Tomorrow night in Milwaukee, I am going to see Glen Campbell perform in concert, but the occasion will more than likely be bittersweet. The man who has given his music to the world for a majority of my lifetime is on his final tour, having recently been diagnosed as being in the early stages of Alzheimer’s Disease. It is not lost on me that all of the facts in the above paragraph, which my lifetime of music as a hobby has allowed me to commit to memory, will someday be foreign to the very person who made them possible.

As someone who has been involved with the health care industry for over 20 years, I have learned that based on the sheer volume of facts that inundate me on a daily basis, it has become nearly impossible for me to forget key elements of my job. As the cost of health care has become a central focus for cuts in a post-war economy, a number of  memories of failed policies of the past are skipping to the front of my mental line. Nowhere is this memory more acute that in the realm of physician reimbursement from the Medicare program.

Forty-one days from now, a song-and-dance act that has been running longer than Cats will repeat itself, as the increasingly polarized sides of our government once again raise the curtain on this year’s performance of Doc Fix. There are slight casting changes with every performance, but the script is the same. In the torch-lit Temple of SGR, an automated computer program threatens to take money away from the white-coated sailors on the HMS Doctor. As the sailors fight off armies of infirmed elderly waving checkbooks from behind the wheels of their Buicks, an unlikely set of heroes, wearing bad suits and American Flag lapel pins, short circuit the program with a stack of paper. As they stand in the setting sun, they promise to one day rid the world of the computer, but vow to be ready for anything else it plans to offer.

Oklahoma it ain’t……

Medicare reimbursement has gone from “pay everything” at the beginning of the program in 1966, to RBRVS and Gramm-Rudman-Hollings reductions in the ’80’s, subsequently to SGR in the late ’90’s, and finally to a yearly hostage crisis, with the only missing element seemingly being the security camera shot of Patty Hearst with a machine gun. We know this because it has affected us all in one form or another over the years and we have internalized the memories of the negative results of every one of these “solutions”.

Might I suggest that the solution doesn’t lie with finding a new payment methodology, but in finding savings from outside contractors for the Medicare program that (because I have it committed to memory) continuously take money needlessly from the program.

You can start by eliminating Medicare Part C. Virtually all of the “preventive benefits” offered to patients under these plans are now codified into traditional Medicare, which leaves Medicare Part C as nothing more than a government subsidy designed to prop up the insurance industry with billions of dollars that it doesn’t require for its survival.

Next we can go to Average Wholesale Price for reimbursement under Medicare Part D, rather than Average Sale Price. Additionally, pick one formulary and take the program out of many of the same hands that currently pollute Medicare Part C.

As for fraud investigations, leave in place predictive modeling and the HEAT teams, because these methods are actually getting to the root of the problem and are returning ill-gotten dollars to the Medicare program. When it comes to outside entities, we need not develop memories of the Recovery Audit  Contractors, because their abhorrent work product is currently on display for all the world to see. Roughly 2/3rds of everything they do is dedicated to purposeless paper shuffling, rather than the detection of actual improper payments. One marvels at the thought of the massive celebrations that would result if the RACs suddenly disappeared. Farther up the chain, the ZPICs on average collect about 2% of everything they extrapolate as an overpayment, but we don’t really know the actual number because the OIG has stated that the baseline data to measure their performance is fatally flawed. This reminds me that until that data is purified, the ZPICs will continue to mainly operate as a middle man for government-sponsored subsidies to the legal industry. Ask your typical taxpayer if that is something they wish to continue.

The development of the human memory keeps one from being fascinated by the latest shiny pocket watch issue being pendulated in our faces by the self-absorbed politician of the moment. Much like Glen Campbell, there may come a day that the many facts parading in our minds will begin to slip away. Until that day comes, in the realm of health care, memories are not just a rudimentary tool of assistance, but a blunt weapon against the many forces attempting to shove unwelcome schemes into an arena currently collapsing from the bad ideas of the past.

Paul Spencer will be a presenter at the Fi-Med RAC Summit in Milwaukee, WI on April 16th and 17th, 2012. Go to the Summit website for further information on this unique educational opportunity. Use promo code “SPENCER” to receive $50 off the registration price for a limited time.

In the last 50 years, technology has changed the way we live. Other than what surrounds us in our homes, institutions such as aviation, public libraries and finance have seen paradigm shifts thanks to the core technologies at the heart of their operations. Perhaps no other sector has been altered quite like the world of health care.

