Transcript Generated by AI 00:00 Hey, Mark Parkinson back and welcome to the 00:03 Thrilla in Manila. 00:05 Pan. 00:07 That's of course, I take off on the Thrilla in Manila and 00:10 the fact that our studio is in some city I can't pronounce man plan. 00:15 What the Hell's the name of the city? 00:16 Manalapan. 00:17 Manalapan. 00:18 OK. 00:18 But we're having the "Thrilla in Manila-pan" because Marc and I have a 00:21 major disagreement. 00:23 When we decided to do this website, one of the things I was super excited 00:26 about was to use it as a platform to encourage states to have quality based 00:30 payments. 00:31 I think one of the biggest risks that we face in the sector are poor providers and 00:35 people that don't do a good job and horrible things happening in buildings 00:39 and the reaction that that could ultimately bring. 00:42 And so I was very excited to talk with Marc about, hey, 00:45 let's just just do everything we can to encourage states to have quality based 00:48 payments. 00:48 And Marc told me that quality based payments are not a good idea that they 00:52 haven't worked out. 00:54 I don't agree with them, but we're going to hear him out. 00:57 So Marc, what's what's the problem that you have 00:59 with states paying people for quality? 01:01 Yeah, this is blasphemy. 01:03 But if there is extra money for quality payments, 01:05 I'd rather the state hold it back and not distribute it than distribute it the way 01:10 they've been distributing it. 01:12 So you're against quality? 01:14 I am against quality incentive payments because they are regressive. 01:18 OK, explain that it the the facilities that 01:21 need the the money least are the ones that earn it. 01:25 So the Medicaid, the facilities that are predominantly 01:28 Medicaid that they don't have staff or they're lower staffed or lower quality 01:33 because they cannot afford to pay for the staff. 01:38 Facilities with higher Medicare invariably have more staff, 01:42 have better outcomes. 01:43 I think we'll use the word quality. 01:46 They're the ones disproportionately that earn the quality incentive payments, 01:51 but they're earning it off the backs of the Medicare population. 01:56 And it is there, it is a, an it's undue enrichment. 02:02 So you're seeing, you're seeing the CCRCS, the 100% Medicare facilities, 02:07 they're the ones that are having the highest QMS. 02:12 And so we're benefiting by these programs. 02:15 No, I wouldn't say, I wouldn't say the 100% Medicare because 02:17 they're not giving you Medicare, right, right. 02:19 But the high, the high percentage, right, right, right. 02:21 So if you got let's, let's take a facility that's got 90% 02:24 Medicaid a share versus a facility that's got 50% Medicaid share. 02:29 The more Medicare you have, the higher your nursing, your staffing, 02:33 the higher your quality scores, the the higher incentive payments you're 02:37 getting. 02:38 So could we fix this or could a state fix this by somehow controlling for the 02:44 Medicare population? 02:47 I it's not the population you want to control for. 02:51 Again, if a, if a facility is doing well and they're 02:55 stable and they're profitable and they're, and they have quality, 02:59 they're being rewarded by attracting more Medicare patients. 03:03 That's the reward and it's the Medicaid, high Medicaid facilities that need a 03:10 boost. 03:11 So it shouldn't be a reward for something that they were doing anyway for a 03:17 different reason. 03:18 But we have seen, I mean, and I don't have to add on this, 03:21 I'm just going anecdotally in a state like Ohio where you have to be in the top 03:25 75% on various QMS in order to get what I think is a pretty significant bump. 03:30 It's like 50 bucks a day. 03:32 Anecdotally, what I'm hearing is everybody's 03:34 scrambling like crazy to improve their QMS. 03:36 So it seems to me like it's having the intended effect. 03:39 I'm not going to comment on that. 03:40 QMS are the least objective. 03:46 How about that or the most manageable of the qualities. 03:49 People respond to the incentives that we give them and if we tell facilities we'll 03:54 give you money if you improve quality doesn't do you do you agree that it that 03:58 it'll cause behaviors that will improve quality? 04:01 Well, let's talk about quality. 04:04 What is the you know, what is the main driver of quality? 04:08 Let's assume it is nursing. A high Medicaid population facility 04:14 cannot afford these staffing levels that a, a high Medicare facility can, 04:20 can afford. 04:22 And if you want them to increase quality, then I prefer a quality encouragement 04:29 payment, if you will, or quality initiative where those poor 04:34 performing facilities that have high Medicaid and the dollars are right there. 04:41 Everything's transparent. 04:42 There's nothing hidden to give those facilities extra dollars to hire 04:47 additional staff. 04:48 If it's used for staff, they keep the money. 04:52 If it if they don't, they give it back. 04:55 It is a completely regressive system that the Ohio system's a little different, 05:03 but I wanted to go to facilities that that cannot afford to add staff because 05:11 of their Paramex. 05:13 Yeah, well, we're going to have to agree to disagree 05:16 on this. 05:17 And because I get the last word, I get to declare that I've won the 05:20 argument. 05:21 But thank you for participating and giving it a, a decent shot. 05:24 I'm going to put on LinkedIn the the data. 05:26 So, all right, well, thank you for watching this segment. 05:31 Who knows? 05:31 But I, I just think we got to incentivize 05:33 quality in any way that we can. 05:35 And I, I think Marc's right, we need to do it probably in a smarter 05:38 way that we have. 05:39 Thank you for watching the segment. 05:41 Thank you. 05:41 Thank you for your support of Park Place. 05:45 Oh my God, If you're still watching this, this means that you watch the end of a 05:49 very long video on Park Place. 05:51 I'm not sure what that means. 05:53 It says something about you or maybe there was just nothing else to watch 05:56 today, or maybe your priorities are a little bit 05:59 off. 05:59 But whatever it is, we really appreciate your support. 06:02 And if you want to continue to follow us, follow us on LinkedIn, 06:06 on our various social media sites and, you know, 06:08 try to find something else to do.
