Health-care official had early influences on career

Working in the health care industry is second nature for Daniel Mathis.

President and CEO of the Nevada Health Care Association, Mathis grew up in Louisiana with parents who were involved in health care.

Today, he presides over a statewide organization that includes most of the state’s skilled nursing facilities and a growing number of assisted-living facilities, which combined employ more than 12,000 people.

Its goal is to promote public health and welfare and improve the quality of care by skilled nursing, assisted living and post-acute care providers.

Mathis, who is behind a push for a reimbursement system based on how sick a patient is or level of care required, works with elected officials to fix deficiencies and improve the quality of care.

Question: What is your background in health care?

Answer: My mother, Lynda, was a regulator in Louisiana, and my father, Michael, was a nursing home administrator in Louisiana. That’s the environment I grew up in. I had the regulator on one side and provider on the other, and it made for some real interesting family conversations.

Question: Did you know what you wanted to do when you were a kid?

Answer: While I was in high school, I would help my father get ready for surveys. I would work in the facilities and do everything from polishing the floors to maintenance, dietary and you name it. One of my first jobs was working for Shriners Hospitals for Crippled Children when my mom was director of nurses there. I would come in after school and clean up. That was my first exposure, and from there I grew into the industry.

Question: Did you always want to be in administration?

Answer: Originally I thought I was going to be a nurse, and I wanted to go to nursing school for reasons other than health care. I thought there would be a lot of women. I was right. Then I found out it takes a certain kind of individual to work hands-on in health care, and I started with the business side, the accounting and administrative side. I learned early on when I got my license as a nursing facility administrator in 1989.

Question: How did your early experience of working with your parents help you in your career?

Answer: I had a lot of interaction with the employees, families and residents, and it really gave me an appreciation for the type of work that we did. Had I not grown up in it, I would have had the general public’s view of what a nursing home or retirement community looks like; but since I grew up in it, it was always a fun place for me. I loved meeting the families and the residents that lived there. They really appreciated the work that I did, and I saw how they interacted with the clinical staff, and it really sank in. I wanted to do the work. I think it was a great training and transition for me. I really enjoyed the path.

Question: What attracted you to the industry?

Answer: It’s the people that you meet. I love working in the buildings. There are a lot of internal rewards that you get. There’s not a lot of external rewards. Nursing homes aren’t seen as good places by a lot of people. People who were involved really needed and appreciated the work that we did. That’s why I did it. It wasn’t for the money. It was for the internal reward. The people really appreciated it and if you wait for the outside (accolades), they are few and far between.

Question: Why did you make the change to the association in 2012?

Answer: The job I had was in buildings in three states, and Nevada was not one of them. I got on a plane, usually on Monday morning, and I usually didn’t get back until Thursday or Friday that week. If I had a troubled building, I had to stay over the weekend. The travel was the biggest thing. The company I worked for kept giving me more and more. I liked the work but didn’t like the travel.

Question: What happened then?

The Nevada Health Care Association position came open. I had been the president, chair or treasurer for the last 10 years, and Charles Perry was the fellow I replaced, and after talking with him he was ready to retire. I knew everybody in the state, association. It was a natural progression for me to take over and try to improve the care of the state.

Question: What does the group do?

Answer: The Nevada Health Care Association is the trade association for the state’s acute care providers. We provide a representation for skilled nursing and assisted living and at our last annual conference in August we changed our structure to a divisional structure so now each type of post-acute care provider has its own board. The skilled nursing folks have their own nine-member board, assisted living has their nine-member board, and we are also working with the home health providers to get them in a division. We are working to get the adult day care providers involved. They would like to participate in the association.

Question: What is your goal?

Answer: The goal of the association is to improve the care delivered in the state. Right now, we are ranked very low federally. Nevada is quite often ranked near 47th or lower in post-acute care standings nationally.

Question: Why is that?

Answer: One of the reasons is our acuity is the highest in the nation and our reimbursement rate is so low. A lot of it is training and education. The nursing home report card received a lot of attention last year because Nevada received an F, and then the work we have been doing the last couple of years and the report that came out in 2014 showed Nevada came out and received a C and moved from 47th to 26th. The report is light on data, but it does show the trending of Nevada is getting better.

Question: What is the problem with the reimbursement?

Answer: Medicaid picks up a very large percentage of the customer base. Between Medicare and Medicaid, that makes up about 75 percent to 80 percent of our customer base. Medicare with Obamacare has cut our rates over the last six years dramatically. With Medicaid we have not had a rate increase for 11 years, and then the last session our Medicaid rate for skilled nursing was cut by $5 (per day). What that did is right now Medicaid is under reimbursing us about $20 below the cost of providing care. A lot of providers have stopped admitting Medicaid and caused backups in hospitals.

Question: What are you doing about it?

Answer: On the legislative agenda this year we have lobbied pretty hard, and we are expecting a rate increase to help with that. Since Nevada was traditionally losing money on Medicaid, they made it up on Medicare. That was the model for 10 years. Now with the last round of cuts with the Affordable Care Act, we had another round of cuts and that reduced the ability of the providers to cost shift from Medicaid to Medicare and now the way the reimbursement is set up the providers aren’t accepting Medicaid. In fact, I have had several providers reduce the number of licensed Medicaid beds in their building. They want out of the Medicaid system.

Question: What are you trying to do?

Answer: We are trying to lobby the Legislature and governor to adjust the Medicaid rate for skilled nursing providers. We think so and the indicators are there will be a rate increase.