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South Florida's Evolving Medical Real Estate Market Print E-mail
Written by Tom Adams   
Friday, 06 April 2012 08:39

"It is yet to be determined who will be the winners and losers, but investors in the medical real estate sector would be well advised to understand the dynamics within the submarket in which they invest."

medical office bldg

The South Florida medical office market is going through interesting changes that are having a significant impact on property owners and market dynamics throughout the region. On one hand the large hospital networks and physician groups are very active as they vie for market share and consolidate operations. On the other hand, the solo practitioners are facing increased pressure to grow, merge or risk being squeezed to the point where it doesn't make sense to continue to practice medicine.

As a whole, South Florida's medical office buildings are experiencing the highest vacancy rates in recent memory. The factors contributing to the increased vacancies include the protracted economic malaise whereby patients are rationing their own healthcare, the mergers and acquisitions of physician practices which often creates holes in buildings and the relocation of doctors into consolidated space.

In the new era of ACO's and medical homes, the provision of healthcare will become more centralized. It is yet to be determined who will be the winners and losers, but investors in the medical real estate sector would be well advised to understand the dynamics within the submarket in which they invest. What hospital networks have facilities in the immediate area? Who controls the primary care market? What are the patient referral patterns and how does that impact the medical office properties that support the healthcare providers?

Whether it's a physician who owns a small office condo, or a national investor who owns a portfolio of South Florida medical office buildings, the criteria involved in operating a successful medical office building are becoming more complex than simply ascribing to the notion that the baby boomer's demand for healthcare services will keep the medical buildings filled with physicians who will gladly pay ever increasing rents. A prime example of this is the medical office portfolio owned by LaSalle Partners, a national owner of healthcare facilities. Their South Florida assets are averaging the highest vacancy rates across their portfolio and there is downward pressure on rents. Fortunately, their projects are well capitalized and strategically located on or adjacent to leading hospitals. As the economy improves, so should their rent roll. Their story is not unique in the current environment.

The challenges described above are viewed as opportunities by forward thinking, business-minded healthcare providers and real estate market participants. Physician groups and hospitals are partnering with developers and medical real estate specialists to develop delivery models that can adapt as the future comes into focus. One can look to Bethesda Healthcare's new hospital under construction in western Boynton Beach, the planned research hospital in Jupiter by Scripps and Tenet Healthcare, and the new medical office buildings under construction at JFK Medical Center in Atlantis and Westside Regional Medical Center in Plantation as prime examples of hospitals leading the way. 2012 will be a year in which significant physician practice mergers and new ACO's are announced. The medical office markets will absorb the impacts of the current state of flux. As the economy improves and physicians gain confidence in their future business prospects, the real estate markets should rebound beginning in 2013.
Special Thanks to Tom Adams, President and CEO of Florida Medical Space and Medical Development Partners, for this informative article. He can be reached at 954-346-8200x 201 for questions and more information.
Last Updated on Friday, 13 April 2012 16:42
INTERVIEW EXCLUSIVE with Bay Harbor Islands Plastic Surgeon Michael Salzhauer, MD Print E-mail
Written by Jeffrey Herschler   
Tuesday, 03 April 2012 06:15

michael salzhauer mdAfter viral video, threat of professional sanctions and accusations of perpetuating negative racial stereotypes, Dr.Schnoz reflects on a busy few weeks.

In case you were in a coma or off the planet, here is a recap:

The story first got picked up by AdWeek's Ad Freak and then ran in the Huffington Post, ABC News, the South Florida Business Journal and a host of other media outlets including yours truly. Click on the links below to see a few of the articles that ran plus the controversial video.

Nose Job Doc Michael Salzhauer's 'Jewcan Sam' Video Being Investigated    Huffington Post

Miami Surgeon Under Investigation    SFBJ

Miami Plastic Surgeon Being Investigated for Involvement in Jewcan Sam Video    ABC News

To see the video, click HERE.

The SFBJ even ran a Business Pulse Reader Survey on the subject. Click HERE to see the poll results.

Below is a transcript of our recent chat:

Interviewer, Jeff Herschler (JH): Tell me about the reaction to the video.

