“The Big Ugly” meets Speaker Academy #19: What’s up with expense checks??

Source: Wikimedia

Source: Wikimedia

This is the latest in the Speaker Academy series, which started here. The series is addressed to patients and advocates who basically know how to speak on a subject but want to make a business out of it. I’ll try to be clear to all readers, but parts may assume you’ve read earlier entries.

I’m really not happy to be writing this, but push has come to shove. Two thirds of my expense reimbursements are past due, and fully a third of them are more than 90 days out.  I’ve seen some people stretch payments at times, but I’ve never seen anything like this.

The stories I’ve been getting about “gosh, sorry, there’s nothing we can do about it” or “gosh, the only person who can write checks went on vacation” or “we only print checks on Thursdays and she was out when she came back from vacation” are familiar, but this year they’re much more common.  What’s up, healthcare? Is The Big Ugly coming home to roost?

wrote about The Big Ugly last year:

… something I’m starting to call The Big Ugly – a wave of suffering that will happen as the medical industry contracts, and everyone tries to find ways to maintain their income. Unfortunately when an industry shrinks, everyone can’t maintain the same income. As anyone knows who’s seen an industry die (like mine, typesetting; or steel in America, or what Detroit went through), it’s painful. Good people get hurt, and organizations fight for survival.

It’s interesting, because the people I work with, for the event are good and almost entirely on time with paying my fees. But expense reimbursements? They seem to go through a different approval and payment process. I mean, things get lost in the expense rabbit hole, and even my good-to-work-with friends are unable to extract them.

Honoring agreements can be done – check out the Client Honor Roll that I posted a few weeks ago in #18 – organizations who have paid every single check on time. All you who say “There’s nothing we can do,” take note: it can be done. So it’s time to start naming names of offending companies.

I know if I do that I’ll never work with that client again, but I’m willing to risk that. It won’t help me a bit, but it will set a precedent: this abuse of business partners must stop. This isn’t so much about me as it is about patient voices who are just starting to speak. For them, late reimbursement can be a serious problem. (More on this in a moment.)

As I said in Speaker Academy #16 (“Being businesslike about cash flow”):

4. There are many ways the train can jump the track.

…Most clients are great to work with. Others are disorganized, and some are schnooks….

  • The disorganized …
  • The weasels. In some organizations the finance people are weasels (there, I said it) who routinely drag their feet on paying all bills, not honoring contractual agreements. Note: finance can be weasels even if your contacts are great….

Weasels thrive in vagueness, and the disorganized live there naturally. So in your communications, be specific…

Well, I’ve used my own methods (very specific communication) for months now, and it’s not working. So, starting tomorrow, I’ll do the blogging that I said (in #16) I’ve never had to do: I’m going to paste in the entire email thread from the current worst offender, with no names attached. And if the money hasn’t arrived by Friday, the names get added. (Their next scheduled check run is Thursday, and I’m sure they know how to use Fedex.)

Honestly, I hope this will cause public embarrassment – within the company – for the individuals responsible for not getting the job done. Actually I imagine (from my experience in business) they are getting the job done, by holding onto cash that they owe other people, all the while saying, “There’s nothing we can do.” In that case, the responsibility is with top management.

In the patient empowerment world – where our lives may be on the line – we know that “There’s nothing I can do” is the expression of being disempowered, and we don’t accept that from each other. As I said in #16:

What [these slow payers] don’t understand sometimes is that to a big business on a fat cushion, being squeezed may be unfair but it doesn’t hurt much. To a tiny business (that would be you) it can be fatal, or at least harmful: to a tiny party, poor cash flow can trigger bounced checks and late fees, which can start the cascade into bad credit scores and other darkness.

Game on.


21 comments to “The Big Ugly” meets Speaker Academy #19: What’s up with expense checks??

  • e-Patient Dave

    btw, the dollar amounts involved in this theft are absurdly small to a huge company, which makes this all the more stupid.

