Joe DeMattos, CEO of HFAM

Episode Transcript

David Pardo (00:01.023)
Joe DeMatos, welcome to the show. Great to have you.

Joe DeMattos (00:12.079)
Good to be here. Thanks for having me.

David Pardo (00:30.303)
This is cool for us. It’s cool for me. I’m excited. We chatted a little bit. I’m excited to learn more about what you do. So who grows up and says one day, I want to advocate on behalf of the Maryland healthcare system. What’s the career path to that?

Joe DeMattos (00:35.663)
What’s the career path? What a great question. And you know, you and I have been passing ways here for a little bit. So it’s neat that we can just be kind of in the moment and have this conversation. And I’m honored to have it with you. So it starts out in Hawaii, you know, like 50 years ago, where I decide one day that I’m probably not smart enough to become a doctor, much to the disappointment of my parents.

And I decided, well, if I can’t become a doctor, how can I repair the world? Literally as a 16 year old. And I said, well, I can, I can advocate. I can, I can go and lobby. I didn’t know what lobbying was. I knew that there were a lot of things that were not going perfectly in the world when I was 16. And I wanted to, I wanted to be a part of changing that. So I did what all 16 year olds do. I lied about my age to get a meeting with the lieutenant governor. And once I lied,

David Pardo (01:36.223)
The first half of that sentence was 100 % on point and then you got us in the second half.

Joe DeMattos (01:39.695)
Yeah, yeah, yeah, yeah, yeah, there you go. So that’s the story.

David Pardo (01:44.831)
So you got a meeting with the Lieutenant Governor, what’d you do with that meeting?

Joe DeMattos (01:47.311)
Yeah, yeah, no. So I went to go see the lieutenant governor when I was 16 and I told him I was 18 to get the meeting, right? So 18 is a big age for young people because they get to vote at 18. So he thought I was a voter and I made a compelling argument. So that got the meeting. But then I got in and I said, hey, I’m only 16. And we talked about what I could do to sort of repair the world. And that led to a career.

in state government and outside of state government that eventually led to me being here, the president and the CEO of the Health Facilities Association of Maryland for the last 15 years, advocating for our sector in Annapolis and on Capitol Hill. And I got to tell you, I feel so blessed to be able to do this work on behalf of the long-term and post-acute providers in Maryland.

who are really providing a critical safety net for Marylanders in need. So short answer to your short question, you decided 16 that you wanna make the world a better place.

David Pardo (02:58.879)
Did you start your career in advocacy with healthcare or did you gravitate towards it?

Joe DeMattos (03:05.297)
Yeah. So it was really, um, but share or serendipity as a young man. Uh, president Reagan was elected in 80. And what that meant when he took office in 81 is that he wanted to take a more conservative, caring, conservative view, um, with regard to public programs, uh, that.

You know, it has always been somewhat controversial, but there are differences between a Republican platform and a Democratic platform. And his platform was more private sector involvement, less government. And what that meant in healthcare in 1981 was the federal government really disincentivizing states for having robust

um, healthcare safety nets, right? It really stressed personal responsibility over the safety net. In my view now, with all these years of experience, it was an extreme approach, but that caused me as a young legislative staffer working in the local house of representatives, the state house of representatives, it caused me then,

to have healthcare in my portfolio when I was 21 years old. So again, it was really sort of incredibly Becheric that just the timing of my age and when I was a legislative staffer caused me to create a portfolio around healthcare. So, you know, I’ve been doing healthcare for over 40 years now.

David Pardo (04:54.527)
So it’s definitely the shared serendipitous that the fair, the winds of change on the federal level were just where they were to make it make sense for you to get into advocacy, to narrow your advocacy into healthcare is state level advocacy for the long term healthcare space. Unique to Maryland. Is it typical in many States? Is it a common thing or did you spearhead?

Joe DeMattos (05:23.571)
Well, so every state in the country has tremendous power over the public health safety net that is provided by Medicaid, both in terms of Medicaid for healthcare insurance to people who are economically disadvantaged or who are sick and in long -term care. And in long-term care, Medicaid is especially important. You know, we set up this really brilliant system.

in 1965, called Medicare and Medicaid. And it has grown throughout the years. And we have this pretty, pretty robust, I think, national policy with regard to health care in Medicare that we can be really, really proud of. It’s huge and it does a great job. But we don’t have a national policy or a national

mechanism for long-term care. Medicaid is that mechanism, a federal state partnership. And inherent to that system is you have to have a medical need and you have to be poor. And so essentially in America, and I think this is a failing of our country, you get care paid for by the government in a state

federal state partnership when you are sick, old, and poor. And I think our country needs to do better at that on a national level. But what that does is it elevates in every state the advocacy on making sure that we have adequate rates for Medicaid days in nursing homes.

and in other settings. Now, the thing that is variable from state to state is how deep Medicare goes or how broadly it goes across other settings than in nursing homes. But, you know, number one on the objective of any state exec in this country, lobbying on behalf of nursing homes is to secure an adequate rate to provide quality care.

