Last week there was a story in our local news about one of the hospitals in town. Seems they’re in a horrible financial position, where they showed a loss of almost $18 million in the first half of the year due to depreciation, supplies, interest and other costs.

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That’s always scary to see, although this particular hospital is about to become part of a larger network of hospitals that will help guide it through some of its financial issues. They’ll survive, although they certainly could have used my services. 🙂

Anyway, like many news stories that show up online, this one garnered a lot of comments from the populace. And almost all the comments were wrong about the problems of the hospital. How do I know? Because I’m in health care, I’ve kept up with the news along with another local consultant, and we both have some inside information on a few things.

Although it didn’t take any of that knowledge to know the comments these people were making were wrong. For one, half of them blamed President Obama and the Affordable Care Act; sorry to say this but if anyone believes a hospital can lose that kind of money because of the ACA, and the news reports mentions other things (let alone the fact that the ACA has nothing to do with revenue or costs), then it’s a stupid statement.

A few other people jumped on the normal bandwagon I see whenever there’s bad hospital news, talking about how much they charge for things like aspirin (which no hospital in the country should be charging for because it’s unbillable per Medicare regulation) or other things. People, if the hospital lost money because of a lack of revenue and you’re saying they’re charging too much for things like aspirin, once again it’s a stupid statement.

Most of the time I don’t like reading comments on news stories for two reasons. One is because people can be pretty mean, especially when they get to hide behind fake names. Two, because it becomes obvious pretty quickly that people have no idea what they’re talking about.

Ah yes, we finally come to the meat of things. It seems that a lot of people have opinions of things but a lack of knowledge behind those opinions. Actually, that’s not the problem; goodness, I have opinions on things without knowing everything about them all the time.

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What I don’t do is open my mouth or write something down when expressing an opinion without some background or knowledge on it. I’ve been known to tell people that I have an opinion based on the little bit that I know but then I’ll ask what else there might be. That way I can gain more insight to see if my opinion was valid or if I need to change it.

Being wrong on something where you only have an opinion on it but there’s no action is bad enough. Being wrong on something where an action has to take place and you tell someone to do something wrong because you don’t want to take the time to look into it can be tragic.

Years ago, I was consulting at a hospital where the project leader had put someone else over a department that handled Medicaid claims. The assumption was that I had a lot on my plate already so this other person could handle it.

The problem was that Medicaid in each state can be problematic if you’re unsure of the rules and don’t take any time to make sure what you’re doing is legitimate. In this case, the billing department turned out to be doing something that wasn’t ethical… only they didn’t know it at the time.

I figured it out and went to the people to tell them they had to stop. They told me it was the only way the hospital would get paid. I told them that proved it was fraudulent, because one never takes something into their own hands in health care billing without checking it out first.

The next thing I knew, the guy overseeing the department came to me and asked me to change the codes so that the department wasn’t changing them, thus would be in compliance. I told him that’s not how it worked anywhere, but especially in New York, which is my state. I told him that I refused, and if his department didn’t stop doing it I was going to force the issue.

For almost a week it was a daily debate. Finally I’d had enough. I called the Medicaid representative in my own area, told her the problem but told her it wasn’t in her district so she didn’t have to address it. I didn’t tell her where I was so she wouldn’t be put in a bad position.

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Afterwards, I went to this guy’s office, called her and put her on speakerphone as if it was the first time I was calling her. I presented the issue so he could hear what she had to say. She said if a hospital was doing what I described it would be illegal on two fronts, one because billing departments can’t just change things to get paid and two, because what they were changing it to the hospital didn’t even have that department; that’s the definition of fraud.

She gave instructions on how they could fix their issue because, it turns out, the problem was known by the state and they’d put a correction out on its website, which the hospital had missed. When we hung up the phone, I told this guy it was his responsibility to tell his people how to fix the issue and that it not only needed to be recorded but written up and reported to the project manager so he could include it in his notes.

I don’t know if that part ever took place unfortunately; I hope the hospital never suffered from an audit later on, although the trouble had started before he took over so he’d have been absolved of all blame.

There are times when offering your thoughts on something you know nothing about won’t hurt anything except possibly your reputation. There are other times when offering your opinion when you don’t know what you’re talking about could be catastrophic. In business and life, if you’re unsure about something that could affect lives, finances, or anything else that might be important, at least so some research before you mess things up.

I know we’re at a time in society where people say or do things all the time without thinking, apologize, and think it’s all good and they should be forgiven. Sometimes, being forgiven isn’t an option because a crisis has been created that could be averted.

For your sake, if that happens I hope someone has insurance like that museum in Taipei that had the 12-year old kid fall through a $1.54 million painting; probably not!
 

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