As Memorial Day nears, I remember the saddest day of my professional life. That was when the medical director at my former company died. I don't know old he was, but his life ended early as a result of cancer he developed after exposure to Agent Orange as a surgeon in Vietnam.
One of our executives wrote that this was not only a personal loss for employees, but an event that created "a tremendous administrative void in the corporation."
It's a cliché in business that everyone is replaceable. Maybe that's true if all you want is to fill a role competently. But certain people bring an indefinable something to the job, a presence, a quality of energy and uniqueness that's often copied but never matched. They're like people in the Middle Ages who, when lighting fires was difficult, carried a metal box that contained a glowing cinder. Our medical director brought a spark to our business.
He commanded respect inside and outside the company. And he worked fearlessly--independent of the good opinion of others--in a class by himself.
Memories of him highlight the key role a chief medical officer plays at a health plan, and how important having the right CMO in place is to control health insurance fraud, waste and abuse.
It's not easy to direct medical policy research and oversee development of policies that are evidenced-based, cost-effective and fair. It's harder still to implement those policies when they're hotly contested. Perhaps hardest of all is being an active medical practitioner with the backbone to make payment denials against peers and, by so doing, risk becoming a pariah in tightly knit specialty circles.
Our medical director handled all this with grace.
He was an ace-in-the-hole at overpayment recovery meetings. At one, an internist who filed hundreds of abusive claims defended his billings and the needless medical tests he ordered. The internist said his practice patterns saved Medicare beneficiaries' lives. Staring him down, our medical director told this doctor--in a tone that brooked no argument--that he didn't save anyone.
Our medical director was the most quietly effective fraud fighter I've known.
A victory against fraud occurred last week: A Medicare Strike Force enforcement action in six cities resulted in the arrest of 90 people accused of participating in fraud schemes that robbed Medicare of about $260 million, as FierceHealthPayer: Anti-Fraud reported.
"Medicare is a sacred compact with our nation's seniors, and to protect it, we must remain aggressive in combating fraud," said U.S.. Attorney General Eric Holder after the bust.
"Sacred" is a word seldom used in health insurance, but protecting what truly matters is what good medical directors do. And so do veterans.
I come from a military family. My father, straight and strong at 91, is a World War II Navy veteran. My brother is a retired Army lieutenant colonel. Six of my uncles fought in World War II, and another served in Korea. And my cousin, a Marine captain, flew in more than 200 Vietnam combat missions.
As Memorial Day nears, I ask myself if it's possible to thank them enough for their sacrifices. And I honor the memory of a veteran medical director who served dynamically on two fronts. Rest well, dear friend. - Jane (@HealthPayer)