Buffed up...1/9

The new administrator for PRMC is not new to Essent, nor Hud. As a matter of fact, he even fell on his sword for both about five years ago. Essent was being investigated for collusion in the bidding process for property. Richard's resignation was meant to pacify the authorities. Since then his fortunes, or the fortunes of those he worked for, haven't been the greatest: His last position was CEO for a hospital(under Cambio management) that went chapter 11. He was also in the Crossroads debacle, and doesn't this press release sound familiar:

Doctors Hospital To Become Crossroads Regional Hospital
More than 200 entries submitted during name change contest
WENTZVILLE, Mo. - Doctors Hospital will change its name to Crossroads Regional Hospital effective July 1 following a community-wide contest to select a new name for the hospital that reflects its service to this growing area.

Hundreds of entries were submitted for the hospital's new name, 37 of which were a variation of "Crossroads". Scott Schultz of Wentzville submitted the winning name. He will receive a one-year membership to the Greater St. Charles County YMCA.

"We were delighted to see this level of community participation," said Richard Salerno, vice president of hospital operations for Essent Healthcare.

Also about Crossroads purchase:

Richard Salerno, Essent's senior vice president of hospital operations, said
Doctors Hospital's 1999 financial results appear to be in line with 1998, when
the 94-bed hospital made a $1 million profit on $18 million in revenue.

So then comes the question as to what happened to the hospital when Essent got it? Which year out of the five did they actually make money? The first, or the last?

No stranger to Texas, between his position in Essent and lately with Cambio (Baptist and Carraway assignments) and, Richard was CEO of North Austin Medical Center, then senior vice president of operations for Austin Surgical Hospital.

But he and Hud have even more of a history, Arcon comes to mind, his resume reflects ARCON Regional Vice President and that Arcon 'sold off' its outpatient facilities. Possibly so, but under court direction, and the Texas clinics a year after they closed.

In the corporate world, you either progress, or you are sloughed off into a corner. Richard progressed up (and past) the CEO position that our facility would have commanded over 10-15 years ago. And now, going from a 615 bed facility to at best less than half...one might say it's not only his last chance, but PRMC's as well, with Essent.

Eat your heart out, Snooze...and the Nashville Business News....

Knizley in the Wind?...3/13

Andrew Knizley, CEO of PRMC has his walking papers...but maybe he doesn't know it yet!

Who does know? Most of E$$ent.

Richard Salerno, will be taking care of our little problem in Paris, despite having some baggage of his own.

Richard just left a sinking ship, a little late, however, since the hospital had already gone under. Carraway Medical, a 615 bed facility, filed Chapter 11 in September, at which time Dick was the COO. They're in the midst of being purchased by a group of approximately 54 physicians.

In the interm, he's been made the CEO--at least on their website. Rumor has him seen in extensively in Nashville.

Guess Andrew needs to pack up his Rolls.... Guess Essent just spat....

...But We Aren't Laughing...1/21

No matter how you slice it, dice it or saute' it...Hud is a dud. So, consequently, Essent is a joke!

Management,...what management?! PRMC could not possibly be handled any worse. Where is our fearless leader, Andrew? How come the only person we ever hear from is Cheryl Perry? Is anyone at the helm of PRMC or...are we just drifting with the tide?

PRMC should be the most updated and profitable hospital in the N.E.Texas area. Instead, it is the least likeliest place preferred for treatment. Our own Paris community shuns us!

Someone once commented that the blog is just a place for gossip. NO! It is a medium for expression of legitimate concerns and/or problems by both staff and concerned patients and community members.

If, indeed,Essent management is listening...Please express your concerns! Does Essent really expect to profit --

• from a facility with a constant turnover in staff?


• from a facility with out dated equipment?


• from a facility with no permanent Doctors/Radiology?


• from a facility that does not pay their employees/no pay raises?


• from a facility that has no reward or incentive program to maintain a "higher standard"?


• from a facility that does not help employees maintain licensure that is needed to be employed?
• from a facility that does not listen to employees, pt family members, or patients?

And this is but a few concerns. I love to care for people. It is what I do for a living.

Yet, at this facility I am held back by either too much politics or dunder-headed policies made by people who have no idea what they are doing! At one time people wanted to come here for treatment and care...not anymore. Essent is capable of turning this place around. So, either spit or get!

