Transforming Nursing Home Care: Dr. Robert Russell's Vision for the Future

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Robert Russell, MD, MBA, Chief Medical Officer of Majestic Care. 

Dr. Russell discusses his career trajectory in internal medicine and geriatrics, emphasizing the need for a redefined perspective on nursing home care. He highlights the importance of engaged leadership, the role of technology, and value-based care in improving outcomes, while advocating for a tiered system to better support various patient needs.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-010226-GK

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Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

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 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical director of Quality Insights, and today we are diving into one of the most complex and important sectors of our healthcare system and my personal favorite. Nursing home care. Joining me is Dr.

Robert Russell, chief Medical Officer of Majestic Care, a multi-state nursing home organization dedicated to compassionate, high quality, post-acute and long-term care. Dr. Russell brings decades of experience in internal medicine and geriatrics, and he's a passionate advocate for improving outcomes and quality in skilled nursing facilities, something that is so very important.

Right now. Before joining Majestic Care, Dr. Russell served as regional medical director for Communic Care Healthcare and currently chairs the Medical Advisory Committee for C-I-C-O-A. Aging and in-Home Solutions. Indiana's largest area agency on aging. He's also a past president of the Indiana Medical Directors Association, a collaborator with the Alzheimer's Association and a frequent keynote speaker on topics like dementia care, value-based healthcare and workforce engagement.

And we're gonna be talking about a few of those subjects today. With his deep experience as both a clinician and a healthcare leader, Dr. Russell offers a unique perspective on what's working, what's broken, and what the future could hold for nursing homes across the country. Dr. Robert Russell, thank you so much for joining us today.

Thank you for having me. It's a pleasure to be here. Yeah. I'm really excited to get into the conversation. I just wanted to start. You've built an impressive career in internal medicine and geriatrics. What inspired you to focus on post-acute and long-term care, and how did that path lead you to your current role as Chief Medical Officer at Majestic Care?

 Oh, that, that's a great question. So, Like most people who enter into medical school, you probably have an idea of what you wanna be when you grow up as a doctor. And  it actually was on the entire different end of the spectrum. I was thinking pediatrics actually, and then found out somewhere along the way I didn't really like their parents too much.

I loved the kids, but didn't like the parents too much. So then I fell back on what my background was in undergrad, which was chemistry, and I was actually entering into, probably going into anesthesia. But during that period of time, you get a little bit of delay between doing your prelim year for anesthesia and going into it.

So I did it internal medicine as my prelim year and did a geriatric rotation. My attending at the time, a very great geriatrician, Dr. Ramsey Hajjar at St. Louis University pulled me aside one day. He said, look, you could go off and be an anesthesiologist, but you're really a geriatrician at heart. Why don't you complete your internal medicine?

And then if you still feel like you wanna do anesthesia, go ahead and do anesthesia. And I did that. And at the end of that, I was offered the fellowship. And at the end of my first year of the fellowship, I was offered. Another second year of the fellowship, which actually only focused on physiatry and post-acute care, which was very unique at the time.

And that's what sparked my interest. And then from there I started getting interest in being an in-house physician for Life Care Centers of America, which had a in-house physician program at that time. And that's what actually started my career in post acute care. I've always been a member of Pulp Med  at the time amda, now Pulp Med as a actual futures fellow with their program.

So I continued to learn more about this space and actually see how this space was underserved, underappreciated, and really in some ways misunderstood. So that started my career in wanting to get more engrossed  and develop myself in this space. I've always also had an interest in business. So along the way I started seeking more leadership roles and that led me into taking my job with CommuniCare as a regional medical director for them.

But prior to joining CommuniCare, I actually started the MBA program with the Kelly School of Business. Completed that program while I was still with CommuniCare, which led me then thus into this role as CMO with Majestic Care. So it's all with been with an emphasis of wanting to see how I could not only better myself, but also find a way to be more relevant and more instrumental in.

Creating an avenue for this, world to be seen better and a narrative to be challenged of what long-term care is, because it's not just long-term care. It's actually to me, the safety net of the healthcare system. I will agree with you, it. Should, it should really be the forefront, I think, in all healthcare  system discussions.

Which leads me to my next question. How would you describe the current state of nursing home care in the United States? I don't want you to mince words. I want you to be very honest. Are we making any progress in quality or do you feel like we're at a crossroads that demands like a major change, a complete upheaval of the system?

Well, I think we're at a pivotal moment. I think it, it is now our time to, actually, to my previous point, it's for us to control our own narrative. For so long. We've let other people determine the perception of what quality is for us. Who we are as an, industry, what we are as an industry, and I think we need to now.

