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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Tavistock To Build Giant Wellness Center In Lake Nona

A huge wellness center with a rock-climbing wall, pools and high-tech equipment is planned for the new Lake Nona Town Center.
Tavistock Development Co. announced on March 2 the creation of an innovative wellness, performance and medically integrated fitness facility which has yet to be named in partnership with Signet LLC and its subsidiary Integrated Wellness Partners.
The new 110,000-square-foot center will be built across the street from Lake Nona Medical City in the second phase of development of the Lake Nona Town Center, Lake Nona’s premier entertainment, dining and shopping district that will have more than 4 million square feet at full build out.
The Lake Nona wellness center will offer a medically-based fitness center, sports performance training center, physician offices, community education spaces and community-based programming, which extends well beyond the walls of the brick-and-mortar facility.
The facility will offer:
  • Childcare facilities with outdoor play
  • Public concourse
  • Indoor/outdoor demonstration kitchen
  • Indoor climbing wall
  • Indoor and outdoor swimming pools
  • Outdoor classroom
  • Outdoor training turf
  • Sports performance area with 40-yard sprint track
  • Wellness plaza
  • Zen garden
The fitness center in the wellness center also will feature first-class equipment and on-demand fitness by Lake Nona partner Technogym.

“The creation of this world-class facility in Lake Nona is yet another example of how we are building out one of the most unique and comprehensive wellness communities in the country,” said Gloria Caulfield, executive director of the Lake Nona Institute. “This best-in-class collaboration with Signet and IWP will create an incredible regional asset, offering world-class programs and services across the entire spectrum of health and wellbeing.”

Memberships will be available, though rates have not yet been released.

“The only solution to overcoming the national health care crisis is prevention that comes ultimately through lifestyle change,” said Jim Ellis, managing director of Integrated Wellness Partners. “The overwhelming evidence shows we need to deliver impactful solutions that create community environments where, increasingly, the default choices for individuals, families and employees are healthy choices. The Lake Nona wellness center delivers on the vision and promise made by Tavistock to the entire Lake Nona community to offer its membership a healthy, happy lifestyle. This then will have a ripple effect on not only the Lake Nona community, but many others for years to come as Lake Nona becomes a health and wellness flagship model for the country and around the world.”

CLICK HERE TO WATCH A PROJECT VIDEO

 

Source:  OBJ
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Medical Office Buildings: Picture Of Health

Medical office buildings have long been considered a niche sector, but surging interest among investors and developers is rapidly bringing the asset category into the commercial real estate mainstream. The aging U.S. population—combined with the sector’s long-term, stable returns and resistance to e-commerce—is providing steady tailwinds for MOB demand.

“Medical office buildings are the hottest asset class outside of multifamily,” asserted Louis Rogers, founder & CEO of Capital Square 1031, a Glen Allen, Va.-based real estate investment and management company. “Investors intuitively understand that medical needs increase as we age.”

To Rogers’ point, the 65-and-older segment of the population is expected to increase by 1.7 million in 2018 and by 9.2 million over the next five years, according to CBRE’s 2018 U.S. Real Estate Market Outlook for Medical Office. That is driving short-term and long-term demand for medical services, particularly in markets with high concentrations of older residents (many of them in the Northeast and Midwest) or those with populations that are growing quickly overall as well as skewing older (characteristic of many southern and western metros). That demand should continue, notwithstanding changes to the Affordable Care Act that have created some uncertainty in the healthcare market, CBRE predicts.
In a sign that institutional investors are ramping up interest in the sector, an affiliate of Heitman LLC announced in February that it had acquired a 1.4 million-square-foot, 17-property MOB portfolio. Texas accounts for seven properties and five are in Indiana, with one apiece in New Jersey, Virginia, North Carolina, Illinois and Missouri.
In its deal announcement, Heitman cited the properties’ recent vintage—most date from after 2005—their affiliations with top health systems, and their locations in high-growth markets. Among the assets is the Medical Arts Pavilion in Plainsboro, N.J., which opened in 2012 as part of a new medical campus developed for the Princeton HealthCare System. In January 2018, the MOB became part of Penn Medicine Princeton Health, formed by the merger of the two university healthcare systems.

