Nicklaus Children’s Hospital, the only pediatric trauma center in Miami-Dade County, is suing the state to challenge a law that would permanently allow another hospital to operate a competing trauma center without having to undergo the same kind of scrutiny, saying that the competition could functionally put Nicklaus’ facility out of business.
Nicklaus filed a lawsuit late last week against the state Department of Health to stop Kendall Regional Medical Center, which is owned by the Hospital Corporation of America, from operating as a Level I trauma center in the region. The department regulates which facilities have approval to operate as trauma centers, which treat the most serious injuries like gunshot wounds and severe burns.
The lawsuit, filed in Leon County circuit court, contends that part of the law — which was passed in March — violates the state Constitution by being written so narrowly that it amounts to a “special law” for Kendall alone. State statute requires that lawmakers notify the public in advance or hold a referendum for voters in the area before pushing through a law that grants a benefit to a private corporation.
A provision in the law requires the state to grant Level I trauma status to any center that had provisional approval for that tier before January 2017 but still did not have final verification by December. Kendall was granted provisional authority as a Level I trauma center in May 2016, though Nicklaus Children’s Hospital — which is part of the Miami Children’s Health System — had challenged the initial approval.
The new law would make Kendall’s trauma status permanent without the facility being required to go through a review or an on-site verification survey, attorneys said.
The lawsuit claims the law allows the Kendall trauma center “to automatically bypass in-depth review, including a determination of need, and to receive the department’s final approval as a Level I trauma center without meeting the same requirements and standards, and undergoing the same approval process, as other hospitals.”
Lawyers for Nicklaus also claimed that allowing Kendall to permanently operate as a Level I center would so limit Nicklaus’ coverage area and revenue that “the predicted volume reduction would amount to a constructive closure of [Nicklaus’] pediatric trauma program.”
Competition from Kendall, attorneys wrote, would drive up demand for a limited number of trauma personnel. Some pediatric patients have already been diverted to Kendall, which is a few miles away, the lawsuit added — the volume of Nicklaus’ trauma alerts during 2016-2017 decreased by 30 percent, according to hospital director of governmental relations Lani Ferro. Nicklaus “is likely to suffer irreparable harm because any final approval of Kendall’s Level I status, and the significant damage flowing therefrom, cannot be undone,” the suit alleged.
“This special law is devastating to the standard of care for the region’s children,” Narendra Kini, CEO of Nicklaus Children’s Health System, said in a statement. “Furthermore, this law will only fragment trauma care and decrease pediatric subspecialty expertise, as pediatric trauma centers afford children a better chance at survival.”
Kendall Regional Medical Center and Hospital Corporation of America — better known as HCA — did not respond to requests for comment.
The legislation including the clause for Kendall was a broad-reaching bill that sought to overhaul the state’s trauma system after years of lawsuits over various facilities in the state — in part as HCA has opened trauma centers at its own hospitals.
Hospitals with more established trauma centers have long fought approvals for new centers, arguing that too many facilities would cut into a limited number of cases and lessen the amount of practice their providers get treating complicated injuries. HCA has argued in the past that adding more facilities expands access to care for seriously injured patients.
State Sen. Dana Young, R-Tampa, who shepherded through the compromise legislation, said the trauma bill was a “nice balance of all competing interests” that had sought to resolve several disputes by grandfathering in facilities that had already received provisional approval from the state or those that had received verification and had their status challenged.
“It wasn’t like picking one or two or leaving others out. We tried to be very consistent,” she said. “The bill took a broad brush in order to get our trauma center statute back on track.”
Kendall was among about half a dozen facilities that were subject to similar grandfathering clauses to resolve their trauma status, according to a final bill analysis. Included was Aventura Hospital and Medical Center, another HCA facility, which had received final approval as a Level II trauma center but had its status disputed by Jackson Memorial Hospital.
Ferro said Nicklaus was not included in the crafting of the bill and began meeting with lawmakers in February to object to the grandfathering provision that was eventually adopted. The law was passed unanimously by both chambers and signed into law by Gov. Rick Scott, a former HCA executive.
Representatives for Nicklaus at the time “didn’t want Kendall approved under any circumstances,” Young added. “I didn’t think that was an appropriate resolution.”
The law also added a strict need formula that would make adding any additional new trauma centers beyond those grandfathered in more difficult. It also reduced the number of “trauma service areas” to 18 regions and created an advisory council to propose criteria for future approvals.
