Posted by texasranger (anonymous) on March 9, 2008 at 1:59 a.m. (Suggest removal)

Why is it the taxpayers and the patients who do pay always have to support the hospital and suffer all the consquences, while others are let off free as a bird. Similiar to the debt owed the city in fines,tickets,if they don,t pay their debt put them in jail and put them to work in the hospital cleaning it up, it,s a mess because they cut back so much the rooms aren,t even cleaned regularly. Let the NOPAYS work out their debt,cleaning,scrubbing,I see many a able body coming and going in and out they doesn,t pay, the people that work there even say that is so.

Posted by dangyankee (anonymous) on March 9, 2008 at 5:54 a.m. (Suggest removal)

"Let 'em eat cake," eh, texas? (The quote allegedly is from Marie Antoinette, once-upon-a-time queen of France, when informed that Parisians had no bread.)

I've been hearing that "no-pay" term for a lot of years now, and it has always irritated me. Know who the real "no-pays" are? If you've got Medicaid, you are a "no-pay." If you have commercial insurance, you essentially are a "no-pay." You may pay premiums for your insurance, but your premium amount of, say, $200 a month (random number), multiplied over a year, would not pay the cost of 1 day in the hospital. It wouldn't cover an ER visit at Community. You're counting on people like me, who have paid for health insurance our entire lives but never use it, to subsidize YOUR healthcare. Sounds a little parasitic, doesn't it?

Yeah, from a hospital's standpoint, a person with no third-party coverage is a "no-pay" because in many cases those people won't pony up the money (since they don't HAVE it) to get their broken bones or cancers or runny noses treated, and there is no third party involved to pay the cost--the hospital doesn't get "reimbursed" for the services it provides. From a human point of view, however, the real "no-pay" is the person who counts on "somebody else" to pay all or most of the cost of services he is rendered, even when he may actually have the money to pay for it himself (rather than spend it on the biggest house or most up-to-date Hummer or whatever).

Fact is, all y'all (us all?) with "subsidized" healthcare have driven up prices to the point that even well-meaning nonsubsidized people cannot begin to afford it. Would you go in for that "necessary" annual checkup if you had to pay the full price, rather than a $10 copay? Probably not. Would you run your kids to the doctor or ER every time they got the sniffles if you had to pay in full, rather than in fraction? Probably not.

More in a minute . . .

Posted by dangyankee (anonymous) on March 9, 2008 at 6:11 a.m. (Suggest removal)

To get back to the point of Mr. Kevin "Goober" Cooper's editorial (couldn't resist that one, sorry!), he may have something here. I'm not sure exactly how "not-for-profit" hospitals operate (despite having worked for them), and I really have no idea what it would take to get one established, but in a community with an apparently shrinking population, maybe "pooling resources" (not the term I'm looking for, but the only one I can come up with at the moment) among existing healthcare providers is a good idea.

One "state of the art" facility serving the area sounds good. What I'm curious about is, how big an area are we talking about? How many people? How "state of the art" does it really need to be? And think outside the "hospital" box: Maybe what we really need here is a well-equipped urgent-care/emergency center, with a locally based helicopter transport service to take critically ill patients to larger facilities in Jackson or Baton Rouge. I don't know.

Yeah, I'm probably a goober, too. I've been called worse, I imagine. I do honestly believe, however, that it is going to take a lot of imagination, and a lot of change of attitude, to "fix" healthcare in Natchez as well as around the country. Our present system is broken, folks--we just don't want to admit it.

Posted by EnKiKur (anonymous) on March 9, 2008 at 9:46 a.m. (Suggest removal)

Comparing NRMC to HMA doesn't wash.

What HMA did was borrow money so some of it's investors could cash out and leave the others holding the bag, and that should be illegal, it is no different than what Enron managment did. It may well be that if the managers of NRMC could have worked out a similar deal for themselves they would have, but that is beside the point.

