Transcript Generated by AI 00:00 Hey, Mark Parkinson back with Park Place and 00:03 welcome to our second segment of Let's Talk. 00:07 You might recall that Let's Talk is our podcast segment where we sit down with a 00:11 complete superstar in the sector and learn from, you know, 00:15 how they've succeeded in doing what they've done and what their outlook is. 00:19 In our very first segment, we had Norman Rockish, 00:21 who certainly did an incredible job in developing and making Marquis what it is 00:25 today. 00:26 And today we have another superstar, Cliff Porter, 00:29 the brand new head President, CEO of the American Healthcare 00:33 Association, who's off to an amazing start. 00:36 Want to thank First Quality, the great people at First Quality who 00:39 provide terrific products for our buildings. 00:42 Their support of this segment allows us to keep this as a free and open site and 00:46 we certainly appreciate everything that they do. 00:50 Cliff, we're thrilled that you're with us here 00:52 today. 00:53 Fantastic and really glad to be with you. 00:55 Now I know that, you know, first of all, it's great that aka finally has a good 01:00 CEO. 01:00 So it's, it's good that you're on board. 01:03 And you know, I, I know that the question that everybody 01:06 wants answered, I'm going to get to it in just a little 01:08 bit. 01:09 And that is how in the heck does Congress cut Medicaid almost a trillion dollars 01:14 and somehow sniffs get excluded. 01:16 We, we got to get the inside scoop on how you 01:19 were able to do that. 01:21 But before we do that, I really want the viewers to understand 01:24 about your background because, you know, when I, when I was retiring, 01:28 people were saying, Oh my God, we're never going to get another person 01:31 that's actually from the sector. 01:34 You know, most trade associations are headed up by, 01:36 you know, good people, But I, I think of them as mercenaries. 01:39 They kind of float around from association. 01:41 They're association people. 01:43 But lo and behold, we have another person from the sector 01:47 running Akka, which is great. 01:49 So tell us how you got involved in long term care. 01:52 No, I appreciate the opportunity. 01:53 Mark and, and I got involved in long term care when 01:57 I was an undergraduate student and I guess around my sophomore year in college, 02:02 I volunteered at a facility, I was Richmond City Nursing Home. 02:06 It was a city owned facility and that was around 1987 ish. 02:12 And I was pretty appalled by what I saw. 02:16 I remember it as clear as day. 02:20 I don't know if you remember Posey restraint vests. 02:23 They're like modern day straight jackets really, but these things were sold. 02:28 You know, I'm I'm I'm marvel at how much, you know, we've advanced since then, 02:33 but folks were tied to side rails and Jerry chairs, very bright stark hallways, 02:39 cinder block walls and a lot of moaning and echoing in the in the place. 02:44 And and I I just said, you know, I don't like the way this looks. 02:47 So we just kind of continue to do the ministry out of, you know, 02:51 compassion more than anything, but it kind of sparked an interest. 02:55 So I, I then decided to be a nursing assistant 02:58 while in undergrad and worked on the weekends and then decided to major in 03:04 Health Administration and pursue a long term care. 03:07 And that that was the beginning of, of 36 years ago. 03:12 Wow. 03:12 I mean, to start out as a CNA and to end up, 03:15 you know, as the president and CEO of August, 03:18 quite a story. 03:19 I know that you started out as an AIT and an administrator, 03:22 I think with a really good organization. 03:24 Why don't why don't you tell us about that experience? 03:26 Yeah, I really do believe, Mark, that, you know, particularly for young leaders, 03:32 it's really important that you connect with a really good mentor, preceptor, 03:37 leader and you being a company that supports your development growth. 03:41 And I was just really fortunate in my career that I really had great stops 03:45 along the way with organizations that we're really about quality and did their 03:50 best to walk the top. 03:51 And so IAIT with Medical Facilities of America, which was based in Roanoke, VA, 03:58 back in 1989. 04:01 And my preceptor was a wonderful leader by the name of Liz Kael. 04:08 And Liz is still around, but she's retired now, 04:12 but a young student. 04:13 We had to do our AIT and if you get to know me, 04:16 I'm always checking on people and I kind of asked around who's the best 04:21 administrator that is doing preceptor ships in Virginia. 