According to the Centers for Disease Control and Prevention, emergency visits climbed to a record high of 146 million patients nationally in 2016 – the most recent year available.

8.3 million of those patients were seen in Florida emergency rooms.

But the state Agency for Health Care Administration reports that the numbers in Florida have flattened since then, bucking the national trend.

Doctor Vidor Friedman, an Orlando doctor and president of the American College of Emergency Physicians, said that could be due in part to more urgent care use.

“I think patients who have insurance are being pushed into not going to the emergency department – if at all possible – by their insurance companies,” Friedman said.

Lakeland Regional Medical Center in Polk County had the highest number of emergency visits in Florida in 2017 at nearly 170,000.

While emergency visits have gone up overall, only 4.3% of patients nationally went to the ER with non-urgent medical symptoms, a decrease from previous years.

“What we’ve seen actually is that the acuity – in other words the people coming to emergency departments – are sicker overall,” Friedman said.

Illness continues to outpace injury as a reason people seek emergency care and the most frequently seen patients are children or senior citizens.

“Emergency physicians are uniquely qualified to provide essential care that patients can’t get anywhere else,” Friedman said. “Nearly two-thirds of visits occur after business hours, when other doctors’ offices are closed. Millions of patients rely on emergency physicians for rapid diagnosis and treatment of acute illness, while emergency departments are increasingly viewed as a hub for care and care transitions.”

The CDC data does not include freestanding emergency departments or urgent care centers.

 

Source: WUSF

Just a day after the state House weighed in on the issue, the Florida Supreme Court on Thursday rejected a public-hospital system’s plan for a new hospital in western Volusia County.

Justices, in a 14-page decision, unanimously ruled that the Halifax Hospital Medical Center taxing district did not have legal authority to issue bonds to finance a hospital in Deltona, which is outside the district’s boundaries. The Supreme Court upheld a circuit judge’s ruling that said such a bond issue was invalid.

“(Part of state law that deals with Halifax) does not contain an express grant of authority for Halifax to operate hospitals outside the geographic boundaries established for the district and, when the relevant language is considered as a whole, only authorizes Halifax to operate within the district,” said the decision, written by Justice Alan Lawson.

The ruling came less than 24 hours after the House unanimously passed a bill that would change state law to allow the Daytona Beach-based Halifax to operate outside its boundaries. The bill (HB 523), sponsored by Rep. David Santiago, R-Deltona, is an outgrowth of the court battle, but it remains unclear whether the Senate will address the issue before the scheduled May 3 end of the annual legislative session.

Last month, Santiago told a House panel that Deltona has been “crying for many years” for a hospital.

“This is a big deal for my county,” Santiago said at the time.

Halifax has been working on the 96-bed hospital project for years, entering what is known as an “interlocal” agreement with the city of Deltona and obtaining a certificate of need — a key regulatory approval — from the state Agency for Health Care Administration in 2016, according to a brief filed at the Supreme Court.

But a January 2018 decision by the hospital district’s governing board to issue $115 million in bonds for the project drew a legal challenge from Volusia County resident Nancy Epps. Circuit Judge Christopher France ruled that Halifax didn’t have the “authority to issué bonds for the purpose of financing the planning, acquisition, construction, or installing of the proposed Deltona Hospital outside of its geographic district boundaries.”

In appealing to the Supreme Court, Halifax attorneys said, in part, that Halifax has long operated facilities and provided services outside the district boundaries, including in Deltona.

But the Supreme Court agreed with the circuit judge and pointed to a general rule that special districts “are created to operate within their defined geographic boundaries.”

“In other words, although the Legislature certainly can grant a special district authority to operate outside of its defined geographic boundary, that extraordinary grant of authority would need to be express and unambiguous — clear enough to demonstrate that the Legislature has created a special district that will operate with a power not generally contemplated for … special districts,” Lawson wrote.

 

Source: Fox35

A medical office portfolio comprised of 23 properties in four states have changed hands in three separate deals valued at approximately $90 million.

Commercial brokerage firm CBRE reports that it represented the seller in the three transactions that involve more than 300,000 square feet of medical-related space.

The traded properties include the Greenleaf Center Medical Portfolio in the Chicago metropolitan Area, the Dermatology Solutions Group Portfolio in multiple markets in Florida and Alabama, and 2061 Peachtree located in Atlanta. The seller’s exclusive advisors for the three deals were Lee Asher, Chris Bodnar, Sabrina Solomiany, Shane Seitz, and Ryan Lindsley of CBRE U.S. Healthcare Capital Markets.

“We continue to see very strong interest in the market for healthcare real estate assets, and investors have allocated a substantial amount of capital to the sector this year. Consistent with previous years, pricing and demand for healthcare investment properties continues to be strong with steady cap rates year-over-year,” says Asher, vice chairman at CBRE.