Joe DeMattos (07:48.947)
to the people in the care at those nursing homes.

David Pardo (07:53.119)
Are you looking to expand the number of people who are eligible for Medicaid also?

Joe DeMattos (07:57.619)
Well, you know, Medicaid eligibility is not really a challenge. Sadly in this country there are enough people who are sick and who are also economically disadvantaged. We are lifetimes away, again, sadly, for resolving healthcare inequity and healthcare disparity.

So we have a huge gap in this country between people who are well and not well. And for those people, we must, it’s an imperative, provide the most appropriate safety net. Now look, if they are able to be safe and receive adequate care in another setting, where it’s also at an economic sweet spot to the payer, in this case, the state and Medicaid,

That’s great. So if somebody is able enough to get care in an assisted living environment or even independently with a great deal of help at home and they can pull that off, that’s great. The problem is that financially for Medicaid, that’s a larger nut. And in a time when we have a historic workforce shortage, having everybody get care at home is really not feasible because we’re already short in the more economic settings, the settings where we have critical mass and volume, hospitals, nursing homes, and other locations.

David Pardo (09:45.055)
You’re saying home care is advantageous, is more desirable, but is less economically available because of labor shortages.

Joe DeMattos (09:54.643)
Yeah, I think, look, if I were actually one of my members now in Maryland and a number of my members now in Maryland have nursing homes, skilled nursing and rehab centers, and they have a long history of having those nursing homes. But they also, some of them have assisted living properties and they are expanding those to meet community needs.

And then some of them also have home healthcare companies. So if I were an operator today, I would view the resident and the patient relative to the quality care I can provide, regardless of the setting and in terms of what is the best setting for that patient or that resident and go from there. And I think that is going to be the way of the future.

I think we will see an increase in volume to other settings. But here’s the deal. We will always need skilled nursing and rehab centers because unfortunately we have the healthcare equity issues that are continuing. People with multiple co -operabilities or a form of dementia, with a form of dementia who need to be in a safe, healthy environment, almost like a hospital setting and cared for for years, not weeks and months.

David Pardo (11:25.407)
sniffs are gonna never go away because of health inequity or because

Joe DeMattos (11:32.211)
You know, a bunch of, so a couple of things. So demographically, we’re at an interesting time in the country. Next year will be the first year that baby boomers hit age 80. You know, the average age roughly in this country of people entering our nursing home is about 83. And the people entering nursing homes typically,

David Pardo (11:32.831)
You said dementia, why is that memory care?

Joe DeMattos (12:02.067)
especially in Maryland, but it varies from state to state and setting. In Maryland, these patients, these residents have multiple core morbidities, right? So they don’t just have diabetes. They have diabetes and congestive heart failure and maybe renal failure and need dialysis, or maybe some need ventilator care. And most common, they all have some form of dementia, right?

So while some people are focusing on the aging demographics purely mathematically relative to the boomers, I think that math is interesting and should be part of the lens that operators look at. But I think a lower percentage of boomers will choose nursing homes than previous generations. We’re already seeing that in the choice of

Medicare managed care plans coming out of the pandemic, as opposed to straight fee for service Medicare. So you do have to look at aging demographics, but what’s also interesting is you should look at healthcare equity demographics and what percentage of the population of that aging population is going to be really sick. So I think

David Pardo (13:08.031)
Why?

Joe DeMattos (13:25.427)
I think if all an operator is looking at is aging rather than pockets in this country where there’s healthcare inequity, I think they’re making a mistake with regard to meeting the needs of the community.

David Pardo (13:41.983)
Why are boomers choosing SNFs or nursing homes less than they are in the silent generation?

Joe DeMattos (13:51.411)
Well, first, boomers and I’m a boomer. I’m a young boomer. Yeah, I’m a boomer. And there’s a bunch of us, right. And the first thing I’ll say about boomers is that they impacted everything in this country growing up. They changed everything. They changed the way we did education. They changed marketing.

