Transcript Generated by AI 00:00 Hey, 00:00 Mark Parkinson back with Park Place, 00:02 and we're continuing our 00:05 investigation as to whether or not Illinois is really the worst 00:08 state in the country to operate a nursing home in. 00:10 And today we're gonna focus on 00:12 the regulatory environment. 00:14 Now, 00:14 I think we all know that 00:16 most providers believe that their state is the absolute worst 00:19 state for survey and all of that other stuff. 00:22 Obviously, 00:23 not every state can be the worst. 00:25 There are some that are better than others and some that are in the middle. 00:28 Uh, 00:29 but it's natural that we all feel that it's quite bad. 00:32 We've decided that we want to do an 00:34 objective analysis of where each state actually stands. 00:38 And so we asked Stephen Little Hale, 00:39 who's the Chief Innovation Officer at Zummit, 00:42 to come up with 00:43 an objective way 00:45 to analyze 00:46 the regulatory environment in a state. 00:49 And Steven has done a remarkable job 00:51 at putting together an index 00:54 that provides us an objective data-driven view of every single state. 00:59 We're gonna be rolling out some features about it 01:01 on Park Place in the next few months, 01:03 but today we're gonna talk about the index and specifically 01:06 about where Illinois rates once you apply the index. 01:09 So, 01:09 Steven, 01:10 welcome back to Park Place. 01:12 Thanks. 01:12 I'm thrilled to be back here and I'm really excited to talk about this topic. 01:16 And thank you for putting this together. 01:18 It's a, 01:19 it, 01:19 it's a remarkable thing that you've done. 01:20 You've created a state regulatory index 01:23 that allows us to provide an objective analysis of 01:28 how states stack up on regulatory issues. 01:30 So tell us a little bit about the index and the things that you use 01:34 to measure a state. 01:36 Sure, 01:36 I'd be happy to. 01:37 We really focused um on what really would matter 01:41 to an operator or to an external stakeholder. 01:45 So there's a lot of noise in the regulatory system, 01:48 um, 01:48 but if a facility is known, 01:50 or rather a state is known for having 01:52 multiple, 01:53 multiple number of tags on average, 01:55 but they're low level tags, 01:57 it's more of a paperwork burden. 01:59 But if a facility is constantly or a state is constantly using DPNAs, 02:06 for example, 02:07 or very high civil monetary penalties, 02:11 that would be a clear indication that not only is a financial burden 02:15 to the operator, 02:17 but it is also a significant operational burden to the operator as well. 02:22 So what we did is we, 02:24 from a pool of criteria. 02:27 Um, 02:27 we tested them to see 02:30 what kind of variation we had 02:32 across the states. 02:34 These are the criteria, 02:35 the 12 criteria that lasted, 02:38 that really held up to 02:40 the research rigor that we applied to all of these variables. 02:44 So these, 02:45 these words probably seem very familiar to you, 02:49 uh, 02:49 the number of days between survey, 02:51 for example, 02:52 um, 02:52 the percent of 02:54 uh uh tags that were in IJ level. 02:58 The amount of civil monetary penalties as an example. 03:03 These had variation across states 03:06 and they all went ultimately 03:09 into the single metric 03:11 that we're talking about here today. 03:13 A couple of points to Mark, 03:15 to remember 03:16 is that 03:18 while these are 12 criteria, 03:21 not all the criteria 03:23 are weighted the same, 03:24 so the criteria are weighted 03:26 based on their significance, 03:28 the potency 03:30 to operators and stakeholders, 03:32 and, 03:33 and again, 03:34 every criteria was weighted using basically a 3 point scale. 03:40 Well, 03:40 I love the idea of putting data and really objectivity towards, 03:45 you know, 03:45 rating these states on, 03:46 on, 03:47 on what their regulatory environment is like. 03:49 So, 03:49 when you apply these 12 criteria to Illinois, 03:53 uh, 03:53 where did Illinois come out? 03:56 Uh, 03:56 certainly, 03:56 let's take a look at the criteria 03:59 in how it played out for Illinois. 