Catching up with Florida Gov. Rick Scott, and what healthcare providers need from Kentucky’s next governor

Florida Gov. Rick Scott was recently on his road show to recruit and sell the Sunshine State like never before. He also decided to send letters to Kentucky business leaders inviting them to the Sunshine State for expansion, while making time for face-to-face meetings.

Gov. Scott bragged (accurately) about the hundreds of tax reductions he and his team have passed, the new and improved bond ratings, the job creation and the reason he believes he will not need Medicaid expansion. Why? Because everyone will have a job before he leaves office!

Signature is still a large health care provider in our former home state of Florida so we always make time to educate, update, and discuss health care policy in context to the goals of the Revolution. And Gov. Scott was ready for us like no other, to hear how the Revolution was playing out back where I grew up.

I remember when every health care organization bolted from Florida, less than two decades ago because they had the same problems we had today. No one was left when we first started to grab the mailed-in keys, saying, “we left town so good luck!”

I met Gov. Scott a few times over the years related to health care, but he knows the Signature Revolution left the state just six years ago because Gov. Crist and Sen. Atwater thought we were bluffing. So, we moved to the Bluegrass State after much deliberation and a great opportunity. We believe the spirit-led call was the right call, but the painful struggle to help bring about inches of change is beyond any vortex I have ever seen.

This recent meeting with Gov. Scott was much different, though, because I wanted to thank him for the great progress from my limited point of view. I see the change Florida has made since we left, and I don’t love it all, but I love 80% of it. He made hard calls early, helped people anticipate the pain, and then managed like a great CEO would. There is no pension time bomb, there has been a return to prosperity for many, and great discussions are taking place at the health care policy level, led daily by the FHCA team that makes the complicated process work.

I watch Kentucky struggle and be discussed at national conferences in a negative light – at least in my long-term care and post-acute industry – like never before because the data screams for change. It is beyond a crisis, if not an epidemic! Kentucky is now scoring near the bottom in nearly every post-acute category as we struggle through another mud-slinging campaign for governor, awaiting one to emerge and lead us out of health care darkness. The recent ads are definitely the opposite of the Lincoln-Douglas debates that we crave as engaged voters; I wonder if we will ever get it right, here.

Since we left Florida six years ago, I have kept my finger on the pulse of both states’ ability to build consensus and modify policy that yields opposite results. For example…

  • Florida has improved oversight to a culture of performance improvement linked to QAPI goals; Kentucky ranks second to worst in the nation in provider fines, at 10 times the national average.
  • Florida made significant steps to address out-of-control litigation; Kentucky dropped to the worst place in America with out-of-town law firms because of our health care economic engine for growth.
  • Florida is considering rebasing their Medicaid system to a ‘quality outcomes approach’ as we speak; Kentucky sits idle, celebrating the fact that we were one of the first case mix states from the Patton administration.

Florida modified their Certificate of Need (CON) laws and process, providing a hybrid solution that protects legacy providers but creates more flexibility for new capital and new construction; Kentucky has the oldest physical plants in the country, and keeps the tightest CON constraints anywhere in the country.

I watch our governor’s race with great hope for real change. I pray for a more bipartisan approach to unify the Commonwealth, finally, but the health care debate has been impossible to set up, even as board chair of Health Enterprises Network.

Do not take me wrong, we love our team. We love the people’s passion, spirit and commitment to excellence here in the Commonwealth. We have upgraded our senior team to world class here in Kentucky, but we just need the government to finally get things done that take us out of the bottom five quickly, or no other health care organizations will be here long term.

We need the next governor to not be afraid of being a one-timer. Someone needs to pull the Band-Aid off because, as I speak in D.C. this week, my peers laugh at our expanding Kentucky portfolio, thinking we are delusional based upon every meaningful statistic my industry tracks.

No one can argue that we need cabinet change for oversight and punitive tactics during the next administration. We need a plan for medical reform immediately. We need reasonable tort reform, and we need better educational and workforce plans because we cannot find the skilled workforce we need to compete in many rural markets where we try to serve our elders.

Our peers are bolting as we speak, my mailbox is full of medical records requests for the next 50 lawsuits from out-of-state law firms, and we fight through survey wars that are really unnecessary to improve quality in the state.

