the details, and to bring our readers all the news of these changes.

This is a Six Sigma innovation which they might take a hint from:

Questions from the Top....5/4

2008-05-02T13:33:00.006-05:00

I almost said from administration, but it's just the cousin formerly known as Matt:

I need a quick primer.....on the one hand Essent is criticized for being money grubbers, putting the almighty dollar ahead of patient care. Then, when the hospitals show losses, they are criticized for not making a profit.

I am quite sure you can reconcile these apparently opposing conclusions.

Guess they're doing a poor job of money-grubbing?

Actually, the two opinions are not mutually exclusive. A hospital can be fiscally responsible, without covertly spying on staff. It's all in the how.

It can monitor the orders so as to have justification for tests run, rather than rejections. It can set specific goals...rather than wavering in the wind...and invest its employees in the process.

Essent jumped in with both feet, not just discounting suggestions, but ignoring them entirely. "We're from Nashville, and you poor hicks ought to worship at our feet." Well, the feet have been proven to be of clay.

Obviously, strategic plans have to change, with the change in the top. But, beware boys and girls: the shifting sands might get you...or possibly the red ink....

Press Ganey and Vestar....4/31

2008-04-30T12:27:00.002-05:00

While surfing not too long ago, I ran into an article that just clicked. Vestar bought a controlling interest in Press Ganey. (You remember Press Ganey, don't you? They measure patient satisfaction. Ironic, isn't it?!?)

Now for those in Rio Linda (one of Hud's expressions), Vestar is heavily invested in Essent. One would hope that the crossover would have a positive effect on Essent...Hah!

More Red Ink....5/2

2008-04-28T12:32:00.004-05:00

If you go to http://www.ahd.com/ and key in for Paris Regional Medical Center, you will notice that the bottom line says it all: $508,231 in red ink.

Sharon Hospital, while having a gross of less than 1/3 of PRMC, produces $1,467,558.

Merrimack Valley Hospital has a gross slightly ahead of Sharon, but out does PRMC: $1,498,033

Nashoba Valley Medical Center nets $860,296.

Southwest Regional Medical Center produces the lowest gross, yet rounds out the company with the greatest losses: $2,411,841.

So, one would hope they have some deep pockets, 'cause if they don't, someone sometime is going to say: Enough!

Disclaimer: The figures published at AHD.com are not current year. Please see the time periods shown on each hospital's sheet. Amounts could be greater or less for the current fiscal year.

New Radiologists....3/12/10

2008-04-25T19:45:00.006-05:00

Well, the Snooze has announced the arrival of two new radiologists. Emphasis on 'new'. The first, LUCHO LOISEAU ROSSMAN has been practicing for three years, after an eleven month fellowship. You wonder how much of that was as an assistant professor?

MICHAEL SCOTT ALLEN, the second radiologist, has practiced for 18 years, with only a small misunderstanding on his renewal--delinquent/non-payment--and an 'active-not-in-practice' during 2002. Maybe it was during his mini-fellowships....(the information on Hopkins and Emory has mini-fellowships listed from less than a week to three months....) Worldwide Imaging sounds like a radiologist reading from his home in a bathrobe...with little to no patient contact.

One good thing, he ought to be able to keep up with dictation! Hopefully he can get past the generalization trap of the on-call services and make definitive statements.

But, here is the story, you be the judge:

A (64) slice of life

Staff reports
Special to The Paris News

Published April 23, 2008

Two board-certified, fellowship-trained radiologists — Michael Scott Allen, M.D. and Lucho Rossman, M.D — are new additions to the Paris medical center.

Their arrival in the community coincides with the arrival of a Toshiba Aquilion 64 Slice CT Scanner on the North Campus where work continues on new cardiology facilities.

The Toshiba Aquilion can perform a whole body trauma in ten seconds, more than twice as fast as conventional multi-slice CT scanners. This speed is especially helpful in shortening breath holds for geriatric patients, patients who are on ventilators and pediatric patients.

In a single rotation, the scanner creates 64 high-resolution anatomical image “slices” as thin as a credit card. These images are combined to form a three-dimensional view of the patient's anatomy for the physicians at Paris Regional Medical Center to analyze. From these images, physicians can view such things as blockages in the coronary arteries, as well as the motion and pumping action of a patient's heart.

Both Allen and Rossman bring extensive experience and knowledge to the hospital’s radiology department, Paris Regional Medical Center CEO Chris Dux said.

“We are thrilled to have them here,” Dux said.

Allen, who is to serve as Medical Director of Radiology, specializes in neuroradiology, muscle skeletal radiology, virtual colonoscopies, magnetic resonance imaging (MRI) and Coronary Computed Tomography Angiograms (Coronary CTA). He joins the staff from a private practice at Worldwide Imaging Technologies in the Dallas area.

Allen received his Doctor of Medicine from the University of Texas Southwestern Medical Center at Dallas and fulfilled his residency at the University of Missouri Medical Center. He has completed mini-fellowships at Emory University, New York University, University of California at San Francisco and Johns Hopkins University.