David Pardo (13:55.231)
Nothing wrong, yeah.

Joe DeMattos (14:16.115)
They changed protests during the Vietnam era and patriotism during the Vietnam era. They are a generation that is known for Woodstock, but they also included heroes in the armed forces. So they’re not a static group. They’re dynamic. But their dynamic group has had an impact on everything we’ve done in this country as they, as we boomers have aged. So boomers view life in this way, generally speaking, that they don’t have an expiration date. That means they feel like they can always contribute. They want to remain engaged. And they were at an age during the pandemic where they fully sort of embraced what was going on.

And I think in many respects, we’re frightened by what we went through. And so what they saw.

David Pardo (15:16.895)
Frightened by what we went through during the pandemic specifically. They saw the mass breakdown of healthcare systems.

Joe DeMattos (15:19.832)
Yeah, I think they were. I think of healthcare. And so they view Medicare Advantage plans as empowering two things that they valued as an age cohort throughout their lives. And that is they don’t have an expiration date, i.e. they want to continue to make choices and they want to continue to be engaged.

which is sort of ironic because when you choose a managed plan, you’re sort of giving away some of those rights. But what they see in those managed plans is the ability to get care as they age, not in an institutional setting. Right. So, I think that’s why we’re seeing an uptick in boomers choosing Medicare managed plans.

because they want to have more of a say on where they receive rehab service. Now, of course, the dually eligible Medicare, Medicaid beneficiaries have consistently had a higher uptake rate on managed care. But yeah, I think we’re seeing a higher percentage of those plans now.

And I think that’ll continue at least in the short term.

David Pardo (16:52.223)
I would love to spend a lot more time on Medicare Advantage and the different types, but…

Joe DeMattos (16:57.528)
That’s our whole next show. We’re only like one third into this show and we’re booking the next show already. Yeah.

David Pardo (17:04.127)
We’re writing the scripts, we’re good. But there was a perfect segue there to talking about HFAM, which I think my listeners would love to know more about.

Joe DeMattos (17:13.531)
So, um, listen, I’m, I’m so blessed to be the president and CEO of HFAM. Next week will be my 15th work anniversary. And I, and I’ll, I’ll tell you, I had no intention of coming to HFAM 15 years ago, but if I had a time machine, I’d absolutely get in that time machine and I would do it all over again. I have zero regrets. So, um, eight.

David Pardo (17:25.023)
Wow.

David Pardo (17:40.415)
You had no intention because you were going to do something else or because like.

Joe DeMattos (17:43.356)
Well, my background was in consumer healthcare policy, and wasn’t in provider healthcare policy. So it was a pretty big jump to go from a career in consumer healthcare policy and being involved, for instance, in lobbying successfully to get a drug benefit in Medicare, Part D. I was part of that, probably one of the biggest hallmarks of my career, or expanding Medicaid in Maryland two years ahead of Obamacare, and being part of that, you know, those are all consumer healthcare policy issues. So the idea of jumping from being, you know, a relative expert with some accomplishment, both federally and locally on consumer healthcare issues, to then go to provider healthcare issues with relatively no background was not my plan. But I was heavily recruited and I really liked the concept that I could advocate with the sector, for the sector, for the benefit of Marylanders and quality care. You know, I took this job, again, kind of a little bit of a negative bit of serendipity. I took this job at the start of the Great Recession when Medicaid cuts were just huge. I mean, the Maryland state budget had to be cut by the Maryland General Assembly two years in a row by $5 billion. Those are gargantuan cuts and a lot of billions. And that meant for Medicaid, cuts approaching 9%. And the people in those nursing homes back at the start of my career, when we had those budget cuts, they didn’t suddenly become 8.5 % less sick.

David Pardo (19:18.271)
It’s a lot of billions.

Joe DeMattos (19:39.005)
You know, so the challenge for the sector at the start of my career was just historic. And there was no better time to train on the job. And there were no better partners in Maryland at the time than secretary John Comers. He was the ideal health secretary as a health economist to partner with the sector during that time.

