Topic number one;
Systematic fraud is presently being orchestrated by almost all local New Hampshire hospitals, ( and is also in progress all over the USA ) This fraud is done in order to accrue far larger profits than circumstances would normally permit. These frauds are all-encompassing, appear to be ubiquitous, and have been employed by every hospital within sight in New Hampshire , and by extension in the USA . All of the CEOs of these hospitals appear to have attended a "School for Scoundrels" somewhere, where they were taught how to behave as conscience free micro Corporations.
Many of these Hospitals employ the Horty and Springer Law Firm of Pittsburgh Pa, which advises hospitals on how to systematically (and quite unethically)control the medical environment and "contain/constrain" the Hospitalemplyees, especially the physicians,for enhanced profitability.
No longer is "nonprofit community beneficial behavior a commendable goal".
(You can't make any money at it)
Step one was to eliminate all services competition in their local area, which they did by systematically driving all of the private practitioners in their catchment area, either out of business, or into employee status, where these practitioners no longer constituted economic competition, and, because they were now salaried employees,had no further say in the business philosophy of the formerly charitable entity.
(If you own all of the means of medical care giving, you can 100% dictate the direction that a patient must follow, each and every turn, in order to arrive at a medical consultation and/or treatment, including where that treatment will take place, and at what price)
Step two, once you had no further competition, with conscience owning, generous, altruistic, well-meaning private providers available, as an alternative to your totally owned and controlled, and fee controlled employee providers, a huge alteration in how much you could charge for a given service presented.
A private practitioner, in many cases, prior to his/her "Hospital orchestrated takeover", would answer his or her phone, in the after hours setting, and would prescribe over the phone, and arrange to see the patient the following day for an outpatient fee.
Total cost?, either nothing at all except the doctor's time, or an outpatient fee which, if it were Medicaid, was about 40 bucks.
That is all yesteryear legend, now. "Not profitable"
Under the new rules of engagement, wherein the hospital owns all the practices, all the Practitioners,and thereby controls how such practices engage with their patients, so that a patient calling after hours, to such a hospital owned practice is answered by a nonphysician, who does not know the patient, does not know medicine, either, and whose Hospital provided instructions are clearly to attempt to refer any and all such calls to the Emergency Room. (where the fee hovers around 1000 bucks.)
If you do this 100 times or more a day, your nonprofit status comes into question, because you will have huge accrued sums of money, which will certainly interfere with your nonprofit status.
Once, as the CEO, you have made that discovery, that you can get an enormous amount more money, for a relatively small service, but now you have to get rid of that money, you go on a building spree, and a fountain appears in your marble floored lobby, or a large atrium with stainless steel or aluminum bracing appears, and your 4 patient "semiprivate"rooms ($1000per night)morph into private rooms ( $3000 plus per night), and, those "expansion to burn up the profit" expenditures being one time and one time only, you begin a continuous expansion plan ,building new very expensive outpatient buildings, and outlying clinics, all over your catchment area.
"All new,all the time" is the new mantra
As the CEO, you are suddenly forcibly engaged in massive expansion, all of it fueled by the simple expedient of altering the care giving pattern in your community, from "NonProfit" and affordable to extraordinarily expensive care.