March 15, 2021
5 Minutes with
BC Advantage (BCA): Tell us about yourself, your training, and how you became an expert in healthcare regulatory compliance and auditing.
SW: I have truly been blessed in both my personal and professional life. I have been married to my beautiful wife Jill Ann for longer than I thought she would stay with me and we have raised three amazing kids (McKenzie, McCord, and McKayla… better known as the McKids!) and have now been blessed with five outstanding grandbabies (Hadley Rae, Phinley Ann, Emerie Rose, Fischer Thomas, and Clyde Patrick). I am a good ol' southern boy as many who know me will attest, but don't let my southern drawl, good manners, looks, and charms fool you! I have been so fortunate to be surrounded by and mentored by some true giants in the industry that have allowed me to take bits and pieces of each of them and apply those pieces to myself to make me as well rounded as possible. The truth is my career which has spanned 25+ years has not always been a yellow-brick road! I have had some stumbles along the way, but as I learned early on in life, the fall is not what defines you, its how quickly you get up and your ability not to fall again over the same bump!
I got into healthcare truly by accident. I was working toward my commercial pilot license in 1993 and due to vision problems (became colorblind), I was forced to figure out something else to do. In my junior and senior years in high school, I was in a program called Health Occupation Students of America (HOSA) and loved working in the various settings they put us in. When I got to college, I focused on life sciences and thought I wanted to go pre-med, but after taking my first business class, I was hooked and transitioned to business. I was one of those kids with severe ADD before ADD was a mainstream diagnosis, which is why I jumped around so much-until I landed on what I do for a career. Even since I began working, I have transitioned my focus several times, until I landed on Regulatory Compliance and Health Law, which was at the 5-year mark in my career.
BCA: Can you describe a typical workday for you?
SW: Every day is different because of the type of cases I get to work on, the clients I support, and the healthcare professionals I get to work with. Over the past 20 years, I have really focused on strategic defense litigation services and audit appeal representation. With the help of what I would say is one of the best professional auditing teams, hands-down, we work with more than 25 law firms across the country preparing cases for arbitration, litigation, and appeal. Beyond that, we do a lot of forensic audits, revenue cycle management reviews, serving as Independent Review Organizations, Facilitators of Settlement or Resolution Agreements with Office of Inspector General, Department of Justice and the Office of Civil Rights for medical practices and health systems.
When I am not working on cases, I provide solution-based services for providers across the country, which include audits and education, development of corporate compliance programs, and serving as Chief Compliance Officer for some of the nation's largest medical groups. I am also very fortunate that I get to present a lot of education sessions throughout the course of the year and author quite a few papers and articles.
BCA: How do you stay on top of the ever-changing rules, regulations, and news that our industry faces?
SW: This industry is ever-changing and growing more complex by the day, it seems. Outside of collaborating with my teammates and other partners within DoctorsManagement, I often engage with healthcare professionals who are members of NSCHBC, AHLA, HCCA, AAPC, AHIMA, and other specialty societies. I work hard to maintain relationships with folks on Capitol Hill that I have engaged with throughout my career, as well as those at OIG, DOJ, and OCR, and some amazing and hard-working folks at CMS and various private payors. Mostly though, I do a lot of independent research and spend my time reading documents that most folks would never want to simply because they are really boring. My very first job in healthcare was in 1995 with The Medical Management Institute in Alpharetta, Georgia. The CEO was Bob Keene, a retired Major (Air Force). Every day, he was in the office before anyone else reading the Federal Register and Part B Newsletters from the various Medicare Administrative Contractors (MACs) around the country so that he could provide guidance to all of the consultants to ensure we were well armed with information before going out to clients. As Bob got older, several of us stepped up and took over reading all of those documents and more, and I guess it just stuck with me throughout the years.
My guess is that I spend somewhere in the neighborhood of 20+ hours per week reading and researching.
BCA: What has been the most reoccurring question from your clients in 2020?
SW: "Am I a government target for audit or investigation?" The reason is, 2020 was such a crazy year with rule and policy changes from CMS, and honestly, all the payers trying to figure out how to cope with COVID-19.
BCA: What do you believe to be the most challenging topic facing the industry in 2021?
SW: I am a regulatory and health law guy, so: payor audits and government investigations will be the biggest challenge/risk in 2021 to healthcare organizations. The risks beyond the normal ones all stem from the changes in 2020 due to the public health emergency (PHE) and those especially tied to the 1135 Waivers (Telehealth, Incident-To, etc.) since many of the guidelines that were relaxed as a result of the waiver(s) are 180 degrees from the normal requirements. Again, the interesting thing will be, once we are out of the PHE, is what CMS will do with the changes made during the PHE, because some of the changes were great for providers and patients alike; and telehealth, while problematic for a number of reasons, has proven to be a sustainable service that should remain in effect after the PHE-in my humble opinion.
BCA: What topic do you feel many practices do not spend enough time or resources on, and how would you direct your clients moving forward?
