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!!

Essent Lenders....11/28

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

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

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

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

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

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

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

I never thought that GE would be just over 12.

Healthcare Alternatives....11/28

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

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

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

Landing On His Feet....11/13

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Can you say, "Deal Maker?"

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

Can you see the writing on the wall?

I Understand....9/29

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

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

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

Salvation.

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

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

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

Universal Healthcare....9/01

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Top 100....10/17

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

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

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

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

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

Rural Health....9/18

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



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

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

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

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


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

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

Who Knows....8/25

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

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

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

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

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

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

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

Hello friends,

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

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

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

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

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

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

- Allan Hubbard
Communications Coordinator (volunteer)
Lamar County Chapter American Red Cross
Community + Camp Maxey
http://www.lamarcounty.redcross.org/ - click on "Camp Maxey" in the menu

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

Cheap To Keep?....7/26

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

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

Rio Rojas boys don't look so bad now, do they???

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

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

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

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

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

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

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

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