CURE FOR CONCERNS

As the real estate industry enters the ninth year of the current cycle, Rogers noted, the need-based, recession-resistant qualities of medical care offer a safe haven for investors, when prospects for other asset categories may be less certain.
In addition, a shift away from hospital campus-based services, adoption of new technology, health-care job growth and tight market conditions are all boosting demand, explained Andrea Cross, CBRE’s head of office research for the Americas. Since 2000, healthcare employment has jumped 47 percent, compared to 12 percent for employment overall. And it’s projected to grow further, adding nearly 1 million jobs over the next five years, CBRE reported.
Lease terms for MOBs are also typically attractive to investors, as tenants tend to be financially stable customers like physicians or healthcare systems with investment-grade credit. MOB tenants also tend to invest significant amounts of capital in equipment and fixtures, and as a result they are unlikely to relocate merely because a building down the street will save them a few dollars per square foot.

STRONG VITALS

The MOB sector’s healthy fundamentals have also expanded the pool of interested investors. The property type registered a lower peak vacancy rate than traditional office properties during the 2008 recession, according to CBRE. Net absorption has outpaced new supply in 24 of the past 29 quarters, and gross asking rents have been stable, reflecting consistent user demand and long-term leases that reduce tenant turnover.
Medical-office cap rates declined to 6.4 percent in 2017 from 8.3 percent in 2010, according to Stephen Newbold, national director of U.S. office research for Colliers International, while sales volume increased over the same stretch to $11.3 billion from $4.3 billion. The top five markets for sales volume last year were Atlanta, Los Angeles, Dallas, Houston and Chicago.
On the development front, Colliers reports that 16.2 million square feet of medical office space was completed in 2017 and forecasts a modest increase to 20.5 million square feet in 2018. States with the largest pipelines include California (5.4 million square feet), Texas (3.1 million), Florida (2.6 million), New York (4.8 million) and Pennsylvania (1.9 million)—all large states with a substantial older population.
The stable, resilient performance of MOBs is attracting lenders, as well. “The market for acquiring existing properties is very strong, and there is a tremendous amount of capital for stable assets,” said Charles Foschini, a senior managing director at Berkadia. One challenge is the three-year-old High Volatility Commercial Real Estate regulations, which stipulate minimum equity and a maximum loan-to-value ratio in order for lenders to meet a 150 percent risk weight requirement. “The HVCRE rules have made it difficult for all but the strongest developers to get financing,” Foschini observed, noting that pre-commitments from tenants may make it easier for developers to secure funding.
In March 2017, Berkadia lined up a $22.5 million bridge loan to reposition 625 Flagler, a 110,000-square-foot Class A property formerly occupied by Bank of America in West Palm Beach, Fla. FRI Investors, the new owner, plans to reposition the 34-year-old building primarily as medical offices; current tenants include Mount Sinai Hospital and Jupiter Medical Center.

DISSECTING THE DETAILS

As MOBs gain in popularity, discerning investors cite qualities of tenants and properties that make these assets attractive. “If you have a strong healthcare system, Class A MOBs, whether on or off campus, remain especially compelling,” said Mary Beth Kuzmanovich, national director of healthcare services for Colliers International.
Assets located on or near hospital campuses provide stability because they are convenient for both physicians and patients, and doctors are usually affiliated with the healthcare system, providing an incentive for them to sign long-term leases. As medical services move closer to patients, particularly in suburbs, patients no longer have to go to a hospital for procedures like outpatient surgery, radiation therapy or dialysis. Accordingly, assets in suburban MOBs are becoming more desirable.
Location isn’t the only factor, however. “The investor class has to be very careful to understand who’s in their building and their long-term financial viability to continue to be able to pay their rent and continue to renew and stay in the building,” Kuzmanovich said.
American Healthcare Investors and Griffin Capital Co., the co-sponsors of Griffin-American Healthcare REIT IV, focus more on the tenant than on the asset’s location, said Danny Prosky, a founding principal of American Healthcare Investors. “Healthcare is a growth industry in all 50 states,” he said. “There isn’t any one particular part of the country that we avoid.”
In October 2017, Griffin-American Healthcare REIT IV acquired Fairfield County Medical Office Building Portfolio, comprising two MOBs located in Connecticut. The 80,000-square-foot portfolio is 94.6 percent leased to 15 tenants with an average remaining lease term of more than seven years. The portfolio’s anchor tenants, affiliates of Advanced Radiology Consultants, occupy about 29 percent of the leasable space, and recently extended their leases to 2029.
Source: CPE
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