The SHB Interview: Mark Parkinson, President and CEO, AHCA/NCAL

by Jeff Shaw

Former Kansas governor transitioned 11 years ago from politician to leading one of the largest healthcare associations in the industry, and he’s never looked back.

By Jeff Shaw

Mark Parkinson’s wide-ranging career in both the private and public sectors, including a stint as an owner and operator of long-term care facilities in Kansas and Missouri, makes him uniquely qualified for his current role.

After earning a law degree and starting his own firm, Parkinson entered politics in his home state of Kansas, serving in the State House from 1991 to 1993 and the Senate from 1993 to 1997. It was as a member of the state legislature that he was introduced to the then-fledgling concept of assisted living.

After investigating the buildings being constructed in his district, Parkinson fell in love with the concept.

“I had been a hospice volunteer, so I was acutely aware of the deficiencies that existed at the end of people’s lives back then,” says Parkinson. “There weren’t places for them to go.”

It was then that he began building his own seniors housing communities along with his wife Stacy, launching their first one in 1996. They both quit their jobs in law to help with operations, and Parkinson left politics — though that turned out to be temporary.

In 2006, then-Kansas Governor Kathleen Sebelius named Parkinson as her running mate in her re-election campaign, and he started his role as lieutenant governor in 2007. In 2009, President Barack Obama named Sebelius as secretary of Health and Human Services (HHS), at which point Parkinson was promoted to governor for the final two years of her term. He declined to run for re-election, leaving politics once again in 2011.

The same month he ended his term as governor, Parkinson took the reins at the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), based in Washington, D.C. His combined history in law, politics and healthcare made him a natural candidate for the job.

Seniors Housing Business spoke with Parkinson about his history, personal accomplishments and goals for the senior living industry.

Seniors Housing Business: Walk us through your career path that led to your leadership role at AHCA/NCAL, including how and why you made the pivot from politics to healthcare.

Mark Parkinson: My wife and I met at the University of Kansas School of Law. Our intent was to practice law. We got married our second year of law school, which is not the world’s smartest thing to do, but we were in love. We’ve been married now almost 40 years.

As we were going through law school, we thought about moving to D.C., but then we decided to go back to Kansas because there was a chance I could get involved in politics. More importantly, I wanted to open my own law firm. 

She worked for a district attorney for a few years while I worked for a law firm. After two years, we formed our own law firm. We thought that was what we would do the rest of our lives. We were very happy.

Then a friend of ours ran for district attorney. I helped run the campaign, and next thing you know I’m being recruited to run for state legislature.

It was a very busy time in our life. I was initially in the Kansas House of Representatives, and that takes up a lot of your life. I later ran for Kansas Senate, and we really had our hands full because we had three little kids, the law firm and my political career.

At that same time, an assisted living company started building facilities in Kansas and it hadn’t gotten them licensed yet. The company was just putting up these facilities up without getting licensed from the state. We got calls from nursing homes that the new communities were taking care of seniors and passing out medications.

The company didn’t believe it needed a license, but we told the company that it needed a license within a year, or we would shut it down.

They got a really good lobbying firm to come and say, “You need to tour these facilities because you’re going to want to license them and open them.”

This was the early 1990s. I absolutely fell in love with assisted living. The only thing in Kansas at the time were nursing homes. I loved the idea that there was an alternative to care.

SHB: How did you get involved in building your own properties?

Parkinson: I went on a tour and said, “This is amazing.” I called Stacy up and told her she had to tour the building. She said, “That’s great. Why did you ask me to do that?”

I told her we should build these things. By the end of that evening we decided we were going to build an assisted living facility. 

We thought it was going to be just one — less of a business venture than something to do for the community. We were incredibly naïve. 

At the time, assisted living was extremely in demand because it was new. We had 20 move-ins on the first day. We quickly realized the people in our building were very old and very frail, and many had memory challenges. They needed more of our attention. Within a week, Stacy quit practicing law and started working full time at the building.

We ended up loving it. We loved what we were doing, and we decided we wanted to make a big commitment. We quickly built a second facility. Once that was built, I quit practicing law and decided not to run again for Kansas State Senate so I could devote my full time to Stacy, the kids and this new venture.

