Thirteen days ago, while I was at my mother’s house, we got a visit from a social worker. I had just recently got in touch with Visiting Nurses to obtain some services for my mother, whose mental health had been slipping over the course of months. It reached a point where I thought she needed more attention, got in touch with her physician, and we got things moving.

Mom and Me
Mom and Me

The social worker was the last person to visit, but instead of talking to Mom she wanted to talk to me. We sat in the dining room and talked for just over an hour while Mom was in the other room watching TV. At one point in our conversation the social worker said to me:

“It’s time for you to step up and take charge. Your mother isn’t in a condition to manage her life on her own, so you’re going to have to do it for her. She’s going to fuss and fight but you must do it. She has no more privacy, and she doesn’t get to make anymore decisions. She took care of you when you were a child, now it’s your turn to take care of her.”

Ouch! I definitely needed to hear that because I’d been trying to allow Mom to have her privacy and independence, even though I’d had to take over doing a lot of things for her. I’d already taken away her ability to drive, and I had to write and sign all the checks because she couldn’t do it anymore, but I’d never looked at any of the finances or anything else. I knew I was going to have to make some moves soon, and when I got home that evening I decided it was time to start looking at some options.

Just about 35 hours later, things took a dramatic turn; my mother fell in her house. Luckily, a friend of hers stayed the night with her because she was concerned about my mother’s behavior earlier in the evening, which was erratic (I had a feeling something was going on but since I didn’t live close I’d called her and asked her to check on Mom). She was groggy and dizzy, missed a step and fell on the floor face down. The paramedics came and took her to the hospital, I got the call, and at 3:15 in the morning I was driving to a different city, trying to find that hospital in the dark.

The good news is that physically she was fine; just some cuts and scrapes. The bad news is that she was evaluated by hospital physicians and they determined that they couldn’t release her because, in their opinion, she could no longer live on her own.

Wow! In the space of just over 40 hours I’d gone from “you need to step up” to “the time is now”. In my mind I knew it was time to take charge, but in my subconscious, I was telling myself “I’m not ready”.

The funny part is that I’d started looking into assisted living centers the day after I’d come home from Mom’s house, with the intention of moving her closer to where I lived. I knew this was a good time to explore it because I could never convince her to move here previously. After the fall, everything escalated, especially because I knew that she was only in the hospital for observation, and if I left her there even one day too long it was going to get costly and have to be paid for out of pocket (she was never made an inpatient).


I spent the Monday following Mom’s fall going through many mental gesticulations, trying to find a place where I could move Mom. It seemed that every time I thought I had a solution, something came up and got in the way. By midnight Tuesday morning my wife and I both went to bed, trying to find some peace after a tough and erratic day. Our emotions were shaky and our thought processes jumbled. We were tired… and we’d be a bit more tired in a few hours.

My wife woke at 3:30 AM; I woke at 5. Separately, we’d come to the same decision; we had to move Mom in with us. There was no other solution, and the lucky part is that my wife used to be a certified nurse assistant and had worked with elderly patients. She not only knew what she might have to do but, because she knows Mom, it would make things easier.

It’s funny that, being an authority on leadership, when confronted with something this close to me I wasn’t initially ready for the challenge. I kept putting it off because I didn’t want to deal with the severity of the situation before. However, when the time came that someone had to take charge and become the leader, I was up for the challenge of it all because it was necessary to do so.

I’m not going to lie; after a week I’m finding that suddenly having to be the leader of the woman who raised me is sometimes as tough as I thought it would be. However, that’s only about 15% of the time. That other 85% is not only going very well, but I’m glad to be spending more time with her, and so is my wife. I have to figure out all of her finances, get her taxes done, and work on ways to get her to sleep more, but I know I’m ready to take these things head on.

Sometimes we’re not ready to lead, but when all options are off the table, someone’s got to do what needs to be done. This time around, I’m glad it was me.
 

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Holidays bring celebrations that make employees and employers alike very happy. Even if times are tough, there’s something about holidays that make most people have a little extra hop in their step, and a smile is quicker to appear.