/wp-content/uploads/2020/08/florida-medical-space-logo.png00ADMIN/wp-content/uploads/2020/08/florida-medical-space-logo.pngADMIN2018-05-18 02:31:172018-05-18 02:31:17Nicklaus Children’s Hospital Challenges Law Allowing Trauma Center Without Full Review
The ancient Roman poet Virgil once said, “The greatest wealth is health.” And those in contemporary times increasingly agree—a 2017 study by the Global Wellness Institute (GWI) found that wellness real estate is now a $134 billion industry. Katherine Johnston, a senior researcher at GWI, says the wellness economy has experienced a consistent upward trajectory in the last 10 years. It is expected to increase by 6 percent annually in the next several years. Residential buildings and communities are ideal for city dwellers and those seeking all-inclusive amenities at their fingertips, but these environments directly impact our health and happiness—proving our sustained well-being begins at home.
Real estate and tech firm Delos, led by Paul Scialla, developed the WELL Building Standard under the International WELL Building Institute, which is a series of comprehensive measures that sets the bar for healthy living through improved air quality, sleep cycles, cognitive functions, and immunity within the habitat.
“We are committed to an evidence-based approach that looks at how the built environment can be used to impact and influence the human condition,” Scialla says.
The institute has certified over 800 projects that integrate air filtration, anti-mold and anti-microbial surfaces, chemical-free materials, lighting that follows the body’s natural rhythms, and consistent water filtration evaluation.
One such new wellness edifice is set to hit sunny Palm Beach, Fla., late next year. Amrit Ocean Resort & Residences—a glass-encased oceanfront tower inspired by the yogic philosophy of mindfulness—was envisioned by Dilip Barot, the founder of Creative Choice Group.
“These consumers define wellness for themselves, using inner science with research and technology to determine their best lifestyle,” says Barot.
Meditation, fitness, and thought management classes are offered along with a personal wellness assistant available 24/7 to customize programs and cater to specific health needs for every resident. The building incorporates heat reflexology floors for posture support, a spa and hammam for purification and detoxing, and mood-boosting aromatherapy.
Consumers are demanding healthier-built homes and residences around the world, with 60 percent of Americans willing to pay more for wellness-designed estates over traditional ones, according to GWI. Perhaps the truest luxury is the discernment to cultivate a lifestyle for both mind and body to thrive.
/wp-content/uploads/2020/08/florida-medical-space-logo.png00ADMIN/wp-content/uploads/2020/08/florida-medical-space-logo.pngADMIN2018-05-16 00:19:142018-05-16 00:19:14Why Wellness Real Estate Is Now A $134 Billion Industry
Skanska USA, in a joint venture with Gates Construction, is underway with a $229 million, 365,700-square-foot expansion and 48,500-square-foot renovation of the Gulf Coast Medical Center, a leading health-care facility in Fort Myers, Fla., on behalf of Lee Health.
Upon completion in 2021, the expansion project will consist of three new floors with 216 patient rooms and 52 intensive care unit rooms.
“Over the years, Skanska has had the privilege to partner with Gulf Coast Medical Center to help the hospital expand and meet growing health-care needs in the Fort Myers community,” Michael C. Brown, Skanska’s executive vice president & general manager of USA building operations in Florida, said in a prepared statement. “With our latest project with Lee Health, we will continue to showcase our team’s expertise in health-care construction to further enhance and grow the hospital’s state-of-the-art facilities.”
CONSTRUCTION IN THE SUNSHINE STATE
In March, Brown spoke to Commercial Property Executive about the Sunshine State’s construction sector and noted it has been extremely active in recent years, as demand for commercial development, public sector projects and infrastructure upgrades rises.
“The demand for skilled labor from across the state puts upward pressure on subcontractor pricing,” he said at the time. “Overall, Florida added 43,900 construction jobs over the past 12 months, according to data from the Associated General Contractors of America. Many skilled employees are in search of careers that open the door to a diverse set of projects over the long-term—as opposed to a short-term position on a single project. This gives firms like Skanska a built-in advantage.”
SCOPE OF PROJECT
The current Gulf Coast Medical Center project also included a 1,300-space parking garage, which was built during phase one of the construction last August.
Architecture firm HKS, Inc. designed the project, which will include an expansion of the emergency department, clinical laboratory, radiology department, dining services and the central energy plant. Gulf Coast Medical Center’s bed capacity will grow from 356 to 624 once finished.
A LEADER IN HEALTH-CARE CONSTRUCTION
Skanska is currently building several health-care construction projects in Florida, including the renovation at the Salah Foundation Children’s Hospital and an expansion at Broward Health North, both located in Broward County.