04:25 Her name came up. 04:27 I drove 2 1/2 hours to Lynchburg, VA to pitch her on me and why she should 04:34 have me as her AIT. 04:37 And I offered to do it for free and she was kind enough to at least offer me 04:45 meals has has pay. 04:47 So I, yeah, I did AIT during the week and then drove 04:50 home to Richmond and worked for real money on the weekends while I AIT with 04:54 Liz. 04:55 Yeah. 04:56 I don't think it's a coincidence that our first two featured people on Let's talk 05:01 are, you know, come from being administrators and, 05:04 you know, that's, that's a terrific thing that you've done. 05:10 How how long were you in AIT and how long did that process last? 05:15 Yeah, well, in Virginia, particularly at the school at VCU where I 05:18 went to school, this particular program had a sort of a 05:22 special dispensation where you only need to do a four month AIT program if you got 05:27 your degree in Health Administration with sort of the specialization in long term 05:32 care. 05:32 So I had to have, I think four or five classes that were 05:35 long term care specific. 05:37 So my AIT program was about four months long. 05:41 And as soon as I graduated, I took my exam, 05:43 my nursing home administrator exam actually, before I graduated and passed. 05:48 And once you got your degree, you effectively were licensed. 05:50 So that was how it worked back then. 05:53 I think it still does for certain programs in in Virginia. 05:56 And then how long were you an administrator, Cliff? 05:58 Yeah, I was an administrator for eight years. 06:00 So from 1989 to 1998, I was an administrator. 06:04 I went from as small as my first job was a 34 bed facility and my last 06:10 administrator stop was a 218 bed, multi floored behemoth of a facility. 06:17 So I've done, I've done it all, opened new buildings, did turnarounds, 06:23 the whole 9 yards. 06:24 I've pretty much seen it all and just we're going to skip that just really 06:29 quickly for just a little bit. 06:31 But you're ADC, you know, grew up in DC, incredible parents. 06:36 In your last stint as an administrator, you were at HCR Manor Care and then you 06:39 ended up running government relations for HCR Manor Care. 06:42 Tell, tell us how that transition. 06:44 Yeah. 06:44 You know, like with any organization, at least in my career, you know, 06:48 I found that I wanted to be involved with the association in some way. 06:52 I just thought it was good not only from a networking perspective, 06:55 but to kind of get a, a better macro perspective on the sector, 06:58 in the industry. 06:59 So I got involved with different committees and, 07:02 and the like along the way as sort of a adjunct to my real job. 07:06 And the one committee I was on was the political steering committee for the 07:10 Health Facilities Association of Maryland. 07:13 And we had a pretty existential issue going on with Medicaid managed care in 07:18 the state, a very aggressive governor who was 07:21 attempting to cut hundreds of millions of dollars from our budget. 07:26 And me and about four other folks kind of got together, 07:30 all operators and developed a strategy in one. 07:35 And that got notice at ACR Manor Care when I was there. 07:40 And one thing led to another. 07:42 And they ultimately asked me to set up and develop a government affairs function 07:47 with ACR Manor Care. 07:48 And at that time they were a $4 billion company. 07:51 So they were big, very big, largest in the space at the time, 07:56 based in Toledo, OH. 07:57 And so how, how many years did you run the GR program 08:01 there? 08:02 Yeah, I did that for about 9 years. 08:04 So from that and then I then I met you and we needed help in DC and we recruited 08:12 you 13 or 14 years ago to run GR at ACA. 08:17 We basically never lost and I got all the credit for it. 08:20 You were, you were doing all the hard work and 08:22 doing all the strategizing, but it was an incredible partnership with 08:25 you, Cliff, for for those 12 or 13 years and I'm 08:28 couldn't be more. 08:29 We had we had, we had a great run, my friend. 08:31 Hope it continues. 08:32 Yeah. 08:33 I mean, we the the pressure that we put on 08:34 ourselves and I'm not sure the members really understood it is we just refuse to 08:38 ever lose. 08:38 And when you're when you you're not happy unless you're pat 100% it's it's it's it 08:42 makes a challenging, but man, we we had a great run. 08:46 So Cliff, you know, thank goodness you're now running, 08:48 running the place now. 08:49 And you came in a really tough year. 08:52 It's it's hard when one party wins everything. 08:55 There's challenges and obviously Republicans have won everything. 08:58 And there was talk, you know, even before the election that that 09:01 occurred, there would be some massive threats to 09:04 Medicaid. 09:05 And lo and behold, that proved to be true. 09:07 And this big beautiful bill has now passed and is now law. 09:11 And if you told me a year ago that Medicaid would get cut almost a trillion 09:16 dollars over the next 10 years, I would have said, oh, man, 09:19 nursing homes are in real trouble. 09:22 But somehow we dodged a bullet. 09:24 And, you know, I know that that's in large part because 09:27 of you and the work that your team has done to the extent that you can tell us 09:32 how in the heck you were able to pull us off. 09:34 I mean, I, I hope the viewers understand that the 09:37 bill specifically excludes cuts to nursing homes where where all the other 09:41 providers get cut. 09:42 How, how were you able to do that? 09:45 Well, I mean, there's a lot to it, as you said. 09:49 And I'm just a big believer that, you know, 09:52 you sort of build credibility over time. 09:54 So it's not like 1 clear thing you do to win. 10:00 I just think it's creating habits and sort of building an infrastructure for 10:05 winning over time. 10:07 And that's a combination of things. 