Really set the tone of what that means and who we are to the world, to the healthcare continuum. And so is it broken? I don't think it's broken yet, but I do think it, it's going through an overhaul, and part of that overhaul is we're not just for seniors, we take care of people who have mental health issues.

We take care of people who are homeless, we take care of people who are disabled. We take care of people who have substance abuse issues. So I think really letting people know that long-term care is probably an outdated moniker in a sense of if you're thinking only geriatric care, if you're thinking only elder care, we're long-term care for people who may not have any other.

Entity or any other individuals to care for them. And we will be taking care of them probably for the continuum of their life. And for some patients that I've had previously that could be 19 years old who was in a disabling car accident, but their body and their organs are functioning well enough that they're gonna live another decade or two or three.

And that could be someone who's in their eighties that now has outlived all of their relatives and their loved ones and have no other caregivers. So I think we're at a point in a juncture where we have to really redefine who we are and reintroduce ourself to the world. I think it's also important for us to also continue to be innovative and to continue embrace tech in this space.

And that's something that's new to us. 'cause we were always late to the tech conversation. We were late to EMRs, we were late to electronic order entry. And now that we are starting to embrace all of that, we're kind of getting light years into, to your point earlier, adapting AI and, and a lot of other things that we're trying to adapt at a rapid fire pace just to keep up.

But it's time for us to embrace that. We have to now know that technology's gonna be a fabric of the healthcare system. It's also has to be a fabric of our delivery of healthcare as well. Yeah. And that's a long conversation about AI and healthcare. Yeah. Yeah. That's a whole nother segment, right? Yeah. So, you know, We're talking about quality as a medical director and now a CMO.

What is your personal take on the CMS five star rating system? Do you think it Oh, really improve quality?  Could it be improved? Is it accurate?  What do you think? Well, You said I don't have to miss words. Right. So, I think it's an antiquated way of looking at what quality is, particularly when the challenges to what I said earlier in the long-term care space.

Are so varied that we need a system that really reflects the complexity of the patients and the residents that we're taking care of. Trying to equate this to living at a Four Seasons versus a Hampton Inn is not the way to do it. I just don't, I just don't agree with it in that way because there are some.

There are a a lot of really good places that will never achieve a five star, that provide great care to some really challenging individuals. That's not fair.  I don't think we have a fair system for the complexity that some places are willing to take. I'm gonna be completely honest. I just had a conversation, just that's why I was a little bit late getting here today with a high level executive at one of the health systems.

That actually understands this, but also says, unfortunately that's part of their referral process. That the five star rating will sometimes be a challenge for some really good facilities that they still send challenging patients to mind. You ever being in their a CO ever being in their, value-based proposition.

But those facilities are still willing to take their most complex patients, but cannot receive the quality, benefit or any type of financial benefit for doing it. And that's not fair. That's not right. Yeah, I would agree. Definitely. There's holes there. So  you oversee multiple centers.  You've heard, I'm sure horror stories, you've heard success stories.

What common traits or leadership behaviors do you see in nursing homes that consistently perform well in their quality measures and also maybe in other ways, like resident satisfaction, family satisfaction, reputation  all of that, the whole picture. That's another great question. I think what I've seen that is successful in successful nursing homes is that you have engaged leadership  and I, I mean all facets of leadership.

That starts with the ed, that starts with the DNS, the director of nursing. That starts with your medical director and then it trickles down to the rest of the staff and they treat. Everyone from the patient and the family well, but they also treat the janitorial services well. They treat the maintenance people well, when you have engaged leadership that know their residents that are available to address family concerns and that work together, those are the facilities that I see be most successful.

Those are facilities that commonly are four and five stars on quality and even on CMS measures because they are in tune with one another to the challenges of their building, to the challenges of their residents, and are working together on solutions for all of that. When you have that, that, that's when you have a winning team and that then tricks down to.

A lot of times much better patient satisfaction and family satisfaction, and even staff satisfaction, which I think we sometimes undervalued. I think pre COVID we had a mentality of everybody's was replaceable and that was a, very wrong mentality.  You leave this job, don't worry, somebody else will come in the door and, pick up this job for you.

Now that we see that we are workforce challenged. I think really making sure that our staffs are satisfied and also are recognized for the hard work that they do is very important. And leaders that understand that normally have very loyal staff. Yeah  I would agree. I. So you touched a little bit on medical directors, and you've been a longtime advocate for strong medical direction and long-term care.

You and I have talked about this in person. Do you think medical directors as a group are meeting the demands of today's complex nursing home environment? Wow. That is another great question.  I, I know everybody from Pulp Med is gonna be listening to this answer, so  I think our challenge is this.  I think there's some very good medical rec, actually, I think  I know some personal, some great medical directors.