The sector really owes the Secretary of Commerce a debt of gratitude in the way he approached that work in a collaborative way. And so we went from that low point to over a period of many years working with many governors and navigating our way through a pandemic to create a rate in Maryland that is amongst the best in the country. And oh, by the way, we rewrote the healthcare regulations right before the pandemic, and we converted the rate paying system in the 2015s, and we’re about to finalize new assisted living regulations. So it hasn’t been just about the rate and providing an adequate rate, a growing rate for the public safety net for Marylanders in need, but it’s been about navigating change. And you know, HFAM has been around for 76 years and we have a record of accomplishment on this front. And look, we work very closely with our other partners in our space because Maryland has multiple long -term care associations. And we work really closely with the Maryland Hospital Association. Let me just say one thing about that. The fact that HFAM had longstanding relationships with the Maryland Hospital Association leading into the COVID pandemic. I have no doubt saved lives in Maryland. We couldn’t have done it on our own at HFAM. The hospital association couldn’t have done it on their own. And then we had great providers, partners in government. And I think Maryland had a competitive, life-saving advantage in the pandemic because we all knew each other. We all had each other’s cell phone numbers. We had trust and rapport and we could get on the phone with one another. So, yeah.

David Pardo (22:20.351)
For those who don’t know, so HFAM is an advocacy group that represents, I think, 156 members.

Joe DeMattos (22:29.151)
Yes, thank you. You know these things. So yeah, we’ve been skilled nursing. Although we don’t really have CCRCs. We have skilled nursing and rehab centers. We have assisted living. We have some home healthcare companies. We have medical equipment companies. We have ambulance companies. And increasingly, those are all very important.

David Pardo (22:31.391)
skilled nursing, post-acute, sub-acute, assisted living, continuing care retirement.

Okay.

David Pardo (22:54.015)
And I’m just curious, I assume you raised money from your community members or from your dues, right? So who joins and why do they join and why would they, meaning?

Joe DeMattos (23:00.351)
dues, right? Yes, our members pay dues.

Joe DeMattos (23:08.383)
No, it’s a great question, right? So if you were in a time machine and you decided 76 years ago or 40 years ago, or even 15 years ago when I took this job, why you would join HFAM, you would join really for two really simple reasons. You would join because there’s more power when people unite and they have one voice and you would join to advocate for adequate reimbursement for rates historically. Now, today you join really for four reasons, four buckets, and they’re all really, really important. Yeah, you do. You joined for four. Number one always is you have to fight for adequate reimbursement to provide quality care. We are the efficient public safety net for people that have been fighting healthcare inequity their entire lives. And that costs dollars and we do that efficiently. So that’s always gonna be number one. No dollars for care, no quality for care, real people are hurt. And the system is disadvantaged because people stay in hospitals longer. So bucket number one is always adequate reimbursement. Bucket number two is appropriate regulation. Not no regulation – appropriate fair minded regulation. That’s where we ended up with the nursing home regs right before the pandemic. That’s where we will end up with the assisted living regs now. That’s where we’re ending up on a change of ownership piece of legislation that will be passed by the Maryland General Assembly next week. So bucket number two is appropriate and fair regulation.

Bucket three, really was highlighted during the pandemic, but it was a bucket item before, my favorite bucket item, and it’s huge now. And that’s the bucket item about managing change. Healthcare has always been a changing environment, but it is now today changing more than ever because we have people that are getting older. We have healthcare equity issues that we have spoken of.

And we have less resources, both federally and nationally. So more demand, less dollars. And that’s huge. That’s huge. So navigating change is number three. And then number four is coming together in a community for best practices for the universal challenges of the sector. And the huge, the biggest universal challenge for the sector.

Joe DeMattos (26:01.921)
is workforce development. And nobody that I’m seeing right now has the precise response to fix it. Not the government, not an individual provider. But in that fourth bucket, if we collaborate, if we create a community of best practices, if we break down bureaucracy, that’s the only way that we solve these large universal issues. And right now, the giant Godzilla of these issues is workforce. We’re still short across the country, 130,000 workers today. Hospitals have a higher number of employees than before the pandemic. Doctors offices have bounced back more workers than before the pandemic. We’re still 133 ,000 workers nationwide down from the pandemic. At the same time as the federal government is talking about mandating staffing.

Look, I’m all for adequate and appropriate staffing, hard stop. But two things, we have to prove that the staffing has an impact on quality. And two, we got to figure out where we’re getting the staff. If you tell me where to get them, I’m all in. But I got to know where to get them. And we’ve got to make sure that we’re just not staffing for staffing. We’re staffing to improve quality to the extent that we can staff to improve quality to the extent that the rates will pay me enough to pay those workers who are godsends. And to the extent somebody will tell me where I can recruit them, I’m all in. Now, let me just add one last point on this that’s super important. I think we’re part of the answer. I think we’ve got to be much more intentional in our sector to grow our own employees, to recruit more intentionally. Because if we grow our own, nurture and develop employees, recruit more intentionally, retention will improve.

