Five physicians request additional time, funds from county to relocate

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Five physicians request additional time, funds from county to relocate

Due to space constraints to Constitutional Officers at the Courthouse, the county has begun the process of utilizing the Pinebrook Medical Center facility for these offices. Several doctors will have to relocate and current discussions indicate the county may give them six to nine months to do so.

The county owns the Pinebrook Medical Center facility and Bayfront leases the space from the county. The hospital subleases to other parties.

Deputy County Administrator Jeffrey Rogers stated, “We are working on making an amendment on our agreement to bring back to you to basically cancel the lease at that time and there will be a time limit for the building to come back to the county. You have already provided some funding to help with the relocation of the hospital subtenants… to help them with moving expenses and subsidizing their rent to make sure these doctors offices can smoothly transition to another location. Bayfront Health has been very proactive in trying to find locations throughout the county for them to relocate to.”

Each of the 5 physicians being relocated, will receive up to $4,000 for moving expenses along with a rent subsidy for up to $1.50 per square foot through the term of each lease. Total costs to the county over three years is $54,818 which will come from the Capital Improvement Fund (which is part of the $3,000,000 moved from the General Fund for space needs).

The agenda item on Oct. 10, 2017 was a presentation of letters received by the county from doctors who are being displaced. Dr. M. Rodwan Hiba, MD, Dr. Mahmoud Bourghli, Dr. Mahmoud Nimer, Dr. Lisa Allen-Khalil and Dr. Karen Wunderlich all submitted letters stating that the timeframe of 6 months for relocation is not feasible.
“The physicians and I understand the duress that the county is under and we would like to help if possible. However the proposed time period of six months to relocate to another space is unrealistic due to logistical and financial challenges that the healthcare industry presents.”

The letters continue,

“...Any new location will require - at the minimum - thousands of dollars for renovations to set up the office correctly. These renovations can take several months due to the design, permitting and construction process. Funds and time will be needed to set up a computer system, phone system and Wi-Fi capabilities. Office staff hours will be spent preparing, assisting and organizing the new space. Time and funding will be spent moving sensitive medical equipment and medical records. Furthermore, our patients - some of whom are very elderly - will need proper notification of the relocation and detailed instructions on how to find us.

“An additional challenge is the pause in payments from the government for care provided once a new location for my practice is identified. It can take up to five months for us to recoup payments from the Centers for Medicare and Medicaid Services (CMS), which is a delay of tens of thousands of dollars in revenue needed to pay not only my Staff and other overhead costs but the costs to relocate. Also of concern is that shortly all the winter residents will returning to Hernando County and all of them will be expecting to be seen by their physician. This results in a huge increase in the demand for physician services leaving limited time for the overwhelming challenges of relocation.”

The doctors ask the county to provide them with at least 12 months to relocate as well as “nominal dollars toward renovations” in addition to the monies offered to them to help relocate.

Mari Jones Elliott, Chief Operating Officer with Bayfront Health Brooksville stated, “I just want to reiterate our support to work with the county. We are trying very hard to help the physicians. It’s our ultimate goal to make sure the patients in the county are well taken care of.”

She explained the Dr. Nimer, cardiologist just moved a nuclear medicine camera into Pinebrook which cost him $10,000 just to transport. “From his perspective, the relocation dollars allocated for this move are not enough to cover him to move that camera again. Ultimately we want to make sure the physicians are going to be able to care for the patients in the county.”

She said that two out of four of the physicians have found new locations, but it has been difficult since commercial medical space in the county is limited. She implored Commissioners to keep an open mind in considering the doctors’ needs.

Paul Schillinger with Dr. Wunderlich’s office spoke to the Commission and stated that the physicians are also taxpayers in the county and understand that this is a better solution than spending millions on a new building. They are caregivers and volunteers in the community and truly wish to help, but also want to be fairly compensated for the extensive expenses involved with relocation and be given a reasonable amount of time to relocate. He stated that they are asking for 12 months, but “if we can leave sooner we will leave sooner.”

Dr. M. Rodwan Hiba, a founding member of Crescent Clinic and 2013 Frist Humanitarian Award winner, stated that he’s had to move twice so far and the biggest impacts to him was that medicare payments stop whenever he moves. “On both occasions that I had to move, I had to borrow money to survive. It takes about 6 months for medicare to start paying you after you move your address,” he explained. He also stated that he performs endoscopy in his office which is level 2 surgery requiring the state to inspect annually. He said that it’s not going to cost less than $10,000 to setup a new endoscopy room that meets the level 2 surgery requirements. “I want to do what’s best for the county, but this is a significant financial impact… The let’s do it now, let’s move out… it may push me out of practice.” He said that his past two moves cost him over $100,000 each time. His lease is not up until 2020.

“Until staff comes to us with a hard recommendation of what we should do to go forward, we’ll take everything you’ve said into advisement for those decisions when they come,” said Chairman Dukes.

Commissioner John Allocco, who has experience with Medicare as a Physical Therapist, said “In the last five years, they are much quicker with change of address. I don’t think it will be a six month ordeal.” Mr. Allocco also said of the timeline, “I think by the time we get plans approved, we’re probably going to be in that nine-to-twelve month range, so I don’t think that extending the time … would be a problem.”

The presentation was an informational item and a vote could not take place.