    In this case, W.O. (“worst offender”) has owed me $1205 for 3+ months. If they’d paid it back within 30 days, it would have cost them 2 months of interest.

    Now, if they have it in an account that magically earns 6%, that’s about 1/2% per month, so their 2 month cheat gained them 1%, i.e. $12.05. And that, ladies and gents, is money they’re basically stealing from the victim. All that, for a $12 theft from the little guy. (Or, probably, less, because who has an account that earns 6%??)

    Again, I’m not so concerned about myself as I am about other unfunded patient speakers yet to come, because 2-3 years ago I was EXACTLY in that place, and it really, truly hurt.

  • e-Patient Dave

    Comments from Facebook:

    A pathologist: ” I think I mentioned once that my hospital used to routinely wait until they were threatened by suppliers to (reluctantly) pay their bills. It was SOP.I was astounded when I found this out. Go for it, Dave.”

    Mark Graban, speaker & author of the award-winning Lean Hospitals: One advantage of going through a speakers bureau is that getting paid promptly is not a problem, thankfully. (I agree. Note that on my Honor Roll post, “special honor” for full payment at or before the event went to SEVERAL events organized by Executive Speakers Bureau.)

    Bart Windrum: Thank you for taking this on. I’m curious to know: have you directly emailed the people in the offending companies about this move you’re making? Given them a “heads up”? [Yes, as I said in the earlier post, I do.]

    Me: In one case, the VP of PR (!) told finance “We can’t afford the reputational risk.” Isn’t that delightful? It beautifully spotlights that they DEPEND on not getting outed. Well, game on.

    Dave Kourtz: Fortunately….there still are many whose word is good. Shame to those organizations that do not honor their commitments. Hope the Fedex truck arrives with the check!

    Bart Windrum: Glad you’re big enough to apply some muscle. Hmm: maybe next time just add a fixed amount to your speaker fee to cover expenses and don’t submit any expenses.

    Dave Kourtz: I do have some (not all) clients that we agreed to a fixed $ for expenses….much easier for all.

    Mark Graban: Do you collect half your fee up front?

    Me: 25%, Mark. I blogged my standard contract in #15: http://www.epatientdave.com/2013/12/10/speaker-academy-15-the-contract/

  • e-Patient Dave

    And an interesting idea from Mark Graban: I suggest switching to half at signing and half right before speaking or at the event. Softens cash flow blow from expenses being paid late.

  • RCatlett

    After a 5o some year career in various types of business I can say with authority that non-payment or late payment of small corporate debts usually means there isn’t enough money coming in to match the expenitures going out. A basic tenet of business is that you must make more than you spend or you eventually go bankrupt and nobody gets paid. If people don’t recieve payment for their goods and services provided, they quit doing business with the offending company…another sure cause for an unsuccessful business. If people are late in paying (no matter what the excuse they give you) go on red alert and be very careful about providing any goods or services (even paying expenses)Ask for payment in advance or go on a COD basis with the worst offenders. Otherwise, you could be the one stuck in the middle and unable to fund your own business.

    • e-Patient Dave

      Thanks, Richard. That’s a far more complete explanation of what I mean by “The Big Ugly”! Not a pretty situation to be caught in.

  • Sherry

    Boeing is paid in 1/3’s the first when you order a plane, the second when they start to build it and the last 1/3 when you take delivery..

    That being said – EHR implementations if you are a consultant you are always expected to cover your own expenses and then submit for reimbursement.. This is a huge expense since you often are forced to fly home each weekend and are in a hotel during the week (they won’t cover the hotel over the weekend but will cover flights oddly enough).. It often is about a month of expenses before you see the first check and I often would cover other people’s expenses for them so they could eat

    • e-Patient Dave

      Yes, Sherry – in Speaker Academy I’m specifically focused on the issues facing the individual who’s relatively new to making a business out of being a speaker in healthcare. It’s hard enough for an individual without investors to make a go of it, and as I said in #16, cash flow is as essential to survival as blood is to a body.