David Pardo (28:01.855)
Why has this sector not bounced back labor -wise while hospitals and other verticals within healthcare have?

Joe DeMattos (28:10.819)
It’s always been hard work. I mean, you know, it was hard work. Yeah, but it’s different, right? So there’s a whole different mindset in the hospital, right? In the hospital, the view of a hospital, rightfully, is that you go there to be saved. You go there to get better. You have an acute experience. A bunch of people rally and they save your life, even if it’s minor or major.

David Pardo (28:14.879)
Hospital’s not a walk in the cake, in the park.

Joe DeMattos (28:40.867)
and you might go home a little bit weaker, regardless of your age, but you go to hospitals to get better and to go home. The irony is that that’s our story on rehab care, right? We make people way stronger. So they’ve had a hospital stay. They’re not strong enough to go home. They come to us for some period of time and they go home more capable and stronger. The vast majority of people who enter a nursing home go home stronger because you’ve got these 15, 20, 25 % that are on Medicare stays and they process out every number of days and they go home stronger. So the irony is, is that we have that same story, but that’s not really the perception of us. And then unfortunately, or fortunately, we are a place where people who have been fighting healthcare disparity their whole lives go when they’re, when it’s the best setting for them relative to their safety and their healthcare, and maybe from a government perspective, relative to the cost. And those people are hard to care for. God bless them. They, um, I’ve seen this with my own eyes and I’ve seen, I’ve seen the connection that passionate professional care providers, seeing the connection in their eyes and their patients and residents. It’s powerful when you see that. So there’s an uplifting part of it, but it’s hard work. It’s really, really hard work. You’re seeing people at their weakest, most vulnerable place and those people die. Those people die after a time. So I think that’s part of it. So I think the jobs in our sector, for the most part, with the providers that I know, especially coming out of the pandemic where we really increased wages. I think those are quality jobs, good jobs, but the public view of them is that they’re jobs of last resort. And when you do the jobs, you realize how hard they are. So we’ve got to work together to publicize that they’re not jobs or careers of last resort, their careers of the first resort for people who care and who can endure and who want to grow their career. And some percentage of people should remain CNAs and GNAs at that entry level or in maintenance or in housekeeping. But we’ve got to do a better job in growing the people that can move from entry level housekeeping, entry level kitchen, entry level maintenance, entry level nurse’s aid, and grow them in other careers in our sector so that those are not permanent positions for those individuals in the nursing home. Now some people, their real calling is in that work. My mom was a maid and she was really hard work, but she was actually really good at it and loved being a maid.

And I certainly benefited from her being a maid. I wouldn’t be here without her or without my dad, who was a journalist. But a fair number of those people in nursing homes, they wanna do it for two or three years and then grow in their jobs. And we’ve gotta do a better job helping to grow them.

David Pardo (32:24.447)
How do we do that?

Joe DeMattos (32:26.342)
We just be more, we have career ladders and prior to, prior to the great recession, prior to the economic downturn of, of 2008, nine, uh, we were pretty intentional about ladders because we had to be competitive in the marketplace. And then coming out of the great recession, people just needed jobs. So career ladders were less important and we kind of got out of that discipline a little bit. Now we’re shorthanded and that’s incredibly distracting to be able to be clawing every day if you work in people management or HR to recruit enough people. So that’s a pretty major distraction. So if we can push that distraction aside and become more intentional again about the career ladders, I think that’s really important.

In Maryland, Texas and Florida, we have the Dwyer Workforce Development Model from Jack Dwyer, where they’re using private sector dollars to provide support services to train and for the, really the life care needs of people entering our professions. So, GNAs and CNAs who need help with transportation or childcare or education. And we’ve got to do more of that and ramp up more of that. The idea though is then who pays for it and who coordinates it. But the issues of childcare and transportation are just two that are major ones with the entry level workforce in our sector. So we’ve got to figure out a way of scaling and paying for that. Certainly the Medicaid rate is not adequate to add that additional cost but perhaps through partnerships we can find a way.

David Pardo (34:27.103)
You mentioned on your docket of things you’re advocating for right now, assisted living regulations. What are those? What do they look like? Is this Maryland specific? I assume.

