On Rain . . . and Dumb Sayings That Ring True

Everyone knows that tired old saying, "when it rains, it pours." But how did that saying come into existence?

After all, it's not even true. As I'm sitting here next to my window, writing this column, it's clearly raining, but it's definitely not pouring. In fact, it's only a slight mist—some might even call it a heavy fog. Earlier today it rained harder than it's raining now, but even then it wasn't quite pouring. A steady, soaking rain, maybe. So who cares, right?

Well, bear with me, because I think you do. That saying isn't really about rain at all, is it? It's really about bad things that happen to you that are outside your control, and the tendency of such events to group together. Maybe you feel like you could deal with one problem at a time, but when they "pour" on you all at once, you've really got some bailing to do to keep your boat afloat. Sort of like dealing with the current financial crisis, denials, RAC audits, slow payers, no-payers, and other challenges that are affecting healthcare much more swiftly and deeply than they used to.

Now we're getting somewhere.

I've talked to a lot of smart folks over the past few months about what this crisis is doing to healthcare in general and hospitals in particular, and none has used the phrase about rain. But I keep thinking about it as I hear them recite the litany of troubles affecting their professional lives. Like a bad song, it keeps turning over in my head.

Whether you're a CEO, CFO, or anyone else in a hospital leadership position, cash on hand is king with a capital K. One person in the know told me the other day that a hospital CFO she talked to told her his cash on hand dwindled by half in the last days of 2008 as he dealt with a tremendous slowdown in pay speed from commercial insurers and a big increase in denials. It's a vicious cycle. Then hospitals have to lay off staff and slow-pay vendors themselves. It's easy to see how a recession builds on itself. You're dealing with declines in patient volumes due to softening on elective procedures. Your payer mix might be changing. In some areas where the weaker players are shutting down, your Medicaid volumes are likely increasing. You're dealing with contraction of the market in hospital spending. In any case, the status quo is no longer effective and you're making drastic, gut-wrenching decisions.

At the same time, you still have to spend on information systems, productivity measures, and other ways to hold your cash longer and get what you're owed in the door. So in financial terms, the weather's bad and getting worse. I, for one, don't envy your job in this financial climate.

Just keep your wits about you and do your best to stay on top of what this mess is doing to your hospital so that when it's raining, and pouring, you won't be the old man who's snoring.