Health Law and Policy Survey

Symposium Preview:

A Q&A with The Honorable Mark Parkinson
President and CEO, American Health Care Association and National Center for Assisted Living


“There is tremendous opportunity to improve health care outcomes. We’ve seen with our members that when payment is tied to quality incentives, the members really work hard to create quality. That’s one of the things I’m really encouraged about.”

– Mark Parkinson



The Honorable Mark Parkinson is the President and Chief Executive Officer of the American Health Care Association and National Center for Assisted Living, which represents almost 14,000 nursing homes, assisted living residences, and facilities for the care of individuals with intellectual and developmental disabilities. Before leading AHCA/NCAL, the native Kansan was a successful businessman and lawyer, state legislator, and most recently served as the 45th governor of Kansas.

Parkinson joined us ahead of our 2019 National Symposium on Health Law and Policy to discuss health care reform and the effect that evolving payment models are having on hospitals and post-acute care providers. The conversation has been edited for clarity.

Q: What changes do you foresee coming from health care reform at the federal and state levels?

A: There won’t be any changes at the federal level. But every state that elected a Democratic governor that hasn’t expanded Medicaid will do so. Over time, even the red states will be under pressure to expand Medicaid – not all of them will, but some will.

The headlines that are out there saying Medicaid was the big winner in this election are accurate.

Q: Putting aside the Affordable Care Act, where else do you expect to see moves to deregulate?

A: Regulatory burden reduction will remain a top priority of this administration. The administration, whether it’s health care or any other sector, is very committed to deregulating, to giving the private sector as much latitude as possible.

The Centers for Medicare & Medicaid Services (CMS) is continuing to say it wants to give the states more authority as it relates to Medicaid, and CMS is also talking about giving the health care plans more flexibility.

There won’t be changes to the ACA because Democrats have the house and Republicans have the senate – the administration will shift to trying to lead through regulatory changes. Primarily those will be to deregulate and to allow the private sector to do more on its own.

Q: What is the single most important issue affecting your members and other nursing homes in the United States?

A: If the Republicans had won everything, it would have been an easy answer: defending Medicaid was by far our most important issue.

However, what is really impacting providers and nursing homes and assisted-living facilities the most is changing payment models, some of which are directed by government, some of which are directed by private payers. Those changes are diminishing length of stay and creating occupancy problems across the country.

The post-acute providers that embrace the changes and figure out how to take advantage of them for their residents and businesses will do well. The most innovative among them are now adding their own insurance companies. So, to the very reality that’s put them at risk, these insurance companies that are changing their payment policies, the post-acute providers are reacting by becoming their own insurance companies.

It’s the story of everything: people who can respond to change and embrace it and lead it obviously do better than people who don’t.

Q: How do you think the relationship between hospitals and post-acute care facilities is being affected as we move toward more value-based care?

A: Hospitals have become far more interested in what happens when people leave their facilities because of the economic impact on them. And so, the business relationship between hospitals and post-acute providers has strengthened considerably and will continue to do so.

In some settings our members, the post-acute providers, are a commodity where the hospitals are looking for the cheapest, quality provider. And in other markets hospitals and the post-acute members are genuine partners in population health management.

We do everything we can to encourage our partners and to encourage a legislative and regulatory environment where our members can be part of the population health management team and not just a commodity within it. You see a whole gamut across the country – some post-acute providers that have really embraced it and have real partnerships and others are just fighting to be a commodity. It’s hospital system by hospital system and post-acute operation by post-acute operation issue.

Q: Where do you see prescription drug costs and efforts to control them heading in the short term?

A: The pharmaceutical industry has outsized power in D.C. and I would be surprised if the system successfully took on the issue of drug pricing.

If the president is sincere and really takes drug pricing on as a top-level issue, it’s possible we could see change.

Q: Where do you think the other drivers of medical costs are, outside of drugs and hospital stays?

A: You look at the data and there are clearly inefficiencies that the market needs to work out. We spend so much higher a percent of our GDP on health care than so many other industrialized countries and we don’t get as good of results, so that tells us we have inefficiencies.

We are slowly squeezing inefficiencies out of the system. For example, under the old fee-for-service system, there was no incentive to fix those inefficiencies; there were incentives to promote them. As we move away from that to value-based purchasing, I am optimistic that some of these inefficiencies will get worked out. The drive to population health management, giving hospitals, accountable care organizations, managed care companies and others an incentive to keep health care costs down is the way we will drive some of these inefficiencies out.

There is tremendous opportunity to improve health care outcomes. We’ve seen with our members that when payment is tied to quality incentives, the members really work hard to create quality. That’s one of the things I’m really encouraged about.

Parkinson will be speaking in depth about post-acute alignment at our National Symposium on Health Law and Policy on February 11, 2019.

To see Q&A with Don Crane, CEO, America’s Physician Groups, the please click here.

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