Joe DeMattos (34:36.805)
Yes, Maryland specific. Look, I think, I think that there’s another disconnect in our country on assisted living. So assisted living historically and still is viewed as a residential setting and not a medical setting. And it is largely still regulated in state government as a residential setting that has some healthcare components. There is a very low percentage in this country, it varies by state to state, of Medicaid dollars being used in assisted living. So going forward, the challenge in that system is that we are seen as residents of assisted living, people who choose and pay out of pocket, largely private pay to go to assisted living in, in places where they still have parking lots and people are driving cars. We’re seeing this higher percentage of residents who are also battling some form of dementia. So in many respects, the average assisted living resident whose private pay looks a lot like what a nursing home patient looked like 30 years ago. But we regulate that setting as a residential setting. For instance, in Maryland, you need to have in a nursing home a registered nurse 24 seven. And depending on how many residents you have or patients you have in the nursing home, the number of registered nurses in a nursing home increases. Well, in assisted living in Maryland, you just need a delegating nurse to direct the nursing staff and they don’t presently need to be in that building 24 seven. So you’ve got to ask yourself, well, where we are with regard to the people living in assisted living, are we in the right place? So what you’re going to see in the rigs moving forward is not a giant leap forward to regulate assisted livings as if they are nursing homes, but you will see some steps forward that on the one hand maintains that assisted livings are largely private pay and are residential settings that they also have a medical care component. By the way, where are you in New York? I saw just now a news flash. I don’t know if you saw it, that there has been an earthquake in New York City. I am not joking. I didn’t get to read it. Okay, got it. Okay, good. You got out. All right, you got out. You got out. We’ll have to see about that.

David Pardo (37:48.223)
I’m not in New York, I’m in Florida. I got out. I got out before the earthquake, yeah.

Joe DeMattos (37:58.503)
that news thing, that’s pretty unusual. It’s pretty unusual. Yeah, there you go. Right, right.

David Pardo (38:02.463)
I’ve never heard of earthquakes in New York. I’m from LA. I remember the 94 Northridge earthquake.

Joe DeMattos (38:11.783)
Do you remember it?

David Pardo (38:13.855)
I do, if you wanna know. I was pretty young, but I actually would have slept through it. My parents woke me up to run outside, otherwise I would have, it worked out.

Joe DeMattos (38:23.175)
I’m glad it all worked out. Back then, I used to go to Northridge a great deal because I still have really close friends that went to Cal State Northridge and had that by that point had graduated, but they had bought a place together when they were in graduate school because they were smart young men. And so, yeah. And so me being the friend from Hawaii was like, hey, when can I use your place in the valley?

David Pardo (38:44.799)
That’s a smart thing to do, yeah.

Joe DeMattos (38:53.479)
And so I used to visit Northridge. I was the fun friend. I was like, I need to come and use your place. And they were like, yeah, come. So yeah, I spent a lot of time in Northridge. No, you know, it’s really pretty ironic is I was there about two months before the earthquake. So I definitely reflected on that. And I was in Washington. About a week before 9 -11.

David Pardo (38:55.519)
You were the fun friend.

David Pardo (39:04.863)
Were you there in ‘94? Were you there during the earthquake?

Joe DeMattos (39:23.303)
So yeah.

David Pardo (39:24.639)
You’re like the reverse Forrest Gump of American history.

Joe DeMattos (39:27.367)
Yeah, I don’t want that to ever change. I have a wife, kids, and I feel like as we all do, I feel like we all have our ways to contribute and I want to keep contributing. But let’s talk more about nursing homes or HVAM. How else can I help you and your listeners today?

David Pardo (39:40.575)
Right.

David Pardo (39:46.015)
Yeah. CMS, want to know more about CMS? What’s it like to work with CMS? How’s it changing? How has it changed since the pandemic?

Joe DeMattos (39:56.199)
Uh, we could be, we could, we could be on, we could, again, we could record like a whole, an entire show on, on, on CMS. So, you know, I studied government at Johns Hopkins and my master’s degree is in government at Johns Hopkins. And CMS is a great place to study. Um, I will say this about CMS. I have met with the CMS administrator. I have met.

David Pardo (40:02.367)
I’m sure we could.