Over the past few days, with CES’ shadow looming over the landscape, a few indicators of the changes that have either come to or are on the horizon for health care came to light.

The first was a study appearing in the American Journal of Tropical Medicine and Hygiene (now THAT’S specialized) that looked at the role of social media in the reporting of the post-earthquake cholera outbreak in Haiti in 2010. Given the ubiquitous nature of Twitter, the study looked at “tweets” emanating from the quake zone in the time leading up to when the outbreak was widely reported by the news media. What was discovered was that Twitter users were reporting the cholera outbreak and bringing forth case data to the world a full two weeks before then outbreak was widely reported.

This story teaches us that in bold terms that the news cycle is evolving to “up-to-the-minute” faster than any of us anticipated. In the case of a disease outbreak, time between identification and treatment can prevent further loss of life. With the threat of pandemics such as SARS and avian flu over the past decade, we now have scientifically-vetted proof that social media can play a very important part in shrinking that time frame.

Part of CES is what is called a “Digital Health Summit”, where a particular innovation or initiative takes center stage during the keynote address. This year was no different, with Ford Motor Company stating that they are partnering with Microsoft and two other tech companies to design a car that will monitor the driver’s health while traveling.

In reading this item, I was immediately reminded of my car trip this past summer that saw me drive from Milwaukee, WI to St. John’s, Newfoundland, Canada and back. In particular, the drive back became what I can only describe as driving between memory gaps. After setting off at 7 AM in St. John’s, I had planned to stop for the night on a Thursday in Moncton, New Brunswick after 12 hours of driving across Newfoundland, 7 hours on a ferry and roughly 5 more hours on the road from Northern Nova Scotia. What I didn’t count on was that apparently Thursday night is “Take Your Mistress Out To Dinner Night” in Moncton, as every hotel room in the town was booked. What followed was 22 more consecutive hours of driving from Moncton to Milwaukee, with stops only for gas, fast food & caffeinated beverages on the New York Thruway and moose hallucinations along the darkened roads of Maritime Canada. Somehow, I arrived safely in Milwaukee at 2 in the morning on a Saturday.

It would have been nice to have had a car that knew I was seeing antlered mirages, so it could shut off and pull over to the side of the road until it detected REM sleep. I hope that Ford follows through on their concept, not just for the exhausted, but for the drivers with health risks that could pose a hidden danger to themselves and other nearby motorists.

The last bit of technology news borrows something from the dark arts of psychic phenomena. On the heels of a study at the University of California-San Francisco which covered development of useful prognostic indicators for older adults, a new website has been created to help create a mostly accurate estimate of an elderly patient’s remaining life expectancy. While planning end-of-life care is a neglected part of the health care debate in this country, there is something about this technology that sends a shiver up my back. One of my all-time favorite short stories is “Imagine A Day At The End Of Your Life” by Ann Beattie. Someday, when my time comes and with the help of this website, I’ll not only be able to imagine such a day, but I may very well be able to mark it on a calendar. Having always believed that life doesn’t include a two-minute warning, I shall look deep within myself in the intervening years to decide how I feel about such a website.

The lightning pace of technological innovation has brought dramatic change to the science of medicine. It would be naive to think that the emerging technologies indicated above are simply novelties, as for every failed invention comes the spark of furthern imagination. Upon my retirement 25 years from now, it is very possible that one or all of these current technological leaps will be considered a quaint stepping stone to what exists at that future moment in time.

Paul Spencer will be presenting at the Fi-Med RAC Summit in Milwaukee, April 16-17, 2012. Go to the summit website for further information. Use promo code “SPENCER” to receive $50 off the registration price for a limited time only.

My experience with Facebook is hit and miss. I am now careful to limit incoming friend requests to “friends of friends”. The reader might find this next bit of information surprising, but I can actually be quite aggressive on certain topics that I come across in my personal life (that was a demonstration of my sarcasm, of course). When I need to pop off about something with the colorful language I learned in my youth as a Philadelphia sports fan, it is best that these are kept sequestered from the majority of my professional contacts. We have LinkedIn for actual professional networking. As a footnote, in order to satisfy any of your lingering curiosity, I have only ever “unfriended” 3 people, and it has been because I discovered retroactively that some of the friends of my actual friends are political troglodytes.

With the generations coming up behind my own (quick note: please do not refer to mine as Generation X; you young punks would be cynical and disconnected too if you grew up around AMC Javelins and Disco music) feeling free to share anything and everything online, intersections with reality are sure to follow. We’ve learned that it’s not a good idea for the local elementary school teacher to post pictures of herself on vacation doing body shots off the locals in Cancun. Additionally, a few frustrated employees have learned that criticizing your employer with language not normally shared in your typical convent earns you an express ticket to the Island of Free Time.