10:10 It's relationships, it's political support, it's grassroots, 10:14 it's personal relationships, it's being data-driven, solutions driven, 10:20 and more importantly likeable. 10:23 And you always have to think about things from the perspective, 10:26 I think in any lobbying effort that you do is that you do have to be likeable. 10:31 You have to go and approach things unselfishly and really try to understand 10:35 what it is that they're trying to achieve and figure out a path or at least attempt 10:41 to figure out a path to create, you know, the the win wins that we all are looking 10:46 for. 10:47 So in the case of this issue specifically, I think the thing the team did is we 10:54 identified the risk very, very early. 10:58 So before anybody identified this as a risk and we didn't know at the time that 11:02 this was going to be the thing in the beginning. 11:06 But you know, President Trump kind of came out, 11:09 he got elected 1st. 11:10 And then during our CPAC partners meeting that we have in January and June of every 11:15 year in a January meeting, we had meetings with key leaders in the 11:19 in the, in the Senate, in the House. 11:22 And in meeting with them, you know, we kind of heard President Trump not long 11:26 before, maybe a day or two before, I think it was the day before, 11:30 he said we're not going to cut Medicaid or Medicare except in the case of waste, 11:35 fraud or abuse. 11:35 So under the leadership of Mike Bassett, who's been a phenomenal replacement for 11:41 me, he worked directly with me in my prior 11:44 role. 11:44 He he got promoted and he's doing a phenomenal job along with Jennifer Haas 11:49 and the rest of the team. 11:51 They just kind of got to work and really thinking about this. 11:54 And we sat down and said, OK, what, what, what in our space is considered or could 11:58 be considered waste, fraud or abuse. 12:01 And immediately, you know, provider taxes came up, 12:03 particularly in conservative circles. 12:05 It's just something that a lot of the conservative think tanks and other policy 12:10 makers really despise, frankly. 12:13 So we just got to work on it. 12:15 And, and the focus really was twofold. 12:18 We want to understand what the administration's focus or, 12:21 or intention was. 12:23 And they were really focused on the expansion population and all the 12:26 increased spending in Medicaid. 12:29 So we took the course of saying, you know, look, 12:32 taking care of the elderly and the infirm is the core and has been core to the 12:36 program from its inception. 12:39 So we know, Mr. 12:40 President, and policy makers, they're just not sure intent to 12:44 negatively impact them. 12:46 And then secondly, while provider taxes may not be the most 12:51 artful program, and there are a lot, there's a lot about its structure that 12:56 can be called to question, at the end of the day, 13:00 it significantly supports our sector. 13:03 And even with it, we still lose money. 13:07 We lose $0.18 on every dollar. 13:09 So taking it away is effectively a cut, which is contrary to what the president 13:14 said he wants to do 1 You don't have an effective alternative to trade for it. 13:19 So for that reason, nursing homes should be viewed different 13:24 when it comes to provider taxes. 13:27 And well, it's, it's, it's pretty remarkable. 13:30 It's pretty remarkable. 13:31 You were able to convince them to treat us differently. 13:33 And, and I, I think you're being modest. 13:36 You, the members, with all the work they've done, 13:39 they've developed some real relationships with leadership on both sides, the House, 13:43 the Senate, Rs, DS and even the president and I, I, 13:46 I'm not sure any other sector has quite the relationships that you do. 13:51 Well, we, we've been fortunate. 13:53 I mean, we do have very active members, owners all over the country. 13:56 And that's one thing, you know, as tough as our business is, 13:59 and we have a tough, tough business. 14:01 But the one advantage that we do is we're practically in every county in America. 14:05 We're, we're everywhere. 14:07 And as a result of that, if you really just kind of do your 14:10 homework and, and kind of reach out and say, OK, 14:12 who's important and then try to find out if any of your members know them. 14:17 And you'd be surprised at, at the level of relationships some folks 14:21 have. 14:22 We've had folks that are, you know, the godfather of a member of Congress on 14:27 the Ways and Means Committee that was really instrumental in helping us with 14:32 something. 14:32 And, and, and it goes pretty deep. 14:34 So, yeah, those relationships I think are 14:36 incredibly important. 14:37 And again, it gets back to credibility. 14:39 We we do what we say and we give data that's legit and we raise issues that are 14:49 legitimate and we don't play games. 