      I also want provider clients to realize, add I said in 16, that doing this to an individual – especially a solo patient – is a whole different problem ethically and pragmatically than doing it to a big well funded business partner.

  • Re: half up front/half just before speaking: if the second half ain’t there are you really not going to mount the stage? The talk session is set in time-stone, the crowd will move on when the clock strikes; payment would require fairy-dust and/or Star Trek transporting. Is this really a practical solution?

  • Dave Harrison

    I’ve worked with a lot of different companies over the years in various capacities — consultant, speaker, etc. I have to say some companies are simply better at dealing with these kinds of expenses than others. Some large recognized brand names that I won’t name are often some of the worst offenders, acting as those the Net terms are “suggested.” For some of them, I just have to accept it … if I want to do business with Company X, I’m going to have to accept I won’t get paid for 90 days past due.

    It clarifies what companies you want to work with in the future. I simply say, “Look, your company can’t pay its bills on time. Sorry.”

  • Anonymous

    Sorry to be anonymous, but you’ll understand why.

    First off, this problem of stretching out payment terms and squeezing suppliers is a general pox on business, not just healthcare:


    I was at a hospital today where somebody in laboratory leadership complained that the hospital hadn’t been paying suppliers. Their one supplier of lab supplies had cut them off from any new deliveries because the hospital owed them $20,000. The impact on patient care would have been huge. The lab had “Lean” inventory levels so they didn’t have extra inventory to ride out the supply chain problem caused by the hospital.

    The hospital was intentionally conserving cash to get up to 90 days of cash on hand due to some finance review related to their bonds (they’re doing a ton of construction and renovation). After that review, they could resume paying vendors and cash would go back down to their usual 75 day level or something.

    1) If the hospital is broke, why are they spending so much on construction???

    2) It goes to show there’s very little business sense in hospitals.

    • e-Patient Dave


      Everyone, if you want to understand the nasty (and, a Forbes blogger said, stupid) business side of this, take 5 minutes and read that whole article.

      Thanks, Anon. Much appreciated and well said.

      I trust you’d agree that this is The Big Ugly happening, yes? (And as I say, for me it’s a lot worse than previous years, so I’m guessing crunch time is coming, some providres are hurting, and it’s going to get worse.) Yes?

  • e-Patient Dave

    I’d like to point out, in the article Anon cited, that the financial calculations were similar to what I proposed. In that article, the company saved $8, and it cost the supplier $369. It’s hard to imagine anything being less of a “partnership”; it’s Party A holding down Party B and screwing ’em.

    Anon says s/he has a distinctive product so has some leverage, some ability to walk away. I will certainly walk away from any relationship like that; I’d do business again, but with the money up front.

    The stupid thing about this is that if they’d just SAY they want to pay $8 less, they could say that, but instead they make an agreement then cheat on it.

    btw, I wonder if the provider/client who’s stringing me out is in such a cash-poor situation, or conserving cash to get some bond approved. I guess we’ll find out this weekend, if their name goes public.

  • Hi Dave,

    The trouble with most big organizations that are booking speakers for a large conference or media event or consultation is the vast wasteland that exists between the very keen organizers that you actually talk leading up to the event, and those who cut the expense cheques who work in the mysterious Finance/Accounting Department. It seems that never the twain shall meet…

    But I had an interesting experience when I was asked by a TV news producer in Toronto recently to fly from my home in Victoria over to Vancouver to film an interview for a national news broadcast later that week. The very keen producer asked me to let her know the details of my flight itinerary so she could let the Vancouver film crew know when to expect me.

    “Ah, no. That won’t be happening!” I reply. “I won’t be putting a $500 return flight onto my own credit card and then waiting endlessly for reimbursement. Let’s put it on YOUR corporate plastic instead.”

    Next thing you know, she is phoning me back within minutes with my requested departure and arrival times, flights pre-paid by her American Express corporate travel card.

    Apparently, all I had to do was ask . . .

