10 Percent...3/6

The original post came out on 1/16/07. The meeting with directors/supervisors was the 12th of Feb, with the RIF (reduction in force) news distributed to the personnel on lucky 13th. It goes in two phases: Voluntary--with severence, and involuntary. So you can do it to yourself, or have it done to you.

I'll make the next prediction: That new grads will be hired to replace those RIF'ed out at lower wages. These people are obvious....frank

Rumors fly, and 10% seems to be the most consistant number quoted for cuts in personnel. But we already have taken cuts, and service has suffered because of it.

Floggings will continue until morale improves. How short-sighted can we be? Apparently far more. Essent has implemented cuts at Merrimack Valley Hospital, and it doesn't seem to help in the long run...but then I forgot: Essent works in quarters! Longterm is not their middle name! So, if this next quarter is fine, but the ER will be short of nurses again during the peak months, but low census, tough Wendell! But Dick gets his bonus!

Right now would be the time to have the staff get up to speed, since attrition will take its toll. As it already has with the people that dropped their notice right before the holidays. There are around 35 nursing spots open--a couple haven't made it to the list. Merry Christmas, Cheryl!

These aren't just the run-of-the-mill positions, either. 2-surgical, 7-CCU, 11-ICU, including a clinical supervisor. And you wondered why all the agency nurses were here?

So, as a patient, I can expect to have completely trained personnel caring for me? Yeah... R-i-i-g-h-t! And there's a reason that I want to come here, rather than go to Dallas? Well, if proximity counts over keeping dear old dad alive, I suppose it's better than having to take off to drive to see him...let's see, with all the gas I save, I can have a heck of a furneral.

And maybe those last 10%, you know, the ones left from the original staff...maybe they can attend as well!

X Marks the Spot...3/12

X is for Ex-
You used to work there? Yeah, I know, same with me.....
This region is crawling with ex-employee(s).
But who is worse off--us, with nothing to do,....
Or those still employed, doing work meant for two?

Just thought you'd be interested in the "cost-cutting measures" that Hud is going through. He did put his house up on the market, I guess 5000 sqft is a bit much to rattle around in. Thought you'd be interested in the house, and the price tag: about $1.8M! I thought that a bit much, but heck, it even has a stone doghouse! Where else can you get that for just shy of $2M?

The people his organization has let go are not in such rarified settings, however. Healthcare has never been a wildly profitable endeavor except for the physicians and the top administration.

Sitting on our raises bought that house, letting go experienced healthcare workers paid for that doghouse...and did cutting the quality of care for patients pay for the bonus room? ...or just the bonuses of Andy and Hud's new trick pony, Dick?

Think about that when you're attending the next weenie and burger bonding experience.

The house that pain and suffering built....

More Cuts...3/21

If you've noticed an absent face at West Paris Clinic, you might be wondering what happened. Jane Tijerina was let go. Another victim of hasta-la-bye-bye management.


But is it a difference with Jane or T (Dr. Tijerina)? Essent has already sued him as a partner in the original imaging center. (Which is laughable, since he only went in as a favor.) And, he's long since lost his head of med staff to Bercher (maybe it's in the name--Dick.)


T has become disillusioned, as have many of us, with Essent's behavior over the last few years, and is not the staunch supporter that he was with St. Joseph's. I guess the reflection possibly fell Ms Jane.


Or, are the Rural Health Clinics in danger of being closed? Doesn't take a rocket scientist to realize that they are marginally profitable at best...Health Solutions closed two, and they were far from that level. Maybe that's why three of the NPs have moonlighted--keeping their options open.


But that would diminish the hospital's patient base that has already gotten thinner. As it is, Cooper Clinic's patients are looking longingly at Greenville's Presby, and Bogata's at Clarksville. Without those referrals, things might slip even more. What a pity....

Calling it Right...3/12

Dave found out there is no job security, and it was mentioned that a lot of us had a Christus Hx. Guess Christus figured it out as well! Check your mail lately?