(From the mailbox, and get might be the operative...stay tuned!...frank)

Back to Rio Rojo...1/15

What are those big boxes being brought into Paris Imaging? Could it be a belated X-mas present...well, in a way. It's the new Gamma camera for their nuclear medicine addition! When hardly anything in PRMC x-ray is generating income except nuclear medicine studies, it's hard to ignore. This could cut heavily into the revenue stream.

So, let's lay it out, Paris Imaging has the newest and fastest equipment in town, including:

1. ultrasound,


2. digital mamography,


3. diagnostic x-ray,


4. CT,


5. MRI,


6. and now nuclear medicine.
   
   Guess the Boyz are back in town....

Updates...1/4

Austin Craun and Greg Schonert may be looking outside the healthcare industry. Rumor mill has Black River Capital interested in the boys. Both had REIT experience prior to Essent, so it isn't too great a stretch...is it?

Zurich American Insurance has been looking at our Northeastern brethern.

Partners Healthcare Systems Inc and one other has been checking out Dr. Rimas Maurukas. Is he looking for a new affiliation? One would hope that they would be a bit wary, as the investigative process hasn't ended.

I have no idea why so many folks from so many countries are searching for the same string of items: "Paris Essent Hud". But, I've had hits from Estonia, Iran, Vietnam, Korea, USSR, and a great number from the 'west' as well. Someone must be passing around an email that has to be titilating.

Oh, and Vestar Capital has been checking us out. That probably means that Essent burns the midnight oil trying to do a risk analysis...hey guys, it's all at risk!

Giving Thanks in the New Year...1/3

I received this e-mail the other day. I do spell check, and in some cases reformat as needed.

Frank,
I never realized what all I had to be thankful for, until I started my new job. I was in shock when I was terminated from PRMC, having worked there for a number of years. You get into a rut, not wanting to make a change, and you find all sorts of reasons to not hop the fence. They made it for me. And, because I was there so long, I had no other history that a new employer would verify. The flighty might have an advantage.

I would say the main reason I got the job is recommendations that former co-workers had given me (they had wanted me to switch years ago, but I thought that things would 'get better') and they now worked here.

But, I was hired and immediately started seeing differences: They actually solicited my opinions! They were happy to see me! I was made to feel I had worth! And they checked back later, to see if during my initial time I had seen anything that they could do better---I was blown away. And the people were so darn cheerful, and so am I, in retrospect.

I see more and more people here that used to work at PRMC, and while I welcome those who join me, I worry about those that are left. Make the move before the move makes you!

There's at least one more of my fellow co-workers joining us, and the commute gets old, but maybe we'll start a Paris expatriate community. (There would be several, I would imagine....frank)

Another, which was quite similar, gets added:

Frank,
The expatriate mentioned in your newest article is me. I couldn’t have written a better explanation of how welcome I’ve been made to feel, and I haven’t even started my new job yet!! HR at PRMC could learn a thing or two about how to treat people.

Disclosure seems to be their forte rather than cloak & dagger politics. Not to mention department heads have exactly the same attitude. The motto seems to be “We want you, are extremely pleased you accepted the position and we are behind you 200 percent!” After trying to relearn how to live in the normal world, the attitude seemed unreal, and once again I am looking forward to working in a hospital atmosphere.

I grudgingly admit that PRMC put such a damper on my outlook of things, it was hard coming back from all of the disillusionment forced upon me by Essent's policies. I thought I had lost my desire or capability to function in that environment ever again.

But with the New Year, fresh starts do happen. As mentioned in the article, I was forced to leave as well, but not through blatant dismissal, it was more insidious, it was through position elimination and an offer to continue at a much lower level, all the time requesting that it would be appreciated if I would use my licensure for the benefit of the department. Certainly I should have no problem with that. How demeaning!

Pretty much the credo of a now ever present problem in Paris. I tried moving onto other things, but apparently, healthcare is in my genetic structure, not to be denied. I was terrified that I would not be able to land a job at any other healthcare provider, as the referrals, again, would only be through fellow co-workers and contacts made during my position at Essent. It truly was a worry on my part. However, happy endings do exist, as the position was offered and I was ecstatic over the prospect.

