Trauma Centers vs. Emergency Rooms: In Florida, New Rules Will Settle Long-Running Feuds

In Florida, a long-running healthcare industry legal battle could be coming to an end, thanks to the rare feat of passing bipartisan legislation affecting trauma centers.
The legislature this week passed a bill that will change how trauma centers are distributed throughout the state. It will also designate some HCA facilities as trauma centers, thus ending several legal challenges. And it will establish an advisory council that can help resolve future conflicts.

What exactly is a trauma center?

“Emergency rooms are not trauma centers,” according to the Florida Committee on Trauma. Whereas any emergency room has staff who can treat a broken bone or mild burn, a facility that is designated as a trauma center “has highly trained specialists in-house or immediately available 24 hours a day, 7 days a week.”
Trauma centers must meet certain state standards and are specially prepared to handle things like major car accidents, severe burns and gunshot wounds. A trauma center can be part of a hospital or in some cases, a stand-alone facility.
Like it or not, healthcare in America is a business, and hospitals must compete for patients, their paying customers. Because hospitals are expensive to run, the state wants enough of them to serve the population, but no so many that patients are spread thin and rates increase. Like about 30 other states, Florida regulates how many hospitals can open, and where. The state regulates trauma centers in similar fashion.
There are 303 hospitals in Florida, 209 of them with emergency departments, according to the Florida Hospital Association. Yet the state has only 27 trauma centers.
Under current regulations, which have been in place for 26 years, a hospital can receive a designation as a Level I, Level II, pediatric or provisional trauma center depending on its offerings. Florida’s 67 counties are divided into 19 “trauma service areas” and only a certain number of trauma centers are allowed in each.
In recent years, for-profit HCA Healthcare pushed to open trauma centers at more of its hospitals. Competitors balked, filing legal challenges that have wound through the courts for a decade.
Some have argued the market should be opened and hospitals should be allowed to open more trauma centers in crowded or lucrative areas. Others have argued that such a move would siphon patients from needier areas and disadvantage rural and community hospitals.
Legislators this year, after exhaustive meetings with hospital industry leaders, said they have finally worked out a compromise. New rules would dictate that no service area can have more than five trauma centers, nor more than one stand-alone pediatric trauma center. The service area borders would be adjusted and the number of areas would drop from 19 to 18. The Department of Health would establish an 11-member Florida Trauma System Advisory Council, which would begin meeting in 2019.
The new rules would also settle the litigation by approving three HCA trauma centers: at Kendall Regional Medical Center, Orange Park Medical Center and Aventura Hospital & Medical Center. One HCA facility, Northside Hospital in St. Petersburg, would not be allowed to proceed with trauma center designation.
The bill passed the state House and Senate unanimously and will go to Gov. Rick Scott for his signature.
Income from red-light camera violations has helped fund trauma centers in Florida to the tune of $12.6M in 2012. Following a mass shooting incident at Marjory Stoneman Douglas High School in Parkland Feb. 14, state lawmakers have been considering measures that would take money collected from applications for firearm licenses and direct those funds to trauma centers as well.

Source: Bisnow

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Medical Office Buildings Should Be On Your Investment Menu

While most of the rest of the real estate investors vie for industrial product and the other more recognizable asset classes, Virtus Real Estate Capital is opting out and doubling down on “cycle-resilient” real estate investments like medical office buildings.

“The easy money has been made in commercial real estate. The easy money has even been made in our property types, which are still more nascent and still have more opportunity than traditional property types,” Virtus Real Estate Capital founder and CEO Terrell Gates told National Real Estate Investor. “We’re no longer in the part of the cycle where you can just sort of put it to work, go long and hope everything works out. We believe you’ve got to dig a little deeper than that.”

According to Gates, high occupancy created by sluggish pipelines and strong, stable demand are what attract him and Virtus to MOBs. Despite strong demand for the product, inventory has crept up by only about 1%, meaning that fundamentals are on the way up.

“New supply is rarely an issue in medical office because there are a lot of natural barriers to entry that keep inventory growth very low. Over the last five years, despite overwhelming demand from tenants and healthcare systems for more healthcare space, inventory growth has averaged less than 1%. What little inventory has been delivered is mostly replacing older, functionally obsolete product. So, for that reason, you’ve seen increasing occupancies, increasing rental rates and overall positive trends for the underlying medical office assets,” Gates said.

