Transcript Generated by AI 00:05 Mark Parkinson back with Park Place and we're continuing to do our deep dive on 00:09 the state of Texas and we've already found out some really interesting things. 00:14 It's certainly feels like Texas is on the upswing. Today 00:18 we're going to talk with a provider, and it's not just any provider. 00:21 Super happy that Robin Underhill, who is the CEO of Cantex. 00:25 She's been the CEO for over 25 years, one of the most respected leaders in our 00:29 space is here to talk with us about what it's like to actually operate in Texas. 00:34 In addition to being the CEO of Cantex, Robin also serves as the vice president 00:39 of the Texas Nursing Home Coalition, which is the very large group that has 00:44 recently been successful in bringing everybody together. 00:48 Robin, welcome to Park Place. 00:51 Thank you, Mark. 00:51 It's an honor to be here. 00:53 That's great. 00:54 Now, Robin, I think you know, and you've been, 00:56 you fought the battles for decades now that Texas has been considered one of the 01:01 toughest states in the country and particularly on the Medicaid side, 01:05 where the Medicaid rate is just often not been enough. 01:09 I think there was a 10 year period 01:10 where there was literally no increase at all in the Medicaid rate. 01:14 But it feels like that's changing now. 01:16 How, how do you navigate this tough situation 01:19 in Texas? 01:20 Yes, you're, you're, you're right. 01:22 It has been difficult. 01:24 I will say I'm both happy and proud that Texas is seeing some meaningful progress 01:29 in its Medicaid reimbursement system. 01:31 We have the coalition, the Texas Nursing Home Coalition to point 01:36 our thank yous to and kudos to. 01:39 I will say that the Coalition worked collaboratively with the Texas Health and 01:46 Human Services Commission leading up to a reimbursement change to focus on a new 01:52 methodology for how Medicaid would function and operate here. 01:57 And so we took a page off the national scene. 02:00 So the federal reimbursement system, patient driven payment model, 02:05 we have it dubbed here in Texas as PDPMLTC and it aligns reimbursement with 02:11 the clinical conditions of the patient. 02:14 I will say for Texas operators, it really comes down to three areas of 02:19 focus for us, clinical programming, accurate documentation and we really are 02:24 looking at staff that have a clinical medical bona fides, if you will, 02:28 to really be able to take care of a complex patient because that speaks to 02:33 influencing the Medicaid reimbursement here in Texas. 02:37 That's, that's great. 02:38 Now, Robin, I know that Texas is also one of three 02:41 states that has that special program where nursing homes collaborate with 02:45 hospitals, I think literally turn their licenses 02:48 over to hospitals and then end up getting a special Medicaid rate that's more of a 02:53 blend of a Medicare and Medicaid rate. 02:55 I think in Texas, it's called the QIP program. 02:58 How, how, how does that impact the state in a 03:02 transformational manner? 03:04 So you're referencing our Texas quality incentive payment program. 03:08 You're right. 03:08 We call it QIP here in Texas. 03:10 It has been absolutely transformative for the skilled nursing facilities here in 03:16 Texas. 03:16 It's brought a generous amount of reimbursement and aligned with quality 03:21 measures. 03:21 So think pay for performance, think that value based a dollar for every 03:26 quality measure that we influence in a positive direction. 03:31 And the proof's in the pudding. 03:33 And I know Meera mentioned this in your last previous podcast that in 2019, 03:40 Texas was ranked 42nd and as of last year, they're ranked 18th in CMS quality 03:47 measures. 03:49 So really speaking volumes about the unity of the skilled nursing industry 03:54 here in Texas and its focus on improving quality of life, 03:59 quality of care metrics in general. 04:02 My last point is QIP has really allowed for us to reinvest in our facilities, 04:09 our staff. 04:10 We're seeing dollars poured into our physical plants, renovations, technology, 04:17 AI, workforce development in a way that we 04:20 hadn't really seen before the introduction of QIP. 04:26 Yeah. 04:26 And I love the way you word that because there are some people back here in DC 04:30 that view these programs as like a, a trick or, you know, 04:33 some abuse of the Medicaid system. 04:35 But what you're saying is it's really materially improved quality in Texas. 04:39 And that far from a trick. 04:40 It's a literal focus on improving quality of care, quality of life metrics. 04:47 And for us as a team to be focused on embracing that patient, 04:51 knowing their journey, being intentional about care and seeing 04:54 great outcomes, that's great. 04:56 Now the, the other thing about Texas that I think 04:59 most people know is it's, it literally is the Wild West in the 05:02 sense that there is no certificate of need requirement. 05:05 How do, how do you navigate that? 05:07 What, what pressures does that create? 05:09 There's no doubt Texas is an open enterprising market. 05:14 It loves an entrepreneurial spirit. 05:17 I, I, I will say a couple years ago, several nursing home operators, 05:22 they came together to challenge that and say maybe we should lobby for a 05:28 certificate of need. 05:30 But the fiber and DNA of Texas is let us not put a cap on entrepreneurial mindset, 05:37 on enterprising growth and competition can be seen as a positive. 05:44 It's positive pressure. 05:45 And I think you're seeing that with our nursing facilities in Texas. 05:50 We're mindful of each other, we respect each other, 05:54 but we're hyper vigilant on all things quality. 05:57 We're focused on our environments. 06:00 Are they remaining relatable, attractive? 06:03 Can we welcome patients and families in and can they see that caliber of the 06:08 facility, look and feel at the level of quality 06:11 care? 06:11 I think the judgement is we're better for it. 06:15 We're we're better to be competitive. 06:18 Now what you I, I think I know you seem optimistic and 06:21 you know, I know things have gotten better in Texas. 06:24 What do you see as the future in operating in Texas? 06:26 I can't use that word because Meera used that word. 06:31 So how about bullish? 06:32 How about energized? 06:34 So you could see it on my face. 06:36 It's exciting times to be a Texas operator. 06:40 We don't take it lightly. 06:43 I will say the US Census Bureau is telling us everyday that a like 1000 06:47 people are coming into the state. 06:49 So growth for any industry including Texas post acute, 06:53 it's a net positive for us. 06:55 So we're excited for that. 06:58 But with that I will say the industry is not complacent Cantex, 07:02 sometimes I'll be like there's no swagger in post acute there's only details, 07:08 there's only knitting, knitting and crocheting, 07:12 minding our P's and Q's and doing the best that we can be doing. 07:17 And I feel like for us we're positioned very well. 07:22 We've got a the strongest reimbursement system on the Medicaid side then we've 07:28 had probably forever. 07:29 I've been operating in Texas, you're right, 07:32 for over 30 years and it's the best. 07:36 And I see our patients, our families, even our staff, 07:39 everyone's benefiting from an environment that's strong, 07:43 it's positive and it's forward thinking. 07:46 So exciting times. Robin, 07:48 great report and thanks so much for spending time here with us today. 07:52 Yes, thank you, Mark. And thanks all of you for your continued 07:56 support of Park Place.