So I happily start my New Year, with a fresh and upbeat state of mind. Much engendered by a company and Administration that practices what they preach. I still hold a great deal of resentment over the state of affairs here in Paris, and probably will for a very long time. And I will fight to be the first in line to cheer Essent's departure. Hell, I’ll even learn to play drum cadences to help them march out of town! Again, thanks for a much needed vehicle for folks to voice their opinions and vent.

I have no problem in your use of this email, edit as you wish. At this point I would be willing to get a magnetic sign to put on my car extolling the virtues of Essent/PRMC, just not sure if I could get the print big enough! HA!

However, don’t use the name, I still have great friends that work there, and would be afraid Essent would vent on them as a result of my opinions. Truly a sad state of affairs!
Happy New Year, and please continue the blogsite, it is good for our souls!

This was sent by a blogger, which kind of represents our reaction towards PRMC:

I guess we r stuck hear with E$$ent!

The New Year has a tradition, that being resolutions. I hope this year Essent resolves to re-evaluate and move on--without us!

Re-Gifted...(quotes)....1/5

Thought I'd decorate the tree, so to speak, with a few choice ones.

"We are attracted to Essent because its hospitals are financially sound(????) and provide essential, high quality(????) care to the residents of the communities they serve," said James L. Elrod Jr., managing director with Vestar's New York office."Essent's business model is consistent with our investing strategy. We are particularly excited about becoming partners with Hud Connery and his management team."

These are the folks that Hud and bud put on their little show for at the Med Staff meeting so long ago. They're also the ones that chipped in $80M for investment. That's why Hud made such a fuss about RRVR taking a fee from the hospital (false), and why he was adament on getting rid of them. Kind of a Hitleristic approach, might one say? One might. His version of the "big lie".

But, it served two purposes: Tarnish the reputation of RRVR, and allay the investor's fears...making them feel that profits would be up $1.2M (what they were supposedly paying the Radiologists to read films.)

So comes a lesson, of sorts. Just plugging in money to the wrong thing does not success guaranty:

“We’ve made significant investments in Crossroads over the past five years, including the construction of three medical office buildings, renovations to the emergency room, and a new 3,000 square-foot outpatient physical therapy facility,” said Bill Heburn, executive vice president, operations, Essent Healthcare. “Despite these significant investments, Crossroads posted a positive operating income only one year out of the five we’ve owned it."

After that, Bill's future was made...or un-made.

Rule Number 1: Never make Hud look bad or laugh at him or contradict him in front of someone. Heads will roll.

One also might wonder about Hal Andrews, and how he disapeared so fast: Apparently he and Hud had rehearsed some song and dance for the Essent board about something. Well, Hal inadvertantly said something that embarrassed Hud in front of the board, (according to HUD , himself) and the next thing Hal knew, he was fired. (Rule #1)

So, Rule Number 2 for PRMC execs: You serve at the pleasure of Hud. It could be that Drew's statement in support of Tony Williams will be imortalized here as well....frank

Glad Tidings?...8/10

Getting close, so I'll say Merry Christmas ahead of time. Guess we're going to find out who's naughty or nice....

From the Northeast--Naughty

Physicians at Nashoba Valley Medical Center strike again!!!! Another physician has entered into a Voluntary Agreement Not To Practice Medicine with the Commonwealth of Massachusetts, which was a disciplinary action. Dr. Rimas Maurukas, pulmonologist is the 5th in a growing line of doctors falling by the wayside in Ayer, Massachusetts. The doctors being investigated by the commonwealth are outnumbering the new recruits. Am I seeing a pattern here??? Quality care just seems to be something NVMC can't attain. Are double digits in our future???? Once again check mass med physician profiles (link on left list.)

From Texas--Naughty

Frank,

Radiology is the ugly-redheaded-stepchild of the hospital! Seems that we are being treated to re-runs of Laverne and Shirley: The courtship of Squiggy! Should someone dig a little into his previous work history, they might be surprised. But that does fit the average Essent recruit--dependent on Essent.

The first graduating x-ray class from PJC is taking their boards this month, and the proof is in the testing. With only a few lined up with jobs in a super-saturated market, it does seem like the students going into the field are a bit naive, and not making informed choices. It's going to be like those schools that are promoed on TV at three in the morning which had such pitiful placements. With 10 applications for each x-ray job, one might need to re-evaluate one's career choices.

From Texas--Nice

Hi Frank,

Someone is reading the blog because an email was sent out by Cheryl Perry to check your education and make sure all your tests are finished. (Referred to the insertion of educational requirements after the listed due date.)

