Mark Parkinson, CEO and president of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), on Tuesday announced plans for retirement after 13 years with the association, and leading its members through the pandemic.
Parkinson plans to stay on until Jan. 15 of next year, as the association launches its search for a new face in leadership; AHCA/NCAL plans to narrow down Mark’s successor this fall after conducting interviews in the spring and summer.
“It’s bittersweet. I am very pleased and satisfied with what we’ve accomplished over the last 13 years. In particular, helping lead the sector through the most challenging time we’ve ever faced, which was the pandemic,” Parkinson told Skilled Nursing News. “On the other hand, I love this job. It’s definitely a bittersweet announcement for me.”
He had originally intended to retire earlier, but when the pandemic hit and then members started having challenges with the Biden administration, including an extensive reform initiative, Parkinson and the AHCA/NCAL board agreed it would be best for him to stay on through President Biden’s term.
“I want to leave when I’m still pretty close to peak performance. I don’t want to stay on too long. Certainly in politics, but even in the trade association world, we see people that stay on beyond their expiration dates, and I don’t want to do that,” said Parkinson.
Parkinson still plans to work with the industry in some capacity after his departure from AHCA/NCAL, but isn’t sure what that will look like yet.
“I very much want to work with providers that are either excellent, or trying to become excellent, and help them achieve those goals,” he said.
Prior to his time at AHCA/NCAL, Parkinson served as 45th Governor of Kansas. Parkinson and his wife, Stacy, previously owned and operated several long-term care facilities in Kansas and Missouri.
“Mark has been an incredible leader for our association, our members, and the long term care sector at large,” Phil Scalo, Chair of the American Health Care Association Board of Governors, said in a statement.
“Mark’s contributions to our association and sector are unmatched, and we cannot thank him enough for his unwavering dedication to improving the lives of our nation’s seniors,” added Scalo. “He will be deeply missed. We thank Mark for his years of service to our organization, and we wish him the very best in his retirement.”
Legacy and loose ends
The most significant accomplishment of his tenure at AHCA/NCAL, Parkinson said, was uniting trade associations within the sector. AHCA merged with the Alliance for Quality Nursing Home Care in 2013.
“We were able to pull those two groups together. That then gave us the platform and the unified voice to make all of the other successes that we had possible,” he said. AHCA/NCAL is now at record membership and has “never been stronger” on the political and lobbying side, he noted.
One success from the coming together of organizations was when AHCA/NCAL was able to advance its quality initiative and improve quality metrics across the board for providers, he said. Parkinson also noted negotiating a new Medicare payment model with CMS, in referring to the Patient Driven Payment Model (PDPM), and getting it implemented in such a way that would work for patients.
In terms of outstanding issues on the table, Parkinson points to the federal minimum staffing proposal. Before his time ends as CEO, Parkinson hopes the rule will be altered in a way that works for providers and residents, or it is stopped altogether.
If the rule is finalized as is, there will “absolutely” be hundreds of closures, possibly even into the thousands, he said. Registered nurses (RNs) are simply not available, he said, and there’s a crisis across the entire health care spectrum to recruit and retain such positions.
“I don’t know that that’s going to happen. I do think that we will have ourselves in a position that we will eventually prevail on the minimum staffing rule, but I recognize there’s a possibility that work might not be finished at the time that I retire,” he said.
Other top priorities before retirement include additional products that were developed for members over the past five years. One such product was a provider network across the country. AHCA/NCAL has gone live in eight different states with eight different provider networks. By the end of this year, he hopes that number will increase to 12 or 15 states.
Parkinson helped oversee the development of an in-house group purchasing organization as well which was launched a couple years ago, and an association-led population health management strategy.
“I almost think of them as different business lines that we started in the last five years,” he said.
A bright future
Despite ongoing challenges of staffing shortages and cost of care, Parkinson said the future of the skilled nursing industry is “really bright,” as demographics change.
There are large numbers of people that are shifting into the 80 to 85 age group in the next 15 to 20 years, and that demand for services will be high.
There’s also some exciting things happening on the reimbursement side as well, he said. Most notably are programs that pay providers for keeping residents well, with the institutional special needs plan (I-SNP), REACH program and PACE program top of mind.
“Suddenly providers are being incentivized to do everything they can to keep their residents healthy. I think that’s a terrific development that will dominate the care that we provide over the next 20 or 30 years,” he said.
Parkinson is also “really pleased” that, for the first time, Medicare Advantage companies are being challenged on their practices. CMS and Congress started in the last few years to ask the really tough questions of managed care companies – he believes this scrutiny will accelerate in the future.
“For too long, they’ve been allowed to skimp on direct patient care. That is not in the best interest of patients,” he said. There will be “additional horror stories of bad outcomes” if managed care plans continue to operate the way they have, he said.
“We’re really glad that CMS has stepped up to address these issues,” he said.
Advice for leaders and the industry
Parkinson had some advice for his successor: first, think of the job as actually two jobs. One is focused on winning policy arguments on the Hill and with CMS. The second part of the job deals more with figuring out a way to work with a very diverse group of providers across the country – multi-state operators, small regional operators, providers operating in states fortunate to have decent Medicaid rates, and those that aren’t so fortunate.
Another piece of advice would be to gear the thought process towards independent providers. Parkinson himself was able to do this because he started out as an independent operator himself.
“Independent operators, they don’t have all the resources that big companies have, they are incredibly passionate about their care, they have signed notes, risked everything, given everything they possibly can to take care of older people,” he said. “I would try to make the decision that works for them.”
As for advice to operators, Parkinson had this to say: the industry needs its trade associations. If trade associations don’t succeed, and there aren’t affiliates in every state capital, then the industry won’t achieve what it needs to.
It makes sense given the majority of provider reimbursement comes from government payers.
“I know it sounds self-serving, but the sector cannot succeed if the trade associations do not succeed … we’re too dependent on state and federal health [reimbursement],” he said.
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