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....

HIPAA Issue and Court....4/11

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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!!