So "Dash away, Dash away, Dash away all"!

Quis custodiet ipsos custodes???12/28

Just when you thought it was getting better:

I've been getting rumors, and now several folks have emailed that I probably should put the warning back on the site as to monitoring of PRMC computers. But, that isn't the only thing....

The clicking that you've been hearing on the phone lines--Yep, Big Brother. The new "smoke detectors"? Some have cameras built in to them. Might be interesting to see what ones actuate from actual smoke....
I've heard that the outlying clinics all have gotten their monitoring upgraded, as well as Aerofit (wonder where the cameras went there! Better keep the swim suits on in the hot tub!)...guess they feel when the cat's away....

Quis custodiet ipsos custodes? (Who watches the watchers?) Me.

Footnote: From a comment, looks like public opinion wins--apparently Huddie doesn't like the flak, and some of the cameras, if not all, have been replaced. Makes me all warm and fuzzy towards Essent. Now we just have to watch the various other appliances to see if they end up in those....frank

Okies from Muskogee....12/12

I'm sorry, I ran out on an ongoing story. MRMC did make a decision, and that was almost a month ago. They selected Capella, and follow the link to see what was agreed to. I really wish they had been the ones bargaining with Essent...for us.

The employees were taken care of:

"• Existing commitments to all employees won’t change."

And standard of care issues as well.

Well done, Muskogee! You get a gold star!

Just one more...well maybe...12/22

Hud Connery, President and CEO of Essent Healthcare commented, "Doctors Hospital is a perfect fit with the Essent model. Doctors Hospital is an essential hospital in the middle of a rapidly growing community. The hospital provides a fundamentally important service, there is a great team of physicians and nurses, and we hope to make the purchase of this hospital part of a grander scheme. It's just the kind of opportunity we were looking for."

For those who haven't followed the blog, Doctor's Hospital was renamed Crossroads--and is now part of SMS, not Essent, after Hud finally gave up. Cat-herding is rough business.

Okay, so just one more:

Quoted from the Paris Snooze, 7/25/04, "Knizley (PRMC CEO) said the best way to achieve such a prestigious rating (one of the top 100 hospitals) is by finding problems the best way he knows how -- by listening to employees."

We just never expected it to be through tapping phones, and bugging the smoke alarms....

Who's Who in Readership...12/12

Just thought I'd give you an update on who actually tries to find this site, rather than stumbling into it (from what I consider outside the norm):

• I've had hits from India, the Ukraine, Turkey, Israel, Italy, Austrailia, China, Iran, the UAR, and even one from Vietnam, but that was a fluke. And either someone has been sending links, or one individual has been bouncing off multiple international servers...because the MSN search is exactly the same for about five countries.
• Numerous mentions have been seen in Power Point presentations given in the Netherlands, Norway, and Germany....
• Various healthcare groups from all over the nation.
• Investment companies.
• Healthcare Management groups.
• Obviously, the highest percentage of hits are from Texas, Tennessee, Massachusetts, and Pennsylvania, but I was suprised at the high numbers for North Carolina, New Jersey (probably the new CEO for MVH and his family), Minnesota, Florida (not just Andrew's defender), and D.C.
• The Dallas hospitals love it, the Essent states camp on it after hours, and I don't know how many people have Google alerts for new comments.
• A chat room would probably lock up someone's server.

I don't get information on the user, just the ISP (Internet Service Provider), and Essent has their own fixed IP (handy for me), as do other various organizations.

Hard Questions...12/16

Last year, Merrimack Valley Hospital lost $87,205. They have been an Essent hospital for how long? Since 2001.

In retrospect, the first hospital (Crossroads) that Essent bought lost money for all but one year (out of five.) From the beginning, they put serious money into the hospital, but like the Titanic, it just kept going down.

Nashoba Valley made $537,676 last year, approximately the same percentage of return on their gross as PRMC. But, their Return On Investment (ROI) is far better, as the price was only $11M. They still have a little over a year to commit an additional $16M in improvements or a new structure. While ground-breaking for a physician's office building has occurred, we'll see how an actual replacement hospital shapes up in the next year. Kind of waiting until the last minute...maybe hoping for an exception to be granted? Or was the timeline on the new hospital completion left open--sort of like the lawsuit by the gay couple....