Interviewee, Michael Salzhauer (MS): Overwhelmingly positive with regard to the demographic I am trying to attract-young people, people with a sense of humor. Overall reaction is 80-85% positive. The few negative comments are coming from persons who are opposed to plastic surgery in general. Reasonable people have the right to an opinion. That said, these people would probably not be my clients anyway. By the way the story has just hit the Israeli media and the response has been 100% positive so far.

JH: You have received over 125,000 Hits on YouTube to date so you have definitely been noticed.

MS: That's far beyond my wildest expectations. Farrell Goldsmith of Yeoville Productions, a local guy, was the video director and producer. He did an outstanding job. And the band is very talented with a great sound and catchy lyrics.

JH: Have you acquired any new patients attributable to the video exposure?

MS: On Tuesday (March 20) evening, we had three new patients come in, all because of the video.

JH: How do you respond to people who say the video is offensive because it perpetuates negative racial stereotypes?

MS: A spokesman from the anti-defamation league said that. It is his job to not have a sense of humor.

JH: How worried are you about sanctions from the American Society of Plastic Surgeons?

MS: I have not heard from them except for their statements to the press. I have already sent a letter of apology.

JH: Will this video catapult the Groggers to major rock stardom?

MS: Definitely in the Jewish rock music niche! I guarantee they are now a household name in every Jewish Orthodox family in the country.

About the interviewer: Jeff Herschler is the Editor and Publisher of FHIweekly and Specialty Focus. He also produces the website
Last Updated on Friday, 06 April 2012 08:48
US Supreme Court to Debate the Individual Mandate; Future of Healthcare Delivery at a Crossroads Print E-mail
Written by Jeffrey Herschler   
Monday, 26 March 2012 19:03

Examining the challenge to the Individual Mandate (IM) that will be discussed by the Supreme Court starting today, the key questions appear to be:
  • Is the IM constitutional?
  • Is an unconstitutional IM severable from the rest of the law or does a stricken IM invalidate the entire law?
  • If IM is found to be unconstitutional and can be severed, thus making the rest of the law still valid, can HCR succeed without it?
I had a chance to catch up with several Florida Health Policy experts and ask them to address these questions.

Addressing the first question, Gabriel Imperato, Managing Partner, Broad & Cassel in Ft. Lauderdale stated, "I believe as a legal matter that it surely is constitutional and there is more than enough judicial precedent to uphold the IM. I do not believe the controversy is driven by legal issues, but seems to me to be more driven by opportunistic political issues." In contrast, Judge Roger Vinson, in Pensacola, stated "I must reluctantly conclude that Congress exceeded the bounds of its authority in passing the act with the individual mandate," in his historic ruling last January (Read more) where it was determined that the entire law must be declared void.

With regard to the second question, attorney J. Everett Wilson, Shareholder, Akerman Senterfitt stated "Irrespective of the Supreme Court's view on the IM, I really doubt that the Court will find that the provisions are so intertwined that the whole law should be stricken. Particularly since many insurance coverage provisions have already gone into effect." Mr. Imperato agrees, "This provision is severable from the rest of the law without invalidating the rest of the law. I believe the 11th Circuit Court of Appeals already ruled in this fashion."

And addressing question #3, Salvatore A. Barbera, M.S., FACHE, a professor at FIU's College of Nursing and Health Sciences made this ominous prediction, "Without the mandate, individuals, especially the young and healthy, would wait until they have a major illness or need for hospital care before buying insurance that cannot be denied due to a preexisting condition. This scenario could drive up premiums." Mr. Imperato concurs, stating "my own personal opinion is that the individual mandate is critically important to any prospect of success in meeting the deficiencies in our health care delivery system." So without the IM, HCR could backfire by driving up health insurance costs and failing to increase the number of American's insured.

What is a healthcare provider to make of all this uncertainty surrounding healthcare policy? Perhaps Heather Siegel Miller, another attorney from Broad and Cassel, sums it up best stating (in the March issue of SFHN) "...regardless of ACA's (the Affordable Care Act) fate, Congress will continue to pass legislation that will force physicians to practice medicine in a manner that will focus on better quality of care while reducing costs."

