Cue the sci-fi music. Lock the hatch door.
We’re launching to a parallel universe where a global pandemic has just struck. The virus is called COVID. The planet is called Perfect World. And the way the virus is playing out there versus here, is as different as two test results –– one positive, one negative.
On Perfect World…
- They have advanced warning. Instead of being caught off guard, they have systems in place to see, understand and act fast.
- They have a centralized plan. Governments and health care communities have already worked together to create a smart, robust emergency plan. A centralized, federal command center is seamlessly integrating and coordinating with every state and county.
- There’s plenty of PPE. Hospitals and senior care communities are dispensing PPE from their 90 day emergency stockpiles.
- There’s little-to-no confusion, fear — or politicizing. A pre-arranged, crisis communications plan is educating and reassuring people. When experts don’t yet know the answer, they admit it.
- Data is being collected, retrieved and analyzed fast. Experts have a real time window into what’s working, what’s not working, what’s ahead, and then making decisions accordingly.
- Seniors are safe and connecting to their loved ones. Family and friends are following the core principles from CMS/CDC during visitations and connections. When needed, they visit virtually, using advanced technologies that are fun and easy to operate.
- There are plenty of caregivers, including nurses. Years ago, government, academia and the healthcare industry invested in creating a clear path to a well-paying, deeply rewarding and competitive career.
The results? Lives saved, businesses survive, people work, children are schooled.
Pretty much perfect –– and unattainable, right?
Not entirely, says the CEO of one of the nation’s largest family owned providers of post acute and senior living facilities. Phil Fogg Jr. is the fifth generation owner and operator of Marquis Companies and its sister Company, Consonus Healthcare.
Fogg is one of the nation’s most vocal advocates for seniors and the senior care industry.
And his platform just expanded.
Fogg is 90 days into his role as new Board Chair of the powerful, American Health Care Association (AHCA), which represents more than 14 thousand skilled nursing facilities and assisted living centers across the US. His constituents are the providers, the people who work there and, most important, the people they serve.
But really, the decisions Fogg and ACHA are driving –– from Congress to state houses to ACHA’s affiliate chapters –– will touch every one of us. No matter our age.
As Fogg puts it, “You either are a senior, you know a senior or you will be a senior. So, we all have a stake in finally fixing problems up and down the healthcare continuum which we all travel.”
In this interview, Fogg opens his playbook on helping a noble profession recover and survive. That includes rebranding senior care, pushing the industry to innovate like big tech, calling for immigration changes, creating exciting new specialties in nursing and lobbying Congress to address what he calls our “new national crisis.”
Q: Phil you’ve really been on the move in your new role. When you’re not leading Marquis Companies, where can we find you working on behalf of the people you represent in the American Health Care Association?
A: Wherever policies are being made that affect us, we want to be present. We’re on the Hill, state legislatures and a dizzying number of political and health care stakeholder groups, including the Centers for Medicaid, Medicare Services (CMS). We’re pushing for better benefits for our heroes—the senior care workers and the heroes they serve. When we secure that, the whole country will benefit because we’ll all need those services.
Q: Before we get to what you’re advocating, how are you feeling about where we are with COVID? Can we all finally breathe a sigh of relief?
A: I’ve stopped predicting anything, but yes, it’s clear, for most people, Omicron is more like the flu. The current threat or main issue is no longer the fear of death mortality in senior care facilities across the country.
Think about this. Senior living communities, once the most dangerous places to walk into, are now among the safest. Thankfully, we got to that point early with Marquis facilities. Our Consonus Pharmacy was picked as one of the CDC’s trusted and approved vaccine providers. Our facilities earned national recognition for registering what may be the earliest and highest vaccination rates in the country for staff and residents. With Omicron, right now, the rate is 25% of the broader communities and with no fatalities.
However, most people don’t realize that industry wide, it’s yet another gut wrenching time for staff. Mandatory PPE and crippling staff shortages are incredibly difficult.
No one wants to repeat what we’ve all been through. One of our goals at AHCA is how the industry works in an endemic environment without shutting everything down. We need to undo all the regulatory guidelines and requirements that aren’t affecting any outcomes but are still negatively impacting people’s lives.
Q: Let’s talk about your broader goals at AHCA. There’s so much to fix. How do you start?
A: With recovery. At AHCA we are first laser-focused on three buckets. All three are about recovery for our providers. The first bucket is recovery of the economics and ensuring there is a sustainable business model. The second is recovery of the workforce. And the third is recovery of regulatory transition– getting us back to sane regulations.
