It is reported that there are more than 400,000 pages in the Federal Register of regulations, rules and requirements controlling and regulating doctors. Frightening stories of Medicare audits abound. In 2003 physician payment was cut almost five percent. This cut caused considerable physician discontent and anger towards Medicare. In 2004, 2005, 2006, 2007, 2008 and 2009, payment cuts were scheduled, but at the eleventh hour, Congress held those cuts but did not stop them. Therefore, in 2010, a combined scheduled cut of 21.2% is mandated by the Sustainable Growth Rate Formula. Medicare CPT recalculations in individual specialties have further whittled down payments to physicians every year since 2000. Insurance companies peg physician payments to Medicare. Insurance panels decide treatment protocols and medication formularies. Physicians must comply or file time-consuming appeals. Congress is pushing to institute Pay-for-Performance, implying that physicians are not doing their best, and “others” are needed to determine the best treatment protocols.

What is happening here? The government, insurance companies and other entities have pushed for a more prominent and controlling role in healthcare. Physicians have conceded and not fought back. Physicians, for the most part, are interested in practicing medicine, not being involved in politics. Other forces have had their way and have undermined physician influence in the healthcare discussion and in the direction of healthcare policy. Political and insurance entities have begun controlling physicians and the healthcare agenda.

The uncertainty and upheaval in healthcare has had profound effects on physicians. These effects have been observed in Florida hospitals and have had influence in physician-hospital activities. A better understanding of the problems facing America’s doctors will help overcome potential conflicts, improve understanding, communication and physician-hospital efficiencies.

Physicians have become disgruntled and unhappy. Many feel they cannot practice medicine the way they were taught or the way they think it should be practiced. They are unable to spend time with their patients and have lost much of their patient-doctor interpersonal interaction. Physicians have been trained to be leaders and have become accustomed to being leaders; now, they have, out of necessity, become followers. The normal pressure and stress of the profession has become compounded by the recent changes and the threat of future changes.

The response to these circumstances depends on the physician’s age, length of time in practice and character. The new and young physician looks for a “job” with set or limited hours. Family, hobbies and outside interests are of importance in his/her vocational choices. The older physician begins to think about an earlier retirement. Apathy and resignation is common to all groups and unconfirmed reports of increased aggressive behaviors and even suicide have been suggested.

Clearly, this cannot be good for hospitals. Apathy, fragmentation of the medical specialties and a disconnect of physicians with hospitals is detrimental to all involved in healthcare. What we are doing now is not working.

Integrating and enhancing communication across medical disciplines and with hospital administrations, working together for our mutual interest and recognition of each other’s unique problems will provide a better chance for political success in influencing government policy in healthcare. Competing for influence and control will be counterproductive in the long run. Controls, regulation and suppression of initiative will not work. Instead, unity, mutual respect, assistance and working together for common and individual goals will benefit both physicians and hospitals. Better understanding and free-open dialogue may help to find common solutions to the problems created by the changing environment. Interactive discussions will help bridge communication barriers and allow physicians and hospitals to be a stronger voice in public policy and improved healthcare.



Hurricane Charley tore through Florida, destroying homes and property. Several hospitals suffered significant damage and were left with almost no resources to meet the unrelenting healthcare needs of their patients.


Frank V. Sacco, Chief Executive Officer, Memorial Healthcare System, takes a moment to talk to nurses before they were dispatched to Cape Coral Hospital to help victims of Hurricane Charley.

Aware of the devastation, hospital officials and staff at Memorial Healthcare System quickly joined the relief efforts. Three teams with a total of 50 volunteered medical personnel and hospital engineers were assembled over the weekend and sent to Arcadia and Cape Coral.

The teams had a mission to help tend to the sick and help relieve hospital staffs who were dealing with their own loss of homes and personal property. The Healthcare System also dispatched the Joe DiMaggio Children’s Hospital Mobile Health Unit, which is equipped and staffed similar to a small clinic.

“The outpouring of support from our staff has been truly remarkable, and their spirit of volunteerism is inspiring,” said Frank V. Sacco, Chief Executive Officer, Memorial Healthcare System. “Our hearts and prayers are with those who experienced tremendous loss.”



Drew Gackenheimer: At the Joseph L. Morse Geriatric Center on the Morse Seniors Campus, the religious beliefs and traditions of the residents are fundamental to the way care is delivered. To truly enhance well-being at a critical time in a person’s life, healthcare professionals must understand the whole person, including their spiritual and core beliefs. To do so requires respect and education. The majority of people served on the Morse Seniors Campus are Jewish; therefore all health professionals and staff at the Morse Geriatric Center and the Kramer Senior Services Agency are educated about Jewish culture, customs, rituals and traditions. Unlike an acute hospital, our long-term care facility is someone’s home for a significant period. Within that context, we strive to make life for our residents and their families as close to “normal” as possible.


