Transcript Generated by AI 00:00 Hey, Mark Parkinson back with Park Place. 00:02 And we're continuing our deep look at Massachusetts to try to figure out what 00:06 it's like to operate nursing homes in that state. 00:10 We had a great interview with Tara, who runs the association, right. 00:13 And now we're here to talk with Steven Littlehale from the Zimmer organization 00:16 about the regulatory side. 00:18 And I, you know, if you watch the Illinois series that 00:21 Steven has come up with, really, I think a brilliant way to analyze the 00:25 regulatory environment in every state. 00:28 And he's here today to talk to us about how Mass fits on that scale. 00:32 So Steven, welcome back to Park Place. 00:34 Thank you. 00:35 Thank you. 00:35 I'm really happy to be here. 00:36 In full disclosure, Massachusetts is very important in my 00:40 life. 00:41 It's where I was born, where I was brought up. 00:43 So I definitely have a, a soft spot for Massachusetts. 00:47 That's great. 00:48 That's great. 00:49 Well, and, and I know you've done, you know, 00:51 such terrific work over the years and, and this this instrument that you put 00:54 together on the regulatory thing, I think it's one of the best things that 00:57 you've done. 00:58 So, you know, we learned in in the last segment with 01:01 Illinois that you've put together a rating system for states that ultimately 01:07 ends up with a grade with seven different possible grades ranging from very 01:12 unfavorable to very favorable. 01:14 Before we get into the mass grade, let's first of all talk about the 01:19 criteria that you use when you analyze a state's regulatory system. 01:23 Sure, absolutely. 01:25 And if you wouldn't mind, I'd like to share my screen. 01:27 That'd be great. 01:28 Yeah. 01:28 If you could pull those criteria up for us. 01:31 I think people will realize that this isn't just like an anecdotal guess that 01:35 you're making. 01:35 You're you're looking at some really important criteria when you decide, 01:40 you know, where does the state fit in. 01:42 So what, what are those criteria that you look at? 01:46 Sure. 01:46 Well, here we are looking at them on the screen. 01:50 They are criteria that not only are important to operators or other external 01:58 stakeholders. 02:00 So to know how frequently a state is citing abuse or how frequently they're 02:07 citing Ijs, for example, or penalizing a facility with a CMP and 02:13 how much that CMP is, there's a lot of variation across all of 02:18 the states on really all of these criteria. 02:23 So it had to 1st feel right from a subject matter expert perspective, 02:27 but then it also had to statistically offer something to this model. 02:32 If it really wasn't contributing to the model, we dropped the criteria. 02:37 So what we're left with are the criteria you hear, you see here on screen. 02:41 The criteria doesn't change, but every quarter, 02:44 we're updating the information as it's made available. 02:49 And so in terms of Massachusetts, let's see how Massachusetts did on all of 02:54 these criteria. 02:57 We are rating each of the criteria on either unfavorable, that's the U in red, 03:03 neutral, that's the N that's in blue or favorable, 03:07 that's the green F. 03:09 And as you can see, there's mostly Massachusetts is receiving 03:14 a favorable green F. 03:17 Now it doesn't mean that for example, the that they are not delivering IJs to 03:24 facilities that they certainly are. 03:27 But when you look at the national average and you look at the distribution across 03:34 states, Massachusetts is not delivering IJs at 03:38 that higher rate. 03:40 Other areas like the amount of the amount, the dollar amount of CMP fines is 03:46 unfavorable because when CMP fines are delivered, 03:50 they're actually higher than what we see in other states. 03:55 But then you've got like 6 or seven criteria where mass is doing really well. 03:59 Percent of G tags that that are that were IJs, 04:02 the percent of deficiencies that were IJs, percent of deficiencies that were 04:06 complaints. 04:06 All all of these are, are favorable absolutely. 04:09 And and I think 1 criteria is worth pointing out and and it's very ill 04:13 illustrative of how we're looking at states. 04:16 So people might wonder what is the days between survey listed here on the upper 04:21 right hand side and you see in Massachusetts it's favorable. 04:25 Why is that there? 04:26 Well, what we hear from operators, from lenders, from Reit's, 04:31 frankly from consumers is that the number of days in between standard survey is 04:38 very important. 04:40 In fact, never did I think in my career a provider 04:43 would ever say I wish I would have my annual survey. 04:47 And the reason is there's so much delay in between standard surveys because 04:55 frankly of shortages of surveyors. 04:59 And what happens is that you, you don't have a chance to reflect who 05:04 you really are to consumers, to your bank, etcetera. 05:08 So if you have a bad survey from 2 maybe even 3 years ago, 05:13 it sits there and you don't have the opportunity to show the world that you've 05:20 actually improved. 05:21 So in Massachusetts, they're really not that bad in terms of 05:25 the average number of days in between survey. 05:29 Sure, there are variations based on the part of 05:32 the state you reside in, but generally speaking, their average is, 05:37 is fairly good. 05:39 So that's what that criteria is about. 05:41 So when you add it all up, when you look at all of these criteria, 05:44 what, what grade did you end up giving Mass? 05:47 Sure. 05:47 Massachusetts up there in the upper right hand corner, 05:51 all those criteria considered, they came out as being favorable. 05:55 So from a regulatory perspective, Massachusetts is considered favorable. 06:01 And I mean, that's really significant because I 06:04 believe there's only 9 states that are in your favorable category. 06:08 And I think there's none that fit very favorable. 06:12 So Mass, at least for now, is really kind of near the top in terms 06:15 of regulatory environment. 06:17 Absolutely, definitely near the top. 06:20 There's room for improvement as you pointed out by noting that there's no 06:25 very favorable in the country, just as there are no very unfavorable 06:30 within the country as well, but the possibility is there. 06:35 Great. 06:36 Well, Steven, thanks so much for this update on where 06:39 Massachusetts fits into this whole scheme. 06:41 Again, I think your grading system is brilliant 06:44 and really adds a lot to the sector. 06:46 And thanks all of you for continuing to follow this report that we're doing on 06:51 the state. 06:52 And thanks for your continued support of Park Place.
