Sound Familiar?

"It was a combination of things that made the hospital start sinking -- shaky management, a declining reputation, the close proximity of competitors and the way doctors started moving patients and practices to other facilities.

Sound familiar? This was the formula for failure at Crossroads Regional Hospital in Wentzville, Mo., before it was bought by Essent Healthcare...."

So goes the story of Essent's first plunge into hospital ownership...ending with the sale of Crossroads in October of last year.

Since Crossroads, Essent's first acquisition, the business model has changed--the hospitals are at the verge of closing their doors, and they are the sole facility in a community. Why did they modify their plan with PRMC?

Probably it was the size of the hospital. On paper, it looked good, and these boys are bean-counters if anything. The number of beds in their system would double!

The problem was two physical plants and all the baggage they got with it. So many things had been bandaided for so long that needed immediate outlays of cash. Big Mac's property management had gone Dallas, pissed off the docs, and unintentionally lost many tenants that built their own offices. Middle management had infused the staff with the philosophy of Monty--we don't have to worry about money, we're non-profit!

This was the philosophy of: the Gibraltar Hotel, not being able to bill for anesthesia because provider numbers were never obtained, not billing services for a year for the Minor Care Clinic (and wondering why it wasn't making money), not getting insurance pre-approval for some surgeries, mis-billing the Out-Patient Surgical Center, Health Solutions' inflated management bills, and the big one--not keeping the existing Medicare/Medicaid rates by renewing on time.

All these problems came from the top down, and, despite the initial chaos, it might have been better to totally replace from the mid-levels on up.

Currently, patients are leaving, staff are leaving, and the ones that still flock to the ER are the true emergencies (few), and the self-pay (no-pay, for the most part) that can't go anywhere else because they have no money and use the ER for an outpatient clinic and drug store. These are also the most likely to sue.

Hopefully we won't be another Crossroads, but then again, it can not stay the way it has been....