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

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

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

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

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

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

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

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

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

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

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

Peds on Hold....6/13

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

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

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

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

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

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

PRAYERS FOR OUR TROOPS ....5/29

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

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

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

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

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

We pray for the protection of children and innocent civilians.

We pray for our nation and our leaders.

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

Walkouts....5/30

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

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

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

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

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

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

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

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

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

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

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

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

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

Pandemic....5/18

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

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

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

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

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

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

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

Monetizing....5/4

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

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

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

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

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

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

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

The Snooze: No News

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


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

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

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

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

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

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

Rodgers said no hearings are scheduled and no decisions expected.

“No news is good news.” Rodgers said.

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

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

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

No movement has been made in the case since.

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

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

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

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

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

Marketing....4/9

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

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

Marketing ideas, hmmmmm:

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

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

Federal Inroads....3/28

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

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

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

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

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

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



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



Can we spell pink-slip?



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



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



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

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

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



Someone has done some fast talking.



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



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



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



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

Feathers....5/29

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

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

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

News from Natchez....3/13

From the Natchez Democrat:

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

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

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

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

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

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

In The Black....3/13

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

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

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

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

• What were the results on MVH and NVMC?



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



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



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



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



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

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

Natchez on the Essent....3/9

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

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

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

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

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

Pay to Stay....3/21

The latest from the 'town meetings':

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

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

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

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

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

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

Puffin' Up....3/7

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

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

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

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

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