Marcum Industry Spotlight: Paul Liistro, Serial Long-Term Care Executive
By Megan Budd, Director, Assurance Services
Paul Liistro is a highly accomplished long-term and senior care services executive who grew up in the industry. Currently, he wears multiple hats as CEO and managing partner of Arbors of Hop Brook Continuing Care Retirement Community and Manchester Manor Health Care Center in Manchester, CT, and Vernon Manor Health Center in Vernon, CT. In an industry flooded by consolidation and large systems, it is rare to see second-generation owners, like Paul and his brother Brian Liistro.
Paul has dedicated his career to the healthcare industry and volunteers his time to boards and committees locally and nationally. He is a past chair and board member of Qualidigm; a representative-at-large for the Board of Governors of the American Health Care Association (AHCA); and a member of the Ann Arbor, Michigan-based Board of Directors of HealthCap Liability Insurance Company. He is also past president of the Board of Directors of the Connecticut Association of Health Care Facilities, as well as a member of the Advisory Committee for the Health Care and Insurance departments of UCONN. Additionally, he is a Fellow of the American College of Healthcare Administrators and is actively involved in the Association of Long-Term Care Financial Managers and the Greater Manchester Chamber of Commerce.
In addition to Paul’s individual accomplishments, his facilities have been nationally recognized. Manchester Manor Health Care Center was selected as one of the Best Nursing Homes by U.S. News & World Report in its 2018-19 national rankings, the sixth time it has been so honored. In 2016, Arbors of Hop Brook was the first assisted living community in Hartford County to receive the Bronze Commitment to Quality Award from AHCA/NCAL. In 2010, Manchester Manor was the first facility in Connecticut to be the recipient of the AHCA/NCAL Gold Excellence in Quality Award and tenth in the nation to receive this honor.
Marcum had a chance to talk with Paul about everything from industry consolidation to what should be on a CEO’s “to do” list each and every day.
Marcum: In industry of constant consolidation, what do you think has been the key factor in allowing you to maintain stand-alone facilities?
Paul: Marching orders were declared when the Affordable Care Act was passed in March 2010 and then ratified by the Supreme Court in June 2012. This was followed by the Protecting Access to Medicare Act (Value Based Purchasing and Quality Reporting Program) and the IMPACT Act of 2014. I guess you could say we got the message. It was clear that high performance was going to be rewarded by being included in preferred provider networks and ACOs. We set goals such as high patient satisfaction, low length of stay, and low readmissions. We focused on our performance in 5-Star and improving clinical capabilities/nursing assessments. This required an investment in electronic health records and progressive software that could provide the necessary data to track our success with these self-imposed goals.
Marcum: There are approximately 215 skilled nursing facilities in the state of Connecticut. What is it that sets your facilities apart from others within the state?
Paul: We took our marching orders seriously. We were able to reduce our length of stay from 30 days to 15 at Vernon Manor and 18 at Manchester Manor. This year, Vernon Manor was among the 27% of all facilities in the U.S. to receive more Medicare due to our performance and improvement in lowering readmissions. On the east side of the river, we are 2 of 3 facilities in the Hartford Healthcare preferred provider network. We are also involved in Prospect Medical ACO and are engaging in discussions with Trinity for inclusion in their ACO.
Marcum: In your opinion, what should be on a senior living CEO’s to do list every day?
Paul: A few things actually. First and foremost, employee engagement. The necessary work is done in the trenches and not from the corner office. Second on the list would be technology. Seek out software to make the staff better by obtaining analytical information which will help to achieve better outcomes for the patient. Finally, beg for money – Medicaid in Connecticut, for 50% of the industry is poor.
Marcum: PDPM is designed to focus on each patient. What changes have been implemented within your facilities to prepare for this new payment model?
Paul: We hope a lot! Actually, hope is not a strategy. We are learning. As of January 2019, nothing has been implemented, but therapy is no longer in charge. Significant changes will be occurring within our therapy department. We will need better nursing assessment skills and restorative nursing.
Marcum: Long-term care means so much more than nursing home care. How can a senior living organization adapt to the changing needs of an aging population?
Paul: As an owner you need to beg for money from the state. Implement changes to excel at PDPM. I believe there is going to be a greater need for more private rooms, so our facilities are transitioning and adapting. And once again, staffing is the foundation…train, drill and reward staff for improving performance.
Thank you, Paul, for giving us some great insight into what has helped bring your facilities great success. It’s clear to me that it’s not a secret sauce being served, but rather a focus on patient care and staff development, with an understanding that in order to grow you need to be able to adapt to change.
Interview conducted by Megan Budd, Director, Marcum LLP.