SW: There is one thing that I tell all clients and those I am fortunate to lecture in front of and write for: your corporate compliance program! Your efforts with how you build, implement, monitor, and revise your compliance program will have the most impact if and when your organization or provider(s) are targeted by the Office of Inspector General or Department of Justice and will play a huge role in a prosecutor's charging decision or whether or not they seek a plea agreement or some other type of resolution to a perceived violation whether it be civil or criminal. A compliance program cannot be a "paper" program; it has to be a living, breathing document and you have to demonstrate a culture of compliance within your organization. That means compliance starts at the top and trickles down to all employees regardless of title or role within the organization. Compliance does not have to be this 3-headed monster that is so complex and overwhelming that no one will comply with it. The truth is that the compliance plan itself is static for the most part; once your build it, unless there is a dramatic change to your organization, it is what it is. The driver of any sound compliance program are the policies and standard operating procedures (SOPs) as those need to remain fluid and written in a way that allows maximum flexibility in keeping with the requirements of published guidance documents. That is why when I draft policies or SOPs for clients or I am advising them how to draft them, I use the KISS principal!
BCA: Do you have 2 or 3 questions you always like to ask a new practice that can really give you quick insight into their potential needs? And why those questions?
SW: Anyone who knows me knows I can't just ask 2 questions, but if I could only ask 2, they would be: First, do you have a corporate compliance program? Second, is it an effective one? (Please see my answer above for why I ask these two.)
BCA: With COVID-19 restrictions in 2020, how has it changed the way you deal with clients for the good and bad?
SW: When the pandemic hit, I thought, oh boy, we are in for it now. I travel 36-42 weeks annually, between speaking at live events to being on site with clients, and in court rooms. The fact that we were able to pivot as an industry so quickly with the help of technology is what saved our industry from the devastation suffered by so many others. The ability to use Zoom or Go-To-Meetings allowed us to maintain that face-to-face relationship with our clients. I think it also allowed us to see clients in their true state and they got to see us in ours. When the PHE first hit, my inbox and my phones were completely blown up, and that lasted for several months as clients were seeking guidance, insights, solutions/work-arounds, and help with drafting policies and SOPs to navigating the PPP and other funding created by Congress and what it could and could not be used for and the terms for repayment and ensuring compliance with all of the information that was thrown at us in such a short period of time.
The bad part to this PHE was the constant changes we were subjected to by the payors and how fast they changed their policies. I do not begrudge them in anyway since this was all new to them and they were trying to figure it out. I think the biggest lesson that I along with all of our clients and most likely the vast majority of healthcare organizations learned from what we went through is that we have to be better prepared. We have to have a contingency plan. We have to have PPE stockpiled, and we have to know where and to whom we turn to internally when we experience something like this in the future. Simply put, we have to have a plan!
BCA: Moving forward into 2021, what's the one thing you would like to see practices concentrate on the most?
SW: I want to see practices get back to normal, but that does not mean being lax. We have to keep our guard up and we have to look at every day like today could be the day we're hit with another crisis, and as healthcare professionals, we have to be prepared. Our frontline workers have been and continue to be the beacon on the hill for all of us. They give selflessly and put themselves into harm's way when others are running in the other direction. Clinicians have to be given a seat at the boardroom table, because things cannot be just about profits. That mentality is what put so many health systems at risk of financial ruin and an inability to properly care for patients. Clinicians, for the most part, do not care about the business of medicine; they care about humanity and how to best care for and heal the sick. I can assure you that many executives at health systems who got sick or had one of their family members get ill with COVID-19 and experienced shortages in supplies were gasping for air and desperately trying to figure out how to rectify their bad business decisions putting profit over care. Let's hope they learned their lesson and have reversed some of their bad policies to prevent the same mistakes in the future.
BCA: Outside of the office, what do you enjoy in your free time to relax and take the stress off work?
SW: Those who know me know I'm a good ol' boy from South Georgia. I spend my time with family and working on our 84-acre farm to get away from all the stress of the 60-hour workweek. There is nothing better than getting on the tractor for 6-hours and bush-hogging or plowing the fields since it is mindless work and it allows me to reflect on what really matters and that is my family and how I can make their lives as great as possible. When I am not doing work on the farm, I am an avid weightlifter. I have been lifting weights since I was 13 and it has always been something that makes me feel healthy, physically and mentally, and without a doubt helps with the physical demands of working our land. Other than that, I love vegging in front of the TV watching the Food Network (Guy's Grocery Games, Chopped, etc.), The History Channel (American Pickers, Pawn Stars, etc.), and Major League Baseball (die-hard Red Sox Fan).
BCA: Before we go, did you want to give our readers any tips or personal thoughts for moving into 2021?
SW: Once we are out of this PHE and life begins to return to a sense of normalcy (whatever that is), don't forget what 2020 was, in the sense it tested us to our limits in many cases. Don't forget those who sacrificed so much and all those who made the ultimate sacrifice to care for the sick. Be grateful for each and every day and don't take for granted any of the little things. Strive to be better today than what you were yesterday and do something for someone randomly, anonymously. I am all about paying it forward, but without getting any of the recognition. I have been blessed with so much in this life (family, friends, co-workers, clients, and even random strangers who brought a smile to my face) that for me not to give back would be shameful. Take time to give thanks for what you have, no matter how little it is, because at the end of the day, there is always someone a lot worse off than you-whether you want to believe it or not! We will get out of this nightmare by the fall of 2021 or once we achieve "herd immunity" (60-70% of the U.S. population will have to be vaccinated), which at some point, we will. Until then, be good to yourself and others!