Sharon Hospital seems to be the cash cow of the organization: Approximately $3.7M from a gross of $98.5. And they got it at a price lower than that of NVMC ($16M outright and $8M more for improvements)! Guess it was worth waiting for--despite assuming liability for a toxic waste dumping problem in NY.

Paris had a total revenue of $363,370,383...yet only made $1.6M over costs. Maybe it's all those locums?

Southwest wasn't in the mix, but lost almost $2M. I imagine that there were some changes.

It should be interesting this year, since the cost reporting period is over and the figures should be posted soon. For those interested, AHD.com is the website.

My questions are many, but here is the predominate one: Do they really expect to turn around a hospital with some paint and TVs? That isn't the problem, but let's see what happens....

Your Comments are Welcome...12/15

It's hard not to hear the comments when you mention that you work at PRMC. I've heard of more incidents involving patients in the last year than in the previous six. Some have been relatives, some have been the actual individuals. E-mail them or if you want it as a comment, just comment. This is one forum in which complaints are asked for, and not swept under the rug.

Additionally, if you have a complaint in general, this is seen by Essent corporate at least once a day, most days six or seven times. Some execs even check it after hours. Trust me on this one. They are very aware of this blog.

If you mention that you don't want any identifiable information included, but in order to make the point to me, there are certain 'tells', that's fine. I'll use what I can, and if it can't be told without identifying you, then I just add it to my understanding of what we are facing.

I was asked why radiology was a hot-button issue here? You go with the gold. The topics with radiology were producing more comments than anything else. One post got 77 comments (and the comments are the best part!) If nursing was commenting more, we'd probably have a broader mix. But with RRVR even making the Paris Snooze, you go with success. There has only been one other that has been better (104), and that was a physician lambasting the medical community for sitting on its hands. Got to admit, there aren't too many that draw that kind of attention.

I will have some financial data a bit later, dealing with Essent's balance sheets. We will see how those go over. Just a few of the basics. All public domain, or subscription, but immediately available to the public for verification.

For the Beancounter in You...11/29

I guess I was too harsh on the bean counters, since I did get several replies defending their honor. A few observations were made that need the light of day, as to why Essent and Paris weren't the right mix:

1. Essent didn't have the assets to be able to swing this large an endeavor. They were very exposed coming into this deal, partially because of a poor evaluation during the 'due diligence' period. They had no idea of the magnitude of what really needed fixing.

2. Short term goaling. Corporate put them on a fast-track schedule, with milestones in the monthly/quarterly timeframe, rather than planning for the long haul. Sort of the difference between Japanese and American corporations: Japanese take a longer approach, while American corporations are more instant gratification driven.

3. Lack of real understanding of the politics of the situation.
They had no real concept of the animosity between the "Holy House" and "Big Mac" crowds, and how it actually impacted Paris healthcare. (Note: the quoted descriptors were not mine, but they seemed to illustrate the point....) Additionally, the dynamics of the physician groups that had formed were foriegn as well.

4. Inability to adjust to the situation. Despite descrepancies in their conceptualize viewpoint and reality, they insisted on staying with the original plan and milestones, forgetting that feedback, adjustment, and re-evaluation are important steps in a project.

5. Mis-evaluation of the area's labor pool. In metro areas, there is always a supply of staff, due to the population base. But, in the Paris area, there are a couple of fallacies in that equation: There is a smaller population and limited draw to the area. The metroplex pays far better. Why drive the same distance to one and get paid less? It's like what put some of the nails in McCuistion's coffin: A Dallas-based management team that assumed the business climate was the same as the metroplex, and implemented policies that drove away their physician tenants.

And the result? Patients are leaving in droves. Shuttle bus services to Texarkana, Tyler/Longview, and Dallas are having to buy more vans. (Maybe Essent invested in those!) Services and procedures that we could previously count on are here no longer.

All we get in return is a visit from a military dictator, who meets with the hospital CEO--probably sharing tips....

Turf War...1/9

What's happening in the so-called war between out-patient radiology and "Red River"? Seems as if the imaging center wins by default. This is not an exclusively Parisian situation, but it does impact the financial health of the hospital.

Typically, studies help spread the fixed costs of a department. When the number of studies for the hospital day shift is only 50 or 60, the result is a net loss per exam. Right now, they should be coming into their heavier census period, but if out-patient studies continue to go down, that won't help them.