Success
Creative Commons License Hartwig HKD via Compfight

It’s also the one time of the year where the adage about happy employees being the most productive employees isn’t quite true. Most people are thinking about celebrations, both at the office and at home, gifts or food, decorations, talking about travel plans or actually taking off early for travel or visitor preparation. Any good manager has to expect that there will be some slacking off around holidays, no matter how good your employees are, because of all the excess distractions.

This brings up a discussion on employee motivation, which also translates into employer motivation. You can’t have one without the other, otherwise it’s a false action, and employees will see right through it.

I had someone ask me years ago what the purpose of motivating employees was for because at least they had jobs and were earning a pretty good salary. I responded that money isn’t always the best motivation for everyone and, in reality, once a person has the job, money falls far down the list of things employees care most about.

To expect people to self motivate themselves the 8 – 10 hours they’re at work is to put your total faith in the professionalism of every person you work with. It would be nice in an utopian society; in real life, petty thoughts and actions are at work all the time.

What constitutes positive motivation? Depends on what you’re hoping to achieve.

Most of the time you’re hoping to increase work production or performance. You might have to take a small step backwards in order to move forward; hence, holiday parties, which creates an atmosphere which isn’t conducive to much work being done, but gives great residual benefit.

Sometimes you’re trying to change the focus of the office because, even if the work flow might seem to be consistent and steady, there’s a greater possibility that things are being missed because your employees concentration isn’t where you need it to be.

You just might be trying to change your own mood; this one bears some extra thought. Many managers and employers discount their own feelings when it comes to the impact it may have on those around them. They may also deny that they have any issues of their own. Pressure does wonders to the human mind, and sometimes we’re oblivious to our own negative performance. We need motivation just like everyone else, and it doesn’t hurt to bring everyone else along when you’ve decided to work on changing your own mindset.

There are many ways to help motivate employees, some specifically work related, some not. Let’s look at some work related ways.

First, Dale Carnegie likes to talk about setting up SMART goals: Specific, Measurable, Achievable, Realistic, and Time-phased. Every person should have a goal to work towards, not as a punitive measure but as something which helps track progress. If you have something to shoot for, you have a reason to exist. This is a good time to work with someone one on one because you can ask them for their input on the goals you both want them to reach for.

May 15, 2013 at 09:13AM
Creative Commons License Arya Ziai via Compfight

Conversation is a great motivational tool because most employees say they really don’t know what’s expected of them by management. This leads into motivational idea number two, that being to make sure the lines of communication are always open.

I know that many organizations have to deal with rampant rumors, and most of those rumors are negative. I’ve always advocated making sure your employees know what’s going on, within reason.

If your company is going to have layoffs, but upper management doesn’t want you to release that information, you can always let your employees know things aren’t going well with the organization in other ways. When things are going well for the organization, or your department, they would appreciate hearing that also. Allowing employees to ask questions and answering them as honestly as you can motivates them because they know they can trust you, and people always work well with those they can trust.

A third motivational tool is consistency in behavior and demeanor. Even bad managers who are consistent gives employees a chance to get used to a certain management style, and will keep things running smoother than working with someone with an erratic personality. You don’t want employees walking around on pins and needles because they’re not sure which version of management is going to show up in the morning.

If people are wary to come to work or be at work because of the behavior of their leaders, then it’s up to you to those leaders to change their behavior. I’d hope for positive changes, but if that’s something a leader can’t achieve and goes in the other direction, just be consistent with it.

Non-work related ideas don’t have to be difficult and can offer beneficial emotional motivation. Those can be as simple as food related things such as doughnuts or lunches, or they can be more complicated, such as bowling night, picnics, etc.

I’ve been asked to present a motivational speech to two different companies before conferences; that might be a bit expensive, but motivational messages can be effective if employees are primed for them.

I knew a manager years ago who used to give motivational CDs to employees he felt might be going through a rough time in their personal lives. He’d ask them to listen to them during work hours, and then come back and talk to him about it later in the day. He said it not only helped employees get out of their funk but it helped him develop more intimate relationships with them.

I’ve also known managers who bring in homemade cookies, or allow their employees to set up one day a week for specialty items for the office; getting others involved, especially if they volunteer, always helps motivation.