Joe DeMattos (40:25.191)
with members of her senior team. I have toured a Maryland nursing home with the leadership of CMS. I view those leaders in this administration as thoughtful, caring, well -intentioned leaders who I would go to work with seven days a week if I needed to, I wouldn’t, I wouldn’t hate showing up to an office and working with them. Having said that two things, CMS is a huge bureaucracy and our government operates, um, along a blueprint that allows bureaucratic inertia. Right? So you should think of CMS as a giant tanker or container ship. And you can’t really turn it very easily because of that bureaucratic inertia. It’s sort of set up that way as any large government institution. And we live at a time when many of the state’s policy directives are in alignment with a relatively progressive agenda on the part of the Biden administration that is also largely driven by organized labor. And so what we’re seeing right now is an alignment of policy that places import on the workforce before necessarily on the provider, I think. And I think that that is amplified coming out of the worst pandemic in a hundred years. So while I would go to work every single day with our partners in leadership at CMS, and I respect and admire them, I will say that, it’s an uphill battle to influence policy right now from a provider perspective. We are living in an age of alignment and advocacy in the age of the worker. And I don’t necessarily disagree with that. I think actually that’s great, but I think it’s coming at the expense in many instances of the provider. And that’s unfortunate.

That’s unfortunate. And so it’s a marathon and not a sprint. And I think there’s a great deal of common ground if we change the paradigm. And instead of coming from the position of I am pro worker or I am pro provider to look at what are our shared interests and our shared interest is quality, is quality.

David Pardo (43:50.687)
Quality of care, patient, end user.

Joe DeMattos (43:53.223)
Yep. Yeah. And efficiency. The thing is, we’re the only people talking about efficiency. I think the government.

David Pardo (44:03.743)
I don’t think they’re allowed to use that word.

Joe DeMattos (44:03.879)
has. Yeah, I think I look, we, we, we, we provide quality care to people who would otherwise really have difficulty accessing care anywhere at a price that is palatable to the government. And I think if you look at a period of decades, the government, sort of that bureaucratic government, we’re not talking about political appointees has not wanted to publicly shout out, hey, one of the reasons why nursing homes are really important to us is that hospitals are more expensive. But all of that is true and no disrespect for hospitals. None of us could be doing the work we do without hospitals. And you saw my or heard my earlier comments about hospitals in Maryland and the hospital association. They’re just very different.

David Pardo (44:56.319)
Sure, sure. They’re just very different.

Joe DeMattos (45:02.119)
And there’s a place in every part of the continuum to meet the needs of the patient and the resident.

David Pardo (45:10.943)
What are the worst opinions that people have that you hear commonly about what you do by advocacy? You don’t have to name names. Yeah. If you have like a really bad opinion about advocacy that’s not nursing home advocacy, I’ll take it. But I meant nursing home advocacy.

Joe DeMattos (45:21.223)
about nursing home advocacy or advocacy in general.

Joe DeMattos (45:29.639)
Well, generally speaking, you know, I think there’s two sides of the coin about advocacy or lobbying. Right. So there’s a whole group of people in this country that glamorize advocacy and lobby, right. Lobbying. They they they they they see the steak lunches and the steak dinners and and you know, and the suits and and all of that. Thank you. I appreciate that. I like this jacket.

David Pardo (45:54.431)
Very nice suit.

Joe DeMattos (46:00.583)
But you know, those dinners, those lunches, by the way, in Maryland, they’re illegal. So they don’t happen. Not in Maryland. They happen in other states, but they don’t, they don’t, they don’t, they don’t really happen much here. Um, but it’s really a false image, you know, um, advocating and lobbying is really mostly behind the scenes and very, uh, unglamorous. And it’s about building relationships and trust and being known to tell the truth, even when it doesn’t benefit you. So that’s really what lobbying is about. It’s not at all glamorous. But when you throw those two things together, the people will say, well, some people will say, well, you know, that person’s just a lobbyist. They’re paid to say whatever their client wants them to say. And that’s not really true because you can’t be a successful lobbyist and operate that way. Your word is your only commodity. So you always have to tell the truth, both to your clients and to the people you’re lobbying. Then about nursing homes in general, obviously the worst thing is that we’re lobbying for the benefit of those greedy providers. And I’ve never looked at it that way. Labor is the number one expense in nursing homes by a lot.

David Pardo (47:02.943)
Right.

Joe DeMattos (47:26.823)
Um, and we want nursing homes to be profitable because nursing homes that are profitable can provide a quality care product to people in need and they can be sustained over the long haul. The worst thing possible is to have a nursing home that’s not profitable. And that’s what you’re starting to see in the Northeast where nursing homes are literally closing because they can no longer make the math work to provide a quality product. So every time we have fought at HFAM alone and with others in the sector to increase our rates over the last 15 years, my view has always been what do those rate dollars mean to workers and to quality care? And if you look at where those dollars are spent, the vast majority still goes to workers.