Drew Gackenheimer, executive vice president, Morse Seniors Campus

For many, that means having the comfort of knowing that our culinary staff observes the laws of Kashruth and that our healthcare professionals know and understand Jewish traditions and celebrations. Faith is an important resource on the journey to healing, comfort, and relief from pain. Rabbi Alan Sherman, the director of religious activities for Morse Seniors Campus, is an essential member of our healthcare team. He works with residents and staff to help them understand and cope with physical and emotional symptoms. He offers spiritual support through visits, prayer and religious services. Often, the Rabbi is also a crisis counselor who helps families find comfort and strength during a very trying time.


Religious rituals provide comfort and support. Rabbi Alan Sherman with a Morse resident .

Rabbi Alan Sherman: Our residents have spiritual needs along with physical needs and so we address both. We encourage and assist them to practice their religious beliefs and traditions. As people age and long-term memory becomes more acute than short-term memory, they naturally gravitate toward recollections from the past they find most comforting. Their religious experiences, especially from youth, are among the memories that become most important to them. We have a synagogue on site to provide residents a place to gather as an institutional community and receive strength and support from religion and from each other. The human contact they experience is profoundly beneficial, especially for those who are less social or more isolated by their illness.



Rendina Companies share their knowledge on the essential keys to the successful development of medical real estate

As in all fields of real estate, commercial real estate is cyclical. But not all areas in the real estate market are directly related to the economic climate. There exist a few areas in commercial real estate that, for the most part, maintain stability and are not heavily impacted by the economic climate. One such industry is medical real estate development, which primarily encompasses the planning, construction and management of medical office buildings. Certain characteristics inherently found in the planning and management of well executed medical real estate development projects include the recruitment of creditworthy tenants, securing triple net leases, the procurement of long-term leases, structuring the lease contracts to include annual escalations in the base rental rate and offering tenants shared ownership in the partnership structure that owns the facility.

Creditworthy tenants

Creditworthy tenants are always integral in stabilizing any commercial building, particularly a medical office building. What makes medical real estate development a viable field is that it attracts financially viable tenants who are stable and willing to commit to long-term leases. It’s the nature of the tenants that make it a good business.

Triple net leases

A triple net lease is an effective way of leasing commercial space. This type of lease requires that all utilities and operating expenses of the building are passthroughs to the tenants. Everything from taxes and maintenance to security and insurance premiums are included in the operating expenses allocated to the tenants. A triple net lease essentially obligates the tenant to assume responsibility for the leased premises. In this type of lease the rental component is noted separately, allowing the owners to easily identify their net investment return.

Long-term leases, annual rent escalations

It is standard practice in the leasing of medical office space for physicians to sign long-term leases. Leases with annual rent escalations are also a standard part of commercial leasing contracts. In order to ensure a positive cash flow in a building, there must be annual escalations in the rent of a project. Long-term leases are a key element to the financing of and stabilization of a project.

Shared ownership

One of the unique opportunities Rendina Companies offers to the tenants of its projects is ownership in the partnership structure that owns the facility. This benefit is provided in return for the long-term lease commitment and personal guarantee on the part of physician tenants. As equity partners, the tenants share in the net operating cash flow and equity appreciation of the project.

Today, more and more healthcare systems are looking to medical real estate development firms to construct, finance, lease, own and manage medical office buildings on and off their campuses. Historically, hospitals built and owned their medical office buildings and, in many cases, have subsidized leases in order to attract physicians to their campus.

Due to a hospital’s complexity and cost accounting systems, it is almost impossible to fully accrue all of the expenses incurred by a medical office building. It is also seemingly less of a priority for the hospital to focus their attention on their medical office buildings. Hospitals generally lack the property management skills needed to maintain a medical office building, eroding the value of the asset. In addition, as hospital reserves continue to deplete due to reductions in reimbursement and rising operating costs, hospitals have been exiting the medical office building management business and have been selling off medical office buildings to monetize their assets and allocate money into their core business of patient care.

Medical real estate developers work with hospitals and physicians to accommodate their needs while providing quality and state-of-the-art healthcare facilities to the community. Historically, medical office buildings were not designed well enough to adapt to the rapidly growing healthcare industry. Today, however, we are seeing more and more medical office buildings that are meeting and exceeding the needs of physicians and their patients. The future of medical real estate development is bright, with more and more physicians seeking facilities that meet their needs and house fellow practitioners. This physician demand – along with the consolidation we are seeing on hospital campuses – is a driving force behind this type of medical development. In the coming years patients should expect to see many of the outpatient services presently being provided by hospitals to be offered by specialists in the comfort of their own fully outfitted and customized medical office suites.



The Martin Memorial Public Relations and Marketing department recently received several Image Awards at the annual awards luncheon. The Image Awards are hosted by the Treasure Coast Chapter of the Florida Public Relations Association and recognize top public relations professionals and programs in the area.

The Martin Memorial employee newsletter, Access Martin, and the electronic consumer newsletter, Health E-news, both received Judges Awards. This award is presented to those entries that achieved maximum results while using a minimum amount of money.

Along with the Judges Award, Access Martin also received an Award of Distinction, which is given to an entry that achieves a set standard of excellence.

Top-scoring entries in each category within a division were awarded Image Awards. The Martin Memorial Web site, www.mmhs.com, was given an Image Award in the audio-visual tools division. It was also awarded a Grand Image Award, which is presented to the top entry in that division