To paraphrase Zig Ziglar, you should always be working on motivating your employees, because you have to eat everyday also; nothing is permanent. So go out there, enjoy the holidays, eat a holiday cookie for me, and get motivated; another great year is coming.
 

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Me: “Man…”

Her: “What?”

Me: “That car in front of us is only going 30 and the speed limit is 45. It’s irking me.”

Her: “What are you in a hurry to get to?”

Me: “Wherever I can be sooner than where I am now.”


Almost all of us hate when someone else is holding us up, whether we have something defined or not. For me, if the speed limit is 55, I want to at least be doing 55. For my wife, if the speed limit is 55 she’ll get there in her own sweet time because it’s rare that she’s worried about being somewhere as soon as she can get there. For each of us, these are habits that we can’t change, and neither of us are really in the mood to change these particular things about ourselves.

There are things that each of us do want to change about ourselves. We each want more money. We each want more freedom. We each want to lose weight. We both want it now!

That’s not how change works though. In the original version of The Secret, Esther Hicks states that when people want things in their life they usually want it now, but it’s probably best that it doesn’t happen immediately because either we’re not ready for it or we haven’t thought about all the consequences of what could occur if it did happen now.

Let’s look at weight loss. It turns out that one can lose 2 to 5 pounds in one day by doing a host of different things. You can get into a sauna, dry or steam, and sit in there for a couple of hours to drop even more weight than that. You can try running a marathon without drinking any water along the way. You can get liposuction and have them remove upwards of 10 to 11 pounds.

The thing is, each of these things isn’t good to do. The weight loss you lose on the first two will come back as soon as you drink some water. The weight loss on the other is too extreme and can cause health issues later on, as it’s recommended to remove far less than that at one time.

Change can be tough to deal with. I proved that doing something over a period of time when you really don’t want to be doing it, even if you’ve committed to it, won’t change your behavior whatsoever. You need encouragement, and you need to see beneficial outcomes for you to believe that particular change is necessary or moving in the right direction.


Knowing this doesn’t change anyone’s mind when it comes to trying to make positive changes that are known to be needed. I remember trying to close a deal with a vice president years ago when he acknowledged that there was a disconnect between his hospital and most of the physician’s offices in the area. We talked for about 90 minutes, and we agreed on a strategy that I had basically come up with on the fly because I understood the issue.

The problem? He thought that everything could change within 3 weeks and he could be done with it. I knew that it would take at least 3 months to see some positive changes. After all, these weren’t people who already agreed that they had mutual interests. Thinking that just because you’ve brought them together for breakfast to begin the process of opening a dialogue after years of fighting with each other over processes and importance could be accomplished in a few weeks wasn’t realistic. When I told him that I felt an immediate freeze. I knew that contract was gone, and his not picking up the phone over the next few weeks confirmed that to me later on.

I also remember being in a hospital that had downsized the business office by 20% just after installing a new computer system and having their receivables growing and their cash falling faster than they were prepared to deal with. I told that vice president that it would take at least 3 months before he started seeing any changes at all; he didn’t like that, but that’s just how things usually go.

You can’t correct anything without doing a diagnosis, discovering what skills might be lacking, figure out what else might be missing and finally deciding on a plan of attack. The hospital did start seeing some things change two weeks before the three months, but I was only contracted for three months so I never found out if the changes I started were ever continued.

There are changes that just take time to come to fruition. You can throw money at some things. You can bring in more people. You can yell and scream and pout and cry all you want. If you’re a smart leader, you’ll recognize that quick changes don’t necessarily bring quick results. Once you get past that mindset, change management becomes a bit easier to deal with.

Leaders can be great agents of change, but they also need to be patient. There will be changes that can be swift and necessary that might work out fast and fine. For anything of real importance though, it’s going to take time. Get used to it, just like I had to wait almost 12 years to finally make a best of leadership blogs list. With the company I’m in, that was worth the wait! 🙂
 

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Hospitals have two main problems when it comes to finances. One is revenue, as in they’re not generating enough, and the second is receivables, as in they’re not collecting enough on the revenue so they can pay bills and buy other stuff.

charge master consultant

Every hospital has a charge master. A charge master is a full listing of all procedures that a hospital provides. The reason there is a charge master is to help make the process of charging for services easier and faster. Charges are usually already priced and coded. The reason I say usually is that some charges aren’t priced because a hospital might be trying to track certain non-chargeable services, while other charges may have the procedures coded by medical records (such as many surgical procedures) instead.

