By Roy Snell

Editor’s note: Roy Snell is a founder and served as the first president of the Health Care Compliance Association from 1996 through 1998. He was appointed to serve as the HCCA’s Chief Executive Officer in January 2001. He may be reached at 888/580-8373 or by mail at roy.snell@hcca-info.org.

There is a theory or, perhaps myth that hurricanes start with a single flap of a butterfly’s wing. Fact or myth, it is clear that the HCCA started with an event just as insignificant as the flap of a butterfly’s wing. In late 1995, soon after the University of Wisconsin asked me to take on the role of compliance officer, one of our compliance auditors met Mary Dunnaway, corporate compliance officer (CCO) for the University of Arizona, and suggested I call her to share compliance war stories. Our conversation was so robust it seemed evident that there must be others out there that could benefit from sharing compliance war stories. Mary agreed to help set up a compliance meeting in Minneapolis as a part of the 1996 annual Medical Group Management Association meeting.

Thinking that they would be a good draw, I called Brent Saunders from Thomas Jefferson University and Ed Longozel from the University of Pennsylvania. They agreed to come and speak at their own expense. Almost everything we did in the first year was at the expense of our organizations and the HCCA owes a great debt of gratitude to The Universities of Wisconsin, Louisville, Pennsylvania, Thomas Jefferson, and the Law firm of Montgomery, Macrakin and Rhodes.

Opportunity to network
The room in Minneapolis was packed with people who had flown in from both coasts to attend the three-hour meeting. About 50 were invited, 30 agreed to come and 60 showed up. It was clear that there was a significant need for continued networking among compliance professionals. So, working on napkins that evening in a Minneapolis Chinese Restaurant, Brent Saunders and I started what would become known as the Health Care Compliance Association (HCCA). Actually some of this story may be embellished due to that lack of a photographic memory, a great imagination, and a real passion for the HCCA. That night it was decided that I’d serve as President and Brent would serve as Vice President.

Some of us stayed on in Minneapolis to attend the MGMA meeting. One of those who stayed on was Debbie Troklus from the University of Louisville. I sat down next to her at a presentation, told her about HCCA and she signed up for duty as our Second Vice President. Since that day, Debbie has contributed more time and effort to the HCCA than any other single individual.

Throughout 1996 and 1997, the search was on for more volunteers. Brent found Lisa Murtha who had taken on the CCO role at University of Pennsylvania. Lisa assumed the job of treasurer and her charisma and practical experience helped attract many new members. We also invited Greg Miller to join the HCCA Board of Directors. He has been a mature voice of reason, helping to steady the aggressive and entrepreneurial nature of the other founders. Tom Suddath became our legal counsel and more importantly our political and spiritual guide on issues relating to conflict of interest, ethics, and integrity.

In the beginning
HCCA started out as a Special Interest Group of the MGMA. The part of the MGMA with which we were affiliated was committed to having their next meeting (February 1997) in Hawaii. We called the MGMA to tell them that we were going to have our first meeting stateside because it would look bad to have a group of people dedicated to healthcare compliance, ethics, and integrity hanging out on the sandy beaches of Hawaii. They informed us that many people were having trouble with the selection of the Hawaii location, and our decision would further complicate their problems with attendance. We reluctantly acquiesced and luckily never received a single complaint. Debbie and I went to Hawaii to conduct the first meeting under the HCCA banner. It was a tough job but somebody had to do it. For many reasons, including that fact that we wanted to help all segments of healthcare, not just physician group practices, we soon parted company with the MGMA.

Greg Warner, the Compliance Director for the Mayo Clinic, joined us in our efforts to advance the HCCA after Mary Dunnaway dropped out for personal reasons. He was named HCCA Secretary. Greg has provided significant leadership, particularly with regard to organizational development, collaboration, and structure.

Regions established
At HCCA’s first annual meeting, held in September 1997 in Los Angeles, CA, many members asked for more local networking opportunities. It was decided at that meeting that HCCA would establish 10 HCCA Regions, based on the Health Care Financing Administration’s 10 regions. First, Greg Warner, then, Sheryl Vacca, and today, HCCA Secretary Michael Hemsley, have all devoted countless hours and significantly contributed to the development of HCCA’s Regions. Our Regions provide the medium for local networking among compliance professionals by offering inexpensive local meetings.

Early in 1998, we were fortunate to recruit Joe Russo and Alan Yuspeh to the HCCA Board. During our Board of Directors meeting in October 1998, we elected Sheryl Vacca as HCCA Secretary and Odell Guyton, Andrea Bohannon, Michael Hemsley and Eileen T. Boyd to the Board of Directors. Each has helped us wind our way through many significant decisions.

We have since added many more individuals from all over the country. Although I reference some of individual contributions in this historical narrative, there are too many to name. You see them working within the organization every day, helping the Board, the Regions, and committees improve the HCCA. All of them have contributed greatly to one of the fastest growing associations ever assembled.

