Transcript Generated by AI 00:00 Mark Parkinson back with Park Place and we're here to continue our series where 00:04 we're doing a deep dive on a state to figure out if it's a good state to 00:08 operate in or not. 00:10 Last month we looked at Illinois. 00:12 This month we're looking at Massachusetts, which I have learned I have a very hard 00:16 time pronouncing, so I'm going to call it Mass from here on 00:19 out. 00:19 It turns out that Mass is actually a pretty good state to operate in. 00:23 And that's true for a lot of reasons, but one of the main ones is that we have 00:28 a fantastic leader in Tara Gregorio, who is the president and CEO of Mass 00:33 Senior Care. 00:34 What you don't know, this is like the 6th take on it. 00:38 Bring up the state. 00:39 I keep screwing up Tara's name. 00:42 We've gotten through a Tara that's as that's as good as I can get it out. 00:45 But Tara, welcome and thank you very much for being 00:47 a part of this. 00:48 Oh, Mark, thank you so much for having me and for 00:51 your great work. 00:52 Frankly, with Park Place. 00:53 I learned something new with each newsletter, with each of your, I guess, 00:58 sessions like this. 01:00 So thank you for having me and thank you for making me feel so comfortable with 01:05 six takes so far. 01:06 Yeah, it's going to be very, you cannot screw up more than I've 01:09 screwed up. 01:09 So I, I've set the bar very, very low. 01:12 But let me just kind of give a little bit of background and talk about you, Tara, 01:16 because you really are one of the best leaders in the space, 01:20 fantastic leader in the state association sector. 01:23 There is actually an, a group of the state execs that have an 01:27 association and you are the president of it. 01:29 It's a really high honor. 01:31 You serve on the AHCA board. 01:33 The results that you've achieved in Massachusetts are remarkable. 01:37 So let's talk about the state now. 01:39 Tell us a little bit about what the nursing home world looks like in Mass. 01:44 Sure, just a high level overview. 01:46 We have 348 licensed nursing facilities in the Commonwealth. 01:52 90% of those facilities are members of Mass Senior Care. 01:55 So we're really proud to have such a high penetration of real strong, active, 02:01 engaged members. 02:02 They care for 100, 000 individuals each year. 02:05 So we see a lot of families and consumers coming in and out of our settings and 02:11 taking care of those individuals are 58, 000 just really tremendously dedicated, 02:17 highly trained, skilled individuals. 02:20 Most of our residents have their were paid for by Medicaid. 02:23 So a top, top priority of ours has always been 02:26 making sure we're closing that Medicaid gap and we've made good progress on that. 02:33 One of the things that jumps out to me as I look at the state is your occupancy. 02:37 Yes, it's really, you know, nationwide occupancy is about 80%. 02:42 There are states where occupancy is in the 60s. 02:44 Tell us about what the story is in Mass. 02:47 Yeah. 02:47 So we have seen a surge in demand. 02:50 Obviously occupancy is a denominator of licensed beds. 02:54 So we have seen closures also during COVID in particular. 02:59 But we have not seen a closure this year and only three. 03:02 So we definitely are bucking the trend in regards to our what are historic number 03:07 of closures. 03:08 So we have increased demand. 03:09 We have an older population and so right now we're at 92% and we look at this by 03:15 regions of the state and in some regions we are at maximum capacity. 03:20 And Mark, you may remember in 2019, just before COVID, 03:24 you all under your leadership at AHCA commissioned a report from Avalere that 03:29 looked at a select number of states. 03:32 And Avalere made the same prediction that is now documented by actually our state 03:37 government in Massachusetts. 03:39 They did a demand analysis and it's not, it's a matter of if we intersect between 03:45 supply and demand. 03:46 It's really, when I estimate it to be within the next 03:50 five years, just given the demographics and the the 03:53 shift to our setting. 03:56 Yeah, it's really remarkable. 03:57 I mean, we're looking at the chart that that was 03:59 prepared as a part of that study. 04:00 And not only do you have a high occupancy, it's not too far out where they're just, 04:03 there aren't going to be enough beds to take care of everybody in the state. 04:07 Yeah. 04:07 It's a massive public health problem, but it's from an operator perspective, 04:11 it creates a pretty good business climate. 