“Paris Regional Medical Center made me feel at home right away. It has a great group of physicians and the best radiology department that I’ve ever worked in,” Allen said. “I am honored to be part of such a top-notch organization.”

Rossman, the area’s only fellowship-trained interventional radiologist, joins the staff after most recently serving as assistant professor of Vascular Interventional Radiology at the University of Texas at Houston and as a clinical interventional radiologist at Memorial Hermann Hospital and Lyndon Baines Johnson Hospital in Houston.

He graduated from the Baylor College of Medicine in Houston and performed his residency and internship at the University of Texas at Houston. He completed a fellowship in vascular interventional radiology at MD Anderson Cancer Center.

“I have been impressed with the significant investment Paris Regional Medical Center has made in the latest diagnostic and interventional radiology equipment,” Rossman said.

“What we have here compares favorably to what is available in most major cities — like Dallas and Houston — and far beyond what you would normally find in a community this size,” he said.

What is a Radiologist?

Nearly all physicians examine patients, obtain medical histories, diagnose illnesses or prescribe and administer treatment for people suffering from injury or disease.

Generally, a radiologist is different from other physicians because he or she diagnoses diseases by obtaining and interpreting medical images. Some images are obtained by using X-rays or radioactive substances, others by means of sound waves or the body’s natural magnetism.

A radiologist correlates medical image findings with other examinations and tests, recommends further examinations or treatments and confers with the referring physician. Radiologists also treat some diseases by means of radiation (radiation oncology) or minimally invasive, image-guided surgery (interventional radiology).

...With Baited Breath....6/11

2008-04-03T07:15:00.006-05:00

It's back in the hands of the judge, again. Arguments have been made, answered, and now it's under consideration.

My contention is that it is a SLAPP suit, but Texas has no provisions against such suits. What is a SLAPP?

Generally, a "SLAPP" is a (1) civil complaint or counterclaim; (2) filed against individuals or organizations; (3) arising from their communications to government or speech on an issue of public interest or concern. SLAPPs are often brought by corporations, real estate developers, government officials and others against individuals and community groups who oppose them on issues of public concern. SLAPP filers frequently use lawsuits based on ordinary civil claims such as defamation, conspiracy, malicious prosecution, nuisance, interference with contract and/or economic advantage, as a means of transforming public debate into lawsuits.

Most SLAPPs are ultimately legally unsuccessful. While most SLAPPs lose in court, they "succeed" in the public arena. This is because defending a SLAPP, even when the legal defense is strong, requires a substantial investment of money, time, and resources. The resulting effect is a "chill" on public participation in, and open debate on, important public issues. This "chilling" effect is not limited to the SLAPP target(s): fearful of being the target of future litigation, others refrain from speaking on, or participating in, issues of public concern.

What is the harm in a SLAPP? Again, it curtails free speech, unless you have the money and time to fight it. While there should be an accountability factor, it shouldn't be dependent on one's bank account...and how much justice you can buy.

New CEO....4/9

2008-03-27T13:59:00.008-05:00

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.

Did I?....5/11

2008-03-23T04:41:00.006-05:00

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....

Integrity, Integrity....3/24

2008-03-22T00:15:00.005-05:00

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 krasner@globe.com.

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?

So, Is an In-flight Lunch Included?....3/20

2008-03-18T15:02:00.004-05:00

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
by 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

When Our Eyes Meet....4/3

2008-03-14T17:01:00.006-05:00

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 speak...how 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

Where Are They Now?....3/16

2008-03-11T01:43:00.007-05:00

"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.

Analytics
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.

Another Court Date....5/1

2008-03-07T19:37:00.006-06:00

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.

More Creativity!....4/27

2008-03-03T13:27:00.003-06:00

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, jminch@lowellsun.com
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.

Just an Observation....3/5

2008-03-02T00:23:00.003-06:00

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.

Creative Financing....3/5

2008-02-27T05:08:00.001-06:00

The Ayer is getting a bit thin.... Browder signed a mortgage agreement with GE Capital for $115M, and an agreed revolving credit of $15M plus $3M swing. What's the difference between that and the investors (which GE has been at a different time)? The hospital secures the loan.

When maintenance money is tight, but capital improvements are available, that's when you know investors are tightening in the moneybelt. Maintenance can't secure a loan...real property and assets can.

What they fail to realize is this: A hospital is more (or less!) than the sum of it's assets. Management can drive down the intrinsic worth faster than you can say "cutbacks". Actually, they may well be aware. GE probably figured having your hand out at the beginning of the line is better than at the end.

Actually, the mortgage was signed on Dec 20, but not recorded until about a month later. It was, in fact, the day after the saga of Dr. Rimas Maurukas came to an ignoble ending with revocation of his medical license in the Commonwealth of Massachusetts.

Vote, And Vote Often!....3/5

2008-02-21T18:50:00.004-06:00

The fourth of next month will be interesting in the national arena, but it will also be worth a look here. I was going to let things slide, but then someone pointed out that Essent has a PAC (Political Action Committee), and hasn't been shy in the past as to who they support and what contributions they will make to their campaigns.