I think we need to move away from the days that anybody can be medical director and just having someone we like. As medical director or someone who may even have a big name in a community as medical director, but they don't add value to the medical direction. I think those days are coming and going because I think the space requires medical directors that understand what it means to provide quality.

Long-term care. Understand the challenges of the operators in long-term care and are willing to work with the operators and within what CMS and what's being mandated is quality. So you can't, let's take for instance, you can't continue to be someone who is very staunch on your stance on anti-psychotics.

If you don't understand how those high numbers of antipsychotic utilization may actually affect the facility. Now, in no way am I saying  that should mean that if you are appropriately prescribing that you aren't doing that for the patient or the resident, but you gotta be very willing to document that.

So it also protects the facility as well. I think those days of good medical director, bad facility are done. I feel all medical directors, if you're a medical director of any facility, you are also married to the quality of that facility. So therefore you should be invested in that facility being the best facility it could be because I'm hoping you're trying to be the best doctor, the best medical director you're trying to be.

I think the challenge is getting the medical directors who may not be affiliated with organizations like Pulp Med. To understand what their duties really are. You're not just there to sign papers, you're not just there to even see residents anymore. CMS has made some clear distinctions between that too.

You're there to provide a high level of leadership and oversight, so you need to learn how to work together in that facility with the other leadership to make sure that you're  showing that you're doing it. It. Yeah. And as, as you mentioned, pulp Med  provides the Certified Medical Director training, which teaches medical directors, all of that.

I am  I will say it, it has really been  the numbers that have individuals who have enrolled in the Certified Medical Director course this past year have been surpassed any other year because. My next question and it, the certified medical director is now a requirement, so any medical director in the state of California, and now Florida, is now required to be a certified medical director, and studies have shown.

 There was a study that was just presented at the last Pulp Med conference, and I had the author  on the podcast actually to talk about it, that these facilities show better quality.  It's just  the results  are there. So what are your thoughts on the requirement about requiring  nursing facilities to have a CMD?

Do you think all states  should have this requirement? So I'm gonna give this question, I'm gonna answer this question in two ways because I'm not always a hundred percent a proponent for another certification. But I am a hundred percent a proponent of you showing that you understand why and what you're doing.

So if certified medical direction, which I do advocate for because I am a member of Pulp Med  is the way that you do it, then I'm a hundred percent for it. In that, does every state needs a requirement? Probably.  Does it have to be a state requirement? I don't necessarily think so. But should it become now requirements of maybe the organizations or even the operators maybe.

Maybe  and should there maybe even be something equated to that, that maybe your invoicing can now have a higher level because you're a certified medical director, or maybe even from a payer source from your payers. Now you get a higher reimbursement. You're a certified medical director, I think that's the next thing to not only show that it not only provides quality value, which we all are for, but it also be an it should be an ROI a return on investment for those investing, the time to learn how to do it as well.

And I think if we went as an organization now to payers to say if we could get more people as certified medical directors. Would you be willing to give them a bump in their reimbursement for what they're doing or even the facility  bump in the reimbursement if they're meeting their quality metrics and they have a certified medical director that shows everybody the value of doing it.

And that makes it so much more beneficial. And then it doesn't have to always be legislative. I'm not always for another law on the books    but if there is an incentive. That makes sense to everyone. I'm always for that as well, and I think there's ways that we can bridge both of those gaps.

Yeah, I like that idea. Yes. So if you had to name the biggest challenge facing nursing homes right now, whether it's workforce, I know we touched on regulatory burden though as we're recording this, the government is shut down, or  some other challenge.  What would it be and why?

Oh wow.  I think our biggest challenge right now will be actually how we continue to bring in a qualified, dedicated staff to this space. Marrying also what we need to do with technology.

I think that's our huge challenge now  and when I say staff, I  also mean our primary care providers, our workforce in general. Getting people in this space that wanna stay in this space, that wanna learn this space, that wanna advocate for this space and provided them with the tools to do their job in a way that's effective, I think that's a huge challenge for us.

Us understanding the changing demographics and ideology of the workforce we're trying to attract. The people that used to work in this space decades ago are drastically different than the people who are coming to this space now, and we need to understand them and also reinvigorate them in a way.

And also continue to attract them in a way that they see this as a viable long-term care career. And that's  something that I think is our challenge right now. Yeah, I would agree. Bringing in that  younger generations definitely. So you've spoken about value-based care and its role in geriatrics.

How do you see this model reshaping nursing home operations and what innovations excite you most in this space? Okay.    I'll  answer this in two parts. So the value-based care piece as I see in this space for geriatrics, I think it really helps to untether. The need for you doing fee for service work to have a quality relationship with your facility and your patients, and to show value to your payer.

So I think that's where we will see a great abundance of initiatives as we're continuing to show quality. That show that there can be some financial  sustainability for you, providing that quality in a way that's also beneficial to the payer, to the patient ultimately, and also to the health systems that are around you.