In the beginning we were unknown and several vendors have helped get our name out there and we appreciate all of their assistance. Opus Communications not only helped promote the HCCA through their newsletters, but they also “contributed” Margaret Dragon. Margaret was named HCCA’s Director of Communications in 1998. She has made our newsletter, Today’s Corporate Compliance, and our Website, www.hcca-info.org, come to life.

Managing growth
The numbers have been fascinating to follow. From two members in a Minneapolis Chinese restaurant in 1996, doodling a mission statement on a napkin, to over 2000 members within three years is amazing. Managing that growth without staff quickly became untenable.

The first sign that we were in trouble occurred when people started to send nasty letters claiming that they were not members. It was clearly strange that people would write to tell me that they were not members and that they didn’t want any more information, some of them were not even in healthcare. Somehow 50 people had been entered into our membership database at random. Don’t ask me how that happened. We cross-matched the database with the membership applications (that we could still find) and with our tail firmly planted between our legs we called the rest to ask if they were members. It was painful at the time but it makes a great story now.

It was clear that we needed help, we didn’t have much money, and didn’t know how big we would eventually get. I hired someone from a temporary agency at slightly above minimum wage and the University of Wisconsin agreed to give him an office, a laptop, and a phone. That was Henry Youmans, a Ph.D. candidate looking for some part-time work, who turned out to be a tremendous asset to the early startup phase. He hit the ground running. Within months we realized that we needed professional help to run the HCCA. Tom Suddath brought Resource Management Plus to our attention. RMP’s CEO, Joe Braden, has been a godsend and without whom we could have never handled the incredible growth we have experienced.

Some of the most interesting HCCA stories were the mistakes we made. Our first Board strategic planning meeting occurred at Rolling Hills Resort somewhere in Florida. It was an easy place to forget. What had once been home of the Miami Dolphins and site of the film Caddie Shack, was now in rough shape. It appeared that the Dolphins had a few too many drinks on their last visit and were pretty hard on the place.

We also now know where the gophers went after Bill Murray dynamited them off the golf course. It was so bad we moved some of the Board members out of the Resort on the second night. Despite the disaster the Board took it all in stride and many of the things we have accomplished to date started as ideas generated during our stay at Rolling Hills. Not a meeting goes by without one of the Board members reminding me of that disaster.

Lessons learned
Part of our history that moves me the most are the meetings. We went from a handful of people in a small room to conducting meetings in prestigious hotels with 1000 attendees. It is very strange to stand there looking at a thousand people telling compliance war stories and thinking back to that single phone call to Mary Dunnaway.

There have been some interesting incidences at the meetings, too. For example, the time we forgot to tell the participants that we would not be coming back to the main ballroom after lunch and hundreds of people left their belongings in the room. It sounds like no big deal unless the hotel needs to break down the main ballroom right away, grabs all the briefcases, folders, memo pads and three ring binders, and puts them in a big pile in a store room. You have no idea how tough it is to sort out hundreds of memo pads and binders with personal notes but no names in them. What a disaster!

At one meeting with 900 attendees we decided not to have handouts. Yes, you heard me correctly, no handouts. The lawyers went nuts. They were accustomed to 10 inch, one hundred-pound handouts from the AHLA meetings and they let us know of their dissatisfaction. Several lawyers sent me long scathing letters about how they felt. If there had been a law against bonehead moves we would have been sued.

The disasters make for great reading but many things did go well. One of the most significant things that went right was Brent Saunder’s involvement in the start up. Every group needs someone to push hard and think big things. Brent is a big thinker. The most rewarding professional experience I have ever had was watching all of these people working together. Everybody contributed something at some time. Even the most inexperienced and quiet members uttered a statement at some point in time that changed the course of events and significantly improved our chance for success.

Building bridges
Another significant achievement has been the bridge we have built between the government and health care. Because HCCA is not a lobbying organization, HCCA has carried on several discussions with the government that has helped ease the tension and improve relations. It has made a difference. Not only do we have increasingly collaborative policies released from the government (some at our meetings) but we also have held government/industry round table meetings that have contributed to a greater understanding of health care’s significant compliance efforts. Additionally, we are very fortunate to now have Lew Morris on HCCA’s Board of Directors. While we have much left to accomplish, we are on the right track.

As Brent and I fade into the sunset, many individuals have stepped up their involvement in HCCA. Mike Helmsley and Joe Russo are now officers of the Association and are helping the other officers set the course for the future. Al Josephs has pitched in everywhere and has been particularly helpful in the development of the certification process. And new Board members Teresa Mullett and Paul Flanagan are bringing new ideas to the group. Many individuals have been added to Joe Braden’s staff who silently contributes to the enormous work behind the scene. In particular, Robert Rupp’s experience managing associations has been invaluable.

One often wonders why HCCA worked. It’s hard to know. Is it being in the right place at the right time or getting the right people involved? To me it’s obvious that it is both. What has kept it going is a simple truth, that people who face significant challenges need to communicate with others facing similar challenges. Compliance professionals face huge challenges. The reason we continue to meet in ever-larger numbers is the very same reason the first call to Mary Dunnaway was made—to share compliance war stories and learn from each other.