What Do You Do When There’s No Real Solution?
Posted by Mitch Mitchell on Jun 15, 2016
Back in 1999, I was the director of patient accounting of a small 2-hospital system in central New York. We were on the verge of becoming a 4-hospital system, the paperwork already finished, and all hospitals moving to one new computer system, as the scare of what might happen at the millennium was pretty big across the country and, unfortunately, the software license for both of my hospitals was expiring at the end of the year.
 |
Before the original 2-hospitals had merged, the one I started with was going through some tough negotiations with the local Blue Cross we had to deal with. For most of the year the hospital was getting a weekly check of an indeterminate amount because both the insurance company and the hospital figured a contract would be signed at some point in the year, which was the good thing. The bad thing was wondering when it would happen.
There was an immediate reason that was an issue. Even though the insurance company was sending the hospital money, officially they weren't processing any payments. Therefore, we couldn't record any payments or adjustments for any patients who had Blue Cross coverage for that year.
By July we knew there was a second immediate problem that was coming. Although our hospital had been promised that all of our A/R information would be transferred to the new computer system, because they'd had problems integrating one of the other hospitals we were told that none of our information would be transferred because there wasn't enough time for the programming to be written.
In September we brought the new system up for the other hospital and everything went pretty smoothly. Yet, for my original hospital, there was still no signed contract and suddenly it looked like it wasn't going to happen at all.
I have to explain why all of this was a big deal. If you've ever been to either a doctor's office or a hospital, you know that it's rare that insurance companies pay a bill in its entirety. This means there's either going to be billing to the secondary insurance or billing to the patient. Normally, if there's a problem with an insurance company hospitals can self pay patients and deal with it on the back end, but since the insurance company was sending us a weekly check we had to treat them as if they were legitimate patients with coverage, whether we actually knew they had that coverage or not.
 |
November comes and it's time to physically start merging two business offices into one location. We had to do that while running two different computer systems and trying to find time to send the billing people from my original hospital to a totally different location to try to learn how to use a computer system they weren't really going to be privy to for the longest time. We moved both offices to an offsite location, which was a major intrusion in our trying to keep up with the work financially, but we did the best we could.
Finally, the contract was signed... Thanksgiving week! The following week we finally started receiving invoices showing us payments and denials... and they were monster files. The directive we had was that we had 3 weeks to process everything we could because they were going to shut down the system two weeks before the end of the year; ugh.
You can't imagine how much work had to go into trying to post a year's worth of payments, let alone allowances and denials. Frankly, even with me helping to post these things and training a couple other people how to do some of it, the best we could do was process only payments, leaving almost everything else alone until we'd done at least that part. We got all of those done within 2 days of them shutting down the computer system, which means we only got to post a few allowances and denials.
All of this was because of the final issue. I'd been told by the VP of Finance that I had to try to come up with an idea of what to do with not only the Blue Cross claims, but all other outstanding claims that were on our soon to be defunct system. The best thing I could come up with was to print everything on paper, a lousy idea because all billing was electronic, and this meant that we were going to have to work off green bar paper (who remembers that?) and type everything into either the new system or our electronic billing system manually do be able to do anything with all those claims.
That's why we had to shut down two weeks early, because the amount of detail we were going to need, and the upcoming holidays, meant we had to be off the system so we wouldn't change any information once we'd posted all those payments.
Suffice it to say that although we got all those claims, what we ended up having to go through for the next 18 months, before our department was shut down and sent out to another city, was almost impossible to overcome. Through no fault of our own, we were left in a situation without a real viable solution for success. I came up with the best idea I could, and the supervisors who reported to me and I came up with the best working solution we could to address the backlog, but it was always a horrifying experience up until the end.
 |
You might be asking why I'm talking about this particular bad scenario in my history.
This past weekend there was a horrific shooting at a nightclub in Orlando, Florida. The gunman, who announced his allegiance to ISIS before carrying out what most people are calling a cowardly act, killed 49 people and injured 56 more (some of them quite serious) before he lost his own life. That it was a gay club that, according to some, he frequented might make this entire story quite strange, but it is what it is.
Over the past few days there have been more arguments for gun control or less gun control, more legislation for the protection of the LBGT community or voices saying there's enough, and a host of other things. The battle lines have been drawn and, as I said above, it is what it is.
The one thing that's bothered me in all of this are people who are railing against the President by saying "he's not doing enough to stop this."
Frankly, I think this is the stupidest thing I've ever heard, and I've heard some stupid things in my life.
The scenario I wrote about above wasn't close to anything like this, yet there wasn't a real solution to the problem. I wasn't getting any help, and nothing I'd asked for was going to be given to me, so I came up with what I came up with, which was as good as it was going to get, but it wasn't all that great.
There are two things that keep running through my mind after something like this weekend happened which, as we all know, isn't the first time this had happened even in this country, but has been happening all over the world for at least the last few decades or so.
The first is that everyone who's saying "someone has to do something" doesn't have a single idea what to do. If there was one neighborhood in one city in one country where all the terrorists lived it would make everything easy to take care of. But life doesn't work like that; heck, it took 11 years to catch up with Bin Laden, and he had kidney issues.
 |
We're still trying to chase down members of Al Queda, the Taliban, ISIS and any other group most of the world is against but there's no real success, and some of the brightest military minds in the world are on the case. If they can't quite figure out what to do and those clamoring for something better can't come up with something better, then it's just a waste of breath and everyone should just shut up about it. I've always believed that if you're going to complain about something you should try to have a solution, and it seems the one solution about banning Muslims from entering the country isn't going to solve anything since the killer in Orlando was born in New York City.