Source: Bisnow
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Hospice Patients Increase As Population Ages

The number of people seeking hospice care is growing statewide as the population ages and health care evolves, resulting in an increasing need for compassionate end-of-life care.
Florida has the second most hospice patients in the nation. Only California has more, while Texas ranks third, national health care data show.
The number of people receiving hospice care in Florida has increased steadily for at least the past 14 years although there was a slight dip in patients one year about about a decade ago, said Paul Ledford, president and chief executive officer of the Florida Hospice and Palliative Care Association.

“The increase in number has slowed a little bit. It used to be it was increasing 4, 5 or 6 percent. Now it’s down to a 1 percent and 2 percent increase annually,” Ledford said.

Florida residents receiving hospice care — either at in-patient facilities or at home — last year are on track to total at least 130,751 admissions statewide, according to health care data to be published in about two weeks, Ledford said. Total hospice admissions were 128,878 in 2016, and 126,156 in 2015, he said.
Ledford said only 3.4 percent of patient days in Florida occur at a hospice in-patient unit. The remaining 96.6 percent of patient days occur where the patient resides, he said.
Florida has 48 hospices. About three quarters of them are nonprofit, while the rest are for-profit, according to national health care data.

Source: Florida Times-Union

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Lawmakers OK Direct Care For Doctors, Patients

A bill that expands direct primary care services is on its way to the Governor’s desk for final approval. Supporters of the measure believe that in the end, separating primary care doctors from insurance standards will ultimately trickle down benefits to the healthcare industry.
Direct primary care is a model where patients pay monthly fees to their doctors for specific care without dealing with insurance companies.
Currently, these agreements are not subjected to insurance regulations, but there is no written law that guarantees that. A bill on the way to Governor Rick Scott protects these direct care agreements, keeping them out of the Florida Insurance Code.
Rep. Danny Burgess (R-Zephyrhills) believes the model could lead to more preventive healthcare.

“With more affordable primary care, we’re going to be focusing in on more preventative medicine. Hopefully mitigating the need, more so than not, to have to present themselves to an ER, to an Urgent Care, or to other forms of potentially catastrophic situations. So preventative care is key, and we need to encourage that, and I think this bill actually helps do that,” Burgess says.

Sen. Tom Lee (R-Brandon) says this measure will not only benefit patients, but doctors who can circumvent the time consuming insurance process.

“We’re obviously looking for ways to be more creative, to offer different service delivery models here in the state of Florida. And this is an approach that would allow direct primary care physicians who want to take advantage of this opportunity to enter into agreements and avoid the 30% to 35% of their staff time that ends up getting consumed in dealing with insurance companies,” Lee says.

Not all lawmakers are believers. Rep. Richard Stark (D-Weston) is fearful the bill could lead to more cases of patients being scammed.

“Eventually people looking to begin marketing it, eventually insurance agents in the field will probably sell it, and unfortunately people who are not licensed, have no idea what’s going on in the healthcare delivery system, they may be marketing this. And we’ve had plenty of scams in the past where people buy what they call ‘discounts to see doctors’, even though this not, it’s similar. And then people use this and they think they have insurance when they don’t,” Stark says.

Because the practice is relatively new, there is not enough available research showing its effects. But, the model has been endorsed by organizations like the Heritage Foundation and Heartland Institute. The bill is now awaiting Governor Rick Scott’s signature.
Source: Florida Trend
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Miami Hospital Files For Bankruptcy

The Miami Medical Center, a 67-bed hospital that suspended patient services in October 2017, filed for Chapter 11 bankruptcy protection March 9.
Here are four things to know.
1. Leawood, Kan.-based Nueterra, along with its partners, acquired Miami Medical Center in 2014 and invested $70 million in the facility. Children’s Health Ventures, the for-profit arm of Miami-based Nicklaus Children’s Hospital, invested in Miami Medical Center with hopes of bringing a unique care model to South Florida. However, the Miami Medical Center struggled to stay afloat.
2. The hospital suspended patient services Oct. 30, 2017, and subsequently laid off its 180 employees.
3. In its bankruptcy petition, the hospital listed its assets as between $10 million and $50 million, and its liabilities as between $50 million and $100 million.
4. Miami Medical Center listed the creditors who have the largest unsecured claims against the hospital in its bankruptcy petition. According to the petition, the hospital owes about $1.2 million to Cardinal Health, $1.4 million to Aramark Healthcare Support Services and about $802,000 to Miami Anesthesia Services.
Source: Beckers Hospital Review

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