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I don’t want to know anything. It sounds like an extreme statement. Well, it may seem extreme, except that the foundation of that is: 1) memory is fallible; 2) it’s hard (actually impossible) to know everything. It’s also effectively impossible to stay on top of everything.

What is good data?

I think once upon a time when we didn’t have access to good data, we depended upon individuals, managers, owners of companies being really knowledgeable, having had a lot of experience and gone through a lot of things. I’m not saying it’s not valuable. I’d like to believe that the experience that I’ve had running a billing company and doing all the things that I’ve done has value. They’ve taught me things.

I think one of the most important lessons they’ve taught me is that I don’t know that much. It’s not that I’m downplaying my own capability, my own intelligence as just so much transpires and moves so fast. Sure, I can tell extraordinary stories about examples, about Michigan, Medicaid, and all the problems that you have dealing with eligibility and the one-year ordeal we had, going through, trying to understand why that wasn’t working even though we were accessing their system directly. Sure, I have that experience and many other experiences like that.

How can you know everything?

I think what that has taught me is a couple of things, the first of which is, you can’t possibly know everything. It’s impossible. The amount of variables we’re dealing with is really extraordinary. Think of how many payers there are in the country. We’re talking about thousands. Think of how many plans there are for those payers. Another order of magnitude or two larger than that. Think of how many procedures there are in the world, payer policies, diagnoses, and other issues you can run into. You start multiplying those things, and you’re into really extraordinary numbers of combinations. I mean, really extraordinary numbers.

Even if one were able to say, “Hey, I know that if you bill this catheter angiography or something like that with this code and this diagnosis to this payer, you’re going to run into this problem,” that’s great. That’s what I call almost like a focus group, where it gives you an area of focus where you can look at something, but we shouldn’t depend upon that knowledge or that information because things change rapidly. Even if we knew that something was okay or not okay at some point (a day ago, a week ago, a year ago), that doesn’t mean that hasn’t changed.

Payment reversals

I’ve seen situations where UHC, for example, put out a policy basically saying they wouldn’t pay for something and then they reversed it a year later. Again, if you paid attention at any point along the way, you’re going to be in trouble because you may not have known that it’s been reversed or hasn’t been reversed or has changed. So staying on top of that is really tough. Number one.

Number two. If you can’t see it in the data, it may not be real. I’ve seen a lot of situations where somebody may say, “Oh, this is what Medicare allows or says is okay or isn’t okay,” but until we actually see that played out (meaning it’s been billed, it’s been paid, especially for commercial and stuff like that, it hasn’t then been recouped at some later time, there hasn’t been some legal case or something of that years down the road), I want to see it in the data, I want to see that that’s actually real.

Getting things right

More than that, we may not have been correct in the first place. Even if we thought we understood something or knew something, that doesn’t mean that we got it correct. I’ve had many arguments with somebody where they said to me, “This is some policy or this is what you do in order to get paid.” Then, I say, “Show me the documentation to prove that.” And they either can’t come up with something or then when we go and find the documentation, it turns out that they’re wrong. It’s not that the policy changed. It’s that they were never correct. What happened was, somebody came to some conclusion somehow.

Maybe, misinformation was just perpetuated forever, but somebody came to some conclusion about something and then passed that information on to somebody else as if it was gospel. We believed it because that person had been around for a long time, sounded authoritative, or whatever it might be. If you say something with conviction and strong enough and you sound credible, people oftentimes believe it in this industry. I think that’s dangerous.

Believe in the data

I think we should really focus on believing in data and believing in what we can prove and not what we think we know. That’s why I’m taking the position, “I don’t want to know anything.” Also, it’s exhausting. Oh, my God, trying to remember everything. Holy crap! My memory is not what it used to be. I used to be able to memorize extraordinary and truly impressive amounts of data.

When I was at Columbia Business School, there was an accounting class. I was sitting in a classroom with sixty students or something like that, and the teacher put up a huge financial chart on the projector. He asked the class, “What is this?” He was basically trying to look for what type of financial document this was. And I raised my hand and said, “That’s the second quarter 2000 statement of cash flow for Cisco.” 

The entire class because I was at the back of the class turned around and looked at me like, “What the fuck?” The teacher said, “Yeah, I was just looking for, “It’s a statement of cash flow or it’s an income statement,” but you’re correct. That is the second quarter 2000 Cisco statement of cash flow.” It was the fall of 2000 when I was in business school.

Memorization

I memorized all of these things, not really intentionally. I looked at financial statements because I was interested in stocks and buying things and stuff like that. I happened to have seen that, and it stuck in my head. So I recognized the financial statement for Cisco for that quarter. That’s what I used to be able to do.

Now, I have a hard time remembering what I did last Tuesday. Maybe, it’s an age thing. Maybe, it’s just that I’m not training myself. I’m not working to memorize those things. I noticed that I get things wrong, I forget things, I can’t remember things the way I used to be able to where I could just memorize massive amounts of data. That seems normal. I’m now in a position where I feel more normal that I can’t memorize everything from a data standpoint. So I’ve got to depend on the data because I’m not going to remember. So I’ve got to run things and look at them and say, “Hey, you know what? I might have a memory, I think, but let me go pull the information and let’s confirm.”

Final thought

That’s my push for “I don’t want to know anything. I just want to rely on the information that’s available to me in reports and analytics.”