Transcript Generated by AI 00:00 Hi, it's Mark Parkinson back with Park Place 00:03 and I'm in a really good mood today because we are rejoined by Mary Ousley, 00:08 who I think you all know my now is the leading voice of quality in the long term 00:13 care sector. 00:14 She gave us a magnificent history of the whole regulatory system in her Let's Talk 00:20 podcast that we have still posted on the site. 00:24 If you haven't watched it, you need to watch it. 00:26 It'll really explain the history of the regulatory system that we have and how we 00:30 got here. 00:31 And it's also pretty inspiring. 00:33 Mary, it's great to have you back. 00:35 Thanks for rejoining us. 00:37 Mark. 00:38 It's always great to talk with you and great to be here. 00:41 I'm excited for our conversation today. 00:44 Well, great. 00:45 Well, we're going to have a conversation about 00:47 staffing because, you know, I think a lot of people in the sector 00:51 have been celebrating the the demise of the Biden staffing mandate and thinking 00:55 that this is all over. 00:56 And behind us. 00:58 You have, I think, a much different and much deeper 01:00 perspective on the whole thing. 01:02 So let's just start out and say, in your view, 01:05 is the staffing mandate over? 01:07 And if not, why? 01:09 Why do you believe that? 01:11 Well, you know, Mark, I think that while, yes, 01:14 we celebrate a mandate going away because you and I both know mandates don't work, 01:19 one size does not fit all and it would just have not been a good thing to do for 01:25 our sector or for the patients we care for. 01:28 But we would be foolish to think that this debate has ended. 01:33 It has not. 01:34 It has it. 01:35 The debate has been there for as many years as I've been a part of this sector 01:39 and it continues. 01:41 You know, I think I've forwarded to you an article 01:45 that detailed a presentation that Jonathan Bloom had done and in it, 01:51 and he spoke to LTC 100 back in April. 01:55 And one of the things that he said that I think is really important, 01:58 he pretty much laid down a challenge for us. 02:00 And since he was the former deputy administrator of CMS, I mean, 02:04 I think he knows what he's talking about. 02:07 And he said, if not a mandate, if not the rule that was proposed, 02:11 then what? 02:13 What are you proposing? 02:14 What is the alternative? 02:16 And as it continues, we need to be coming with clear policy 02:22 direction. 02:23 I don't think we're putting that direction together yet. 02:26 I know we're thinking about it a lot, but we already have bills filed in 02:31 Congress. 02:32 The advocates and others are adamant every day about staffing and what we need 02:38 to do differently and challenging us to meet the challenges of today, 02:43 which we talk about high acuity, all of the things that are happening in 02:48 our centers. 02:49 So not going away, but if we're not going to be the voice 02:54 that directs this, who is? 02:56 Because a voice will direct it. 02:59 Yeah. 03:00 I mean, it's a great point. 03:01 If we just sit back and do nothing, something's going to happen to us. 03:06 So we should probably use this time, post the demise of the prior mandate to 03:12 develop an alternative. 03:14 And whether it's the sector doing it or individual buildings doing it, 03:18 what what do you, what do you think that alternative should 03:21 be? 03:22 What? 03:22 What should we be doing? 03:25 We need to think of this in some degree as in phases, 03:30 entering the next phase of what we need to do, 03:34 not it's not just what regulatory or legislatively needs to happen. 03:40 I think we as a sector need to be thinking what is it that we want to be, 03:45 you know, what is the right thing to do? 03:48 Do we think that post acute and long term care should be a viable part of the 03:53 healthcare continuum? 03:55 And if the answer is that is yes, and I think it's all yes, 04:00 then we need leadership. 04:02 We need leadership to step up and say what should we look like for the future? 04:07 What is our consumer asking for? 04:10 What do they want? 04:13 What does our government want? 04:14 What do our payers want right now? 04:16 What is Medicare expecting? 04:19 And I think about it in three components. 04:25 What kind of care should we be delivering? 04:28 How are we coordinating that care both internal to our organization and external? 04:36 And then what is the level of customer satisfaction? 04:39 So in phase one, I think about leadership needed, 04:43 and I mean from all major organizations, from the American Health Care Association, 04:51 leading age CEOs of both large and small organizations, administrators, 04:57 clinical leadership nationwide, to determine how do we create a model of 05:03 care that takes into consideration the full ability of registered nurses, 05:10 nurse practitioners, and of course physicians to design and 05:15 direct a framework. 05:17 And framework for me is a really big word there. 05:21 A framework that ensures that every resident, 05:24 every patient internal to every center gets the care that they need. 05:30 Understanding that that care is different. 05:34 How do we coordinate it? 05:35 How? 05:35 What is the level of physician involvement? 05:38 It is freeing the registered nurse up to do with more registered nurses. 05:45 To me, the debate ended a long time ago as to 05:48 whether or not we should have registered nurses in our centers every day, 05:53 24 hours a day. 05:55 Even with the challenges of today, we need to have more registered nurses 05:59 and for me, the right thing to do if that's phase one, 06:03 when I, it's like pulling every pulling everybody 06:06 together and developing a plan for what what it should look like rather than just 06:10 sitting back and waiting to see what gets proposed. 06:14 And, and once we can design that model. 06:17 And Mark, I'm not saying I've got all the answers. 