The Hobson Choice


    Just a thought from the outside looking at this whole process of the take-over of the hospital: I wonder if it is rigged? Have you ever heard of The Hobson Choice? The Hobson's choice is a free choice in which only one option is offered. Often the Hobson Choice is used to convey the sense that one has a choice, but actually is given only one, with the apparent outcome being offered is "take it or leave it". It actually is no choice at all.

    Large businesses often use this technique when they wish to ostensibly manage the outcome. The first casualty of this arrangement is truth: What appears or seems real is not, like the proverbial magician's sleight of hand. It is known as the shell game.

    Here in our community of Beaufort County, we have an uproar over a business outcome that probably has already been predetermined; i.e. "The Hospital". In business, these large corporations are talking to each other and usually have predetermined the deal before it ever happens. Consequently, the "Hobson Choice" (named for Thomas Hobson) is used all the time in big business. Most executives from different companies meet for lunch and discuss business, but always have a strategy for a preferred outcome.

    Maybe CHS, has been given certain incentives by UHS to come back to the negotiating table. They have tactics in play just like a well-planned out war game. That's right, it was probably UHS that invited CHS back! I would bet my right arm that UHS and CHS have been conversing!!! The Hobson's Choice in play, I have seen this happen all the time, and have been in the boardroom and "THE GOOD DEAL' is planned - "You take this one, we will take the next one." I feel UHS will get this deal. So the deal makers will travel to little Washington, sit at the table, poker face in play and listen to all the concerns of Hood Richardson, Brenda Peacock, Suzanne Gray and Alice M. Saddler, but behind closed doors these executives will talk and "Squeeze the proverbial turnip, till there is no juice left.

    We all know this is an unfortunate situation for the taxpaying citizens of Beaufort County, who are, and will continue to be in dire distress. The laying field is narrowed by the "players," and those people on their team are well aware how their game is played, and you can rest assured they have done their homework. Many are sitting back laughing, and love to see this division of people, who do not have their facts straight: Blabbing to exhaustion about points that do not matter to the issues at hand. Back door deals happen all the time in business, along with conflicts of interest i.e.: Buster Humphries on UHS Board. Maybe some of the doctors in town have been promised something to help this deal along, maybe not. When you are at a top level with the "TEAM," to make these mergers, take-over, acquisitions, buy-outs happen all sort of things are discussed in the boardroom. You can see this in bidding wars. So often the bids are predetermined, even in open and closed bidding. Is it legal? No. Sometimes they get caught, a slap on the wrist and a fine.

    A case in point: of just one example that comes to mind: The Pine State Milk Company bidding with Flav-o-Rich, Pet, Inc. and other companies. The executives of these corporations met in a Piedmont restaurant, divided up North Carolina into 103 districts. They decided what company would bid lower, which would bid higher, or refrain from bidding. This cost the school lunch program was higher than necessary by millions of dollars due to the inflated prices of their product. Its victims: The schoolchildren, their parents and all the taxpayers, who pay the free lunch bill.

    Now, I am not alluding to illegal activity on the take-over of the hospital like some in Washington, NC. I just understand the negative nature of how Big Business operates. This is chump change to these large corporations. Most of you are belly aching, and rambling on about stuff that does not matter. It does not matter if they are purchasing a hospital, a Macy's Department store or a billion dollar deal. Something is only worth what another party is willing to pay for it. I hope that this is not a "take it or leave it" as espoused by the "Hobson Choice," and the Deal reduces the negotiating grounds for the Beaufort County Commissioners.

    All this talk of over-throwing the commissioners etc. is nonsense, pure pabulum! If you want to be in the public spotlight, then get your name on the ballot next time. Let the process that began last week continue along. The finger pointing, name calling, blame game is over. It will go through the legal channels, and great changes are on the horizon. They will be for the better because the hospital cannot be run any worse than the past management team. We all know that for a fact as to why it is in the shape and condition it is now. You cannot only blame basic management problems on Medicare and Medicaid reimbursement. We all know the books are a fiasco and that a new auditing company is trying to make heads and tails out of the numbers, and there are the massive problems in the billing department, the list goes on and on. Fact: Controls where not in place, and it all boils down to bad management.