04:01 So this is Illinois here 04:02 and you'll either see the letter U, 04:06 F, 04:07 or N in the analysis. 04:09 So U is unfavorable, 04:11 F is favorable, 04:13 and N is neutral. 04:16 So let's pop down to, 04:18 let's say the the third criteria, 04:21 the 04:22 percent of G or higher tags that were IJ. 04:26 Illinois actually 04:28 was favorable in this criteria, 04:30 meaning 04:31 that 04:32 sure they had tags that were G and higher, 04:34 but surveyors weren't inclined to jump right to an IJ. 04:39 And you'll see how different that is in other 04:41 states as we introduce other states to this mix 04:44 or 04:45 going across to the other side, 04:46 the months on a special focus facility. 04:50 Once you're on the list, 04:52 every state, 04:53 the amount of time you spend on the SFF list varies considerably by state. 04:58 And in the case of Illinois, 04:59 it was unfavorable. 05:01 There was a lot. 05:04 Greater number of months on the SFF list 05:07 if you were 05:08 in Illinois facility on that list. 05:11 And, 05:11 and all of these you're, 05:13 you're comparing them to the data in other states 05:15 and really sort of coming out with a ranking. 05:18 That's right. 05:18 That's right. 05:19 We're, 05:19 we're seeing how far the criteria is from the national mean, 05:24 how many standard deviations away 05:26 from the national mean. 05:27 Um, 05:28 and then, 05:29 uh, 05:29 in a sense, 05:30 giving an idea of how each state compares to 05:34 other states, 05:35 but also how its performance is based in comparison to the national average. 05:39 So when you add all this up for Illinois, 05:41 where does it rate relative to the rest of the country? 05:44 Really kind of interesting because as you, 05:47 as you said, 05:49 Many people in the state will believe that 05:51 they are operating in the worst state imaginable, 05:55 but in the case of Illinois, 05:56 it was actually neutral on the state regulatory index. 06:00 So there's 7 06:02 different buckets they could have fallen into, 06:04 and they were right in the middle. 06:06 And just, 06:07 just very quickly, 06:09 they could have been very favorable or very unfavorable. 06:14 Almost every state fell into one of those buckets, 06:17 unfortunately, 06:18 or rather fortunately, 06:19 we don't have a state that is very unfavorable, 06:22 but Illinois 06:23 fell in the neutral 06:25 category. 06:26 So you've, 06:27 you've taken all this data and you've, 06:29 you've ranked every state and, 06:31 and they're in one of these diff different 06:33 buckets, 06:33 and it just so happens that the very first state that we focus on, 06:36 Illinois is right in the middle. 06:38 Exactly right, 06:39 but you can see, 06:40 uh, 06:41 bordering Illinois, 06:42 every single state has, 06:44 uh, 06:44 or almost every single state has a different experience 06:48 in terms of the regulatory system. 06:51 Well, 06:51 Steven, 06:51 this is really fascinating. 06:53 I think a fantastic tool, 06:55 um, 06:55 because again, 06:56 it, 06:57 it feels like no matter where you are, 06:58 it's impossible and hard and very, 07:00 very punitive, 07:01 and frankly, 07:01 it's probably punitive in every state. 07:02 It's just less punitive in others and more punitive in some. 07:06 Uh, 07:06 but by creating this tool, 07:08 uh, 07:09 I think you've really added something that's quite valuable, 07:12 um, 07:12 for the sector. 07:13 In future, 07:14 uh, 07:15 uh, 07:15 months, 07:16 I know we're gonna be unveiling some additional features about the tool where 07:19 people will be able to gather information about every state out there. 07:22 So, 07:23 Steven, 07:23 thanks so much for putting this together and, 07:25 and 07:26 thanks for answering the question, 07:27 at least on the regulatory side as to whether or 07:29 not Illinois is the worst state in the country. 07:31 It's clearly not. 07:33 And we hope that you find this information valuable 07:35 and thanks for your continued support of Park Place.