The people of Adams County should call for a full accounting of Quorum's activity with NMRC, not just a bunch of general random numbers published in the paper. Individual instances of mismanagment are no excuse for lumping them all together and then saying "it ain't us, it's the system!".

Posted by gemccull (Gary McCullars) on March 9, 2008 at 9:52 a.m. (Suggest removal)

Dangyankee, I suppose your statement maybe true: If you have commercial insurance, you essentially are a "no-pay."

My health insurance is/was a part of my pay/retirement package. I worked for the benefit and do not consider it a freebie.

The first dollar plans for health insurance all but gone. Now, even those of us, who have medical insurance, have some rather large deductibles, out-of-pocket maximums and sizable monthly premiums.

So a visit to the doctor or ER has some financial burden. Enough that you have to ask yourself, am I sick enough or hurting enough to shell out several hundred bucks.

Just my opinion.

Posted by xenon314 (anonymous) on March 9, 2008 at 10:45 a.m. (Suggest removal)

The day Natchez Community Hospital and HMA come to the taxpayers looking for a millage increase is the day that you can effectively compare NRMC and NCH.

HMA answers to Wall Street and its stockholders - obviously, the one-time dividend wasn't a great idea, and Wall Street hammered the stock because of it. Lesson learned! And when you need money to meet payments, and you're short on cash, doesn't selling some of your assets make sense?

Business 101 - you cannot borrow your way to profitability, and that is what NRMC has been attempting for years.

Posted by memorytalk (anonymous) on March 9, 2008 at 11:08 a.m. (Suggest removal)

One thing that no one is talking about is the fact that Community Hospital pays city and county taxes and lots of it! Remove that tax base and then let's see what happens! You can bet the citizens of Adams County would see a tax INCREASE then! Save a hospital that pays NO taxes to the county and STILL can't make a profit? HUM??

Posted by topper (anonymous) on March 9, 2008 at 11:19 a.m. (Suggest removal)

Memorytalk I agree with you. No one seem to think about Community pays taxes and NRMC dont. I would also bet that Community makes a profit every year are HMA would have sold them. It is all about the management. The fault with NRMC is that Quroum has done what it is known for. run the hospital in the ground. They still got their payday. I am glad after years we are finally saying enough and getting rid of Qurum. Now we got to find the right management to get us on track. I would love to see the finacials of how much we are paying for these doctor practices that dont even admit to our hospital. I here one doctor is already putting her house on the market and is going to leave town. Does the people realize we employee the ER doctors too. Their payroll is pretty high too.

Posted by topper (anonymous) on March 9, 2008 at 11:22 a.m. (Suggest removal)

I believe as an employee of NRMC we deserve the honest up front picture. Do we need to be out looking for jobs? It has been said that the bond payment and the three pay periods is going to wipe out the funds. Is this true? There is no sense in people bad mouthing the hospitals and the care or the billing because they have a personal grudge. The fact is the poop is about to hit the fan and I want to know where I stand in my future, do I have a job next month? I believe there needs to be an open forum with the board to inform us we have the right to know.

Posted by woodduck (anonymous) on March 9, 2008 at 12:26 p.m. (Suggest removal)

Topper,
I agree with you 100%. Everything thus far has been rumor and innuendo. If NRMC had an administrator, perhaps he/she would have a meeting with employees to tell them just what is going on and what the possibilities are of either closing or staying open.Esentially that is what the employees want to hear. Of course the administration doesn't want to do that, because if they said, “unless we have a miracle, in 30, 60, 90 days NRMC will be forced to close it's doors", there would be a mass exodus of employees.