Maybe we can negotiate our seniority... since they're using it as a hook....

The Letter Game...3/11

ESSENT



E is for Employees
Employees are our most important resource.
....We say it's true; we know that these are facts.
But when things tighten up in the finances,
....Our most important resource gets the axe.








S is for Stockholders
Jerry was an employee, and every word he had
....Was all about the Stockholders and why they were so bad.
"They siphon all our profits, skim the cream right off the top.
....There's nothing left for us, and soon this company will stop!"
But Jerry's had a change of heart and ceased his wayward talk--
....He finally saved enough to buy a thousand shares of stock.

S is for Stockholders
So important we say it twice
....ARCON, Essent, is it worth the price?

E is for Employees
So important that we're given time
....but not enough value to give a dime.
A nickle is what says our worth
....since money's tight, it's like a dearth.

N is for New
A brand-new hospital! Now that's what we need
....To make profits rise with an excellent speed.
A new CEO! Yes, that's the thing
....That finally will make the bottom-line sing.
Let's add something new--maybe two, three or four,
....Although we did just fine without them before,
And don't really need them. Oh, yes, it's all true,
....But we still think we ought to have something that's new.







T is for Teamwork
"We must work together," the manager said,
...."Or quite angry the new boss will be.
We all have to march on in lockstep ahead,
....For it's teamwork that he wants to see."
So we all got in step with the slowest of all,
....So we wouldn't leave any behind,
And our group's productivity slowed to a crawl,
....But our manager has peace of mind.

























P is for Paradigm Shift
Knizley had a paradigm, if you can get my drift,
And every time things got too slow, that paradigm would shift.
It shifted on the nurses, the techs and such.
It shifted left, it shifted right, and all without a clutch.
It made the CEO rejoice, for each new paradigm
Meant he could use that buzzword in a memo one more time.




I just liked using Paradigm myself....frank

Death-sent, not Essent...3/8

Ok, tell me what kind of drugs these people are on.... Does anyone else remember a certain post last year at about this time? Hint: Was about the Cath lab. Yep, a whole series of comments and another post were generated by the hit and run techniques of the cardiologists.

Well, if that made you leary of hitting our "Welcome to McDonalds, may I take your order" type of medicine, this ought to have you running screaming down the streets.:

The cath lab secretary is going to be reading telemetry and pulling sheaths!

This is not to occur immediately, they are going to train her. Essent-ial training. Wonder how many minutes...or hours...she'll get.

I for one, have some serious reservations. And, all concerned better have their malpractice insurance paid up as well.... Too bad she won't be able to get some. It all falls to the Dr's and hospital's liability. But, she'll certainly be named in the lawsuit.

I can just see it now: "Cath lab, can you hold? I'm holding pressure on a cath site so we don't end up with a pseudoaneurysm, and watching a monitor, but I'll be glad to schedule a day you can bring lunch...."

Yep, just where I want to go, the Chest Pain Center. Would you like fries with that?


You might wonder why the video? Because we don't want those patients to miss waking up to the sound of your voice....frank

Single Payer Response...3/18

The single payer controversy has rumbled through the blog in a couple different incantations. Here is a video response....


I'd like some feedback on the youtube inserts (if you think they're good, praise away. If you don't like them, silence is golden....just kidding....)

Checking the Pulse...3/7

A long awaited face to face with Dick and Dud. Here's the short version:

Attending the lunch with Hud and Rich were (one each) employees from Supply, Aerofit, Radiology, Cath Lab, Pharmacy, ER, Cooper Clinic, 5A, and a person from either CardioPulmonary or RT, not sure which she was from.

The "royalty" attending were Hud, Rich S. and Stacy Etheridge... taking her lil lap dog notes...LOL. Besides the wonderful fast food (hamburgers and chili dogs) the subject was "who wants to rat out their managers and/or co-workers".