The Greenleaf Center Portfolio consists of 13 medical office buildings clustered around a high traffic intersection within the Chicago metropolitan area. The buildings total 197,385 rentable square feet and were 93% leased at the time of sale, with 44% of the rentable space leased to investment grade-credit and health system tenants. CBRE reports the property was sold to an unnamed institutional fund.

The Dermatology Solutions Group Portfolio consists of eight dermatology facilities totaling 51,505 rentable square feet located in Florida and Alabama. The properties were 100% leased to Dermatology Solutions Group with a new 10-year lease which was signed by the physician practice at closing. The buyer of the portfolio was an unnamed public healthcare REIT, according to CBRE.

2061 Peachtree is a five-story class A medical office building located in the highly affluent South Buckhead area of Atlanta. The 47,936 rentable square foot building was built in 2013 and is adjacent to Piedmont Atlanta Hospital. At the time of sale, the property was 100% leased to a diverse set of tenants, including Georgia Hand, Shoulder & Elbow (GHSE), the largest hand and upper extremity practice in Georgia. The property was purchased by an unidentified REIT, according to CBRE.

 

Source: GlobeSt.

A medical office building near Plantation General Hospital traded for $10.9 million in two transactions.

Plantation-based 4100 Hospital Drive LLC, managed by developer Bruce Chait, issued two deeds for $5.45 million each for the 37,436-square-foot medical office building at 4100 S. Hospital Drive to 4100 Hospital Office LLC, managed by Janalie C. Joseph in West Palm Beach. Keystone Real Estate Income Trust provided a $5.8 million loan to the buyer.

The price equated to $291 per square foot.

The property last traded for $3.25 million in 2017. It was built on the 3.2-acre site in 1968.

Plantation General Hospital is slated to move into a new building on Nova Southeastern University’s campus in Davie.

 

Source: SFBJ

In its most recent national medical office report, Marcus & Millichap revealed that there’s an increased demand in off-campus medical office and a rise in mergers and acquisitions is changing the landscape of healthcare systems and care delivery. Medical office property sales velocity across the entire U.S. increased 5 percent over the past year.

A key point of the report forecasts that medical office properties will sustain a positive outlook in 2019 as strong employment and aging demographics align with favorable sector trends that will boost performance.

“Demographic trends and mergers and acquisitions are accelerating demand for medical office as firms desire more modern spaces and baby boomers retire at a rate of roughly 10,000 per day,” Al Pontius, Marcus & Millichap’s senior vice president and national director of specialty divisions, told Commercial Property Executive. “Cheap financing via low-interest rates makes cutting costs a quick way to grow profits and revenues,” he added.

Acquisitions and mergers are on the rise, Pontius explained, due to regulation and cost control among insurers and providers as well as innovation at the biotech, biopharma, medical device and pharmaceutical firms.

Naturally, baby boomers are a key driver of overall demand and, as this segment continues to increase year after year, Pontius noted it will create the need for more medical office space and the services they provide. Another factor in the need for space is an increase in enrollment in medical school over the past 10 years, which means the requirement for services will grow and the need for medical office space will grow nationwide.

DEVELOPMENT STATUS

Construction activity for 2019 has experienced somewhat of a broad slowdown, with concentrations in sunny, retirement-oriented states such as Texas, Florida, Arizona and California. “Building facilities remain extremely modern, with locations on and off campus as service areas expand to more suburban settings,” Pontius said. “While development had been increasing over the past few years, the completions remain well below the peak of the last cycle and we will see deliveries that is much lower in the year ahead.”

The report revealed that vacancy remains broadly higher in markets seeing the most construction as developer excitement has slightly exceeded the considerable demand that currently exists, particularly in the Southwest U.S. Marcus & Millichap also highlighted that institutional investors and REITs are focused on high-quality medical office buildings that are fully occupied near major hospitals or in medical corridors.

“Other locations where development is more expensive—NorCal, NYC—or the markets are less ‘sexy,’ such as Midwestern cities, remain much tighter than the overall market. Demand is highest in the Southwest and Southern United States, where retirees are rapidly moving to,” according to Pontius.

There’s been a lot going on around the healthcare industry. Earlier this month, Healthcare Realty Trust expanded its portfolio with the acquisition of two medical office properties totaling 158,338 square feet in the Washington, D.C. suburb of Fairfax, Va., for $46 million. Also this month, Catalyst Capital acquired a medical office building that serves as a U.S. Department of Veterans Affairs outpatient clinic in Lowell, Mass., for $11.4 million.

 

Source: CPE

The Memorial Healthcare System acquired the site of its new children’s health facility in Wellington for $14.75 million.

