Transcript Generated by AI 00:01 Mark Parkinson back with Park Place and we're continuing our review of Florida 00:06 and what it's like to operate in Florida and very happy that we have Steven 00:11 Littlehale here with us today. 00:13 Steven is the Chief Innovation Officer at Zimmet and you know obviously a well 00:18 known national expert on lots of parts of the long term care system. 00:23 Recently, he's developed the State Regulatory Index, 00:27 which is a very cool tool that analyzes the regulatory environment in every state. 00:33 I think many operators believe that their state is the hardest to operate in from a 00:38 regulatory point of view. 00:39 And I get that it's really hard everywhere. 00:42 But what Steven has done is he's taken a bunch of objective criteria and applied 00:46 them to each of the states so that we can get a real feel for what is it like to 00:51 operate in the state. 00:52 It's hard everywhere, but is it incredibly hard or some less or 00:56 lesser level of being hard? 00:58 So Steven, welcome again back to Park Place. 01:02 Thanks very much. 01:02 I'm really happy to be back and, and especially happy to talk about my new 01:07 home state, which is Florida. 01:09 Yeah, I've noticed that you moved down there. 01:11 I see on your LinkedIn page you're now it's like list you as Florida. 01:15 So that's great. 01:17 So Steven, I love what you've done with the state 01:20 regulatory index. 01:21 And before we get into Florida's ranking, just explain how you've come up with this 01:27 objective way to look at a a state's regulatory system. 01:30 Sure, I'd be happy to explain that. 01:32 So just to be clear, it's really focused on survey and 01:36 certification under the umbrella of regulatory. 01:40 There's other components outside of survey and certification that would fall 01:45 under regulatory, but this is really focused in on the 01:50 survey elements. 01:51 The way we came up with the criteria is we really talk to subject matter experts, 02:00 not just myself, but subject matter experts who know the 02:05 many levers within the survey and certification process that actually cause 02:13 great amounts of trouble either financial concern or work workforce effort to 02:21 respond to these regulatory survey outcomes. 02:26 We looked to see if there were it were indeed variability across the country 02:32 between the States and we finally threw some careful testing, 02:37 were able to identify a, a handful of criteria that really does 02:43 separate the regulatory experience within each states. 02:49 I'll, I'll go through them very quickly and 02:51 they're up on the screen now. 02:53 So things like the number of CMP civil monetary penalties, 02:59 but also the amount of those penalties if a state is likely to give IJ tags, 03:07 if they're going to give A tag over G, or even the months that someone might 03:15 spend on the SFF candidate list or the SFF actual list. 03:22 Those are just some examples of some of the criteria that cause operators concern 03:28 and ultimately would be helpful for anyone considering a any kind of 03:33 relationship with the facility in any state to know about. 03:37 Yeah, I think it's a really brilliant system. 03:39 And I, I don't want to spend too much time on 03:42 this because I do want to go to Florida, but in multiple ways, I think your, 03:46 your measure has been validated. 03:48 And one of them is, is that if you go back and look over time, 03:51 there's not, there's not wide variation within the 03:54 states. 03:54 The states are staying pretty much in the same general area. 03:57 Is that right? 03:58 That's right. 03:59 That's exactly right, Mark. 04:00 I would be concerned if we were seeing a lot of ping ponging between the 04:07 categories. 04:08 We have 7 different categories that ultimately a state falls into. 04:13 And when we do see change, we're only seeing movement between the 04:17 adjacent category. 04:19 So someone might go from being favorable to neutral or neutral to favorable there. 04:27 There aren't wide swings, which is great to see that the measure is 04:33 stable. 04:35 Yeah. 04:35 So when you apply your standards and objectives to Florida, what, 04:40 what grade does Florida get and and why? 04:44 OK, sure. 04:45 So what I'm sharing right now is the specific criteria, 04:49 all of them in where Florida ranks on each of those criteria, 04:54 everything from unfavorable neutral to favorable. 04:58 And on the next slide, you can see that ultimately we have a 05:04 favorable ranking for Florida and it has been favorable throughout the duration of 05:11 our measuring using this index. 05:14 So Florida is really a highlight within the country in terms of regulatory, 05:20 specifically survey certification experience for its operators. 05:26 Are there one or two areas where you see it doing particularly well that that jump 05:30 out at you to for it to end up in that category? 05:33 Sure, That's also another great question. 05:35 Well, when you look at things like DPNAS or 05:39 DDPNAS, the months on a candidate list, average health index scores from survey 05:48 deficiencies, all of those are, are really favorable in Florida compared 05:56 to other states. 05:59 Yeah. 05:59 Now I'm sure there's many operators in Florida that are watching this and 06:02 they're saying, wait a minute, I, you know, survey is a nightmare here. 06:06 And, and I'm sure you know, it certainly can be at times, 06:09 but relative to the rest of the country, it looks like Florida is in that small 06:14 group of states that we can actually say that the regulatory system on the survey 06:18 side is somewhat favorable. 06:20 Yes, I, I absolutely, Mark, I agree with what you, 06:24 how you surmise that absolutely Florida's not a bed of roses. 06:28 There's, there's one particular issue that does 06:32 call up 'cause operators concern. 06:34 But looking at the other criteria, you can see that they're either neutral 06:39 or favorable. 06:41 Well, Steven, thanks again for joining us. 06:43 Again, I am thrilled that you've put this index 06:46 together. 06:46 I, I, I think it's such, so great to finally have an objective way 06:50 to really analyze, you know, what's happening in the States. 06:53 And you've provided that to the sector. 06:55 And we appreciate you coming to Park Place and telling us about it. 06:58 Always a pleasure. 06:59 Thank you. 06:59 Great. 07:00 And thank all of you for your continued support of Park Place.