The other part was about how Essent saved the day by coming to Paris... with all the $$$ Essent has put into PRMC, why would anyone get the idea that Hud was a flipper??? Besides, "it's these dang rogue physicians that are the real problem...shame on them for not doing enough elective procedures (caths) to pay the bills".

What a relief to know that Dr. Hashmi and Dr. Bercher will be the playground monitors, keeping them kiddiegardners from staying at recess too long...:)

Remember the statement at the beginning of the blog? Something about Stalinist Russia? Looks like chili dogs and burgers were all it took to turn some into informers. The KGB didn't die, it just moved to Paris....frank

Do You Feel the Undertow????3/3

The drain is swirling, and that's where Essent seems headed. New AHD figures are out, and Paris went from a net of $1.6M to $288,275. The gross was more, but I guess efficiency isn't their forte.

"But", you might say, "didn't we have $14.4M more that we didn't spend on RRVR???" Unless, gasp, Hud was a Liar??????? No, say it isn't so........

One might think that Hud might be juggling as fast as he can. If revenue is down, how is he keeping investors happy? Well, they aren't happy, but somewhat pacified by being told that the updates, building program, and personnel changes are to blame for the shortfall. Damn, wonder if he used that excuse for Crossroads????

So much for his 10-15% ROI......

Speedbump......3/5

What might end up as an axle-high speedbump to Essent is the legislation under consideration by Texas lawmakers for mandating safe nurse/patient ratios. However, in their sneaky little ways, they have already been preparing for some of that: Support staff lay-offs.

The way it goes is like this: Support staff was 'invented' to free nurses from non-nursing duties. Essent is cutting support staff. Result, nurses will be forced to do more of their own support. Remember the example of how things have changed?

The following job description was given to floor nurses by a hospital in 1887:

In addition to caring for your 50 patients, each nurse will follow
these regulations:

1. Daily sweep and mop the floors of your ward, dust the patient's furniture and window sills.
2. Maintain an even temperature in your ward by bringing in a scuttle of coal for the day's business.
3. Light is important to observe the patient's condition. Therefore, each day fill kerosene lamps, clean chimneys and trim wicks.
4. Wash the windows once a week.
5. The nurse's notes are important in aiding the physician's work. Make your pens carefully; you may whittle nibs to your individual taste.
6. Each nurse on day duty will report every day at 7 a.m. and leave at 8 p.m. except on the Sabbath on which day you will be off from 12 noon to 2 p.m.
7. Graduate nurses in good standing with the director of nurses will be given an evening off each week for courting purposes or two evenings a week if you go regularly to church.
8. Each nurse should lay aside from each pay day a goodly sum of her earnings for her benefits during her declining years so that she will not become a burden. For example, if you earn $30 a month you should set aside $15.
9. Any nurse who smokes, uses liquor in any form, gets her hair done at a beauty shop, or frequents dance halls will give the director of nurses good reason to suspect her worth, intentions and integrity.
10. The nurse who performs her labors and serves her patients and doctors without fault for five years will be given an increase of five cents a day, providing there are no hospital debts outstanding.

As nursing shortages plague our country, nurses become a valuable commodity. So why is Essent attempting to drive off the good ones?????

We might end up with good ratios, but if we are bogged down with the other things, where do the patients fit in? If we aren't careful, the windows we'll be dealing with will be Pella, not Microsoft....

Or Best Offer......3/6

Well, rumor has it that Hud might need some money. So, being the good neighbors that we are, we decided to help him sell his house.

Fer Sale

It’s a right purdy place, actually got inside plumbing! Got’s a neat porch so’s your dog can lay about a bit, maybe shake those fleas….Got’s real electric lights, and even cable hook-ups (Hey Ma, maybe we ought to wander over and check this out!)

5520 Stanford Dr, Nashville, TN

Heard the folks were taking in boarders, but he’s moved on to Paris, so they might give you a right-smart deal. 'yall come by and see us.....

Did I happen to mention that we have the actual listing* for the house? The asking is about $1.8M...frank

*The house sold.