Wellington Office Parc LLC, managed by Leon Ojalvo of Liberty Base and Alan Benenson of MAS Development, sold the 30,000-square-foot building at 3377 N. State Road 7 to the hospital system, which is part of the South Broward Hospital District. The Joe DiMaggio Children’s Health facility was completed on the 3.5-acre site in February.

The center includes advanced imaging equipment, outpatient surgery rooms, and rehabilitation services, including sports injury rehabilitation. It focuses on six pediatric specialties: endocrinology, pulmonology, otolaryngology, orthopedics, general surgery, and neurology.

This facility is part of Memorial Healthcare System’s strategy of bringing advanced care, including ambulatory surgery, to patients who don’t live near its hospitals.

 

Source: SFBJ

At least two of WellCare Health Plans’ 12,000 employees know they will have jobs after the Tampa-based managed healthcare provider is acquired by Centene Corp.

Ken Burdick, WellCare’s CEO, and Drew Asher, executive vice president and chief financial officer, are expected to join the senior management team at Centene after the deal closes, likely in the first half of 2020.

Neither Burdick nor Asher has yet signed a contract with Centene, but that process is underway, said Michael Neidorff, Centene’s chairman and CEO, speaking on a conference call with analysts and investors.

“The additions of Ken and Drew are very positive,” Neidorff said. “We have talked with them about specific positions that will give them some increased scale and growth over what they’ve been doing. It will be very beneficial to Centene and the combined companies, but in fairness to all the employees in both companies, I’m not going to say anything more than that because it will just create an issue that over time will become very clear and positive for everyone.”

Centene (NYSE: CNC), a St. Louis-based Fortune 100 health insurer, said early Wednesday it would pay $17.3 billion in cash and stock to buy WellCare (NYSE: WCG), one of the largest publicly held companies headquartered in the Tampa Bay area. The deal is worth $305.39 a share for WellCare stockholders, a 32 percent premium over Tuesday’s closing price of $231.27 a share.

The combined company will be a leader in government-sponsored healthcare programs, including Medicare, Medicaid and the health insurance marketplace. It will have about 22 million members across all 50 states, with estimated 2019 combined revenue of about $97 billion and earnings before taxes, interest, depreciation and amortization of about $5 billion. It will be headquartered in St. Louis, with “substantial” operations in Florida, Centene said.

By the second year, the deal is expected to produce about $500 million in annual net cost synergies, a term often used by businesses to describe cost-cutting measures such as combining similar operations or systems, or job layoffs.

WellCare, with $20.4 billion in 2018 revenue, is one of the largest employers in the Tampa Bay area, with about 4,500 local employees. In February, the company said it expected to hire more than 1,000 new workers across Florida.

“I welcome the fact that WellCare has the strength in its employees that it does,” Neidorff said. “I have told everybody that will ever listen that I am not concerned about having opportunities for good people. I’m concerned about having enough good people for the opportunities. When you have a company that’s growing at the rate we are, we want to ensure that people are growing with us and we have those kinds of opportunities.”

WellCare has a major real estate footprint locally. The company has a 380,000-square-foot campus on 71 acres at 8725 Henderson Road, made up of five buildings, a cafeteria, fitness amenities, and covered parking and walkways, connected by scenic wildlife preserves. It also has three satellite offices in Tampa. One year ago, it renewed the lease for its local properties through 2030.

“Upon close, Centene is committed to maintaining a substantial presence in the Tampa Bay area. WellCare will operate in a business as usual capacity,” a spokesperson for WellCare told the St. Pete Catalyst.

A critical part of the decision to agree to the deal was similar corporate cultures, Burdick said on the conference call.

“Both organizations are oriented toward a strong local presence. Both organizations think about a holistic approach to members with integrated solutions, and great respect and appreciation for everybody in the organization at all levels. So in those three areas there was great alignment of the culture, which makes us excited about what we can do as a combination,” Burdick said.

There’s been a lot of speculation about succession at Centene, and analysts wondered if Burdick, who is 60 years old, would be a candidate to succeed Neidorff, 76. Neidorff, who recently extended his employment contract by five years, said the Centene board has been developing several potential successors. “I expect when I’m ready to hang up the spurs, they’ll have a choice of two or three people,” Neidorff said.

The deal was announced amid debates over health care policy at the national level, ranging from some Democrats’ calls for Medicare for all to a continued push by the Trump administration to repeal the Affordable Care Act.

On the conference call, Neidorff said he expected the judicial system to eventually uphold the ACA, and that Medicare for all, with a price tag ranging from $28 trillion to $38 trillion over 10 years, is unaffordable.

“This is a great transaction. It puts two great companies together in a very meaningful way serving a lot of audiences that you can never do enough to serve,” Neidorff said. “This really will prove to be a very successful and serious transaction.”

 

Source:  Catalyst