Can the estate be 'an enabler'?

'Estates as the enabler' was the title of an interesting debate session on the morning of the second day of November's Healthcare Estates conference, in which participants focussed on what part healthcare buildings and other 'built assets' would play in a future UK care landscape potentially quite different from that of today. HEJ editor Jonathan Baillie reports.

A guide to interpreting economic studies in infectious diseases.

Healthcare providers continue to seek improved methods for preventing, detecting and treating diseases that affect human survival and quality of life. At the same time, there will always be financial constraints because of limited societal resources. Many of the discussions on how to provide economically sound solutions to this challenge have not fully engaged the input of clinicians in the field. The purpose of this review is to increase economic knowledge for clinicians. We cover healthcare cost elements and methods used to assign value to a health outcome. We outline the challenges in conducting economic studies in the field of infectious diseases. Finally, we discuss the meaning of efficiency from multiple perspectives, and how the concept of economic externalities applies to infectious diseases.

Leasing physician office space.

When leasing office space, physicians should determine the effective lease rate (ELR) for each building they are considering before making a selection. The ELR is based on a number of factors, including building quality, building location, basic form of lease agreement, rent escalators and add-on factors in the lease, tenant improvement allowance, method of square footage measurement, quality of building management, and other variables. The ELR enables prospective physician tenants to accurately compare lease rates being quoted by building owners and to make leasing decisions based on objective criteria.

Non-acute care facility ownership: if not you, who?

Physician groups now face a dynamic medical real estate market that can provide an attractive alternative to self-owned and self-financed outpatient facilities and medical office buildings. The ownership and financing options available to physicians and physician groups considering the development of new medical projects have expanded greatly over the past few years and are likely to continue to evolve in the foreseeable future. This changing environment, driven by new sources of institutional capital and the emergence of qualified developers, has led to a more competitive market for physicians and groups seeking real estate capital partners, and physicians are starting to take advantage of it. Physicians and groups have embraced third-party ownership and management of real estate, because it can preserve capital resources and minimizes risk. These groups are using third parties to develop and own new medical real estate projects. This article describes medical real estate project development alternatives, the attributes and concerns of developers, typical transaction terms, and a recommended process for physicians and groups to select the best real estate development partner.

Safe space. How you can define fair market value for medical-office building lease agreements with hospitals.

When entering into office-space lease agreements with hospitals, physician practice administrators need to pay close attention to the federal antikick-back statute and the Stark law. Compliance with these regulations calls for adherence to fair market value and commercial reasonableness--blurry terms open to interpretation. This article provides you with a framework for defining fair market value and commercial reasonableness in regard to real-estate transactions with hospitals.

Losing its exemption. Mass. appeals court rules that not-for-profit, hospital-owned clinic is liable for property taxes. Hospitals wonder who's next.

Not-for-profit hospital-owned physician groups may have to pay property taxes, according to a ruling from the Massachusetts Appeals Court. With federal and state officials showing interest in the tax-exempt status of not-for-profit hospitals, the case involving Sturdy Memorial Hospital could have national implications. "This is an issue coming out from under the covers," says healthcare lawyer David Hilgers, left.

Common mistakes doctors make in building a practice space-and how to avoid them.

Time invested upfront in practice planning, examining lease or purchase terms, and carefully selecting landlords or partners yields long-term financial and efficiency gains. This article outlines the salient factors that physicians must consider when planning office space and defines the five most common mistakes that most tenants make.

Office space planning and design for medical practices: Part 2, Remodel or build new.

The decision to build anew or remodel/add-on to your existing facility can be a tough one. Your practice could possibly have multiple levels of ownership, equity, or lack of equity in the existing facility, emotional ties to the current location or building, etc. This article will deal with just how a practice makes that decision.

Selling real estate to meet capital needs.

Real estate can provide a means for hospitals to raise capital. Selling a building and investing proceeds in revenue-producing operations may yield greater return than rental income. In a ground lease, a hospital can require the buyer to adhere to certain limitations that are beneficial to the hospital's strategic goals.