Last year, the University of South Florida hired Skanska to build the $41 million Morsani College of Medicine and Heart Institute tower in Tampa, Fla.
It also completed a major expansion of UF Health Shands’ Cardiovascular and Neuroscience Hospital in Gainesville last November.
/wp-content/uploads/2020/08/florida-medical-space-logo.png00ADMIN/wp-content/uploads/2020/08/florida-medical-space-logo.pngADMIN2018-05-09 20:58:572018-05-09 20:58:57Florida Medical Center Gets $229M Facelift
A chain of mental health clinics in Central Florida has filed for bankruptcy amid financial troubles and after a lawsuit where employees of the chain accused management of engaging in Medicare fraud.
Sanford-based Coastal Mental Health, which has eight locations across the region, filed for Chapter 11 bankruptcy Monday declaring more than $500,000 in debt. But it was the interest rate on the debt that made it unusual — much of it was at 30 percent to 50 percent.
The company reported $4.5 million in revenue, according to bankruptcy documents. The company reported revenue of $4.8 million and a deficit of $241,000 in 2016, the last year for which its tax forms were available.
Coastal is trying to reorganize its debts after several lenders had its bank accounts frozen, said the company’s attorney, Joel Aresty. He said the filing of the bankruptcy will thaw its accounts.
“As far as I know, the clinics will remain open,” Aresty said, adding that the clinic argues the interest rates were unfair.
Aresty told the court he didn’t think the situation required a third party to oversee how Coastal’s patients’ would be cared for during the bankruptcy.
A whistleblower lawsuit alleging Medicare fraud at the chain was dismissed in December, but a judge gave the federal government permission to refile it.
Two former employees of Coastal accused management of forcing them to change diagnoses so that the chain could bill Medicaid. The federal and state governments also joined the suit as plaintiffs.
The company fought back, saying the two employees who sued were trying to damage Coastal because they started a competing business. The former employees were barred from filing a new case.
One of the plaintiffs in the suit said the firm had tried to force her to change a diagnosis that a patient suffered from substance abuse and drug dependency.
According to the suit, she had tried to refuse to prescribe the patient Xanax, after the patient admitted he was high on cocaine and also took Xanax daily, even accepting it as payment for his business.
Many local mental health clinics are experiencing more trouble getting reimbursed for care, putting stress on their finances, said Candice Crawford, CEO and president of the Mental Health Association of Central Florida.
The issues at Coastal come as the 10-year anniversary of the federal mental health parity law prompts many to say that some insurance companies are imposing stricter coverage limits for mental health and addiction treatment than for other medical conditions — even though that’s what the law was intended to prohibit.
The Chicago Tribune reported insurers are abiding by the parts of the law that prohibit charging higher deductibles or setting stricter limits on treatment frequency for behavioral health services. But they see potential violations when patients and providers are told services are not covered because they are medically unnecessary, or because that treatment is subject to pre-authorization requirements.
Such decisions are more difficult to dispute but make behavioral health services less accessible, the paper reported.
/wp-content/uploads/2020/08/florida-medical-space-logo.png00ADMIN/wp-content/uploads/2020/08/florida-medical-space-logo.pngADMIN2018-05-06 21:58:122018-05-06 21:58:12Florida Chain Of Mental Health Clinics Declares Bankruptcy
When James Corbett was growing up in Queens, New York, he saw a lot of people who were untreated for mental illness. He has devoted much of his career toward finding better ways to treat mental illness and increasing access to care.
“I feel like we’re losing people,” he said. “The common test of morality of a society is its treatment of its poor and vulnerable.”
Over 43 million Americans experience mental illness each year, according to the National Association of Mental Illness. Over 10 million Americans suffer from both mental health and addiction disorders. More than 60% of adults with mental illness didn’t receive treatment in the previous year, but a shifting healthcare landscape is creating more funding and opportunities to provide care.
Corbett, formerly senior vice president at Centura Health in Colorado, has created a new company, Initium Health, that will focus on behavioral health and population health, provide consulting and education to health systems and providers and help find ways to repurpose hospitals and facilities. Corbett will be speaking at Bisnow’s National Healthcare West event June 7 in Los Angeles.
Increased demand for care, a scarcity of locations and insurance requirements to cover mental health have led to additional interest in this area from healthcare systems, real estate investors and private equity.
Increased Need For Behavioral Health Facilities
Behavioral hospitals are one of the fastest-growing types of healthcare facilities because of unmet need, Corbett said.
There is a lot of opportunity for new construction and renovating hospitals into behavioral health facilities, he said. The need has been so great that many people with behavioral health issues are crowding emergency rooms when they should really seek treatment at a behavioral health clinic, he said.