Look, I don’t get into politics. I just know what worked and what didn’t. The provider relief fund under the previous administration and FEMA was efficient and effective. What we have now is not. And many fine facilities that care for our senior population are in trouble. The timing is tough. We’re racing toward a historic era when for the first time in US history, seniors will be the country’s largest population.
Q: How do we recover and plan for the next health care emergency? There are so many competing and siloed agencies weighing in.
A: Exactly. But let me start out with a bright moment. I had the opportunity to thank, in person, the former Deputy Director and Director of the Centers for Medicare and Medicare Services, Dr. Seema Verma. She did a tremendous job breaking through bureaucratic and organizational blockades to get the resources where they needed to go. But it shouldn’t be that hard. Those roadblocks must be removed. We need more people like Seema.
Here’s what we know didn’t work –– decentralized decision making. Think about it. We have 50 states, each has different state departments of human services and each state has different counties and each county has its own public health department. So, you have 50 states applying the federal guidelines hundreds of different ways.
There were a few states that we couldn’t get the government staff to pick up the phone or return the messages we left. As a provider, it was ridiculous.
Before making drastic changes in guidelines or requirements, we could have allowed important trials in two or three states rather than all 50 states. Then if those trials were successful, we would have rolled it out nationwide.
Consequently, we didn’t have a lot of data driving decisions around what was working and what wasn’t. For instance, we didn’t adequately coordinate data for vaccine rates and masks to actual outcomes. So, everything became politicized.
Q: What about PPE and making sure providers in the future have what they need?
A: Again, at the federal level, just as with oil, there needs to be an emergency supply.
Guess which country makes most of the world’s supply of PPE? China. So, we not only had this confluence of the virus spreading out of the same country that controls the PPE supply, but China’s own supply chain breaks down along with the rest of the worlds. So which country do you think is going to get most of the PPE and first?
We were fortunate at Marquis, because of our incredible business partners and suppliers, we always have an emergency supply of PPE. Our Consonus Pharmacy turns inventory every 17 days. Our wholesale distributor makes deliveries every day. That helped us control costs and protect our residents and staff.
Q: Let’s talk about the current workforce challenges.
A: I don’t think we should accept having 14 million people out of the workforce–and the devastation it’s causing. That’s a massive amount of people to be out of the workforce. Recovery won’t happen until we get those people back. It’s not just a nursing shortage either. Many other fields, like engineering and the restaurant industry, are experiencing shortages.
We could have done a better job of helping people stay in the workforce by offering incentives like tax credits. Instead, we initiated policies that helped fuel the massive exodus and now the global supply chain bottleneck.
Understandably health care workers are worn out. Many are retiring. Those who are staying are in the position to demand higher wages, but providers need help.
Q: The real issue sounds like long term, licensed nursing shortages. What’s the answer?
A: I think the White House should declare the workforce shortage a national crisis because it is. A light bulb went off when my wife and I were in Croatia, just before the pandemic hit. I was asking people how strong the medical field is in Croatia. Almost all of them said the education in Croatia was great but there are no jobs. They all go to Germany.
In the short term, I’d open the spigot on immigration, both H1-B renewals and applications. This would then open temporary work visits and make it easier for qualified people to enter the US and work in jobs we need to staff up. Let’s give them a timely process for renewals and extensions.
I’m happy to say we’re getting some support on expediting the extensions.
We also need to expand the capacity of the education system to produce more registered nurses and other healthcare professionals. If we don’t, then we’ll have problems with quality of healthcare and access to care.
You know the odd thing is that with all the much needed national and global discussion on equality and access, if we don’t fix our healthcare system, the only people who will get quality services will be people with money.
That’s not equality.
Q: Even if we have more qualified people entering the US for those senior care jobs, don’t we still need more US citizens to enter the field? Can our education systems support that influx?
A: That’s all part of the national health care crisis we’re in right now.
We need federal dollars and programs that work like the Peace Corps, but in healthcare. And we’re working on that. Government, academia and the healthcare industry must work together and create a clear path to a well paying, desirable, rewarding career. We’ve got to reframe and rebrand what these jobs are. These jobs save lives. And, as we say at our Company, help people live their best lives.
It wouldn’t be hard to figure out how many professors, support staff, clinical times and practicums it would take to boost the number of nurses in training.
Right now, there are roughly 50 thousand nurses in training every year. We need 200 thousand a year.
We were already facing a nursing shortage due to demographics and retirement. Our industry should have better anticipated this and increased the capacity of our education programs.
Q: How is the work shortage problem compounded by inflation and other higher costs for providers? Give us a snapshot of the numbers the providers are crunching right now.