    BUT, there was the little niggling matter of $20 reimbursement for the return taxi trips from the floatplane terminal to the downtown TV studios that day. I had dutifully submitted my taxi receipts to the very keen Toronto producer on the Day Of – who promised that the cheque would be “in the mail”. Then I waited. And waited. And then I started sending weekly e-mail reminders. And leaving phone messages. And more waiting. All for 20 measly dollars!

    Nothing seemed to be working – the once-keen producer in Toronto wasn’t even returning my calls or acknowledging any of my weekly emails. Perhaps they were just hoping I’d politely go away over such a small amount – and to tell you the truth, I was feeling a bit cheap for hounding them over 20 bucks. But to a heart patient living on a very modest disability pension, every dollar does count.

    So finally, I did the only thing I could think of: I went straight to Twitter, asking both the producer and her employer directly when I could expect to receive the past due $20 reimbursement for my Vancouver taxis on ? Within hours – HOURS! – I got a reply tweet and an email from the no-longer-keen producer: “Sorry, sorry, sorry!” Blahblahblah… And the money arrived a couple days later. Just. Like. That. Thank you, Twitter!

    • e-Patient Dave

      Thank you, Carolyn! Good for you!

      Doesn’t that once again just illustrate what I said? “They DEPEND on not getting outed.”

      As I said: Game on. Maybe we add to our contract terms, “Name and home address of your CFO.” :-)

      — But seriously, I again want to spotlight the clients who ARE great partners, paying everything on time. I’ll paste in the honor roll again:

      Special honor

      These clients paid their deposit and expenses on time, and paid the rest of my fee at the event – or even before! In chronological order:

      Dignity Health, March 2013
      Michigan Hospital Association, May 2013
      SAS Institute, May 2013 (via Collaborative Agency)
      PFCC Partners annual meeting, June 2013
      Iowa HospitalAssociation (Executive Speakers Bureau), June 2013
      National Council of State Boards of Nursing, Aug. 2013
      Kansas Hospital Association (Executive Speakers Bureau), Aug. 2013
      Qualidigm (CMS’s Connecticut Quality Improvement Organization), Sept. 2013
      ESRD Webinar (End Stage Renal Disease), Sept. 2013
      Tennessee Hospital Association (Executive Speakers Bureau), Nov. 2013
      Virginia Hospital & Healthcare Association (Executive Speakers Bureau), April 2014

      Honor Roll

      These clients paid every single invoice within 30 days. Thank you!

      Aligning Forces for Quality speaking tour, Humboldt CA, Jan. 2013
      Health Action Council, Columbus OH, Jan. 2013
      “My Health Counts” TV program (WNED-TV), Feb. 2013
      Institute of Medicine roundtable, Feb. 2013
      Regional Telehealth Conference (Billings, MT), March 2013
      IKF (my Swiss host), March 2013
      Saskatchewan Health Quality Council Summit, April 2013
      Wharton MBA Lecture, April 2013
      British Medical Journal (essay honorarium), April 2013
      BMJ / IHI Quality Forum, April 2013
      Michigan Hospital HR Conference, April 2013
      Maine Hospital Association (Executive Speakers Bureau), June 2013
      The Alliance (book order), June 2013
      U of Wisconsin web lecture (Patti Brennan), July 2013
      AHRQ / Westat, July 2013
      Meditech (LSS Data Systems), Aug. 2013
      Book order – National Council of State Boards of Nursing, Aug. 2013
      Stratis Health (project work), summer 2013
      Trillium Partners “Back to School” conference, Sept. 2013
      Book order – Orion Health, Sept. 2013
      Schulman Associates IRB, Sept. 2013
      Facilities Guidelines Institute, Sept. 2013
      Berci’s social media course at Semmelweiss University, Budapest, Sept. 2013
      NEHI annual meeting, Oct. 2013
      NEHI book order, Oct. 2013
      World Parkinson’s Congress, Oct. 2013
      Penna Hosp. & HC Association (Executive Speakers Bureau), Oct. 2013
      National Kidney Foundation of Michigan, Oct. 2013
      Partnership for Quality Care, Nov. 2013
      Nebraska Hospital Association (Executive Speakers Bureau), Nov. 2013
      AMIA Fall Symposium, Nov. 2013
      Heartland Kidney Network, Nov. 2013
      Executive Speakers Bureau (internal event), Jan. 2014
      NQF Annual Meeting, Feb. 2014
      HIMSS consumer symposium, March 2014
      Wharton MBA lecture, March 2014
      National Board of Medical Examiners 100th annual meeting, April 2014