04:14 Yeah, I think that regarding business climate, 04:17 when I think about the positive sort of the wind at our back that you often talk 04:22 about the progress that we've made in Medicaid, We have seen a 50% increase, 04:27 if you can imagine in our Medicaid reimbursement over the past five years. 04:32 We have moved to be a CMI state, so our acuity and Medicaid payments are 04:38 based on PDPM. 04:40 That's had a profound impact on revenues over and above our Medicaid rate 04:45 increases. 04:46 We are setting aside funding so that nursing facility operators can invest in 04:51 their physical plant because we are a high cost state in some instances 04:56 relative to workforce. 04:57 So we document that 83% of all funding goes right out to direct care and what 05:02 does that mean about our building? 05:04 So we've been real thoughtful with our government partners to make sure that 05:09 we're allocating as often as we can money for capital improvement because that will 05:15 be essential in making sure that we have the the supply to meet the demand. 05:21 We also have when we think about the the responsiveness of our Medicaid program, 05:27 we also have resident specific Medicaid add-ons. 05:32 So really looking at specific diseases with high need populations like those 05:37 that need one on ones, those that have behaviors, 05:41 those that have SUD and, and you name it, trach care. 05:45 So we have a variety of also add-ons and now we incentivize our Medicaid 05:50 facilities to take on more Medicaid. 05:53 So we have what's called a high Medicaid add on. 05:57 So we're trying to be adaptive to meet the needs of our our providers. 06:03 Yeah, I mean the the reimbursement that you 06:06 results that you've achieved are really remarkable, 50% increase in Medicaid, 06:10 all of the add-ons that you talked about, obviously a really good reimbursement 06:15 environment. 06:15 Tell us about the regulatory perspective. 06:18 I know a lot of people feel like their states are are really challenging. 06:21 Everybody feels that way. 06:22 I think what what is it like in Massachusetts? 06:25 Yeah, for sure. 06:25 Massachusetts is a rigorous state to operate in. 06:29 We have a Department of Public Health that does take their responsibility very 06:35 seriously and strictly to survey. 06:38 And so we have had some time, particularly over COVID, 06:41 where we saw a spike in increased number of deficiencies, 06:45 increased number of IJs just a really, I think also a culture that had our 06:50 members feeling very uncomfortable. 06:53 So we do what we always do at Mass Senior Care. 06:56 We take the feedback from our members and then we go to the agencies and 07:00 proactively talk about how can we improve this process? 07:03 How can we, we, we be respectful to one another, 07:06 but more importantly ensure the safety and well-being of our residents that is 07:11 focused on resident centered care. 07:13 So we have seen a decline. 07:15 I'm, I'm grateful to say thanks to the hard 07:18 work of our members of overall deficiencies. 07:20 So the the deficiency number is declining, number of Ijs is declining. 07:25 We're seeing improvements where you want to see improvements, 07:29 fewer falls with injury among our residents, UTI's, other infections. 07:33 So real positive, positive results and that goes back to 07:37 investment and then the gains we're making on workforce. 07:41 And I need to acknowledge the tremendous amount of work our members have done 07:46 related to workforce first and foremost. 07:49 And you remember these days, Mark, when we had the provider relief funds, 07:53 our members put that right into wages. 07:55 It wasn't one time bonuses. 07:57 They knew the marketplace, they knew the value of their workers. 08:00 And so we grew rate, we grew wages by 40% over the past five 08:06 years and that's astounding. 08:10 But as a result, you know, we have seen the results of that in terms 08:15 of a decline in in vacancy rates, a decline in costly and disruptive 08:20 temporary nursing agencies and so really good performance. 08:25 And so I just want to make sure we acknowledge that link between funding 08:29 workforce and quality. 08:31 So those are our foundational, if you will. 08:34 I mean these are fantastic results on reimbursement and on the regulatory side 08:38 with reductions in deficiencies and fines. 08:41 How have you achieved that? 08:42 What, what do you attribute it to? 08:45 Well, I, I go back and I attribute it always to 08:47 the members. 08:48 We are as good as the active engagement and solidarity of our members. 