So I think that's where  we will get the best saliency out of this because now oh, the more that I do to  help to prevent. Some of these things that are been long-term challenges, the better I will do and the better the facility will do.  Yeah.    Let me work on that with you.

And I think that's where we have a lot of  optimism around what this is possible  what's capable and what's possible with value-based. Because now we all knew quality was needed. We just couldn't really understand how to make quality truly the way that we actually compensate performance, for lack of a better way of putting it.

And now the more quality you show, the better you can do, and it also is helpful to the patient. So I think that's where we have a lot of optimism around it. Now  the second part. Of your question really revolves around innovation. The acceptance that we are gonna have to all of us who are in this space are gonna have to be efficient and also learn how to adapt and integrate a lot of innovative tools into how we deliver healthcare.

That, that means in how we alert one another, how we communicate with one another, how we relay information to one another, and also how we deliver the care itself so that it becomes a lot more seamless, less time consuming and really centered around the patient in general. Yeah, I think that future is, in the value-based care space.

 So it, I feel like it's exciting. So I guess we'll see my last question, and I'm really excited to hear your answer. Things are ever changing in our government space, especially in healthcare right now. So if you were in charge of healthcare in the United States, what would you prioritize or change?

To strengthen the nursing home sector and improve outcomes for residents? Oh, wow. This is a great question. It it It is so funny because I'm poised to, in a few days, head to DC to be a part of the CMO summit. Pulp med's first ever CMO summit, which I'm looking very much forward to, and I'm sure this will be a topic of discussion.

So this is a very timely question. If I could change anything, I would start with. Changing the perception that long-term care is outside of the healthcare continuum. It's actually a fabric of the  healthcare continuum. So that would be one of the things I would start with first.

Secondly, it would be the recognition and how we actually reimburse. How we actually value long-term care. So looking for a payment model that actually makes it sustainable and also attractive for people to be in this space and to provide them with the support financial inducements to make some of my earlier comments to make the necessary changes in innovation and workforce development.

Workforce sustainability. And thirdly it would be in the area of regulation. I think we have antiquated regulatory I guess policies. That are on  roles for the type of residents and the type of care that is given throughout the continuum? I would actually think it would, we're at a point in a juncture, we need  a tiered kind of healthcare long-term care system, like maybe even  like we have for trauma centers.

If you take care of this level of patient. You become a tier three long-term care system. If you take care of this type of patient, you become a tier two long-term care system. And if you take care of  some of your more easier less challenging patients, you become a tier one healthcare system.

I think the more complex you are. The higher tier you are. Therefore, you're also seeing like a level  like a high level trauma center. In that way, I think that's where we should actually change. So if you're taking care, a large amount of behavioral patients, disabled patients, patients that need a lot of care, vent and HD patients, you become a different tier in the healthcare system.

So your reimbursement's different and the way we look at you is different. The way we regulate you is different. I think that's where we should move to. So that would be the three things I would advocate for.  Don't ask me if I've ever thought about this before. 'cause that sounded like a really good answer, didn't it?

Genius.  That is just amazing. And you can think about  you really can tailor. Staff for that kind of tier system, really to bring in individuals you know, at the, the top of their skill level as, as well as  medical director. So yeah, absolutely. I think, if I was going to do to your earlier question, I was gonna do away with the star rating, it would be in favor of a tiered.

It would be in favor of, okay. Yeah, we'll figure out another way we can. I think the stars are still great for quality. I don't think they're great for CMS overall, but for CMS overall, now we have a tiered system for you. So I think if we could marry the quality for the stars in quality with a tiered system that would be what I, because not even everyone level one trauma center may not be the best place to go If you have something simple going on.

Yes. But if you are in a motor vehicle accident, that's exactly where you wanna. Yeah you better patent this idea pretty quick. Someone's gonna steal it. I don't, I don't know. I have this, uh, recording going forward, so if anybody tries to steal this, you heard it here first, right?

So if people want to learn more about Majestic Care, how can they learn?  Oh, well, you can always visit our website and we're on social media as well as Majestic Care. In Kentucky, we are known as Bluegrass Consulting Group. So if you're in a Kentucky market, you may see us differently. But in our other markets, which include Indiana, Ohio, Michigan, and now  coming soon, West Virginia, as of  11 one.

You could just find us by majestic care  dot com  and we're there. So that's how you can learn more about us. And like I said we're on, Instagram, Facebook, and occasionally on TikTok. Wonderful. Dr. Robert Russell, thank you so much for joining us today. I enjoyed the conversation.  Thank you so much and it was such a pleasure to talk to you again and talk to you in this way.

It was really a lot of fun.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.