    If you don't like the outcome of this take-over, then you have choices as an individual. If UHS loses the deal, then drive less than 20 miles on Hwy. 264 West to seek your healthcare in Greenville. If UHS wins the take-over and you are not happy, then drive 20 miles on Hwy. 17 South to Williamston to a CHS facility to seek healthcare. And if you don't like those choices, then drive to Raleigh, you will have several choices there. Or get in your car and drive 5 hours north to John Hopkins. Or move to a new location! Who cares! I don't care where you seek your healthcare, it is your choice. You can't make all the people 100% happy, there will always be disgruntled people. There are many good companies that give quality care in our surrounding area.

    The only person I would like to see on the negotiating team is a North Carolina licensed attorney well-versed in Federal anti-trust and trade regulation laws. We need to be asking this company: Who is your compliance officer, and does he/she know North Carolina Law? Also, do you have a compliance committee? What is your employee training program, and how does that relate to your compliance manual, and we also want a copy of policy and procedures manual?

    In this litigious society, we must consider all the current cases that deal with healthcare. The Sherman Antitrust Act is not to protect competitors, but rather to protect the competitive process. The Robinson-Patman Act, the Hart-Scott Rodino Act, the Nestor vs. Webb- Anti-trust claim, in which the Plaintiff alleges that the defendants have conspired to monopolize the market in NC counties for the market for Kidney Dialysis treatment services: new in court as of 10/2010, must be considered. Furthermore, this begs to be asked: How many lawsuits has your company dealt within the last 5 years?

    I have more questions, beginning with: Why do you think there are so many attorney offices located around Pitt Memorial Hospital? Tell us about your QI Department? What is the average turnaround time in your in-house lab departments? We would like a list of the number of procedures performed monthly by your doctors compared to a hospital our size. What are your expectations of our present MD's? How many patients should they see daily to break even to meet your quotas? Which health service is your greatest money producer? ED, Surgical Services? What do you think is our greatest need? Tell us your staffing to patient ratio. How are you going to market the services of the hospital? What will be your average advertisement expenses on a yearly basis? Out of all the hospitals that you own, which one is your greatest producer? Can we travel there, talk to the present employees, get a feel for the environment, and ask questions? Have you already converted to EMR, & if not why not? Do you have a Clinical Practice Council? We would like to view your Informatics Data. Show us your Joint Commission Reviews. How much money do you spend on equipment a year? Do you believe in flexible scheduling and staffing? Do you send and educate your HR Department for legal Federal Updates, HCFA rules and regulations? How many contracts and who do you contract with for IV Meds? Oral Meds, DME Equipment? What are your plans for the hospital based home health? Do you require Certified Coders in your Coding and Billing Department? If not, why not? What is your turn around time on billing? What is your average for denials? Tell us about your employee health insurance plan. What are your plans for BRMC?

    To CHS: We know you currently have bargaining relationships with UNIONS at 8 of your 123 hospitals, with your stock trading at $32.87 on 11/09/2010. How will the unionization affect your stock? These are my questions and I am sure I will be adding on to my list as I learn more about the facts of each company.

    It is so much more than combing through annual reports! What will be a good match for this community and to help it prosper? I don't hear any of these questions presented at present.

    Doctors, nurses, support staff, community get busy with your questions! A committee should have been formed months ago, compiling all kinds of questions for the negotiating team and trying to help them, but all I have heard is a bunch of total stupid bickering nonsense that has not been any help to carry forward this process. It has been, I WANT THIS, I WANT THAT. After all, from what I have seen and heard from this community on healthcare, it has been a big disappointment, and frankly, I don't think most of you could negotiate a good deal on a good used car! So there! The climate has turned very political and the basic main issues have been forgotten.

    All the best to the negotiating team, my prayers are with you and I have faith that you will do your best for the best DEAL for all of Beaufort County, while insuring quality healthcare. I think it is a good team, an unbiased team with diversified backgrounds, and I feel each member is committing a tremendous amount of time and effort and they are not taking this feat lightly.

    Thank-you.





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