November 18, 2013

Thoughts on Veterans Day

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As I write this, it’s mid-afternoon on Veterans Day. It’s also one of those rare moments when I actually reminisce about my time in the U.S. Air force – more than eight years, actually – and whether I made a difference.

Oh, I’m no martyr. I know my time in the service had meaning: for the country, the Air Force, and for me personally, of course. You see, I was a medic during the Vietnam War era. I never served overseas, you understand, unless you count Alaska as “overseas” (which the military does, actually), but I spent a lot of long days and nights helping take care of those extraordinary women and men who did serve in combat roles in southeast Asia.

On a personal note, my two children were born in military hospitals, my daughter in an Air Force hospital in Alaska, my son in a U.S. Army hospital in San Antonio. And as a medic, I spent more than 90 percent of my working time in Air Force hospitals and clinics, where I learned two things: 

  1. The work of healthcare never ends; and
  2. The expectations of patients never diminish.

Now, I’ll grant you that recent events in Washington, D.C. appear to be somewhat problematic, vis-à-vis those two truths. The government shutdown (thank you Republicans, Democrats, Independents, Libertarians and Anarchists, because you all get to share the responsibility) and the multiple controversies surrounding President Obama’s Patient Protection and Affordable Care Act ($600 million for a website that was flawless still would be unconscionable) have brought the entire health care system – and more specifically, the government’s role in that system – under scrutiny and into question.

And that’s exactly as it should be.

I am satisfied that we in healthcare are distinguished by certain common characteristics – not universally, but at least in terms of “majority” – as we would not be able to fulfill our respective roles if we didn’t share most of these characteristics. (And for those of you who already are assuming the mantle of “He never walked in my shoes! Hold on to your hats. I’ll get back to you.)

First, we care about others. I don’t care if your politics are right, left, or down the center stripe; no ideology has exclusive claim to “caring.” The only ways we differ are in our preferred approaches to imparting that care.

Second, we tend to be “risk averse.” Financial managers protect their money; clinical professionals fear malpractice(or, more specifically, “malfeasance,” “misfeasance,” and “nonfeasance”). Oh, and I’ve been both a clinical professional and a financial manager.

Third, we are not wild about regulations, whether imposed (by governments at all levels) or voluntarily assumed (the Joint Commission, which, by the way, has nothing to do with smoking). Regulation is a necessary evil, and while we hate it, we embrace it for a number of reasons.

Finally, we want lives and careers that are fulfilling, that remind us, every day, that what we are doing matters.

These are the reasons my reflection on my time as an Air Force medic is useful to me, on occasion: It helps me focus and get back to my “center.”

  • I cared for others and they for me;
  • I personally took few risks, except for riding a motorcycle on freeways;
  • I was not overregulated (highly structured, but not regulated); and
  • I went home most days certain I had done some good while continuing to provide for my family.

And all of this brings us to (drum roll) the point (alright, the “points.”)

  1. Many of the people calling the shots (both elected and merely appointed) have no concept of the notion of “caring.” For too many of them, it appears to run counter to their core psyche.
  2. People in government jobs (or recently elected to another two-, four- or six-year term) don’t need to be risk-averse; the risks they take don’t put themselves in jeopardy. They get to take risks with our lives.
  3. Regulations are the lifeblood of American government. If you doubt it, just refer to the number of pages in the Patient Protection and Affordable Care Act. Governments embrace regulation as a core component of bureaucracy because they allow long-distance control. A bureaucrat can call the shots without having to get their hands dirty, and then can tell their constituents (or their supervisors) what a great job they did today!
  4. Part of career fulfillment and personal security is being able to follow the American Dream: to become whatever or whomever you wish to be. Regrettably, that’s counter to the philosophy, embraced by so many, that being different is bad. In the last half of my life, government has done everything it could imagine to ensure that we all are “average.” Let’s hear it for the center of the bell curve: “Mediocrity above all!”

The simple truth is that regulation is the primary tool of those who truly believe they know more about what we do – or should do – than we do. Whether it’s in the form of ICD-10, Medicare rules, healthcare reform, or any other component of the unending Federal Register flood, we need guidance, control – because clearly, we wouldn’t do the right things on our own!

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

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Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.