14:53 So I think over the years, that's earned policymakers respect and I 14:58 think it paid off this trip. 15:01 And Cliff, on top of winning the Medicaid issue, 15:04 you've had a pretty good year with some other stuff too. 15:07 It looks like the staffing mandate, for example, 15:09 but we were also worried about for the last three years, it looks like it's dead. 15:12 Is that right? 15:13 Well, it's dead. 15:14 And a lot of that credit goes to you, particularly strategically on the legal 15:18 side. 15:20 And you know, we got 2 decisions based, you know, on that, 15:24 on that particular issue, which was fantastic. 15:28 And obviously, we got a little lucky with the low per 15:32 bright decision to kind of help, help us with those ultimate outcomes 15:37 legally. 15:38 And then you sort of compound the, the, I call it the double bonus, 15:43 which was the favorable changes as it relates to Congress and the fact that the 15:49 actual rule cost $22 billion. 15:52 So once that thing got scored at $22 billion and once Republicans won, 15:58 making the case to repeal it was a significantly lighter load because 16:03 obviously they want to save the money and and also, you know, 16:08 eliminate A1 size fits all standard. 16:11 So we had a lot of lot of the planets aligned on this one. 16:15 But I think good preparation legally, a good preparation and a potential 16:19 legislative strategy. 16:21 And then other things happen and the wind blew our way and we put the kite in the 16:24 air and actually and actually finish with it. 16:26 So we we're really excited about that outcome. 16:28 That was an existential issue for us, as you all know. 16:31 Yeah, it would have been, it would have been devastating. 16:33 And then as if two big wins isn't enough, I think it looks like we've got a 16:37 Medicare increasing happening as well. 16:39 Tell us about that. 16:40 Yeah. 16:40 So we're excited about that. 16:42 I mean, I don't I don't think it's out. 16:44 It's supposed to be out really soon, so, but we're anticipating a really good 16:49 result there. 16:50 We just were fortunate enough to bring on John Kane from CMS to run a reimbursement 16:55 department. 16:57 John's done a phenomenal job his first month or six weeks with us and has just 17:02 been an incredible resource. 17:05 So we're really optimistic that we're going to have a a very favorable payment 17:09 rule, which is great. 17:11 And lots more to come. 17:13 Yeah. 17:13 I mean, it looks like maybe a 3% or so somewhere 17:16 around their increase. 17:17 Yeah. 17:18 Which is maybe even a little better. 17:20 We'll see. 17:21 OK. 17:21 Well, that'd be great. 17:22 And, you know, I know the one thing I still hear about, 17:25 even even in retirement as I run around the country is regulatory relief. 17:30 You know, some of the states, the survey process is just crazy. 17:36 Where do you, you know, with the Trump administration, 17:38 you would think maybe there might be, you know, some help there. 17:41 Where do you see that headed? 17:42 Yeah, well, I'm, I'm really excited about our prospects 17:46 around regulatory relief. 17:49 And we're we're advancing this solution is called, 17:53 we're calling it the better way. 17:56 And essentially we're saying, you know, look, we, 18:00 we've done some of the same things since 1965. 18:05 Some things haven't changed since 1965 and then more recently if you think about 18:11 it, and that was frankly when I came into the 18:15 sector, the last fundamental change we had in 18:18 sniff policy was OBRA 1987 and that was a humongous reform piece of legislation 18:24 that fundamentally changed long term care as we know it. 18:29 So I was kind of came in the sector on the front end of that revolution and 18:34 nothing has changed since then other than things getting more and more restrictive 18:40 and less and less consistent with the patients that we serve. 18:45 So, you know, the best way I can describe it is that 18:49 you sort of have these political winds that blow and, 18:52 and depending on the season that you're in, you know, 18:55 folks will bolt on additional requirements onto a structure that was 18:59 never really built for that anyway. 19:01 And it just becomes a very clunky, unmanageable kind of situation. 19:06 And that's, that's sort of the perils that our 19:08 operators deal with each and every day. 19:11 As you said, I'm a, I'm a former administrator to my right 19:14 here are both my administrator licenses that I look at every day. 19:18 And I try to have them be as a reminder to me to really think about policy from 19:21 the perspective of the folks that have to do this every day. 19:25 And when I do that, you know, I just get more and more frustrated 19:29 because ultimately the job is a lot harder than it was even when I did it and 19:33 it was hard then. 19:35 So our proposals are really about not eliminating regulation because we we 19:40 aren't pollyannish in in thinking that that's good public policy. 19:46 But we want to rationalize our regulations because they become utterly 19:50 irrational. 