A: In your typical nursing home facility 70% of expenses are workplace related. We’re working hard to convince Congress to get federal dollars to the states and increase the Medicare rates to providers so we can accommodate those higher wages.
What many people don’t understand is how much our providers are getting hammered. There’s a 2% increase in our Medicaid rates. Inflation jumped 20 to 25% in one year. CNA rates jumped 14.5% overnight. We’re facing the threat of a Medicaid payment cut. And only now, a full year later, we’re getting payment for the last two quarters for 2020 and the last quarter of 2021. We still need to get another provider relief fund for quarters two, three and four of 2021.
Q: Have you been successful in capturing any federal or state funds for the providers?
A: Yes, and here are a few examples: We’re helping retrieve federal funds for testing. In Oregon, for example, we were one of the best testing states in the US. So that’s been great.
We secured an end of year bonus for our health care workers who stayed.
We’re fighting some regulatory mandates in the Build Back Better Act, so we made sure we were way ahead with all the finance committees like Ways and Means.
So, I think we’re doing a really good job of advocating and getting way ahead to secure results.
Our biggest issue on the Hill is always a lack of education and or understanding what’s going on in the real world and all the workforce challenges. At times it’s really frustrating. But we can’t get myopically focused on things. ACHA is battle savvy. We’re used to anticipating threats and fighting like crazy for change.
And personally, I don’t get very emotionally engaged in politics. I just deal with the situation at hand.
Q: It looks like your extensive lobbying experience is coming in handy. Most recently you’ve been on the Hill with the Senate Finance Committee.
A: I’m really excited about that! It goes back to filling the gap in our national nursing shortage but also planning for the next healthcare emergency. One of the initiatives we have is with the Chair of the Senate Finance Committee, US Senator Ron Wyden of Oregon, my home state. We’re hoping to create an entirely new specialty in nursing––infection prevention. Think of how that can help us in our next emergency.
Q: You’re also pushing for an investment in facility infrastructure, which you say will make senior living even safer, especially in a pandemic.
A: Yes, there are two key changes we want to make. Improving the air exchange systems and the room size and occupancy. Across the country, facilities need updated airflow and exchange systems and additional private rooms.
Q: This gets us into technology. You’re known for investing in and incubating new businesses. Is that something you’ll drive with ACHA?
A: Yes. Our industry needs to think big like the Googles and Amazons. We need to create and adopt new technologies. Here are a few examples from the Age Right PAC Network, a think tank of providers and insurers I’m a part of, which collaborates to create solutions in post acute care.
During COVID, we weren’t satisfied with the length of time it took to get test results. So, we funded a saliva testing lab run by a world renowned molecular immunohematologist. In no time, we were getting results in 24 hours rather than the norm, seven days.
We also funded a company that performs surface testing and created a partnership to get early and abundant PPE.
So yes, we’re tech focused.
Right now, ACHA has a great relationship with Johns Hopkins Medical Center. There are some exciting developments in innovative data collection on everything from vaccine efficacy to disease related treatments. It’s going to be a game changer!
We’re working on improving technology interoperability, interfacing and efficiency. One of the biggest problems is all the different stops we each make on that healthcare continuum, from birth to seniors. If we better track and integrate our medical histories, we’ll be able to focus on identifying problems before they start. We can keep people living their best lives, longer.
We really don’t have a choice.
The “senior tsunami” is coming. Those baby boomers, soon to be the largest population in the US, are used to quality services and technology delivered how they want it and when they want it. They should and they will demand that in their senior living communities.
To survive, our industry must deliver.
Q: Are you hopeful? Can we achieve anything from that parallel universe we outlined?
A: It’s not hard to have hope, but it depends on what hope is. If hope is getting back to pre-pandemic, yes, we’ll get there. It’s just going to take time to refill the workforce and ACHA is working hard on that.
Is it possible to achieve all that happened in that alternative universe? (Laughter) No. But we can do better than the last two years if we implement some of the initiatives I’ve outlined. We’re working hard at ACHA to first save this wonderful profession. And I want to assure people that the team and staff at ACHA are tremendous advocates. You can’t have better advocates.
Q: Finally, if what happens in the senior care industry affects all of us, what can each of us do?
A: Remember. Remember what we just went through and the lessons learned. We have short memories. If we aren’t careful in ten years, we’ll be learning another hard lesson. We need a playbook and that’s what we’re working on.
Hop on the ACHA website to learn what we’re advocating.
Finally, advocate for the seniors in your life and for the people who care for them. It’s really important!