For those charges that aren’t coded by medical records, this means that they have to be coded in the charge master. Most charges only have to be given a procedure code once, and then it remains that way forever. However, many others change on a regular basis.

The average number of years that facilities have someone come in and review their charge master is 3 to 5 years. Since big changes occur around the beginning of every year, and small changes occur quarterly, this means that hospitals may be charging for services that don’t exist and not charging for new services that have codes, and not getting paid because their codes aren’t up to date. On the first issue, even mistakenly charging for services that don’t exist could be considered fraud by Medicare, which could issue financial punishment by as much as triple the amount of charges they say a hospital fraudulently charged for.

Procedure codes aren’t the only thing one checks on in a charge master review. One also checks revenue codes, classifications which tell insurance companies where services are provided. One also compares what hospitals are charging for services and compares them with Medicare fee schedules (there are two different types) to make sure hospitals are billing more than what Medicare reimburses. This is because Medicare will only pay based on what they’re billed, so if the hospital charge is lower, not the actual fee schedule price, hospitals could be losing reimbursement dollars.

If a hospital has a charge master coordinator, or someone who’s only job is to perform this function, then an annual charge master review probably isn’t needed, but it can’t hurt to have someone check things out every 3 or 4 years; even accounting departments get audited. If they don’t… well, the consequences could be costly.

I spent six months at a 2-hospital system in New Jersey years ago doing their charge master, as they hadn’t had anyone working it in almost 2 years. I also did a check of their revenue. It turns out they’d actually had a charge master review by someone else 3 years earlier, but never implemented anything that had been recommended. By the time I left, they’d increased revenue by a couple hundred million combined. Later on I spent a year at a hospital in Westchester County. By the time I left there, they had more than doubled their yearly revenue.

Charge master reviews don’t take all that long to do if everything is set up properly. First it’s a review of all files. Then there are the department interviews, which is the timely part if access to the directors of all the ancillary departments takes time to pull together. Like most organizations that do this work, we charge based on the size of the facility. The larger the organization, the more complex the work, which means more time to do everything properly. Money on expenses can be saved if both parties are set up to do video or phone conferencing.

A charge capture, or revenue review, takes a little bit longer, and it probably works best to have it become part of the charge master review. The interviews with department directors are more comprehensive. They’re also educational, as anyone worth the work wants to spend more time with the directors and possibly some of their employees, giving instructions on charge capture, coding, and anything else as needed.

How much does all of this cost? Each organization has their own processes for coming up with the fees to do this sort of thing. To determine my fee, I start off with the hourly rate I want to get paid, estimate how long I think the entire process will take, then I give a project price for the requested work. If there are other projects the hospital wishes to explore, those fees will be add-ons, but the rates will be less if added to the original project that if it became a standalone.

Besides, that’s the wrong question to ask. A better question would be how much your hospital would be willing to spend if revenue increased by millions of dollars a year that you didn’t previously have, especially if you estimate than your reimbursement will average anywhere from 20 to 30%. Even if it was only 10%, no consultant’s fee is going to be anywhere close to that. 🙂

If you’d like to know more, check out my two-part series on what it is that charge master consultants do. Any questions or comments, please feel free to add your comments below.
 

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A couple of days ago a friend of mine shared an update that someone had posted on LinkedIn. It was a picture of her and 5 other young women at their company Christmas party, wearing dresses that they would probably wear out to a club. Two of the dresses could have been considered pretty revealing, while the other 4 wore dresses that fit them well enough to show off their figures.


Based on her question, it was easy to assume that when she first posted the image, she and the rest of the ladies took a lot of heat for the pictures, with some people saying all of them were dressed inappropriately for a company party. At the same time, there were a lot of crass males who wrote things I’d never think of repeating anywhere.

All of this happened on LinkedIn, which is supposed to be about business, where I’ve been shocked by the kind of deportment I’ve seen over the last two years; business professionalism has definitely changed over time.