One such intersection with reality was this recent story from Mission Hills, California. An employee at Providence Holy Cross Medical Center, who was recently hired through a staffing agency, came across a patient’s medical record with featured conditions that he found amusing. He then took it upon himself to post the page from the medical record, complete with patient name and date of admission, as a photo on his Facebook page, accompanied by comments that mocked the reasons for the patient’s encounter. When told by his more level-headed, law-abiding friends in the Comments section of the post that he was violating  HIPAA laws, he said (and I must quote this verbatim so the reader can fully internalize it), “People, it’s just Facebook…Not reality. Hello? Again…It’s just a name out of millions and millions of names. If some people can’t appreciate my humor than tough. And if you don’t like it too bad because it’s my wall and I’ll post what I want to. Cheers!”.

It has never been my professional goal, but how I wish I had law enforcement power for just 10 minutes when I read things like this.   

I was born in the semi-mythical Time Before Pong, but there were two lessons I learned before the age of 6. There are five distinct human senses, and everything on television is fake. With new technology, my 22 years in health care and with the story above in mind, allow me to add an extremely important caveat; while your computer can stream television shows, what you type on Facebook is not, in fact, a mythical television show, but reality. Yes, it is two-dimensional, but no, it is not fake. If you create it, it exists. Additionally, thanks to online archiving, if you create it on a popular networking website, it exists beyond your lifespan, allowing succeeding generations to see not only that you had a bad sense of humor, but that your version of belly laughs came at the expense of someone’s legally codified right to privacy.

Social networking, and the prevalence of internet usage in general, offers challenges that did not exist at the time the HIPAA laws came into being. Health care providers of all types now find themselves playing catch-up to a public social structure that is quickly migrating away from meaningful, face-to-face discourse and toward two to three sentences of unexpurgated online communication (complete with photos) to hundreds – or perhaps thousands – at a time. Many employee policies on technology usage remain woefully inadequate for this environment.  

People employed at all levels of the health care field must be made aware of what is and isn’t allowed when discussing their work in a permanent public forum. Since I have your attention, I’ll start, using myself as an example. I’m a compliance officer for a company that does high-end data analytics that allows health care entities to quickly identify their highest areas of compliance and audit risk. We also provide some medical billing services, but I’m not going to tell you for whom. I see protected health information for medical conditions as part of my daily duties, but that also is none of your business, and I keep it at work.

On a personal note, I am currently employed by bosses whom I actually like and respect and who have done wonders for my professional development. If that happened not to be the case, I would save it for happy hour, which I never document or photograph for public consumption anymore, as my multiple glasses of dark beer kept spilling on my camera phone. To round out, I live with my wife, son, dog and obnoxiously loud nocturnal cat, my main hobbies are music and being a fan of ice hockey, and my bar trivia team can usually be found on Wednesday nights trouncing the local competition at O’Lydia’s Pub in Milwaukee.

Now you have all you need to know to begin to update your employee policies for social networking, as well as my general background, demonstrating once again that there are indeed acceptable paths to spreading wisdom on the internet.

As Vice President – Corporate Development, Hoover will focus on strategy, business development and organizational alignment for the Fi-Med family of businesses.

Mr. Hoover has served on a variety of boards and committees for various professional organizations including the American Surgical Hospital Association, the Wisconsin Hospital Association, and the Wisconsin Bar Association, in addition to numerous community-based charitable organizations.

Here at Fi-Med, we are very competitive and so we have decided to take advantage of our competitive nature by splitting up the entire office into two teams to see which team can collect the most food items. We will be collecting food until January 25th.

Even though times are tough for all of us, let’s take a moment to consider all the other families that are struggling to put food on their tables and try to find ways that we can help. Below is a list of important facts that concern the Milwaukee area:

Food Facts

• Each year Hunger Task Force distributes more than 6 million pounds of food to Milwaukee’s hungry.
• Each month Hunger Task Force-affiliated food pantries serve 37,500 people, and soup kitchens and homeless shelters dish up more than 58,000 hot meals.
• Milwaukee suffers from the seventh-worst poverty in the nation, with a poverty rate of 24.4 %. More than 34% of Milwaukee’s children are living in poverty, the ninth worst in the nation.
• Nearly 40% of families who visit food pantries live on less than $800.00 per month. Many families, even food stamp recipients, are unable to sufficiently feed their families.
• Hunger Task Force advocates for well-run government programs that help people feed themselves and their families, including Food Stamps (FoodShare), School Breakfast and Lunch; Women, Infants and Children (WIC); the Fueling Young Minds Summer Meals Program and the Child and Adult Care Food Program.