REITs are buying more behavioral health hospitals while health systems are entering joint ventures to create new behavioral health hospitals, according to a report from Cushman & Wakefield.
In March, the San Francisco Department of Public Health, through a partnership with the University of California, San Francisco, Dignity Health and Crestwood Behavioral Health, opened a 54-bed facility at St. Mary’s Medical Center in San Francisco. Care Capital Properties bought six behavioral hospitals for $400M in a sale-leaseback transaction in 2016. Sabra Health Care then acquired Care Capital Properties in 2017.
The Affordable Care Act created an increased demand for physical space because of requirements that insurance companies provide behavioral health coverage on par with healthcare services, Meridian CEO John Pollock said. At the same time, healthcare systems are pushing care services, including behavioral health, out of the acute care setting and into outpatient locations where costs are lower, he said.
California, in particular, is experiencing significant demand due to need and the continual expansion of services. About one in six adults were diagnosed with mental illness in California in 2014, according to a report from the Healthforce Center at UCSF.
California voters passed the Mental Health Services Act in 2004, which increased funding for mental health services and providers. In addition, Medi-Cal, California’s Medicaid system, expanded coverage to underserved populations, and initiatives by the Veterans Administration caused demand to increase, Pollock said.
The Trump administration’s initiative to stop opioid abuse and reduce drug supply and demand expanded evidence-based addiction treatment in every state, reduced red tape on Medicaid reimbursements for treatment and expanded services to veterans and their families through Veterans Affairs, Pollock said.
A New Kind Of Behavioral Health Facility
The treatment of behavioral health has been on the doorstep of primary care physicians, a majority of whom don’t have the proper training to meet these needs, Corbett said.
“The need is so immense, it is really starting to build into primary care practices,” he said.
Progressive systems are creating integrated practices with primary care, dental and mental health capabilities, he said. This can create a new level of real estate construction and requires more careful planning between real estate professionals, physicians and healthcare administrators, he said.
“Investors have also warmed up to behavioral health clinics and recognize that the challenge it takes to find and get a clinic approved also make the clinic a great investment,” Pollock said. “Systems are more likely to renew than go through the headache of finding a new location.”
Most people don’t want outpatient behavioral health clinics in neighborhoods, Pollock said. Meridian often works with healthcare systems to find and entitle challenging parcels for new ground-up development and find and convert existing buildings to meet requirements.
The company has worked on projects in Downtown Oakland and San Francisco, Pollock said during a recent Bisnow event in Sacramento. It is working on a two-story, 30K SF behavioral health facility in Turlock, California.
Choosing a site often requires extra attention to the surroundings and local zoning ordinances, Pollock said. Once a site or building is chosen, careful community outreach and education coupled with a coordinated plan with the city is often required, he said.
Behavioral health clinics typically fall into the same zoning as a traditional medical office building, he said. The most challenging site requirement is parking ratio, which is particularly difficult in a dense urban environment, Pollock said.
Behavioral health facility interiors tend to be less clinical and have more welcoming features such as natural light, warm colors and textures, Pollock said. There is less plumbing than a traditional medical office building since there tend to be more counseling and group rooms, which make the cost of interiors less expensive.
Facilities often include amenities such as fitness centers, yoga classes and outpatient therapy, according to Cushman & Wakefield.
The Opioid Epidemic Is Pushing Demand
Building more behavioral health facilities with all the bells and whistles still might not be enough to meet demand for care. The opioid crisis will only increase demand for behavioral health services.
Supportive housing is increasingly becoming a model to provide care to people with substance abuse issues. While working at a health system in Maine, Corbett helped put together a 15-unit supportive housing facility for mothers with substance abuse. Mercy Housing also has developed more supportive housing with medical treatment, he said. He said those with addictions often do better when they are with others trying to recover.
Attracting, training and educating licensed healthcare professionals will be a big part of meeting demand for substance abuse care. Issues of providing access more evenly across counties also will require a long-term vision and collaboration with providers and developers, Pollock said.
“With the opioid epidemic showing no signs of slowing, I fear that demand will continue to grow, which means there is a lot of work to be done in the foreseeable future,” Pollock said.
/wp-content/uploads/2020/08/florida-medical-space-logo.png00ADMIN/wp-content/uploads/2020/08/florida-medical-space-logo.pngADMIN2018-05-03 03:23:552018-05-03 03:23:55Unmet Need In Behavioral Health Creating A New Healthcare Real Estate Opportunity
