Fix My Practice - Blog

Mistakes Physicians Make When Leasing Space for Their Practice

The Physicians Practice S.O.S. Group ® www.ppsosgroup.com

Fix My Practice – Mistakes Physicians Make When Leasing Space for Their Practice

The old adage may be, “Physician, heal thyself,” but when it comes to real estate, you are best served by an expert who will capitalize on market conditions to obtain the best possible real estate outcome for you and your practice.

As a physician, your time is best spent focusing on your practice and working with your patients. The same way you hire a practice manager to manage your practice, an attorney to handle your legal affairs, an accountant to handle your taxes, and a financial adviser to manage your wealth, find a qualified, conflict-free medical office expert, someone worthy of your trust, and then empower that real estate professional to guide you in your real estate planning and negotiations to save you time, risk, and money.

In a lawsuit, it is illegal, unethical – and even illogical — for an attorney to represent both the plaintiff and the defendant. There is an obvious conflict of interest. In real estate transactions this practice is called “dual agency,” and it carries with it the same inherent conflict of interest, except that it is legal and done all the time by so-called “full service” real estate agents. We are unique because we represent only tenants; never landlords.

Landlords hire the “full service” real estate agents to find doctors to fill their empty medical office buildings. These agents’ interests are in lock step with their landlord employers and their singular aim is to maximize the rent paid by the medical tenants.
On the other hand, tenants want to pay less rent. And yet many unsuspecting physicians trust these very same landlord/full service agents to advise them in their real estate negotiations.

These physicians are often later disappointed that their agent did not do more for them in the negotiations. But if they understood the agent’s true allegiance, they would understand their motivation.

The inherent conflict of interest that exists in dual agency relationships plagues the commercial real estate industry and should be avoided by physicians – and other tenants – at all costs.

Here are 3 items within your lease that we help you navigate through during the lease
negotiations. There are many more hidden or not so hidden items that we as your licensed real estate agent and health care consultant can help you through.

1. Signing a Personal Guarantee

Landlords love personal guarantees. However, as a tenant, you should not. A personal
guarantee is a legal contract between a landlord and an individual to guarantee a specific obligation of a business, usually the remaining rental obligation under a lease. Personal guarantees provide the landlord with additional recourse in the event of a default on a lease agreement. The implications of a personal guarantee are significant because your personal assets (e.g., house, cars, retirement funds, etc.) are at risk should you default on your lease.

The landlord will tell you the high cost of the tenant improvements that are often needed for medical office space creates additional risk, and that you need to sign the personal guarantee to provide additional security for your full performance of the lease. We disagree. The landlord who owns a medical office building should expect a high level of tenant improvements will be required. Further, the rental rate for medical office space is typically higher because of the tenant improvement contribution by the landlord. This is nothing more than a simple application of risk and reward. Yes, there is risk to the landlord in a real estate lease transaction, but that is why the rental rates for medical office space are higher than those for traditional office space. At the end of the day, it all comes down to the negotiations.

If the landlord wants to reduce risk by requiring a personal guarantee, should there not be a corresponding reduction of the rental rate? Are the improvements highly specialized? Is the medical practice a new business, or is there a solid history of financial performance to ease the landlord’s concerns? Are there other suitable properties where a personal guarantee would not be required?

If some form of personal guarantee is warranted, there are steps you can take to protect
yourself and limit your exposure. For example, if you are in a partnership with multiple doctors, try to limit your guarantee obligation to your percentage ownership in the practice. Also, you should be able to structure a guarantee that declines each year as the landlord’s exposure is reduced.

Additional weapons in your negotiating arsenal can include a release of the guarantee based on the percentage of the lease or loan paid off, a specific end date for the guarantee, exclusion of certain personal items from the guarantee, and in some circumstances, personal guarantee insurance.

2. Underestimating the Cost of Tenant Improvements

Tenant improvements for a medical office suite can be very expensive. Building out space to fit the unique needs of your practice can range anywhere from $50 to $250 per square foot, depending on myriad factors such as the current condition of the existing suite (warm or cold shell), the level of specialized requirements for the practice (e.g., plumbing in exam rooms, lead walls for x-ray units, surgery components, etc.), and personal choice of improvement finishes.

It is important to understand the implications of the current condition of the suite and how that affects the purchasing power of each tenant improvement dollar the landlord is providing. A $25-per-square-foot allowance for a second-generation dental practice may be adequate, but the same allowance will barely get you started if you are building out from a “cold shell.” The point is to understand what you are getting into before you sign a lease. Our team helps you assess the current condition of a space by developing a detailed and competitive budget for the construction project while you are still evaluating your options.

3. Underestimating the Timeline and Complexity of the Build Out

Just as the cost for tenant improvements varies by practice specialization and current condition of the suite, so does the project’s complexity, and ultimately, the timeline for delivery of the finished space. For example, a practice requiring a surgery suite and digital x-ray units will take substantially longer to design, permit and build than a family practitioner’s office that may just require individual exam rooms.

We typically advise our medical clients to plan for a minimum six-month build-out period in order to design, obtain the appropriate permits, and construct the suite. For expensive and complex medical projects, the build-out period can be a year or even longer. So it is crucial to deploy the right team of experts from the outset.
Time is one of your best leverage tools in real estate negotiations. If you run out of it, things can get expensive fast. Our team of licensed real estate professionals provides professional lease negotiation, construction, space design and project management so that you understand the complexity of the project and can plan accordingly.

By Regina Mixon Bates, Principal
Bates Realty Group and The Physicians Practice S.O.S. Group

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider’s face daily. The Physicians Practice S.O.S. Group is committed to and has helped healthcare providers across the country with new practice startups, IRO needs, improving patient flow and providing practice management and compliance solutions. Feel free to call our office to discuss any needs you might have.

Data Breaches: Why are there so many?

The Physicians Practice S.O.S. Group® www.ppsosgroup.com

Fix My Practice – Data Breaches: Why are there so many? 

Why are we hearing about so many breaches and I believe it is because we are not educating our staff about all the potential risk.

HIPAA security starts with employee education. You can lock your systems down, run scans, use antivirus, do regular patching etc. However, in reality, all it takes is for an employee to click on something, or upload something and like a magic trick…you now have a breach. The latest victim is Blue Cross and Blue Shield. An employee uploaded a file containing member information to a public facing website. The worst part is that this happened in April and was not discovered until July. It exposed over 16,000 patients. While it was only 1% of its members, but it happened, and 1 patient is 1 patient to many.  The immediate questions that come to my mind regarding this were: Did they provide employee education? Did this employee simply upload the wrong file, or did they not understand what they were doing? Was it malicious?

The data was out there for 3 months and they are unable to determine if it was accessed. The breach included names, date of birth, diagnosis codes, provider details, and procedure codes. All the information needed to process claims. No social security numbers or financial data such as credit cards were exposed. This is important because that is the information that could be used in medical identity fraud.

This breach will serve as a stark reminder for practices to have proper access controls, network monitoring, policies and procedures and employee education in place. Bi-annual training and training upon hiring will help eliminate some of these unnecessary breaches.

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider’s face daily. The Physicians Practice S.O.S.Group is committed to and has helped healthcare providers across the country with new practice startups, IRO needs, and providing practice management and compliance solutions. Call our office to discuss any needs you might have.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S.Group | www.ppsosgroup.com

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