Essent in the Spotlight...2/28

One of the most documented acquisitions that Essent has made has been Sharon Hospital in Connecticut. It is interesting to see some of the statements, in context, about that process, and Essent's preparation for it.

Political Connections:
A supporter for the privatization of Sharon Hospital was the governor, John Rowland, who later resigned. Former Gov. Rowland was subsequently convicted (and sentenced to a year in federal prison) for what was essentially accepting bribes during the period that included the Sharon purchase. "People seeking to do business with the state resorted to various sleazy means to curry favor with top officials."

On July 1, 2006, Rowland spoke to an association of scholar athletes in Kingston, Rhode Island, about the lessons he learned. A "sense of entitlement" and the arrogance of power" were two of the biggest things that ended his political career, the Hartford Courant quoted him as saying.

He warned that the arrogance is very easy when you're put on a pedestal, and you "start to believe your own press releases. ... It [becomes] all about me. You start to block out what else is around you."

One would almost think he was talking about Hud. They probably got along well...so well that the governor wanted to seal the deal for Sharon behind closed doors, but the Attorney General of CT got involved.

Another person of note that was encouraging the conversion to for-profit was Rep. Nancy L. Johnson, for which there were direct campaign contributions and attempt at a breakfast fund raiser at the hospital (see Breakfast...for a Price). Hud has never been terrifically shy as far as contributions.

Therrien (Sharon Hospital CEO) describes Johnson as "a true friend" of Sharon Hospital who has "been with us every step of the way, working with our staff to remove red tape and help us meet our shared vision." He did not detail the "red tape" that Johnson had helped to remove. A “paid for by” attribution at the bottom of the one-page letter said, “Paid for and Authorized by Nancy Johnson for Congress.”

But, the process of dealing with the Attorney General's office was revealing as well. Several errors were made, and documented in the findings:

55. Contrary to Mr. Connery’s July 10, 2001 testimony presented under oath that Essent had no plan, on July 17, 2001 Essent submitted a copy of an undated draft document entitled Business Plan & Due Diligence Summary, Proposed Acquisition of Sharon Corporation and Certain Affiliates in response to the Attorney General’s Request for Production, #15. Section 3 of this plan states, "Sharon Corporation and its subsidiary West Sharon Corporation, owns 13 parcels of real estate with an approximate value of $4.1 million. The total annual rent collected from the properties is approximately $430 thousand. It would be management’s intention to sell a substantial portion of these properties to offset the capital that will be committed to the property." It appears that this draft business plan was prepared in the latter part of 2000 or the early part of 2001.

70. At OHCA’s public hearing held on July 10, 2001, Mr. Connery and his associates failed to provide satisfactory answers to numerous OHCA inquiries concerning the assumptions and basis for the projections upon which the projected financial and inpatient volume statistics (with and without the proposed sale) were formulated. Mr. Connery assured OHCA that these assumptions would be submitted to OHCA during the following week with Essent’s Certificate of Need ("CON") application filing. The CON application was not officially submitted during the following week and no such assumptions and basis for the projections were ever submitted to OHCA in this proceeding by the Applicants.

72. On July 24, 2001 subsequent to OHCA’s public hearing, the Applicants submitted a "corrected spreadsheet" for Sharon Hospital showing revised estimated/actual and projected operating results and inpatient volume statistics with and without the sale of the Hospital to Essent. No assumptions or explanations of any of the numerical changes contained in the second submission of the information previously submitted to OHCA were included with the "corrected spreadsheet." In addition, there was no explanation or a breakdown of how many months included actual results and how many months were projected for the FY 2001 estimated/actual amounts.

77. Mr. Connery did not explain how "sheer stability" would directly result in the large projected increases in patient revenue and inpatient volume statistics with the sale above the levels currently experienced by the Hospital. In addition, there was no explanation given of why there were large decreases in projected inpatient volume statistics without the sale from those estimated for FY 2001, while projected outpatient volume statistics without the sale were greater in FY 2002 and FY 2003 than those levels estimated for FY 2001.