About the author:  Mr. Herschler is the publisher of the weekly digital newsletters FHIweekly and Specialty Focus.  He also produces the website  

Last Updated on Tuesday, 24 April 2012 20:14
Florida Legislation Regarding Pain Management Clinics Print E-mail
Written by Troy A. Kishbaugh & Sarah L. Mancebo   
Monday, 19 March 2012 08:02

The Florida Legislature passed House Bill 7095 in 2011 to address the problem of prescription drug abuse in Florida.  Florida is known as a primary source of prescription drugs across the country.  According to the Drug Enforcement Administration (“DEA”), 49 of the top 50 practitioners dispensing oxycodone in the United States between certain periods in 2008 and 2009, were located in the State of Florida. 

The Florida Legislature responded to this statewide crisis by enacting laws that regulate prescription drugs. The law now regulates all entities in the supply chain for prescription drugs, including wholesale distributors, pain-management clinics, pharmacies, pharmacists and practitioners (physicians, dentists, veterinarians, osteopathic physicians, naturopathic physicians, and podiatrists). These new laws also impose criminal violations. House Bill 7095 became effective July 1, 2011. Below are some of the important amendments from the legislation.

In 2009 and 2010, the Legislature began regulating pain-management clinics and physicians who practice in them. On October 1, 2010, the Florida Statutes began to require "pain-management clinics" to register with the Florida Department of Health ("DOH") as a pain-management clinic. The following year, in 2011, the Legislature amended the definition of a pain-management clinic to require registration for all publicly or privately owned pain-management clinics that (i) advertise in any medium for any type of pain-management services, or (ii) where in any month a majority of patients are prescribed opioids, benzodiazepines, barbiturates, or carisoprodol for the treatment of chronic nonmalignant pain, unless certain exceptions apply.

Since 1986, practitioners who dispense "medicinal drugs for human consumption for fee or remuneration of any kind . . . ." have been required to register with his/her professional licensing board (e.g., Board of Medicine) as a dispensing practitioner. But now, as of January 1, 2012, physicians who prescribe any controlled substance for the treatment of chronic nonmalignant pain must also register with their respective boards to designate themselves as "controlled substance prescribing practitioners" on their practitioner profiles. Also, prescriptions for controlled substances must now be written on standardized counterfeit-proof prescription pads produced from a vendor approved by the DOH or electronically prescribed as set forth in the Florida Statutes.

Physicians are also prohibited from dispensing Schedule II and Schedule III controlled substances, unless certain exceptions apply that are set forth in the Florida Statutes. The dispensing of these drugs illegally is a third degree felony and grounds for licensure discipline including, restriction, suspension, revocation, probation, fines, letters of reprimand, remedial education, or corrective action. If Schedule II and III controlled substances were in a physician's possession that were acquired for dispensing when House Bill 7095 became effective, the physician was required to (i) return all Schedule II and III controlled substances under each physician's DEA number to the wholesale distributor from which the controlled substance was purchased, or (ii) give the undispensed controlled substances to law enforcement.

By enactment of these laws, among others, the Florida Legislature is very serious about enforcing the new regulations regarding prescription drug abuse in the state. It is crucial for physicians to ensure they are complying with these laws.

For more information about these prescription drug abuse laws, please contact Troy A. Kishbaugh and Sarah L. Mancebo with GrayRobinson's Health Law Team.
Last Updated on Monday, 26 March 2012 19:02
FDA Schedules Public Hearing to Evaluate Potential New Drug Approval Paradigm Print E-mail
Written by   
Friday, 16 March 2012 08:42

On March 22 and 23, 2012, the U.S. Food and Drug Administration (FDA) will hold a public hearing on a potential new paradigm that would enable the agency to approve drugs that would otherwise require a prescription for nonprescription use under conditions of safe use. In this newsletter, we provide a summary of the proposed paradigm and address some of its implications.

Read the full article here.
Last Updated on Friday, 16 March 2012 08:47
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