My friend… he posted the link on Facebook, which brought up the picture, and asked us what we thought about it.

What did I think about it? I thought it was another lesson in human behavior and confirmation that no matter who you are, what you are or what you do, everyone’s watching you… all the time. Some will like it, some won’t, but they’re always watching.

My initial thought was that the dresses, while provocative, weren’t anything I hadn’t seen before. Back in the 90’s my hospital had a holiday party and there were a few ladies who had the bodies and the confidence to wear the same type of thing. The only different between then and now is that we weren’t all carrying around smartphones with cameras back then.

Even without them, we were still judged fairly often and quickly… even if we didn’t always hear about it. When you’re around a lot of people on a daily basis, every move you make is scrutinized by someone. Everything you wear is analyzed by someone. Whether you gain or lose weight, are happy or sad, are boisterous or quiet… you’re being watched and inspected and examined and dissected and ranked and liked and hated all at the same time.

What people think about you isn’t your business. – Jack Canfield

That’s a nice phrase, isn’t it? Unfortunately, it’s only 75% true at best. No matter what we do to bring money into the house, even as an independent consultant, we all have to decided what’s worth the trouble we might bring upon ourselves and what might be detrimental to our progress and success.

@djcharleebrown keeps the party rocking @whiteoakkitchen! Dance party! #whiteoakturns3
Christine via Compfight

There are people who are willing to stand on principles while others will sell their soul to kiss up to a superior. There are people who are strong minded and can handle people who don’t understand the intricacies of something and there are people who cave because they think everything that goes on is an attack on their soul and character. Sometimes those people are us; sometimes those people are the ones doing the judging.

I’m not above the judging thing. There are people I never plan to talk to based on things they’ve said and done on social media. There are people locally I’ll never give a minute of my time to because of something they’ve done to irk me. None of us have to deal with people whose character we’re uncomfortable with; that only makes sense.

I know I’m judged as well; that’s only fair. I also know I’m judged on many more levels than a lot of people who do what I do; that’s not martyrdom, it’s just reality. This means I understand that there are things I either shouldn’t do or shouldn’t do them so they’re visible. It also means that I understand that if I decide to do them anyway, such as talk about certain topics on this blog, that I might alienate some people who are uncomfortable with the subject matter. I’m good with that; as we say around here, “I’ma be me!” 🙂

What about you and your career? Can you handle the fallout of having pictures posted on social media where people say certain types of things that could possibly cost you your job or your company loses potential business? Do you worry about the fairness in being free to express yourself balanced against a populace that might have alternate views? At your own company, are you willing to stand up for a principle or will you keep silent because it’s in your best interest?

These are important questions to ask oneself, because the answers you come to will be important when deciding when to post certain things online, or say certain things online, or exhibit certain behaviors no matter where you are.

After you have those answers, what other people think or say or do when you do or don’t do your thing won’t matter anymore. Just remember though; everybody’s watching, all the time, and there’s no getting around it.
 

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This will be the last post of 2016 on this blog; I think it’s time for a short break. It’s also time for a bit of a breakdown of why I’ve lost confidence in the overall good of people, some introspection of myself to handle it, and some retrospection to help me move forward. As usual, the final blog post of the year is about me… and about this blog and my business.

The end to 2016

This is the year that I lost trust and confidence in society and the betterment of man… and woman. I’ve always believed in the best of people and said that in the end good things would win out; I was wrong. Not just in this country but in most countries around the world, this has been one of the worst years for decorum and people making truly informed decisions… and there’s no one to blame but each other.

For my part, I almost quit social media; that’s where my mind went. However, I knew that if I quit social media, I’d pretty much have to shut down my businesses as well, which includes my blogs. That’s one of those “cut off my nose to spite my face” thoughts I had to get beyond because I knew there were other ways to cope.

My way… remove myself from the bad and the hate in the world and concentrate more on myself, my family and my career. Even if I don’t trust people in general anymore and possibly question my patriotism, I still have some basic goals, which do involve the career I’ve created for myself.

I don’t need the news to talk about leadership or diversity; I have life experiences and enough knowledge on this subject to last as long as I’m in the mood to continue doing it. The same with health care; the only news hospitals care about is what’s going on with them and what I might be able to help them with.