Most of the time our residents would live with us until they died, but some residents were discharged to nursing facilities. We had one resident in particular who we loved and whom we had to discharge, and there wasn’t a great option in our area. 

She lived in that nursing home for about two months after we discharged her. I stayed with her as she died, and it was not a great experience. There were other residents wandering in and out. It was not the peace you would want.

I vowed to myself that we would never discharge a resident again. We would build a nursing home.

It was different than the nursing homes in our area. We had private rooms, the amenities you’d expect in assisted living, but licensed and operated as a nursing home.

We ended up with six buildings. Then Brookdale came along in 2006, and it liked this idea of an upscale nursing home. Brookdale made an offer we had to take, and we ended up selling.

Take it to the house

SHB: What are the accomplishments you are most proud of from your time in politics?

Parkinson: I got ridiculously lucky. In 2006, Kathleen Sebelius asked me to run with her as lieutenant governor. Then the luck got even more amazing when she went out to D.C. to be the Health and Human Services secretary, which made me governor of Kansas for the last two years of her term. 

It was one of the best times of my life. I was in a place that needed a specific skill set that I happened to have.

From 2008 to 2010, the country was in the midst of the biggest recession since the Great Depression. State budgets were drying up, unemployment was high, there was general panic in the economy. When there’s that sort of chaos, that fits into my wheelhouse. I had developed our business. I knew about strategic planning, developing goals and getting out of crisis situations. 

I really felt I was in the perfect place.

Our objective during the Great Recession was that Kansas wouldn’t just survive it, but that we would prosper. We could look back on this as a time we moved the state forward.

We created a coalition of Democrats and moderate Republicans and got a lot of things done. 

We got a small sales tax increase to get the state through the recession without laying off employees. We got a public smoking ban enacted. We got a bill passed that said 20 percent of power had to come from wind energy. We negotiated agreements with all the small airplane manufacturers to stay in Kansas for the long term, and they’ve done that. We passed a multibillion-dollar highway plan.

We passed all this during the Great Recession. That’s what I’m the proudest of.

Priorities on the Hill

SHB: With regard to senior care, what are the top legislative priorities right now?

Parkinson: We are in pretty much the same situation from lobbying as we’ve been for the last couple years. Providers are struggling with reduced census and an increase in costs, including a very challenging labor force situation. 

Our approach all along has been that we need to get our members enough money from federal and state governments to survive until census recovery can occur. In 2020, we set as a goal to get $10 billion from the federal government, and we were able to exceed that goal. In 2021, the goal was to get $10 billion principally from state governments, and we were able to do that. That’s our goal again in 2022 — to get money principally from the state to survive until census recovery.

At the federal level, our priorities are to get the government to extend the public health emergency. That’s tied to a number of Medicaid increases with the states.

Second, there is the labor situation. AHCA developed a temporary nurse’s aide program that allows people to become certified to work in buildings with much less training than typically required. Over 200,000 people have trained to become a temporary nurse’s aide and are working in buildings. That program only exists as long as the public health emergency exists, so we have to keep it going.

There are some other waivers. For example, in order to get a Medicare benefit, there’s a three-day stay requirement. That’s waived during the public health emergency, so folks don’t have to go to the hospital for three days.

The public health emergency is currently in effect until the middle of April. It will be really important that HHS extend this emergency for another three months. 

Another big priority for us is payment. Under the Patient-Driven Payment Model (PDPM), every year the Centers for Medicare & Medicaid Services (CMS) decides what our payment rate will be. That determines our rates on Oct. 1 for the next 12 months.

There are folks out there that believe we should be cut, that our margins are too high for Medicare. We think it’s really important that we don’t get cut in 2022. We want CMS to treat PDPM in a reasonable way.

We also want to get more money out of the Provider Relief Fund (PRF). It’s been good for skilled nursing, and okay, but not great, for assisted living. Now it’s out of money. We’re working hard and hopeful that Congress will add more to the fund.

Our most important strategy is working with the states. The states still have money. They have money left over from the various recovery acts. We have 50 state affiliates, and we’re assisting them in working with governments and legislators to make sure assisted living operators get their share. It worked well in 2021, and we need it to work again in 2022.