I still believe something great can happen here, and I pray for every political leaders to pull down the info from these web sites and tell me why we want to be ranked there! Let’s get unified, all share some pain, realize who the real enemy is, and bring it full circle so we become the beacon light that we know we can!

I told Gov. Scott I would see him on my next family vacation or at our new grand openings, where we won a few CONs, but our hearts and minds are in Kentucky – where we can make a real difference.

With that, we strongly urge all our Kentucky stakeholders to go out and make your voice heard!

Which school of thought prepares post-acute providers for future success?

jkw_LHE_041513_208Leaving the LTC100, you could almost feel the ground starting to shake – and you can really feel it.

It is scary for most of us mere mortals who do not have a crystal ball to consider questions like: What is the real rate of change? How much risk can you tolerate? How does operational fatigue play into it all? And how do you get your team on the same page anymore while continuing to focus on core fundamentals that get harder daily, new mental modes required to assess the future, and the cultural implications on all of your stakeholders who just need to provide great care to the more complicated residents, 24/7?

Personally, I could see Anita M. McGahan’s framework of Industry Cycles of Change in many sidebar conversations, even if they did not know they were using it!

There are really too many conferences with spins on same themes, so many talking heads everywhere around us that could operate a lemonade stand, and the plethora of online healthcare futurist bloggers telling us we are all screwed in the end, that we should give up and go into medical tourism.

I ask myself often, ‘how many futurists can you trust without just giving up and throwing in your towel (or in my place, the keys), anyway?’

There seem to be only four distinct schools of thought circling around post-acute providers that I know intimately with no clear, absolute boundaries between them.

Heck, with leadership turnover at many shops, hospital C-suites changing rapidly, and REITs getting scared of future rent collectibility in many tired and dated centers, I always say just pick one that you believe in your heart and go with it.

The schools of thought I run into often…

School 1 – When we do the basics of quality, post-acute services will be chased by everyone so keep it simple, be a late adopter and in the end they need you anyway. Keep solid surveys, keep your team on fundamentals, squeeze your last liquidity left in the core business of fee-for-service and the other vertical healthcare providers will help pay you to convert later?

School 2 – We must be the first to embrace the new healthcare policy, new customer mindsets, and related technologies. Go ahead and grab the ‘halo effect’ and brand equity, because they all need to find innovative providers. During that vetting period, your team can learn things like rapid prototype options and innovation frameworks, and by trying many versions, you will be the first to figure it out. You know your core business is declining daily, so why wait? Recreate like the Blue Ocean framework taught us.

School 3 – What the heck is going on? Heightened regulatory scrutiny, closing networks, hundreds of new middlemen taking pounds of flesh soon, growing staffing challenges, just to name a few. These demands are getting insane and too risky too swallow. The provider has very little upside left – get the heck out of dodge and let one of these futurists or competitors who do not believe it will change buy us because the good days are over. Half of my close peer friends are thinking this way as we speak.

School 4 – Our best days are ahead of us. Just ‘Andy Dufresne’ it, like Shawshank Redemption, because with digital paperless, EMR, hand-held technology, value-based alignment, gain sharing, more transparency, and lower costs, we are going to win big anyway!!! We will be ahead of surveyors finally, see customer activity virtually, and that old way was misaligned anyway. So let’s get on with it and finally make some real hay in a more aspiring way – because when it finally turns, it will be beautiful.

Here, where we are at the Revolution today, we try to live School of Thought #2, but every time we stumble big time, we revert back to School of Thought #1. But School of Thought #4 will make all of the pain turn to joy someday if we can just see the mountaintop.

There are so many mixed signals from external forces that make it challenging to get everyone on the same page, so over-communicate if time permits and don’t ever give up because they all need us even if they act like they don’t. We are still the most inexpensive service that no one ever wants, but many really need like never before.

What I Learned From Jim King

FullSizeRenderThe past week has been difficult for our city because one of its most influential leaders of the past few decades passed away. But for me, I also lost a great friend and mentor.

My first contact with Mr. King was a phone call to tell me my CPEs were late for my CPA license – he had checked the registry – which tells you a lot about his expectations and belief that things should be buttoned up at all times.

Since early in my career I have been blessed to feel, like many, that I was under the ‘Jim King Tent.’ We became close over a personal matter that joined us in a trusting and intimate way, and bonded us as kindred spirits forever.