The second is that we have to get used to a reality in this world that anyone who's willing to give up their life for a cause, no matter the cause, is pretty hard to stop... almost literally impossible. Sure, sometimes there might be some odd signs that hopefully someone notices and reports, but for the most part we never see them coming until it's too late. Even with professional, smart people in charge, no one could stop 9/11, the bombings in France, the IRA attacks in England back in the day, Pam Am Flight 103, the Munich Olympics in 1972, Timothy McVeigh and the Oklahoma bombing, President Kennedy... you name it, feel it, hate it and then try to name a workable solution that would have definitely prevented it.
There are a lot of things good leadership can overcome. That's why I write this blog and have written my books, because I know that good leadership is ultimately better than bad leadership. However, I recognize that even good leadership can't solve everything, especially when the deck is stacked against them.
My situation proved that to me. Terrorists should prove that to everyone else. Sometimes the best we can do is try to do the best we can do and hope it works out for the best, and not give up and let bad situations and bad people keep us down. Sometimes that's the best solution available; it's a lousy solution, not a real solution, but if the remnants of a supernova were coming our way, we wouldn't be able to solve that one either.
Just something to think about. As many people have said over the centuries, let's try to be good to each other; it may solve more issues than it causes.
Hello Mitch,
As a part of a start-up company sometimes I get puzzled what to do and what to not.Sometimes failures break me down and thanks to your article I have got lots of inspiration and motivation.
Thanks again for sharing such an useful article with us.
-Debadeep
Glad to help Debadeep. Overall we can only do the best we can, and I’m betting that your decisions are good ones the majority of the time.
I think there’s always a solution. The fact that it would be uncomfortable, or difficult, or would require someone else to help implement, doesn’t mean there’s not a solution.
The solution for this “war on terror” is to define an enemy, define success, and put our troops on a path that moves from where we are in the direction of success.
“Get those guys and those guys and those guys and maybe check over there just in case” isn’t an achievable strategy.
See also, the “war on drugs” that we’ve been fighting since the Nixon administration (he’s been out of office over 40 years ago and we don’t know what success looks like there, or how to achieve it).
Your problem at the hospital could have been solved by the people with the money in their control making a decision four months earlier. It’s not that there wasn’t a solution — it’s that you were the wrong person to try to find a solution, because the solution required authority you didn’t have.
Take that without judgment on you; they asked you to find a solution, but didn’t give you the power to implement what would have actually been the best one. That’s poor leadership on your bosses’ part, it’s short-sighted, and it’s not your fault.
Anyway, I have a story for you sometime soon. Maybe I’ll email you.
This is a great comment Josh! Course I have to say my piece. 🙂
I didn’t say there wasn’t any solution; I said there wasn’t any real solution, or a good one. You’re right, the other powers that be might have been able to alter things, but none of them really cared. Thus, it was all piled on me to come up with something, thus I was the one who had no real solution to the problem, and could only come up with what I did because I had no other options.
As for terrorism and drugs (I’d forgotten about that one), I still think there’s no real solution.
For instance, you look at drugs. Do you focus on heroin, cocaine, crack or the new designer drugs that kill people quicker? How can anyone find a solution against drugs that people create in their own kitchens with things they can buy at a department store?
Terrorism is kind of the same way. Do we go after just ISIS, the Taliban, Al Queda? We don’t even know who these people are for the most part, and if kids in the U.S. decide to join these groups, we don’t know who that is either. On this one I have a solution, but it would be the cruelest one possible and there isn’t a country in the world that would support it. It’s got a history though that proves it can work, but this is 2016.
It was so much easier when I was a kid. The enemy was communism, which meant if a country declared they were communist, they were the enemy. Then came Vietnam and that’s when that particular enemy belief fell apart. Of course, I tend to believe that was one time when our country really didn’t know what it wasn’t to achieve as well as under estimated the resolve of those who knew the territory way better than we did. That lesson was kind of learned when it came to Afghanistan but forgotten when Iraq came.
Uncomfortable, difficult… yup, I’d agree with that. Dad used to tell me that the solution to stop someone from picking on you was to beat them severe enough so that they and others who knew them would never try to do it again. I thought it was probably a great solution, but I never had the stomach for it. It’s still a great solution, but how many of us not only don’t have the stomach to do it but would hate our government, aka leaders, to do these things, no matter the outcome? Something to think about. 😉
Well, we do know what to do with the drug war…we know that education on the demand side is about 10 times as effective dollar-for-dollar in getting product off the street as enforcement on the supply side.
We also know that nations (like Portugal) and states (like Massachusetts) that have decriminalized possession in amounts for personal use and instead steer people toward rehab instead of prison see a bigger decrease in drug use than states that continue to put users in prison.
Further, we know that states like Colorado that have legalized recreational use of some drugs are seeing huge influxes in tax dollars, and aren’t seeing increases in crime as use grows.
So, there is a solution, but it comes at the cost of jobs on the enforcement side and a decline in revenues on the incarceration side.
Some of the difficulty in coming up with solutions is that you have to actually want to solve the problem.
Really motivative thoughts and tips shared about taking initiatives for finding a solution in any situation.We should keep faith in ourselves in any situation.We should believe in ourselves for doing any work.
We really should do that, which would hopefully allow us to figure out the best solutions. Still, we also have to recognize that sometimes those solutions might not be very good based on the factors against us.