Sharon Hospital tried to host a fund raising breakfast for one Senator a few years back, and was promptly slapped down as being in violation of campaign contribution rules. That's when they formed the PAC.

So, who are the contributors, and who are the recipients? It will certainly be interesting, and possibly telling.

I'm fac_p, and I endorsed this ad.....

All the News Not Fit To Print.....3/15

2008-02-20T05:23:00.000-06:00

Events and Orders of the Court

03/12/2008 OBJECTION TO AFFIDAVIT OF R. WESLEY TIDWELL
03/06/2008 BRIEF PLTS BRIEF IN OPPOSITION TO JOHN DOES NO. 1 MOTION FOR PROTECTIVE ORDER
12/20/2007 MOTION FOR PROTECTIVE ORDER
12/17/2007 NOTICE OF INTENT TO SERVE SUBPOENA ON NONPARTY REQUIRING THE PRODUCTION OF DOCUMENTS
12/14/2007 ORDER RESCINDING ORDER RELATING TO THE DISCLOSURE OF JOHN DOE #1'S IDENTITY
10/01/2007 ORDER RELATING TO THE DISCLOSURE OF JOHN DOE#1'S IDENTITY
09/28/2007 LETTER FROM JAMES RODGERS TO HONORABLE SCOTT MCDOWELL
09/27/2007 SUPPLEMENTAL PETITION PLTS FIRST
09/24/2007 LETTER FROM JAMES RODGERS TO HONORABLE SCOTT MCDOWELL
09/14/2007 JUDGE'S RULING
09/12/2007 PLAINTIFF'S SUPPLEMENTAL BRIEF IN RESPONSE TO JOHN DOE NO. 1'S OPPOSITION TO THE DISCOVERY OF HIS IDENTITY
09/12/2007 ARGUMENT FROM JAMES RODGERS
09/07/2007 PLTS BRIEF IN RESPONSE TO JOHN DOE #1'S OPPOSITION TO THE DISCOVERY OF HIS IDENTITY
08/07/2007 VACATION SCHEDULE J. MICHAEL TIBBALS AUG. 17-26, 2007

08/06/2007 LETTER TO JUDGE MCDOWELL FROM JAMES RODGERS

07/24/2007 ORDER AGREED ORDER AMENDING JUNE 10, 2007, ORDER AND DIRECTING NON-PARTY CEBRIDGE ACQUISITION, L.P.,dba SUDDENLINK COMMUNICATIONS TO PRODUCE RECORDS PURSUANT TO THE FEDERAL COMMUNICATIONS ACT.

07/11/2007 NOTICE OF APPEARANCE/SUBSTITUTION OF COUNSEL FOR NON-PARTY CEBRIDGE ACQUISITION LP D/B/A SUDDENLINK COMMUNICATIONS

06/19/2007 ORDER GRANTING PLAINTIFF'S MOTION TO NON-PARTY TO DISCLOSE INFORMATION

06/19/2007 PLAINTIFF'S ORIGINAL PETITION

Looks like Suddenlink isn't rolling over...or doesn't have the data...floating IP addresses are tricky things....frank

Ever Wonder Why....2/27

2008-02-12T21:48:00.010-06:00

I received this promo from Dell and Microsoft:

Your choice of a PC can dramatically improve the lives of people living with AIDS in Africa. Windows® is proud to partner with Dell™ and (RED)™ to give you an opportunity to buy (PRODUCT) RED next time you buy a PC.

For every purchase of a Dell (PRODUCT) RED PC, Windows and Dell will make a contribution of $50 to $80, depending on the product purchased, to The Global Fund to help improve the lives of people in Africa affected by AIDS. $50 is enough to pay for almost four months of life-saving antiretroviral treatment for one person suffering from AIDS.

It's simple. You choose Windows Vista Ultimate (PRODUCT) RED, we give to The Global Fund, and people in Africa benefit.

It is a beautiful choice with a powerful impact.

My question, to the drug manufacturers, and our elected officials is, Why does four months of antiretroviral cost $80 in Africa, and why shouldn't it be the same price here?

Last I heard, the treatments, not just the cocktail, cost thousands per month. So why are we paying (at levels that threaten to bankrupt our healthcare system) the much higher price for the same drugs? Is it because they can get away with it?

But, it isn't only that. What has happened to our healthcare system? Years ago, in a fee-for-service era, you got sick, you went to your doctor. He listened, you talked. He talked, you listened. You paid him. Simple. Now, with the system we have, you pay the HMO, they pay the doctor, a percentage of what he bills, so he feels the need to cram more patients into the time slots. Little talk, less listening. Less paid. The price of progress.

This really isn't the fault of a free-market system. It happens in socialized medicine as well. The money you would have paid to the HMO, would go to the government. They would 'manage' the system. The physician receives less, as does the patient. ...And the level of caring is even less. ...And what program has government 'managed' correctly, or under budget?....keep thinking.....