From what it sounds like in the editorial and other articles today, NCH is not going to be the "White Knight" riding to the rescue of NRMC. Rumors are just that, rumors, but I have heard that because of HMA's financial situation some of their hospitals may be on the block. I was told that they were trying to sell their small rural hospitals to concentrate on their bigger more profitable urban/suburban hospitals. It also sounds like the larger Private/non-profits in Jackson have no interest in a purchase of NRMC. I'm sure Baptist, St. Dominic’s. etc would much rather invest their profits in building new facilities in the White collar Suburbs of Jackson, rather than investing in a struggling hospital in Natchez. It’s all about demographics and payer mixes. no matter how you cut it. The Jackson area has UMC to absorb most of the trauma and "Self Pay" patients, so the Private/non-profits can concentrate on folks with Private insurance and Medicare. We don't have that luxury in Natchez. The hospitals here have to take everybody that comes through the ER doors.

All of the big players in Jackson are well aware of the situation in Natchez, they know what the potential is here, and I would be very surprised if one of them steps up to the plate as long as there are 2 hospitals in Natchez. As long as you operate 2 facilities, with almost total duplication of services, the potential for profit are non-existent. And while I hate to use the term profit, we have to remember Hospitals are businesses. They have to pay their bills, pay their employees, set aside money for capital expenditures, just like any other business in the world. So, if there is no potential for profit, then there is probably no incentive to invest. Ask yourself the question,” would you invest your pension/retirement funds in a business that is failing, has no concise plan for a turn around, and faces ever declining revenues from its customer base?" No you wouldn't, and that's why I don't hold out hope that some other hospital entity is going to come in here and buy/lease NRMC.

Where does that leave us? I don't know. I keep hearing, "Everything is going to be OK, everything is going to work out". Believe me, I hope too, but hope is just that, hope. The Titanic was "unsinkable" . Folks held out "Hope" until the decks were awash and the inevitable suddenly dawned, "The ship is doomed".

Posted by woodduck (anonymous) on March 9, 2008 at 12:27 p.m. (Suggest removal)

(more)

If you want to see some grim statistics, “Google” “Closed Hospitals USA” The figures you see are certainly alarming. California, in the most booming time in the states history 1996-2006, had 71 hospital closures. In the USA from 1990-2000 there were 460 hospital closures. I’m sure in almost every one of these closures; folks were saying “Everything is going to be OK!!”

Posted by NatchezEnema (anonymous) on March 9, 2008 at 1:09 p.m. (Suggest removal)

Let me tell you when you have an attorney doing all the talking, instead of hospital management. I would be looking for a job. The people need to know the "REAL DEAL" of what is going on at this hospital. Just more of the Natchez way of doing business. Back door under the table talks. Deceit is always born in secrecy!

Posted by Peace007 (anonymous) on March 9, 2008 at 1:17 p.m. (Suggest removal)

Looks like the doctors may have to go back to toting medical bags and doing house calls in exchange for a hot meal or a live chicken (pig or cow).

Posted by dottie (anonymous) on March 9, 2008 at 3:35 p.m. (Suggest removal)

This whole issue stinks!!!!!!!

Posted by gemccull (Gary McCullars) on March 9, 2008 at 4:51 p.m. (Suggest removal)

"Call me crazy, but somehow it just seems more logical to have the healthcare system more worried about providing good care than providing good profits or dividends."

It still boils down to "best management practices" unless you have an DEEP POCKET like a taxpayer. Management decisions should be based on return on investment, discounted cash flow, years to recover investment, projected cash flow, etc.

But remember, even the deep pocket of a taxpayer will only get you so far before revolt/recall/etc.

Posted by woodduck (anonymous) on March 9, 2008 at 5:19 p.m. (Suggest removal)

I firmly believe that hospitals that are doing well financially are better positioned to deliver superior health care. That's what makes the Private/non-profits superior in the long run. they are bound by law to plow all of their profits back into the system. That could be reflected in higher salaries, more and better equipment, expanded services and more dedicated funds to cover uncompensated care.

I have worked in both situations, Hospitals that were foundering, drowning in debt, as well as ones that were making a profit. I can assure you the profitable ones were by and large much better managed, the workers morale was higher, the equipment better. All of which leads to superior care. The struggling hospitals were usually understaffed, equipment older and more prone to breakdowns, supplies often not available on a timely basis. In these hospitals the keyword was always "backordered" Which generally means the vendor hadn't been paid and wouldn't ship supplies until the bill was brought up to a current status. In almost every case, the morale was lower, as the staff never knew when the axe was going to fall.That is exactly the condition that NRMC is in today.

