As Lambed HCA’s chief operating officer, Martha Mulch had clawed her way into a top management post of this large hospital chain by stepping on, over, and through others. Desired results were achieved at any cost and no sacrifice was too great. However, the years of trench warfare were evident. Her round face was a road map dominated by craters and deep furrows. Accentuating her rather plump body was the hairdo from hell. It appeared as if some ill-spirited hairdresser had placed a bowl over her head and then cut her hair short at a precise angle so that it would curl underneath. With the small, oval bald patch on top, the hairdo was an exact replica of the head of a giant penis. In polite company and well out of earshot, she was lovingly referred to as “Mushroom Head,” but the nickname “Dickhead” was far more appropriate for such a mean-spirited individual who ruled Lambed HCA with an iron fist.
GeeHad sneered at Johnny Cinch, Lambed’s CFO. This healthy, athletic, thirty-five-year-old accounting protégé had cut his teeth at Arthur Andersen, an unfortunate career choice, made even more disastrous by his handling of the Enron audit. By virtue of the two years he subsequently spent in prison for his misdeeds, Johnny had been blacklisted by all the large and semi-reputable accounting firms. As if this was not enough misfortune, his personal esteem had been crushed by a nasty divorce and the resulting bankruptcy. GeeHad knew that this was the right man for the job precisely because Johnny’s reputation was tainted. Most importantly, he had learned that Johnny was an expert at playing the corporate shell game and backdating executive stock options. Revenue and expenses were mere numbers on a piece of paper, and debt could easily be shifted from one company to the next. GeeHad felt sure he needed the talents of such a man to line his pockets.
“Johnny, where are this quarter’s operating results and next quarter’s revenue projections?” GeeHad demanded, finally deciding to get down to business after his tirade.
“Ah…” Johnny mumbled nervously, shuffling the profit-and-loss statement to GeeHad and each of the other executives. “For the quarter, Lambed HCA showed a profit, but relative to the same time period last year, our revenue was down ten percent, and our expenses had increased by well over eight percent. Unfortunately, it now appears that next quarter’s projections will also be disappointing,” Johnny concluded, as his voice started to wane. He knew GeeHad would not be pleased.
Immediately GeeHad turned beet red and began wildly beating on the conference table.
“Damn it! These results are absolutely unacceptable! We are a publicly traded company and every quarter our stockholders expect us to exceed our projections. Revenue must go up, and expenses down! Now, let’s start on the revenue side. Johnny, what exactly was the problem?”
“Well, sir, we are being squeezed across the board. The percentage of self-pay patients continues to increase at an alarming rate, and they seldom pay us a dime for valuable services rendered. Additionally, Medicaid recently… Unfortunately, I can’t foresee a viable solution to these problems.”
“Damn it, Johnny, I’ll give you a solution to this problem. I want those sorry, self-pay bastards and the worthless group of unemployed Medicaid deadbeats thrown out of our emergency rooms! Is that understood?”
“Yes, sir,” GeeHad’s corporate minions mumbled collectively.
“GeeHad, by federal law we’re not allowed to deny anyone access to medical treatment, regardless of their ability to pay,” Dr. Cornelius Lyon interrupted.
“Bullshit! Dr. Lyon, get creative! You will either be part of the solution, or part of the problem. You implement an emergency room policy denying those sons of bitches access to our quality medical care, or I will find someone who will! These thieves overrun our ERs and consume our valuable resources. Hell, we need to be pampering the paying customer. I could give a damn if the bastards end up dying in the street! However, as a humanitarian, I do have a soft side. So, if need be, we will purchase vans to deposit their dead carcasses in the slums down on Lower Third. Do I make myself perfectly clear?”
The executives around the table began to chuckle, as they all were accustomed to GeeHad’s tyrannical outbursts, leaving little doubt as to his position on any issue.
“Yes, sir, loud and clear! I will find a solution,” Dr. Lyon answered affirmatively.
Dr. Lyon had been very adept at meeting GeeHad’s demanding expectations over the years. He had no other choice but to do so, though, because, as a convicted felon, no self-respecting hospital would give him privileges to continue practicing as an obstetrician. Convicted of Medicare fraud, Dr. Lyon had spent over a year in federal prison, but was miraculously pardoned by the governor. Now, at the age of seventy, he felt untouchable. Without question he could implement policies which, if scrutinized by federal prosecutors, would result in his underlings taking the fall. Such was the price of success. The more he thought about it, the more he relished the challenge. In his mind, there was something very exciting about circumventing the law.
“Johnny, what’s our problem on the expense side of the ledger?”
“Well, sir, the cost of doing business is increasing across the board. Our labor expenditures continue to escalate at an alarming rate. Also, the drug manufacturers, citing the cost of product development and the threatened loss of patent protection, find it necessary to increase the price of their products by fifteen percent every year. Additionally, our expenditures for supplies and products keep rising, as well as the costs for telephone services, water, electricity, and sewage,” Johnny replied, his voice lowering as he bowed his head.
“That’s outrageous! It’s clearly time to squeeze the greedy drug manufacturers and our worthless suppliers,” GeeHad insisted, pounding the table yet again. Seconds later, he was calm and rational. Dead silence suddenly filled the room. Everyone gathered around the conference table felt that this was the eye of the storm.
“Now Johnny, please share honestly with me your overview of where Lambed HCA stands,” GeeHad asked in a cold and calculating voice.
Johnny Cinch squirmed in his chair. He could feel the beads of sweat ooze from his pores as dozens of self-serving eyes ripped into his soul, demanding answers.
“Well, the percentage of self-paying patients continues to increase, whereas the percentage of paying customers is decreasing. The net result is the loss of millions of dollars a year due to indigents not paying their bills. For example, in the emergency room we collect only thirty-seven cents on every dollar billed. Given these facts, along with the prohibitive costs of complying with existing federal mandates, it’s a miracle that any hospital is turning a profit,” Johnny concluded in an ill-fated attempt to rationalize his dismal corporate report.
GeeHad took a few moments to review the quarterly profit-and-loss statements from each of the twelve hospitals he controlled. All appeared to be in line, but the numbers were extremely discouraging. His train of thought was interrupted by a thunderous explosion from a lighting bolt, which felt like it touched down only blocks from the hospital. The lights flickered but remained on. Once again, the boardroom was deadly silent.
GeeHad stood and walked toward the window. It was pitch black outside, so he could not see the street below begin to flood, but he could make out the tops of tall trees being whipped back and forth. The rain was now coming down in sheets, pounding against the glass, and the force of the wind was so strong that it caused the windows in the conference room to vibrate.
Suddenly, there was a brilliant flash of light, followed by another thunderous explosion, and then the lights went out. Sixty seconds later, the hospital’s generator came online, establishing emergency lighting. In the subdued lighting, the conference room took on a sinister glow.
Somehow, GeeHad felt energized by the violence of the storm. He turned toward his executives and, with a deep, confident voice, issued the marching orders.
“We are in a war, and in this war you either win or you lose. The bottom line is that we need to increase revenue and slash expenses.