What is the solution? For Essent, the automatic solution is to cut staff, one of the largest costs. How does that affect the new graduates appearing in December? It can cut in several direction: Hire the top guns in the new class, paying them entry level, and raise the performance bar to the existing technologists, hoping attrition would create openings and lose some of the higher paid staff? Or not hire any FTEs (Full-Time Employees), merely keep a supply of PRNs on tap to fill the peak periods through May. Or, just cut staff.

However, the solution may be taken away from them. The new class has been working in several different clinical settings, and has seen the differences in facilities. They might opt out of the PRMC setting for other markets, should that be viable for their situation.

Say AAAHHH....11/15

We're all healthcare professionals, aren't we? Okay, except for the beancounters, I mean. Which means we come to work, sick or not.

Personally, I hated going back to designated sick days--PTO was the best incentive to make it in no matter what...that way I could tack on a few extra days to a vacation that otherwise wouldn't be there. For Christus it was a good deal, they had less unplanned absences, which meant better staffing effiency.

Retrogressing to sick days opened the gates to people taking un-planned-for absences, rather than scheduling time off. Essent's new policy is slap in the face to anyone with children, an ill spouse, or chronic conditions which keep them from building up a surplus of sick days.

The policy (amended this month) is that in order to be paid for a sick day you have to have forty hours of sick time accrued at the time of the call in. To be paid on the second day if you are sick you have to have twenty hours accrued. So, if you have an extended period of illness, come back to work, and have a relapse--you won't get paid for the first day if you don't have a week's sick time banked! If you didn't have at least half a week, you wouldn't get paid for two.

I have plenty, but I know several people that this would knock to their knees. I would venture to say that the northeast doesn't have to put up with arbitrary B.S. like this--because of the union contract. I can feel myself drawn to the dark side....

Retaliation...11/10

Commenting in the blog has been risky, but the courts have made it likewise for employers. A dismissal for cause is hard to justify on the basis of suspicion. In a right to work state, however, you can be fired for wearing the wrong style of shoes. Right to be fired for any reason might be more appropriate. So the northeastern crowd has the advantage.

One of the things that I was referred to was a legal guide for bloggers, which may turn out to be quite handy.

But, as they say: "Don't worry, be happy...."

Free Speech...or is it?...10/31

Apparently, according to sources, Essent has filed a complaint with the Texas Attorney General's office against the blog. The Attorney General is progressing with an investigation as to validity of charges.

While not a public company, Essent certainly has a public presence. Everything published in the blog is available on the net for the price of a connection. Generally, links are included. Any comments from individuals, with the exception of spelling/grammer, are published verbatim.

But, who knows, they actually might be able to shut it down. Hopefully not. Based on the popularity and contributions from readers, it seems needed.

If it is taken out of play, it would seem that freedom of speech is becoming very limited in the state of Texas!

For the Best...10/19

I guess it is for the best: an interventional program that was top-notch, reduced to "we do most." If you saw the original write-up for the interventional suite, it seems a shame to have all that potential going to waste. But, the alternative is to have radiologists working in unfamiliar settings, with unfamiliar staff and equipment, doing procedures that they haven't practiced in possibly years. Not what I would call a best case scenario....

But, here is what others are saying:

Check it out! Essent updated the website. They removed all of the procedures that they no longer perform in the radiology department. So the listing on this site now is the only record of what used to be available. Still the site says, "All radiologists affiliated with the program are board-certified." Technically, this is true since there are currently NO radiologists affiliated with the program. It would also be correct to say that "All radiologists affiliated with the program shoot themselves in the head each night before going to bed." This would be equally true because once again, there are NO radiologists affiliated with the program.

Regarding all of those wonderful nuclear medicine scans that the new website mentions...funny that it doesn't mention that none of them can be read after hours on call. So if the ER doc needs a V/Q scan...better wait until tomorrow if you want to get it read. As to the after hours sonography...better hope that the sono tech knows what he/she is doing. There will be NO radiologist to consult until sometime tomorrow, and that radiologist may be in another state!

And, I've heard that Paris Imaging is jumping in the Nuclear Medicine market with their own camera. Sounds like the hospital is going to get a run for their money. So all the outpatient studies will be available in a new facility, and generally cheaper. Too bad our insurance (the hospital's) won't cover the entire cost, but you know, I figure it would be worth the additional expense....frank