88. Essent did not submit, as requested, the Indigent and Charity Care policy of Crossroads Regional Hospital of Wentzville, Missouri for when it was known as Doctor’s Hospital prior to Essent’s purchase, nor did Essent explain the reason why the policy was not submitted.

We can say without too much fear of contradiction that a lot of the answers to those questions raised by the Findings of Fact are fairly self-evident:

1. Their figures were just thrown at the wall to satisfy the hearings.


2. They intended to sell off the properties included.


3. They didn't want anything about Crossroads to come out.


4. And, sheer stability---give me a break....

Medicare Fraud Raises Its Ugly Head...2/21

One of the biggest payers in the Paris mix is Medicare. Because we are so dependant on it, the thought of a Medicare audit strikes fear into the hearts of CEOs and billing personnel as well.

Well, the spectre of doom might be standing at Essent's door. The hospital is trying to pass this off as Dr. Xavier's responsibility.... Yeah, they'd love it if that were the case, but I think that we have to look deeper.

Can we say incompetence? These are mostly the same folks that forgot to bill patients for an entire year while the Minor Care Clinic was operational. These are the same folks who turned over billing for EKGs to RR when they were losing money at it, and RR made money. These are the same people that failed to pre-cert for surgeries, and to get provider numbers for locum CRNAs.

But, we also have to look at the corporate guiding lights--Hud and his crew came from Columbia/HCA to a great extent, and others, which have had Medicare billing problems before. These are also the people that feel that getting fines for non-compliance is cheaper than paying a director's salary.

Maybe Medicare will change their minds....

Patience, Hud, Patience...2/19

All the tag lines indicating "PR" are either interviews or Essent PR releases....

PR: Connery said he was prepared for public scrutiny.

frank:You asked for it, you got it.

PR: To tell the difference between diamonds in the rough and lumps of coal, Connery says he relies on his instincts and something he calls "experiential capital," meaning his experiences as chief operating officer of HealthTrust, a company that owned 110 hospitals before being bought by HCA.

frank:Now remember, this is the guy that sued HCA unsuccessfully,twice. He stayed with HCA how long after acquisition?

PR: Essent has acquired Crossroads Hospital in Wentzville, Mo., formerly known as Doctors' Hospital, and Merrimack Valley Hospital in Haverhill, Mass., which was previously called Hale Hosptial. Those hitherto financially failing institutions, Mr. Connery estimates, should turn a profit of at least 12 to 15 percent within two years.

frank: Is this relying on his fabled 'instincts'?? Crossroads failed miserably, MVH lost money in 2005, and none of the hospitals are returning a net of even 10%.

PR: After all, the company he leads, Essent Healthcare, has grown its revenues to $300 million this year from $20 million just three years ago.

frank: It really doesn't matter what your gross is, it's the bottom line, folks. The retailer that sells something at cost, but gives a quantity discount because he'll 'make it up in volume' must attended the same school as Hud.

PR: “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."
PR: It would be easy to forget that Hud Connery Jr. is a patient man.

frank: Or running scared. If he'd bailed on Crossroads when it was obviously a loser, it would have been all over---he just made it look better than it was until he could pick up Sharon Hospital and NVMC. (Enron could have taken lessons!) Dumping Crossroads after he doubled the gross made it easier to swallow for investors.

PR: Connery said he was prepared for public scrutiny.
PR: The chief executive officer of one of four suitors seeking to purchase Muskogee Regional Medical Center said he will answer any questions from the board, but not in public.

Third Time's the Charm....2/9

I really wish I'd placed a counter on the blog the first year I started; I really have no idea on historicals, and the only comparison is last year's counts. I started it in Feb, because January was a high month and I kind of wanted confirmation that I was on the right track.

I got it.

114,444 was the count at midnight the 31st of January. What does that say? Remember The Customer? If people get good service, they possibly will tell their friends...if they received bad service, they will tell...and tell...and tell....

We have been served badly, and a lot of people are saying so....