06:19 We have lots of younger clinicians out there today managing great companies and 06:24 a lot of people have stepped up to do many of the things that we've talked that 06:29 we're talking about right now. 06:30 But I think when I'm talking and you're create a plan, 06:35 Everyone I've ever mentored in my entire career, if they've all will say, oh, 06:41 I heard that make a plan, make a plan. 06:44 And what is your plan and how do you execute against that? 06:47 So what I think model of care, I think about designing and and the model 06:54 of care when I help develop the ISNP Medicare Advantage program for Pruitt 07:01 Health and a model of care lays out what will our team look like? 07:07 Registered Nurse, Nurse practitioner, LPN, CNA. 07:11 But who manages and directs that care? 07:15 It is one of the saddest days ever for me when I'm on a call or talking with others 07:20 in our sector and they talk about the fact, well, you know, 07:24 the director of nursing, she's having to give meds right now. 07:28 So she really hasn't been able to do this. 07:30 And so, and a lot of those individuals that 07:33 continually have the title but don't get to direct the actual nursing care, 07:38 they don't want to work with us anymore. 07:41 They left because they couldn't do it. 07:45 So RNs #1 for me designing that model and that team and what does it look like and, 07:51 and starting to step forward then with policy makers, CMS, 07:55 Congress and say this is what we believe we should do. 08:00 How can you help us do it? 08:03 We want to be a collaborative partnership. 08:06 We don't want to be the enemy. 08:10 And sometimes we're looked at as not partners. 08:15 But if we develop the policy, I believe, and start to figure out how we can do it, 08:21 then we can have huge impact in designing the future, 08:24 not just of the nursing center, but of our sector overall. 08:29 It's changed. 08:31 It's changed. 08:33 So it sounds to me like you're issuing a challenge to AHCA, to LeadingAge, 08:38 to CEOs of companies of any size to create a platform to get together and 08:44 come up with a plan. Right. 08:47 And I don't see that happening right now. 08:51 Well, you know, we're doing some things right now. 08:54 I think we're doing it nationwide. 08:59 We're looking at our older buildings and saying we need to tear those down because 09:05 people, consumers want private rooms. 09:08 We need to rebuild, we need to have prettier buildings. 09:11 But we're we're not thinking about the clinical infrastructure and I use 09:16 infrastructure. 09:17 This is not a clinical thing. 09:19 This is our business and we need to decide what we're going to do with our 09:24 business and the clinical infrastructure. 09:27 Consumers are demanding that just as much as they are demanding private rooms. 09:33 And you know, Mark, we're talking about going to value based 09:38 care, a value based care model for all Medicare 09:41 beneficiaries. 09:43 The Biden administration set that goal for everybody being in a value based by 09:49 2030. 09:50 This administration obviously not carrying forward a Biden goal, 09:54 but it's still happening. 09:56 It, it may not be moving quite as fast, but I really haven't seen it slowing down. 10:01 And so people think about value based care and they think about oh, 10:05 our quality metrics, we're five star, we're good for that, not a problem. 10:10 Value based care is so much bigger. 10:12 It is the payer saying that we're not, we're no longer willing to pay for 10:17 inefficient, ineffective care that could be 10:20 characterized as poor. 10:23 And our clinical infrastructure is what changes that. 10:27 This particular company that I worked with, care coordination, 10:31 I say Intel and turn it to the center, what happens to that patient from the 10:36 second they are notified that someone is coming in to their discharge, 10:41 How well is that care coordinated according to the plan of care? 10:46 How well is it coordinated with the payer, with the hospital? 10:51 This particular organization had a case manager paid for by their corporation 10:58 whose office was in the hospital. 11:01 And the I mean, those are the kind that is the clinical 11:05 infrastructure that is being. 11:08 It's not something in the future, Mark, it's now. 11:12 And we have to make the decision are we going to do it or not? 11:16 Yeah. 11:17 Well, I mean, this has been very enlightening, 11:20 somewhat sobering because because I think you, what you're saying is, is true. 11:25 You know, the staffing mandate was not possible to 11:28 implement and it would have put the vast majority of providers in the country out 11:32 of compliance. 11:33 And it wasn't clinically backed up. 11:35 There wasn't the, the, the research to say this is where we 11:38 should add resources, right? 11:40 It was a political instrument. 11:42 It was someone else's voice telling us what we think. 11:46 We need what I'm saying and we need our voice telling us and our, our, 11:51 our patients and residents what we need. 11:54 Yeah. 11:55 I mean, I think the message is loud and clear. 11:56 It's not a time to to celebrate and do nothing. 11:59 It's a time to figure out what we want to be, as you said, 12:01 when we grow up and do this in a in a smart, logical way. 12:05 And hopefully. 12:06 I mean, if we could do what you've just described, 12:09 just imagine the outcomes that we would achieve for residents across the country. 12:14 Absolutely. 12:15 And people would no longer say I had to put my mom there. 12:20 Yeah, Yeah. 12:22 Well, Mary, thanks for rejoining us. 12:24 Thanks for this message. 12:25 We'll see if the sector reacts. 12:28 And it's not just a sector. 12:29 I mean, if this is on me, it's on you. 12:31 It's on all of us. 12:32 Absolutely, absolutely. 12:34 So just just demand that we move forward, we create plans and and we do the right 12:38 thing for the residents in our building. 12:41 So Mary, thanks again for joining us. 12:42 Mark, I do want to make clear, I'm not saying that I supported that 12:46 mandate. 12:46 I did not and and it would not be the right thing to do for, for, for any of us, 12:52 but most specifically for the individuals we care for. 12:58 Mary, thanks again for joining us and thanks 13:00 all of you for your continued support of Park Place.