I spent most of 2016 in a depressive state, mainly because of outside influences that have nothing to do with my daily life. Sure, I have some personal issues as it involves my mother’s health condition, which I’m finally starting to be more proactive in dealing with, but that had less impact on my mindset than it should have.

In retrospect, I had some milestones this year. I celebrated my 11th year of blogging about leadership. I hit 1,300 posts on this blog and 1,700 on my other main blog. I also hit my 15th year of self employment and went to two conferences that had nothing to do with health care… the first ever for me. I also spoke to 3 groups this year, although I ended up writing about being a revenue cycle consultant instead of giving it as the presentation because there was a miscommunication with the person who booked me; it happens! lol

I did some nice things this year, had a few accomplishments… but I’m ending the year thinking more about reinventing both my business and my personal life; good thing I have my Franklin Planner.

What’s coming for 2017? Specially I don’t know; does anyone know for sure? I do have some things I’m planning on working on, but I think I’m going to hold most of those close to the vest for now. What I will say is that I’m expecting to do more in 2017 than I did in 2016. This means writing more, doing more videos, promoting myself more on social media and at local networking events and going all out to make this one of my best financial years ever. If I can keep my peace of mind, all’s the better.

I want to feel more like the guy in the picture at the top right, not like the guy in the picture on this blog post. I’ve already started working towards that goal, as I’m in the process of redesigning my office for the first time in 10 years… with my wife’s help of course. New office, new perspective, new goals, new demeanor… the skies the limit!

I invite you to come along as I leave 2016 behind… for good! It didn’t happen; Just think of me as having a Pam moment and 2016 being Bobby Ewing (how’s that for a reference?). Onward and upward; first star to the left and straight on till morning… I’ll see you in 2017!
 

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I have a video coming out on Thursday that talks about 3 easy leadership lessons that everyone should be able to learn that will make them better leaders. They won’t make anyone a great leader, but they’ll certainly improve them a lot.

learning easy leadership lesson

With that said, and in an attempt to write a shorter post than usual (following a 4-part series about succession planning), I decided to limit myself to talking about one of the habits, and it’s the most effective one.

That habit: treat others like you want to be treated. That’s it; that’s all it takes. I can’t leave it at that, so let me embellish it a little bit.

The one thing that seems to be universal in business, whether someone is in a leadership position or not, is that they want to be respected. The lines of respect change based on the job, but overall people want to be respected as humans, which in turn means they want to be treated in certain ways.

I don’t know a single person who likes being yelled at, even athletes. I don’t know a single person who likes being demeaned or put down all the time. I don’t know a single person who likes being condescended to.

Yet I know a lot of people who do one or all of these things on a consistent basis. It’s irksome enough to get us riled in our personal lives, and often we won’t take it from people we don’t know, and sometimes we don’t want to take it from people we do know.

But what about having to take it from someone you report to, where retaliation could cost you your job or a chance for a promotion down the line? I wonder what managers think that treating someone bad by doing any of the 3 things I mentioned above is good leadership, good management, and inspiring to any employee who works with them.

Do you know any who you think believes this makes them effective? I bet you know some in leadership positions who do this, and you might believe they think these are good leadership tactics. What I bet you’ve never done is turn the tables on them to see how they respond to it.

I have. Because I subscribe to the theory that we all deserve to be treated right, along with the words of Dr. Phil who says “we need to teach people how to treat us”, I have given back what I’ve gotten from people, either those who thought they could tell me what to do or weren’t paying attention to their behavior.

Why did I do it? Because I adhered to the Dr. Phil theory first, which means I treated everyone the way I wanted to be treated, but some people couldn’t learn the lesson. Luckily, it didn’t happen all that often, but when it did I acted with intention, and each time I got my point across eventually. I tend to normally be very nice, but I can be a bit caustic when I feel I need to be.

Why did it work? Because I’d already established a baseline behavior, which I could change in a heartbeat. It’s hard for someone to complain about another person’s behavior towards them when almost everyone else is telling them how nice you are. lol

Don’t be that person who needs to be slapped across the face by being shown that you’re a jerk. Treat people how you want to be treated; really, can that be so hard?
 

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