08:53 We have a phenomenal board of directors. 08:56 We have a great team at Mass Senior Care. 08:58 So we are absolutely first and foremost solutions driven, right? 09:03 We use data, we use the government's data. 09:06 We report a lot here in Massachusetts. 09:09 So as good as like it might be to transact, right, 09:11 we are turning around chows in 90 days in Massachusetts, 09:15 which is unusual when I talk to some of my other state colleagues. 09:19 And that's in law, and that's as well as a commitment. 09:22 But we report a lot of data. 09:24 And so we use that data actively to dispel myths, 09:27 to push the ball up the field. 09:30 I also have a set of mottos that are rather simple. 09:35 The first is certainly a good defense is a strong offense. 09:42 So we are part of every discussion that is occurring in and around healthcare 09:47 policy here in Massachusetts. 09:49 And that makes a big difference. 09:50 We're well respected. 09:51 We have a great lobbying team. 09:53 But again, it's our ability to make sure that we are 09:57 using good policy to put solution. 09:59 So we are our trusted and recognized partner with our governor as well as with 10:05 legislature, good relationships with consumer groups, 10:08 labor. 10:09 But my mottos are, you know, go to the ball. 10:12 Mark, I don't know if you know this, but I love tennis. 10:14 I'm not a great tennis player. 10:15 I love to play it, watch it. 10:17 But it is if you ever heard me taking a lesson, 10:19 the coach would be saying go to the ball, go to the ball. 10:23 And so that has become a motto and metaphor for the work we do. 10:27 So I enter every single opportunity there is to advance the priorities of our our 10:34 members. 10:35 Like for example, I got this call from Chris Wright, 10:37 who's a member in Mass Senior Care and he's like, hey, Tara, congratulations. 10:41 I saw you were appointed to the Rural Transformation Health Fund program. 10:45 And that's, you know, $190 million that will go out to 10:48 providers that impacts 20 nursing facilities in the state. 10:52 That would have been easy to just be like, OK, we're going to testify and be done. 10:56 But we ran into that. 10:58 And so that will have a meaningful impact. 11:00 So that's an example of us always going to the ball. 11:04 The other is never, ever give anybody a reason to say no. 11:09 If you're going to say no to me and my 100,000, the residents, 100, 11:14 000 residents that my members care for, it better be for a good reason. 11:19 It's not because we yes, it is true. 11:22 I am very aggressive in that way, much to probably the frustration and 11:27 chagrin of my, my, the membership as well as my, 11:30 my colleagues at Mass Senior Care. 11:32 But those are the ways that we have been able to successfully move the ball up the 11:38 field. 11:38 And I'm not, and thankfully I have a board that 11:41 they're not afraid of failure because, Mark, we will win. 11:45 We always win. 11:46 We might not win in the first year. 11:47 Like people told me, Tara, you'll never become a CMI state. 11:51 Guess what we are, you'll never get certified medication 11:54 aids in Massachusetts. 11:56 We got them last year. 11:57 You'll never get a two year base year. 12:00 We have that now, like all of these things. 12:02 So I'm actually more motivated when people say no. 12:05 So we're always trying to put those sort of lofty goals on the on the field and we 12:12 advance them. 12:13 So I'm just tremendously proud and grateful to work for an organization and 12:18 a board and a membership that is innovative and wants to be part of these 12:22 discussions so actively. 12:25 Well, Tara, thank you very much. 12:26 I mean, this has been inspiring. 12:29 The results are amazing, both on the reimbursement and the 12:33 regulatory side, on the quality side, on all from every angle. 12:37 And I think that the viewers will clearly understand how they've happened. 12:42 They haven't happened by accident. 12:44 The members have come together, 90% of them are in the association. 12:47 They're not fighting. 12:48 They're working together and they have an amazing leader who obviously goes to the 12:54 ball on every opportunity and in any battle. 12:58 Tara, I would want you on my side for I 13:00 wouldn't want you on my side. 13:01 I would want you leading the effort depend on you to lead, Mark. 13:06 But thank you very clear. 13:07 You know what what you've done. 13:09 So anyway, thanks, Tara, and we look forward to continuing our 13:12 discussion on Mass over the next few weeks. 13:15 And thank all of you for your continued support of Park Place.
