In an exclusive interview with Provider, Mark Parkinson, president and chief executive officer (CEO) of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), reveals the organization’s priorities for the coming months and beyond on the legislative and regulatory fronts.
At the same time, he notes how 2020 is a special year with both congressional elections and a presidential vote in November. And, on a more personal level, Parkinson discusses the factors that motivate him to start anew every January in the battle to promote the interests of the residents who reside in long term and post-acute care (LT/PAC) facilities and the providers who serve them every day.
Provider: What are AHCA/NCAL’s priorities for 2020, and how does the association formulate these issues each year?
Parkinson: The process is that the issues are driven by members. In the fall of every year we survey our board and our key constituency groups and ask them what issues they want to focus on for the following year. We hold a strategic planning meeting in November to review input and then make decisions on what to work on.
For 2020, the board decided that the principal issues will be first to protect any gains we achieve through the new PDPM [Patient-Driven Payment Model] to make sure that our benefits from PDPM continue. Second, to defeat the CMS [Centers for Medicare & Medicaid Services] rule that would restrict provider assessments and intergovernmental transfers. And, then thirdly to work to ensure that assisted living continues to be regulated at the state level and not at the federal level.
Provider: PDPM was such a huge transition last year. Is there much more work to be done in this area for AHCA/NCAL in 2020?
Parkinson: PDPM and what happens with PDPM is one of our top issues. We are pleased with the success CMS had in rolling out PDPM. A thousand things could have gone wrong, but CMS got them all right, and the new payment model was successfully rolled out. Our members also pretty seamlessly implemented the changes, and while there aren’t data out yet it sounds like they are getting good results with patients, and of course that is the most important thing.
We continue to monitor PDPM and the impact it has on patients, and the issues of budget neutrality and expenses are high on our priority list. We will be following all of those things, and if adjustments are needed, we want to be involved with CMS to make sure the best interests of our residents and our members are first and foremost.
Provider: This is an election year. Can you talk about how important it is to be active in the political and policy process as an association, and why grassroots interactions with members of Congress matter?
Parkinson: The reality is that in order to have a seat at the table in Washington, D.C., you have to be strong politically with your lobbying mechanism and you also have to be really strong on policy. So, we work quite hard on both the political side and policy side because ultimately policymakers are not influenced without strong, sound policies.
For grassroots, it is incredibly important as the most effective form of lobbying is not having people like me or outside consultants go into congressional offices to lobby, but instead the most effective lobbying is when members get active. And, really the best way to do this is for members to talk to members of Congress and get them into our buildings to see the work providers are actually doing and the challenges providers face in doing that work.
Provider: When January rolls around every year, how do you stay motivated to start fresh?
Parkinson: It is really easy since one of the things I get to do with my job is to run around the country and meet with members in the locations where they are taking care of residents. When I am out doing that and see the work they are doing and hear the passion in the voices of their teams, it really becomes clear how important our work is in D.C., to have that work continue.
I was just in Iowa with Ted LeNeave [president and CEO] and his team at Accura HealthCare and was able to meet with all 40 of his administrators and directors of nursing, and meeting them made it easy to get excited to fight on behalf of people like that as they are all completely aligned with taking care of the residents in their charge.
Provider: Is there a new focus on how AHCA/NCAL relays the successes of the profession in 2020?
Parkinson: We launched the Why I Care Campaign where members tell individual stories of success with residents and also tell why they are involved in the profession. I am convinced that showing data and percentage improvement in quality will not change public perceptions of our profession. It is the individual stories that are needed.
Provider: Industry data seem to point to a bottoming out and possibly a modest strengthening of occupancy levels in segments of the LT/PAC space, like for skilled nursing centers. What is your view on occupancy levels moving forward?
Parkinson: We hope that we have made progress on occupancy, with data pointing to a possible bottoming out a year-and-a-half ago. And, at the same time occupancy may have bottomed out, the demographics started to help. This is because starting in 2018 and for the next 40 to 50 years, the 80- to 85-year-old group grew significantly. This of course will help occupancy.
Hopefully, the last 18 months are a period of stabilization and not a blip but a start of a long-term improvement.
Provider: Another key issue for providers is workforce, specifically the ability to attract and retain staff. What is your take on where the association and profession stand on this significant concern?
Parkinson: With national unemployment so low [around 3.5 percent] there are going to be workforce challenges all over the country. We need Congress to pass our bill that will allow CNA [certified nurse assistant] training schools to operate easier, we need immigration reform to attract more workers to the country, and we are providing relief to our members by offering a new program on best practices for attracting and retaining workers. But, any scenario will be a challenge as long as unemployment is so low.
Provider: In a general sense, what is the business outlook for skilled nursing and assisted living?
Parkinson: I think the outlook for both is as positive as it has been in many years, particularly on the skilled nursing side. It was not long ago that skilled nursing was viewed as an uninvestable space, but the last few years with stable occupancy and gradual improvement in Medicare and Medicaid rates, the sector has stabilized with fewer bankruptcies and other problems. This, however, comes at a time the sector is still operating with nearly 0 percent margins nationwide.
Assisted living has been strong for the past 30 years as a sector to invest in, and though it is market-driven and there are some places where there is overbuilding, it remains so.
Taken as a whole, with the aging of the population and other factors, both skilled nursing and assisted living are poised to do quite well in the 2020s.