One of the biggest problems we have here, and it will NEVER be solved with 2 hospitals in Natchez is the "keeping up with the Jones" theory that is prevalent. So return on investment, utilization, etc. have never factored in to the decision. If it had, we wouldn't have a Cath Lab at NRMC. We wouldn't have 5 family practice physicians on salary in and expensive office building that we can't afford. We would have a shared MRI and 64 Slice CT scanner, not 2 of each in a town of 19k. Unfortunately, hospital administrators get caught up in this "Arms Race" as someone so aptly described it, and logic and reason go out the window.

Posted by aesa (anonymous) on March 9, 2008 at 11:10 p.m. (Suggest removal)

A hospital succeeds or fails based on its payor mix...and as long as the patient population has very little health care insurance the hospital will suffer. It all comes does to jobs in the area...no jobs...no insurance...no cash for hospital.

The plant closings hurt Nat bad..real bad!!! Medicare patients alone can't float a hospital.

Seriously why would anyone BUY Regional with it debt requirements, and why would anyone want Community when its entire business plan is based on being a part of HMA.

The docs have carved out the "best" business lines for themselves at their own doc owned facilities...that is the nature of the beast.

What Regional needs is a strong management team/CEO.
A good one is worth his weight in gold!
They need a good leader!!!

...and they need one fast!!!

.

Posted by NoWireHangers (anonymous) on March 10, 2008 at 2:31 a.m. (Suggest removal)

I wish that someone, independent of the hospital and the hospital board, would bring in someone honest and intelligent like a CPA to take a look at the books. I realize that hospitals across the country are losing money but I think that someone who isn't related to anyone on the board, or someone completely independent of anyone in Natchez, needs to audit the hospital books for the last six years.

Posted by dangyankee (anonymous) on March 10, 2008 at 3:19 a.m. (Suggest removal)

Dahling, I love you (you can keep Park Avenue, although it was a cool place to visit), but what good would that do? Even if an independent and honest (if you can find one) CPA were to take a look at the books and prove that Quorum ripped NRMC off for millions, what good would it do? Quorum would never pay it back, anyway. I'm just saying "if"-I'm not accusing anyone of anything.

The past is history. While we need to learn from history, we need more to look not just at the present, but at the future--specifically, the future of healthcare in Natchez, Mississippi. That will take both honesty and vision. Ultimately, I suspect it will take sacrifice.

Sacrifice of community ego, mostly. First step on this road is not, "do we need two hospitals," but rather, "do we need even ONE hospital?" If so, what does that hospital need to be, what does it need to focus on? A town of less than 20,000 people, a "region" of perhaps twice that, doesn't need a hospital that can do "everything," not with bigger and better equipped medical centers less than an hour away by helicopter. Moreover, a community of this size cannot AFFORD a "do-everything" hospital.

So, what do we need here?

1. Emergency center--we do have emergencies here, everything from snakebites to heart attacks.
2. OB/gyn--whole lot of pregnancy going on.
3. Probably something endocrine: I don't know this, but suspect there is a whole lot of diabetes around here.
4. Geriatrics, given that we are a "certified retirement community."
5. Pediatrics (see number 2, above).

Ship the rest to Jackson or Baton Rouge.

Posted by NatchezEnema (anonymous) on March 10, 2008 at 10:56 p.m. (Suggest removal)

Misery loves company. Why is it when things get bad the Democrat goes searching for some town with the same problem to make things not look so bad around here, or we are not in the boat with a big hole alone. What a waste of time. Why not spend the time asking tough ?'s to the board of this hospital.