19:51 And we want to create a regulatory construct that actually improves quality 19:56 versus has a purpose of penalizing people and punishing people for non compliance. 20:02 And again. 20:05 You know, there is such a thing as non compliance 20:07 of good faith and I have a fundamental belief that again it's it's a lot more 20:12 constructive and better for the patients and everyone involved if we approach that 20:16 from a collaborative constructive approach. 20:19 And then there's unfortunately a very, very small group of providers out there 20:23 that probably shouldn't be in the business. 20:25 And I do think that there is a space for regulation to address those operators as 20:32 well. 20:32 And if the very, very small band of folks that that don't 20:36 want to do things the right way, the policy should address them 20:40 effectively and quickly. 20:43 So I think, you know, we can navigate a way to really 20:46 rationalizing the system so that we have, you know, 20:49 fresh young leaders that want to do this work. 20:52 This is hard work as it is. 20:54 And if you're a young person, it's a lot of other things you can do 20:56 with your life. 20:57 And why would you, you know, choose to to punish yourself working in 21:02 an environment that's so difficult? 21:04 Same for nursing and clinical staff as well. 21:07 So I'm excited. 21:08 There's a lot that can be done just by virtue of the administration putting out 21:12 a memo. 21:13 And we've got to give you some early news. 21:16 We've got a meeting scheduled soon with Doctor Oz and we're going to sit down and 21:21 talk to him at length about about our ideas. 21:25 That's super. 21:26 So clip on the personal side, one of the things I always admired about 21:30 you is that because of your success in DC, we had headhunters that were coming and 21:35 trying to hire you away from Akka while I was there, often offering more than 1,000, 21:39 000 bucks, you know, significant increase in your salary. 21:43 And I've heard that because, you know, in large part because of the success 21:47 you've had this first year, there's people out there offering you big 21:50 jobs right now, but I don't feel like you're going to 21:53 leave you. 21:53 You seem more like a long term care guy that that I'm association mercenary. 21:58 Why, why have you why have you stuck it out? 22:01 What's, what's, what's caused you to do that? 22:04 Well, I mean, look, I mean, I never thought in a million years that, 22:08 you know, nursing homes would be the envy of DC. 22:12 And based on this outcome, we kind of at least this week are a bit 22:15 in the healthcare policy world, the envy of Washington, 22:18 How the nursing homes do that, you know, kind of taught. 22:21 And so it has attracted some attention. 22:23 But one, I just started in October and I made a 22:27 commitment and I keep my commitments. 22:30 And I've never really been motivated by money, Mark. 22:33 It's just not something that motivates me. 22:35 Sure, I want to, you know, I want I want to do well, 22:38 don't get me wrong, But it's not the thing that, you know, 22:42 gets me up every day. 22:44 So for me, it's really about, you know, this next 10 years of my life and, and, 22:51 you know, I'm 58 and I've got about another 10 in 22:55 the tank, I think. 22:57 And I really do want to make a difference. 23:00 I want to be able to walk away from this time when I retire and say that, you know, 23:06 I helped create a different world and helped prepare the sector for this 23:11 explosion of people that are coming into our sector. 23:14 I talk about it often, but 4 million people between now and 2030 23:19 will be turning 80. 23:20 Another 4 million will be turning 80 between 2030 and 2035, 23:24 another 4 million after that. 23:27 So we are having, we're going to be inundated with demand. 23:30 And it's just important that we take good care of these folks as they come in our 23:36 setting and hopefully create a better life for them. 23:40 And then selfishly, you know, I'm getting old. 23:42 So hopefully, you know, this world that I helped create, 23:45 I'll be able to benefit from it as a patient. 23:49 Well, Cliff, we can't thank you enough for joining us 23:51 here today on Let's Talk. 23:53 Congratulations to the incredible start that you're off to this year. 23:58 Really more important, Congrats on almost 40 great years in the 24:02 sector. 24:03 I love the fact that the sector is led by somebody that started out as a CNA, 24:07 that's been an administrator in buildings as somebody that's still really involved 24:11 in the sector. 24:12 I know that you know what everybody's up against every single day and we're just 24:16 thrilled to have you. 24:17 So thank you all for for joining us again on Let's Talk. 24:20 I hope you've enjoyed this segment. 24:21 We want to make sure we think first quality first qualities, 24:25 the sponsor of this Let's Talk segment. 24:27 As you know, they provide fantastic products for our 24:29 buildings. 24:30 And we really, we couldn't make this a free and open 24:32 website without first quality. 24:33 So thank you very much to them. 24:35 And until next time, I hope things continue to go well for you. 24:38 Thanks so much.