So many, that customers are leaving....

So many, that staff are leaving....

So many, that two other communities said no way to the Essent way....

This is kind of a "third time's the charm"...Hud has to prove that he's still viable as an acquisition corporation. If he's not, then he's either too cautious, or Essent's business model is no longer consistent with an investment strategy....

Here at Essent...2/23

We make you read your own X-rays....

.
I'd say that's one way of taking the radiology groups out of the equation....

Is this how we make patients invest in their own care?

...and do they have to fee-split?

Jersey Devil?......2/15

Hammonton, NJ is the next target. The Kessler Memorial Hospital has been losing $60,000 per month in their dialysis center, which, in comparison to some of the Essent attempts, doesn't seem that much. The forclosure hearing of their center is scheduled for Feb 13th, possibly taking a facility valued at $733,000 out of play.

But, they're getting ready to close...the hospital filing for bankruptcy in September...and have to make some serious decisions. One would hope that of the three other suitors, one would be a better choice.

Someone from Cherry Hill, NJ has been keeping an eye on the blog, but who knows, they might be from Essent. In any case, the fix-ups in the hospital were for a dog-and-pony show. Personally, I'm just looking for the pony.

Some news articles:

Seeks relief....

Undisclosed suitors....

Increased useage of facilities....

Size Matters...2/7

From some avid readers:

Did anyone really look at that picture in the Snooze?

Dick looks like he was ready to take a bite out of something...

And Hud looks like he's ready to deliver...but maternity is on the North Campus.

Too bad we don't do hair transplants, 'cause Huddie looks like a before shot for Hair Club for Men.

Why is it that most of the people that Hud hires are short? Maybe he has that short-man syndrome, or Napoleon complex. Can't stand to have someone towering over him.

Maybe Hud came to Texas to feel larger, think Geico Insurance commercial--even geckos feel taller!

Lights, Cameras, Action......2/26

When Essent spends an hour flipping through the blog pages in the afternoon, they're generally checking to see if I've guessed/discovered what is going to happen next...lousy tell, guys. Then Connie Murchison was slinking around north campus all weekend. "When she showed up on Saturday, we just figured, hey, spot check....but then she did a walk through on Sunday too...hmmm"

Could it be another dog-and-pony show? Columbia Healthcare checked the blog as well, but so did Christus, ETMC, and Hopkins County. Who knows, maybe the hospital is back in play...or maybe Essent is trying for another poor slob....

If so, the walk-through will probably be today or tomorrow. Anyone have connections at the motels? Hampton would be my guess. Or they'll bring them in early, blow and go, and all we'll see is seat-of-the-pants and elbows.

Well, if we see a single group of slightly bemused people that are dressed funny on a tour (at this point, anyone in the market for a buyer and considering Essent would have to be bereft of an internet connection, and slightly addled, hence the 'dressed funny'), then they're trying the Muskogee routine, again. Multiple groups--they're selling.

Hopefully their medical Chief of Staff has the same skepticism that Muskogee's had and does some calling outside the tour.

Who Would You Like?...2/28

Time for proactive measures. In each of the acquisitions, Essent has sat back like a big spider, waiting for someone to dangle a morsel in front of it. Most if not all of the hospitals that Essent has tried for have hired firms to search for buyers. Why not get ahead of the game...save Hud some time (and shorten our association as much as possible!)

My proposal is that we limit comments (no, "Anyone but Essent" spikes) to those from former employees that have gone elsewhere, employees that wish they were with a former employer, or patients that have had a good experience(s) at other hospitals.

This might not have an application, now, but it could prove useful in a sale/bankruptcy situation. Look what happened the last time with nothing to go on.

I'll even entertain comments from employees of hospitals that are in acquisition mode, that are not former PRMC employees, if they discuss why they feel their hospital is a good place to work.

If we do get to the situation, we can trot out the list and ask for the negatives. Right now, go positive, folks!

If we have been bought, it would be interesting to see where on the list the new owners are....