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Real Estate Bisnow
The largest commercial real estate publication in the United States.
January 18, 2012 
Monday (Cab) LTile

There's uncertainty afoot at hospitals. It's from a hybrid financing model where some patients are cared for under a fee-for-service model (our friend Urban Health prez Dr. Neil Calman calls it ping-ponging patients between specialists) and others where provider reimbursement is focused on saving money through a more collaborative model focusing on the end result. What's it mean for real estate?
Neil Calman at The Roosevelt Hotel on Jan. 17, 2012
Yesterday, at Bisnow's New York Healthcare Real Estate Summit at The Roosevelt Hotel, Neil, who's also a primary care physician, said hospitals aren't going to desert a fee-for-service model for a reimburse-for-results treatment except where the government has ceased funding to force their hands. And so hospitals end up with a mixed-message hybrid.
Bob McNamara and Phyllis Lantos at The Roosevelt Hotel on Jan. 17, 2012
Our 250 attendees also heard from New York-Presbyterian Hospital CFO Phyllis Lantos (above with Lend Lease CEO of the Americas Bob McNamara). He says yes, hospital beds do float the boat for hospitals, while primary care through her organization's ambulatory (that means walking in, not riding in a car with red sirens) care services lose tens of millions of dollars, perhaps $100M, each year. (Ambulatory care performs worse in New York, by the way.) And yet NY-Presbyterian's next capital plan will likely include another ambulatory center.
Paul Williams and Rick Krainin at The Roosevelt Hotel on Jan. 17, 2012
Empty beds, on the other hand, can bankrupt a hospital (no revenue from privately insured patients to fill the gap created by treating uninsured and Medicaid patients). That's just what's happening in Brooklyn, where Paul Williams (president of the Dormitory Authority NY) and our moderator Rick Krainin (Arent Fox) both have ties to hospital systems.
Elisabeth Wynn at The Roosevelt Hotel on Jan. 17, 2012
Greater New York Hospital Association's Elisabeth Wynn says some hospitals' patient loads are as much as 85% government payers, and they face a steep hill, considering the federal government is cutting $155B from Medicare payments and subsidies for treating the uninsured over the next 10 years. The state has also cut $1.4B from hospitals over the past five years. The way out of the hole, she says, is stepping away from the fee-for-service model and preventing hospital admissons, through ambulatory care, for instance.
The Roosevelt Hotel on Jan. 17, 2012
Bob says another place where hospitals could face financing chasms is in FASB and IASB's rules (being drafted) to hold leases as liabilities rather than operating costs, adding that PricewaterhouseCoopers anticipates a 58% bump in hospitals' debt if and when those rules are implemented (looking a ways off for now). States will need to fill that gap, perhaps through municipal credit or even sovereign credit. He says Lend Lease has worked on projects in Brazil, Southeast Asia, and Western Europe, where hospitals are finding financing fortune through public-private partnerships that bring in sovereign credit.
Rich Galietti and Brycan Arcati at The Roosevelt Hotel on Jan. 17, 2012
Rich Galietti (left, with Bryan Arcati) of our event sponsor, Hauppauge-based Champion Architectural Window and Door, says his firm makes aluminum, thermally broken (don't worry, that's a good thing—energy-efficient) glass windows and doors. The 60-year-old firm considers itself a start-up for all its R&D efforts of late. Rich says they like to call themselves "old dogs learning new tricks."
The Roosevelt Hotel on Jan. 17, 2012
The best way to tell we've put on a good event: when the crowd that forms around the stage to speak with our panelists is as dense as at Woodstock (well... we can dream).
David Neinstein at The Roosevelt Hotel on Jan. 17, 2012
Speak softly and carry a big bowl. We (meaning Bisnow-er David Neinstein) will go to any length to be green, even when this is the container the hotel provides for us to collect (and later recycle) name badges.

REFM's Three Big Surprises
Bruce Kirsch
Real Estate Financial Modeling founder Bruce Kirsch can illuminate the dark world of JV partnership structures. He says it's often a murky, secretive business, usually discussed just over cocktails or on the golf course. In these sensitive deals, the devil is in the details: A simple “and” or “or” in the agreement can make a world of difference for either party. Casting a net (and a 100-question survey) nationwide, Bruce has ID'd dozens of these structures. The result (and here’s where you benefit): a searchable database of venture partnership structures at your fingertips. Join Bruce for a free seminar at noon EST this Thursday, Jan. 19, to hear all the details and how you can put this research to work for you. Bruce promises at least three big surprises found in 2011 that can benefit you in 2012. To register, click here.
We think disco is ready to make a comeback, which is why we bought 37 leisure suits and hired John Travolta to give us dancing lessons. Email amanda.metcalf@bisnow.com and amanda@bisnow.com.
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