SHB: Why do you think the assisted living industry should continue to get government payouts as part of the COVID pandemic? 

Parkinson: Long-term care was the epicenter of the pandemic. Nursing homes and assisted living communities care for our most vulnerable population and were hit particularly hard by this virus. 

Additionally, long-term care had systemic challenges prior to COVID, such as chronic underfunding and workforce recruitment and retention issues, and the pandemic exacerbated these challenges. As a result, providers continue to struggle with an economic and labor crisis and are in need of additional resources and support.

SHB: Have there been any big victories as a result of AHCA/NCAL’s efforts that you want to share with our readers?

Parkinson: We’re very proud of the fact that we’re a mission-driven organization. We want to provide solutions up on the Hill. And we’re also data driven.

When I think about what we’ve accomplished, the first thing that comes to mind is our National Quality Award Program, which was developed before I came to the organization. It’s a program where operators can apply for an award to show they deliver a certain level of quality of care.

There are over 5,000 buildings that have gone through the program. I think we’ve really moved the needle on quality across the country. 

The second accomplishment I’m really proud of is the temporary nurse program. I can’t think of an association accomplishment that has impressed me as much. Our clinical team figured out that there was going to be a massive labor shortage. The team developed the curriculum and testing and brought it to CMS. And CMS said, “That’s okay with us if you can get the states to go along.”

Over 250,000 took the training, and over 200,000 now work in buildings. That’s amazing. We need to keep that going.

The third accomplishment is reimbursement victories. Even before the pandemic, we had a very thoughtful team on how to secure funds for providers and had a pretty good rate.

We believe the most important data point is employee engagement and satisfaction. For the past seven years, we’ve been recognized by The Washington Post as one of the top employers in D.C. We have the highest rate of employee engagement of associations. That’s something I’m very proud of.

Selection as a top workplace is based solely on employee feedback gathered through an anonymous, third-party survey administered by research partner Energage LLC, which measured several aspects of workplace culture, including alignment, execution and connection.

SHB: What does a community going through the rigors of the National Quality Award Program need to demonstrate? 

Parkinson: The AHCA/NCAL National Quality Award Program is a rigorous, three-level process that evaluates an organization’s capabilities against nationally recognized standards for excellence, making it one of the most comprehensive and cost-effective performance assessments available to long-term and post-acute care providers. 

Each progressive award level — Bronze Commitment to Quality, Silver Achievement in Quality and Gold Excellence in Quality — requires a more detailed demonstration of superior performance. Providers are nationally recognized for achieving each award level and eventually join the ranks of the best in long-term care.

Pay it forward

SHB: Tell us about your charity work.

Parkinson: The thing Stacy and I are most involved in now is a scholarship program. I went to Wichita State University for my undergraduate degree, and we developed an undergrad program that develops four-year scholarships provided to first-generation immigrants, with a preference for DREAMers (The DREAM Act is short for Development, Relief and Education for Alien Minors Act).

Stacy is greatly involved in D.C. teaching English as a second language and helping immigrants. We both believe the economic success of the U.S. involves getting immigrants involved.

We’re now in our fourth year of the program, so we have five students at various stages. We hope to do this the rest of our lives and possibly after we die.

We’ve also chaired the campaigns of programs that we really believe in such as shelters for battered women and child abuse programs. But right now our attention is on the Wichita State program.

We also have a program that brings students to D.C. for a semester, usually their last semester, coordinated by the universities. This exposes students to opportunities in D.C. All we do is provide the funding. 

They complete their last semester here and it exposes them to a different part of the world. We felt the fact that we both had the opportunity to come out to D.C. when we were in school was very valuable to us. 

Even though we went back to Kansas, we thought that time in D.C. was a really important part of our lives.

We’re bringing three of our five current Wichita State students to D.C. in early March. We want each of them to come out at least one time while they’re undergrads. We’re really looking forward to their visit.

SHB: What’s something people in the industry would be surprised to learn about you?

Parkinson: I like to gamble. When I was 12, an uncle taught me to play blackjack. I’ve been playing blackjack in casinos now for 50 years. It’s been a fun hobby.

There was also a period when I got deeply involved in tournament poker and had a lot of fun with that.

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