Future Leader: Bryan Hickman, SVP of Investments, Invesque

The Future Leaders Awards program is brought to you in partnership with PointClickCare. The program is designed to recognize up-and-coming industry members who are shaping the next decade of senior housing, skilled nursing, home health and hospice care. To see this year’s future leaders, visit Future Leaders online

Bryan Hickman, senior vice president of investments at Invesque, has been named a 2020 Future Leader by SNN’s parent company, Aging Media Network.

To become a Future Leader, an individual is nominated by their peers. The candidate must be a high-performing employee who is 40 years old or younger, a passionate worker who knows how to put vision into action, and an advocate for seniors and the committed professionals who ensure their well-being.

Hickman sat down with Skilled Nursing News to talk about how he came to skilled nursing and the main issues for providers as they think about the future.

What drew you to this industry? 

Unless you were sort of born into the industry, i.e. part of a family-run business, you probably didn’t necessarily see yourself being in the skilled nursing industry. I grew up here in Toledo, Ohio, and was expecting after completing undergraduate work to go somewhere other than Toledo, because that’s typically how things work. I got a call out of the blue from a gentleman named Chuck Herman, who had heard that I was graduating and suggested that I come back and interview for a company called Health Care REIT [now Welltower Inc. (NYSE: WELL)].

I’d never heard of it, but figured: What the heck, I’ve got nothing better to do. So I drove back to Toledo and by the time I was on my way back to campus, I already had a job offer. Well, I didn’t need an economics degree to know that the same amount of money in Toledo and the same amount of money in Washington, D.C. — I’m going to be better off at home, so I guess I’m heading back. That was how that played out.

This is an interesting question to ask given the COVID-19 situation, but what do you foresee as being different about the skilled nursing industry when you look to 2021?

You would expect that someone who invests in a long-term asset class like real estate would probably have a longer-term view on the world. All I know with any certainty is that whatever I tell you right now is going to be wrong. That’s how 2020 has played out for me thus far. But I also know I’m not alone in that.

My biggest concern today is the continued erosion of the transitional care patients from the industry. Right now what you’re hearing from a lot of the operators is that due to a decline in elective surgeries and just a general decline and utilization of hospital services generally — because people don’t want to go there and catch coronavirus, a fairly logical thing to want to avoid — it’s really taken its toll on the Medicare, managed care, and commercial patient population in the facilities. And it’s no secret that but for a few states where Medicaid reimbursement is more substantial, those are your patients upon which you actually make any kind of margin.

I am, at this point, deeply concerned that if we roll forward into 2021 and we have continued to further prove out that more of these transitional care patients — that were seeing shorter and shorter lengths of stay already — are actually finding new ways to continue the rehab at home, that could be a real problem for an industry that otherwise looked like it poised to start to really rebound and recover from the doldrums of the late teens.

With that as the backdrop, if you could adjust one thing with an eye to the future of skilled nursing, what would it be?

I don’t think anybody necessarily wants to go back in time to a cost-based reimbursement environment. But the bottom line is you’re going to put a lot of operators out of business and you’re going to end up with patients who are going to have to move up the acuity spectrum, if what I outlined does happen — the payer mix continues to shift towards predominantly more Medicaid. That puts pressure on operators, some of them stop operating or significantly reduce their bed count. As a result, they don’t have capacity to take patients.

The other thing, if I had that magic wand, is I would love to see some sort of grant or aid made available so we can actually address the physical infrastructure of the industry — because one thing that the pandemic has taught us is that the predominant use of semi-private rooms basically sets you up for disaster in a situation of a serious communicable illness. 

To learn more about the Future Leaders program, visit the Future Leaders homepage.

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