Through the years he took my wife, Sony, and I to Derby when we still lived in Florida. He and I had regular lunches, discussed how to improve our city, watched U of L games and shared political fundraisers. Every time I was with Mr. King, I learned life lessons to remember.

Here is my list:

Lesson 1 – You can successfully serve your family, business and city at the same time.

Lesson 2 – You can hold strong views grounded in personal experience, but still meet people halfway – which he did for me several times when I needed him most.

Lesson 3 – You can build a great legacy without a head start. Personal or professional, his achievements were always carried out with passion, diligence, and great planning.

Lesson 4 – There is no time for excuses or failure to execute – Mr. King overcame obstacles with amazing tenacity, never thinking about failure.

Lesson 5 – Do your homework because details always matter. Mr. King spent countless hours reading every loan, city ordinance and financing obligation; his technical business acumen built a lasting bank and saved our city millions of dollars. It was all in the details.

Lesson 6 – You can lead the people and still be one of them. Mr. King had great charisma and a scary memory so he maintained relations with ease, but his crowd was never just the powerful and influential – it was always everyone.

Lesson 7 – Be Present. When you were with Mr. King, he looked you in the eyes, ignored his phone, asked questions and made you feel like your issue was his issue to solve together.

Lesson 8 – Support your children’s dreams at all costs. Mr. King supported, pushed, and challenged his kids. He protected them but also taught them everything he knew about leadership and responsibility – which was a blessing to watch.

Lesson 9 – Always go “all in.” Mr. King relentlessly pushed himself and everyone around him. When he believed in anything, there was no “I’ll try” – it was a quest to make sure it happens no matter what!

Lesson 10 – If Mr. King really liked you, you were blessed. I knew I could go to Mr. King for personal or professional counsel, and would always receive unconditional love.

At our last private lunch we talked about the illness briefly, but we talked more about his love for his beautiful wife, Debbie, and how he kissed her differently now. We talked about future hopes for his family, and dreams still unfulfilled for our great city. Like always, we held hands and prayed for a miracle to beat his cancer, thanked God for abundant blessings, asked God to protect our loved ones, and to guard our children’s souls!

My life was changed by Jim King. Now that he is gone I am just going to try and live his life’s lessons, which I learned up close and personal!

A version of this article appeared in the Jan. 23 edition of Business First of Louisville.

Redeeming Cuba: Historical Perceptions Through a Pop Culture Lens

IMG_6061We are all stamped mentally with our own personal imagery of Cuba in a peripheral way. We really cannot escape it: the epic stories of Fidel Castro’s meteoric rise, the Bay of Pigs disaster that, in the end, accelerated the communist legend overnight and created New Age Communism.

People of my generation grew up fearing the Cold War and the Iron Curtain like nothing else, often having childhood nightmares because our parents told us a complicated story at the dinner table that the world almost ended over a 9-day period, because Cuba let Russia aim active missiles right at our backyards. Literally, with only a few communist fingers tapping buttons, it would have been the end of the world as we know it.

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What would Che Guevara and Fidel Castro say today about their political partnership?

(This is the first in a two-part series.)

I’m not going to lie, I don’t really even like drinking rum or smoking cigars. But when I got my first chance to travel to Cuba and look inside the Castro hype, I was in from day one.

IMG_6054With the help of the leadership team and our amazing Bluegrass Chapter at YPO (Young Presidents’ Organization), we secured a license as a humanitarian group taking medicine and aid, and supporting local artists while studying their world-renowned arts.

This would give all of us our first real chance to take a deeper look at the communist political model up close and personal. The ‘Marxist Revolutionary’ school of thought has been our greatest ideological competition, and really, our greatest enemy for the last 100 years.

From the beginning, it was Fidel’s revolution and his partnership with Che Guevara, combined with other historic events, that have kept governmental resentment sky high, even now.

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The Largest Hall of Fame Ceremony in the World!

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This week, the Signature Revolution continues to break elder care world records.

We recently helped establish a new Guinness World Record for ‘Longest High-Five Chain’ in the world when SHC of Terre Haute residents and stakeholders joined the community for the United Way’s ‘High Five Campaign for Every Child.’

And last week, the most senior athletes in the world competed in regional Senior Olympics events ranging from Tampa to Tennessee to Louisville, where hundreds and hundreds of elder athletes competed to win team championships and prestigious medals with cheering crowds.

But this week is even bigger.

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