Transcript Generated by AI 00:05 Mark Parkinson back with Park Place and we are continuing to do a deep dive on 00:09 Texas and what it's like to operate in Texas. 00:12 And we're, you know, getting some surprising reports from 00:15 folks that, hey, things have turned around in the state 00:18 and can be pretty darn good. 00:19 Today, we're going to look specifically at the 00:22 regulatory environment. 00:23 And we're joined by the probably the best provider in the country to talk with us 00:27 about it. 00:27 Meera Riner is the COO of Nexion, which has 56 skilled nursing facilities 00:32 in Texas, Louisiana and Mississippi. 00:36 But more important, she's one of the leading experts on 00:38 nursing home quality in the country. 00:40 And the proof is that she's won the Mary Ousley Champion of Quality Award, 00:44 which is the highest quality award that can be stowed in our sector. 00:48 She's actually moved down to Texas to work full time to to work on the 00:53 operation there. 00:54 And Meera, we're thrilled to have you join with join 00:56 us today. 00:57 Thank you. 00:58 Now, Meera, Texas has historically been considered 01:01 one of the toughest states in the country to operate in. 01:04 When you think about operating in Texas, what, 01:07 what's like one of the first things that comes to mind? I would say relationships. 01:13 Texas is a big state with a lot of different stakeholders, 01:17 and relationships really matter here. 01:20 You can't come into Texas and bully your way to success. 01:24 You have to build trust. 01:25 You have to listen, understand different perspectives, 01:29 and be willing to work together. 01:32 I found that when you approach people with good data, mutual respect, 01:37 and a genuine willingness to collaborate, you can accomplish some pretty remarkable 01:42 things. 01:43 I think what we've accomplished around immediate jeopardies is a great example 01:48 of that. 01:49 Well, let's talk a little bit about that 01:51 because I mean, first of all, it's refreshing and, 01:54 and and you know that that even in a state as large as Texas, 01:57 or maybe because it's, it's so large, you relations, 01:59 relationships really matter. 02:01 You're you led an effort to reduce IJs in Texas and appeared, you know, 02:07 obviously been very successful. 02:09 Tell us about that effort. 02:11 What did you do? 02:13 We actually started with the data. 02:16 Texas was clearly an outlier. 02:18 At one point we were approaching 1000 IJ tags, 02:21 and when we compared ourselves with other states, 02:25 it was obvious that something was different in Texas. 02:29 This was a case of where bigger is not better. 02:32 So we didn't take that information to the state and say, hey, you have a problem, 02:36 fix it. 02:37 We said here's what the data shows us, let's understand why and let's work on it 02:43 together. 02:44 And that's exactly what we did. 02:46 We had lots of meetings at various levels. 02:50 We had open conversations, joint training sessions and discussions 02:55 about how guidance was being interpreted and applied, 02:59 and providers and regulators all had the same seat at the same table to work 03:05 through the issues together. 03:07 So we didn't just bring them a problem, we brought them what I call a partnership 03:13 and really helping them understand how this affects us on a national level in 03:19 terms of reputation and how lawmakers and the federal government, you know, 03:25 look at how Texas performs. 03:27 So that partnership was pretty amazing. 03:30 So you started out with almost 1000 IJs a year. 03:33 Where are you at now? 03:35 So the result has been pretty remarkable. 03:38 We went from exactly 923 IJs in 2024 and we ended fiscal year 26 at 337, 03:47 which was a 63% reduction in just two years. 03:54 And what's important about this mark is we didn't just accomplish that by 03:58 lowering the bar for care. 04:00 We improved communication, education, consistency and collaboration. 04:07 Yeah. 04:07 I think what's really exciting about that is, first of all, you did it in Texas, 04:10 which is an incredibly important state to the sector. 04:12 More nursing homes in Texas than in any other state. 04:16 But I think this is a road map for other states. 04:20 I mean, this can be done in other states, right? 04:23 Yes. 04:24 And it's proof to me that you don't have to choose between strong regulatory 04:28 oversight and a collaborative relationship with providers. 04:32 You can have both. 04:34 And ultimately, when you do, residents benefit and that's what we were 04:38 able to show them. 04:39 Now I know at your core it's all about quality, 04:42 taking care of residents in a great way, which you've done such a great job in 04:46 your whole career on. 04:47 Have have you been able to have the numbers moved in Texas? 04:50 What have you seen there? 04:52 Absolutely, Mark, When you look at like the CMS five star 04:57 measures, specifically on the quality measure, 05:01 you can see that Texas went from 42nd in the nation in 2019 to 18th in 2025. 05:08 And our average QM score increased from 3. 02 in that same time frame to 3.75. 05:18 That's tremendous progress and something our providers across the state should be 05:23 very proud of. 05:25 But I'll say this, I don't think we're finished. 05:28 Quality isn't a destination. 05:30 It's something we get to work on every single day. 05:33 Rankings and awards are wonderful because they validate the work that's being done. 05:38 But ultimately, what matters is what those improvements 05:42 truly translate to for the residents and families we serve. 05:47 Nora, what what do you see for the future in 05:49 Texas? 05:50 Mark? 05:50 I'm very optimistic. 05:53 We certainly have challenges ahead, workforce reimbursement, regulation, 05:58 residents coming to us with more complex needs. 06:02 But Texas has developed something incredibly valuable. 06:07 We've learned how to work together. 06:09 We built relationships amongst providers, regulators, associations, policy makers, 06:15 allowing us to have some really difficult conversations, 06:19 but actually solve problems at the same time. 06:23 So now we get to build on that, keep raising that bar on quality, 06:27 strengthen our workforce, make sure reimbursement supports the care 06:32 that our residents need, and continue keeping the residents right 06:36 at the center of every decision. 06:38 Texas has made a lot of progress, but our best work is still ahead of us. 06:44 Mira, thanks so much for that positive message. 06:46 The the residents of Nexion and the sector are really lucky that you chose 06:51 long term care. 06:52 And thanks so much for being with us today on Park Place. 06:55 Thanks for having me, Mark. 06:56 And you know, this is just a continuing series in Texas. 06:59 What we're finding out from our prep interviews and the interviews that we're 07:03 putting up on the side is that things have definitely turned in Texas from the 07:07 very nasty reputation the state had had in the late 90s and early 2000s, 07:11 it's clear that things are much better now. 07:14 Congratulations. 07:15 Thank you. 07:16 Yeah. 07:16 It's just great to see what's happening. 07:18 And thank all of you for your continued support at Park Place.
