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.

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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.

...!!!?? Orlando
corinne glaziou via Compfight

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.

11 settembre 2001 - 11 settembre 2011
Riccardo Francesconi via Compfight

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.