In their own words

“I lost my job. All I get is FoodShare and it’s not enough. I came here because I ran out of food.”-Visitor, Salvation Army West Food Pantry

“I have three children. I’m a single parent trying to hold down a job and go to school.”-Visitor, House of Peace Community Center Food Pantry

“All around, there just isn’t enough food.”-Visitor, St. Benedict’s Community Meal Program

Preferred Food Items

• Fruit and Juice: canned pears, apricots, pineapple and peaches
• Breakfast Items: Dry cereal, oatmeal, grits, and pancake mixes
• Protein: Canned meat, poultry, fish, peanut butter, beans, nuts and high-protein main dishes such as chili and stews
• Vegeatbles: Canned corn, green beans, carrots and peas
• Baby Items: Powdered or concentrated infant formula (Nestle Good Start), food and diapers
• Dinner Items: Pastas, rice (plain or mixes), potato mixes, macaroni and cheese dinners
• Lunch Items: Canned or dry soups (vegetable, beef or chicken) and canned pasta items

Please join us as we all work together to really make a difference this holiday season by starting your own food drive!

Like some, however, I am feeling this recession thing but I figured I had at least 2 cents to shell out and give some of my ideas for giving this year that won’t cost a thing except a good heart and a little time…

• Give a thought to our troops overseas  who aren’t coming home for the holidays.
• Give blood if you can. It could help someone get home for the holidays.
• Give a hand to your neighbor with something they may not be able to handle alone.
• Give words of encouragement to someone you know who may have lost their job or home this year.
• Give thanks because you still have a job and home this year.

I spoke to a young lady from Georgia on the phone last week who was calling to give her Tricare Military Insurance information to bill a claim for her 1 yr. old son. When I asked her who the primary insurance carrier was, she stated her husband, Jeffrey. She went on to tell me he was recently killed in Afghanistan. My heart instantly felt heavy. Before I hung up with her I gave her my blessings and I could hear the sincerity in her voice when she said thank you. My heart instantly felt lighter. I know my kind words and the things listed above are free to give and recession proof. Happy Holidays!

Did you find this information helpful? If you have information that you think would be of interest to the medical or business community and would like the information posted on our blog, please submit your request for review to my attention at or via DM on Twitter@fimed

Fi-Med Management, Inc. Ranks No. 1344 on the 2009 Inc. 5000 with Three-Year Sales Growth of 237.7%

NEW YORK, August 12, 2009–Inc. magazine today ranked Fi-Med Management, Inc. NO. 1344 on its third annual Inc. 5000, an exclusive ranking of the nation’s fastest-growing private companies. The list represents the most comprehensive look at the most important segment of the economy-America’s independent-minded entrepreneurs. Consumer electronics maker Vizio, Internet giant GoDaddy, rental car service Zipcar, and beverage maker Honest Tea are among the prominent brands featured on this year’s list.

“Savvy trend spotters and those who invest in private companies know that the Inc. 5000 is the best place to find out about young companies that are achieving success through a wide variety of unprecedented business models, as well as older private companies that are still expanding at an impressive rate, ” said Inc. 5000 project manager Jim Melloan. “That’s why our list is so eagerly anticipated every year.”

Fi-Med Management, Inc. is an award-winning financial management firm providing comprehensive claims, coding, billing, lockbox and financial reporting services to the medical industry.

The 2009 Inc. 5000, unveiled today on Inc.com, serves as a unique report card on the U.S. economy. Despite the ongoing recession, aggregate revenue among the companies on the list actually increased to $214 billion, up $29 billion from last year, with a median three-year growth rate of 126 percent. The Inc. 5000 are responsible for creating more than 1 million jobs since their founding, making the list perhaps the best example of the impact private, fast-growing companies can have on the economy. Complete results of the Inc. 5000, including company profiles and interactive database that can be sorted by industry, region, and other criteria, can be found on Inc.com.

Contact: Lisa Velasquez 714-935-0073

Adrian joins an impressive field of winners in the Wisconsin business commmunity. Awards were presented May 3 at the Wisconsin Business & Technology Expo. The Small Business Times also profiled Adrian’s achievements and the success of Fi-Med.