And if you look at wages and benefits coming out of the pandemic, on average, they have increased tremendously. So, yeah, I’m lobbying not for those greedy nursing home operators. I’m lobbying to make sure that there is a place for people who have no other place and that there’s a job and a career for somebody who thus far maybe hasn’t been able to access a job or a career.

David Pardo (49:01.663)
Beautiful, well said.

Joe DeMattos (49:03.591)
Thank you.

David Pardo (49:06.399)
That sound means it’s time for fun questions.

Joe DeMattos (49:08.423)
Mm-hmm. Mm. All right, let’s have a fun question.

David Pardo (49:13.631)
Joe, what’s the most life-changing purchase you have made under $150?

Joe DeMattos (49:19.303)
Those would always be donations.

David Pardo (49:22.879)
God, that’s a really good answer.

Joe DeMattos (49:24.263)
Yeah, always donation.

David Pardo (49:27.871)
Is there like a, besides HFAM, is there a nonprofit that you feel very close to?

Joe DeMattos (49:31.943)
Yeah.

Joe DeMattos (49:36.327)
Yeah, right now I am raising money for the leukemia lymphoma society. There are so many people that are fighting blood cancers in this country and there’s so much need for support. It’s an issue that I care about from a policy perspective, but also personally, my father had blood cancer. One of my dear friends was just declared in remission in December.

So maybe we’ll include a link for people to support the Lymphoma Leukemia Society. Yeah.

David Pardo (50:08.927)
Let’s do it. Joe, if you have like a special team link, we’ll get that in the show description. All right. Let’s do wow. Okay. You win the award for most provocative, interesting answer that questions over. Um, we’ll have to get you a plaque or something on it. Or, or that I was going to say the plaque. That’s what everyone thinks. The advocacy guys are always running around with plaques and fancy suits and statements. Love it.

Joe DeMattos (50:12.711)
Yeah, I do. I do.

Joe DeMattos (50:20.583)
Thank you.

Yeah, give me a plaque, would you, please? Or just donate to the Lymphoma Leukemia Society.

Joe DeMattos (50:33.223)
Yeah, there’s like a whole office with plaques right now. You just can’t see them.

David Pardo (50:37.919)
You had a billboard and you knew a million people would see it. What would you slap on it?

Joe DeMattos (50:46.951)
Hug your loved one.

Joe DeMattos (50:51.111)
hug your loved ones or be kind to a stranger.

Yeah, or eat more vegetables.

David Pardo (51:00.255)
These are different messages.

Joe DeMattos (51:02.247)
Yeah, you know, but those are important, important messages. You know, all of these chronic illnesses that we’ve been talking about, you can fix a lot of them with activity and proper eating when you’re in your 30s, 40s and 50s. Unfortunately, I work out, but I don’t eat particularly well. So I’m not the best student of that.

David Pardo (51:24.479)
I wanted to say also a lot of these diseases are inflamed by social isolation and by not being close to people. So that’s the common thread between your three billboard messages. Where do you get your healthcare news?

Joe DeMattos (51:32.551)
Yes, there you go. Yes, yes, yes.

Joe DeMattos (51:41.479)
Oh, I think for work, there’s no other source like McKnight’s. And then in terms of data, I’m a really big fan of Mark Zimmett and his team. And again, you know, I told you I went to Hopkins, I got my master’s degree there in government. So I’m a bit of a nerd when it comes to data. So I don’t just look at the news. I like to look at the source data.

David Pardo (52:05.087)
And this is the guy we started this conversation with saying you weren’t smart enough to get into med school. We’re ending it with time to look at primary resources and assess the data yourself. Like that. Joe, where do people find you online? How do they learn more about and from you and what you do?

Joe DeMattos (52:15.911)
Yes. Yes.

Joe DeMattos (52:23.143)
Listen, if you go to hfam.org, you will find information about me, information about HFAM. I encourage you to look. We’ve been around for 76 years. That’s a couple, one or two years before the internet. So that’s really cool. And a number of decades before we did Medicare and Medicaid. So hfam.org. And then I am super engaged on LinkedIn. So if I don’t get some LinkedIn invites from this interview, I’m going to be really, really, really concerned.

David Pardo (52:53.247)
Will do. If you’re listening, if you got to this part in the pod, find Joe on LinkedIn and in the friend requests, in the connection request, make sure you let him know where you heard him first here in the long game Joe thanks for joining us.

Joe DeMattos (53:08.583)
Thank you, my honor. What a pleasure.

David Pardo (53:11.327)
It was a lot of fun, thank you.

Joe DeMattos (53:12.467)
It was fun. Thank you.