Posted by dangyankee (anonymous) on March 11, 2008 at 12:10 a.m. (Suggest removal)

It has nothing to do with misery loving company, NatchezEnema. It is "about" taking a wider view--removing one's head from the sand. Like it or not, Natchez IS part of the United States, and affected by trends, economic and social factors, etc., that are not purely local. I'm not sure what you mean by "asking tough ?'s to the board of this hospital," but assume that you're implying that the board was totally responsible for putting NRMC into its current state. Maybe the board was partially responsible, maybe not, I am not in a position to know--but I DO know that they had no control over most of the factors putting the hospital where it is. Did they have any control over the decline in regional population? Did they force IP, et. al., to close and thereby reduce the insurance-covered population here? Do they have any control over Medicare and Medicaid reimbursement rates?

Just for fun, show me three, only 3, "tough questions" that you would ask the board. I'm honestly curious.

Advantage to "searching for some town with the same problem" is that maybe, just maybe, we might get some glimmer of an idea as to where we go from here. I'm only guessing, but imagine the hospital board has been doing just that. While I don't know any of the board members, personally or even by name, I assume that, (A) none of them are idiots, (B) none of them are in it "for the money", and that (C) probably all of them care for both the hospital and the community it serves, or they wouldn't be putting up with the headache of being on the board.

I also know that the board lacks the power to return us all to the 1970s, or even 1980s, and MAY lack the power or vision or whatever it is going to take to meet the truly monstrous challenges facing small-town (and big-town) healthcare providers today--I'm not sure anyone has that kind of power or vision.

Seems I've heard people here or in another discussion say something like, "we have to live within our means, they should, too!" Okay, take that tack on it: You're cruising along, living within your means, maybe spending a little here and there to increase your property's value, adding a patio or a deck or a swimming pool, etc. Then, all of a sudden, your income is cut in half, and your balloon mortgage suddenly . . . balloons. What do you do, NatchezEnema? Most of your expenses cannot be cut. You have no "wiggle room." What do you do? The creditors keep knocking on your door. Your kids still need fed. The car payments must be made. You have only half the dollars now that it takes to do all that. What do you do? Ask "tough ?'s" of yourself?

Posted by redusmfan (anonymous) on March 11, 2008 at 6:10 p.m. (Suggest removal)

Ok, I will say a small part and move on about this subject.

I understand that Natchez needs 2 hospitals. Competition creates new ideas and strategies. (Remember when there were competing high schools in Natchez??) Anyways, NMRC has to look at the possibility of deleting unprofitable services right away. if it is not paying for itself, close the service down. I know that will make people scream, but it is the only way to get back in the black.

Also, they need to downsize. The hospital has continually grown while the community has continually shrunk. If I had a grocery store and I kept building it bigger and bigger while I had less customers, people would call me a nut. What is the difference in the hospital? Please do not try and justify them building a bigger building and bigger units while the customer base is shrinking. It will not work in business economics.

Say what you want to about me, but this is the truth.

Posted by NatchezEnema (anonymous) on March 11, 2008 at 7:22 p.m. (Suggest removal)

OK! Question 1. Why did the hospital expand (build a new floor to house more patients when the general population was declining. Question 2 Who's grand idea at the hospital was it to buy more expensive equiptment ( the same equiptment that humanna had and river park had) Question 3 Who's idea was it to keep the top dog at the hospital when employees and customers said he needed to go because he was out of touch. Question 4. Who at the hospital is responsible for looking at the general market at making recommendations on budgets and debt control. In other words who in the HELL IS RUNNING THIS PLACE. Need I say more?

Posted by redusmfan (anonymous) on March 11, 2008 at 7:25 p.m. (Suggest removal)

enema, that is what I was trying to say in a nice way

Posted by NatchezEnema (anonymous) on March 11, 2008 at 7:31 p.m. (Suggest removal)

One more question. dear sirs when the debt was at 3.5 million why wasn't more done or said about it instead of waiting till the hospitals only choices were to close, file chapter 11, bankruptcy, or raise taxes? Duh! These are not really tough questions, they are just direct questions don't leave a lot of wiggle room on the responses. Get my drift?