  • I have used a bit of word-marketing to get my fee up front.

    Saying to the customer “…my price is $ x, but if you pay in advance…its x-15%.”

    Controllers are happy to grab the discount…..and I get the $ I originally wanted.

    (I do consulting as an Executive coach and some minor other projects)

  • bart Windrum

    So Dave, you mentioned a ton of outstandings. Have all of them come in? This thread has gone dark…

    Another thing I picked up when doing software training years ago: before you leave for the gig call the Accounting department, speak w/the supervisor, familiarize him/her w/your gig and its $ particulars, ask how to get paid, etc. Nothing like a) hearing things from the horse’s mouth (I presume I’ve got the beast lined up right ;) and b) becoming known.

    • e-Patient Dave

      Oh, heck no. The work continues. There’s half as much seriously past due, but still plenty. Cash is tight here.

      Several people have suggested that I get my money up front, or charge a flat rate for expenses. Your idea about contacting the check-writers is sensible. Thing is, this crap was RARE before this year. Hence the title of this post.

  • e-Patient Dave

    Since this post, most of my past due payments have come in. (As has happened before, the one that I was going to blog about, pasting in our emails, miraculously was paid immediately. So much for “nothing we can do.”)

    But I want to catalog here some specific things from emails I’ve received (and sometimes text messages) this year. When you haven’t been paid, and you’ve asked, the first time you get one of these from a client, prick up your ears and ask for specifics on when you’ll be paid. (Again, see “Some is not a number” in #16.)

    If that does not materialize on that date, You Might Be In Weaselville. Ask nicely but firmly and specifically one more time: “On Dec. 8 you said X. I don’t think it’s happened. Can you check? This is becoming a genuine problem for me and I’m concerned.”

    Here’s a list – I’ll add to it as time goes by:

    “Gosh, sorry, there’s nothing we can do about it”

    “Gosh, the only person who can write checks went on vacation”

    “We only print checks on Thursdays and she was out when she came back from vacation”

    For an April 23 inquiry on a March 12 expense report:
    “We’re finally closing out the event and will process reimbursements this week.” (May 19)

    Nothing after that until June 9:
    “Because of some unforeseen barriers, the close out of this project was delayed.”

    “I thought it went out – let me check. I’ll get back to you in a couple of days.” (Respond: “Thanks – for my notes, what day will I hear from you?” or “I need to update my notes – could you find out now? It is late, after all.”)

    “Your reimbursement is already being processed.” Perhaps – but notice that there was no “by when” on it. It actually arrived 11 days later. By Fedex.

    Better news is “The check was sent out Fedex today.” But even this has sometimes turned into “Gosh, we don’t know what happened.” So ask: “Could you ask them for the tracking number?” Then you can verify it’s been shipped, and track it online.


    There are more, but you get the picture. As I say, the first time you hear one of these it’s not good – remember the Honor Roll of clients who are NEVER late. The second time, it’s trouble.

    (Note: if you’re really short on cash, one way to avoid this whole thing is to ask the client to directly pay for airfare and hotel themselves. Or perhaps negotiate a flat fee for expenses, so you never even touch this world.)

  • […] #16 (January) I said “For a small business, cash is king.” Then in June, #19 was titled: “What’sup with expense checks??”  To a small business (like a patient […]

  • […] “The Big Ugly” meets Speaker Academy #19: What’s up with expense checks?? […]

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