Agenda 06/10/2008 Item # 6D
Agenda Item No. 60
June 10, 2008
Page 1 of 3
COllIER COUNIY MANAGER'S OFFICE
3301 East Tamiami Trail. Naples, Florida 34112' . (239) 774-8383 . FAX (239) 774-4010
May 29, 2008
Jay L. Temkin, M.D., M.A.,P.A.
2180 Immokalee Road, Suite 316
Naples, FL 34110
Re: Public Petition Request to Discuss Medical Impact Fees for Non-invasive Medical
Consultation Offices
Dear Dr. Temkin:
Please be advised that you are scheduled to appear before the Collier County Board of
Commissioners at the meeting of June 10, 2008 regarding the above referenced subject.
Your petition to the Board of County Commissioners will be limited to ten minutes.
Please be advised that the Board will take no action on your petition at this meeting.
However, your petition may be placed on a future agenda for consideration at the
Board's discretion. If the subject matter is currently under litigation or is an on-going
Code Enforcement case, the Board will hear the item but will not discuss the item after it
has been presented. Therefore, your petition to the Board should be to advise them of
your concern and the need for action by the Board at a future meeting.
The meeting will begin at 9:00 a.m. in the Board's Chambers on the Third Floor of the W.
Harmon Turner Building (Building OF") of the government complex. Please arrange to be
present at this meeting and to respond to inquiries by Board members.
If you require any further infonnation or assistance, please do not hesitate to contact this
office.
Sincerely,
,q'VWL /J
JamesV. MUda-'{
County Manager
JVMljb
cc; Jeffrey Klatzkow, County Attorney
Joseph Schmitt, CD&ES Administrator
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2008-05-29 12:33
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Agenda Item I'BbJitlD
June 10.2008
Page 2 of 3
Reauest to SDeak und,r Public Petition
Please print
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Is this subject matter In ongoing Code Enforcement ca..? V..
NolIJ: If either anawer la ''ye.'', the Board will lI..r the ltitm but will have no
dlscuulon regarding the ltitm Ifter it is presenllJd.
Please exolain in detailthe reason YOU are reouestino to speak (attach additional
Daae If necessarY):
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Please exPlain in detail the action YOU are asking the Commisl1ion to take (attach
additional page if necessary\:
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ACCELERATED PSYCHOTROPICS
JAY L. TEMKIN, M.D., M.A.,P.A.
Adult Psychiatry
Agenda Item No. 60
June 10, 2008
Page 3 of 3
RECEIVED
OFFICE OF THE COUNTY MANAGER
May 28, 2008
To: THE BOARD OF COLLIER COUNTY COMMISSIONERS
MAY 2 8 2008
ACTION
The issue:
The rising medical impact fee voted on JWle of 2007, which went into effect last January 2008 to the tune of$48 a
sqllllrC foot (from 536 a sqllllrC foot) is seriously hampering efforts to operate and rent space for a small medical
practicelbusiness in Collier County. There should be. separate category created for small Don-invasive medlcaJ.
roDSUItattOD omee (UDder 700 square feet) that Is listed with the rest of eommereW orne. spae.. Oliver and
Tindal, the company hired to do the impact study, did not look closely at the different types of physicians or the
differences between medical practices in their study. All MOs were basically lumped into one category, whether it be a
large clinic or a small solo practitioner, large or small office without regaro to the type of practice, volume of patient or
the number of staff in the office.
Consequences:
As a result, it is nearly impossible for a solo practitioner to rent space in this county for noninvasive consultative
purposes. For mental health practitioners such as a psychiatrist or a psychologist who does not have physical contact
with the patient, does not do injections, does not need specialized equipment, does not need examination rooms, does
not need a nurse, any commercial office space would be quite sufficient and unfortunately off limits to a psychiatrist
such as myself, who can very well use a very modest 300-500 square feet of office space to run a practice. Larger
buildings approved for medical use turn out to have relatively large suites (usuaIly over 1,500 squire feet), the square
footage of which is way excessive of the amount needed and therefore not financially affordable to a solo mental health
practitioner. There also is resistance by landlords to downsize these offices into smaller more affordable units.
At the moment I am in a month-to-month rental situation whereby the landlord declines after multiple attempts by me
to sign a lease because he is hoping to rent the entire 1690 square foot office of which I only occupy 190 square feet.
As a medical pmctice I cannot continue to be month to month not knowing when I would have to move, not being able
to plan for conference I vacation time out of town. .
The other problem that I had run into is the unwillingness of landlords to pay the difference between regular
commercial impact fees and the medical impact fee. For example, I found a small compact but useable new office at an
executive office building on Airport Pulling Road. The Suite is only 312 square feet the impact fee (tax) for that space
was calculated to be additional 58,600. which is more than the annual rent of 57000. The landlord underotandably
refused to pay the fee because he wouldn't see a profit for at least the first year.
I see patients once every half an hour to once an hour. The traffic and road impact is very minimal. Never once was
the Fire Depar1ment,EMS or Police called to my office in the six years I practiced Psychiatry in this County.
The impact fee situation forced some mental health professionals to be dishonest with the county and rent office space
under' Administrative Use' but see patients in their office even though they are not supposed to under this type of
occupational license. There was even one psychiatrist who allegedly saw patients at his home in a converted garage.
To complicate the issue even more Medicare reimbursement is less every year. This year, Community Health Partners
(which cov,,", CoJiier COWlty, Sheriff, School district and NCH employees) has lowered payment to mental hcalth
practitioners. I had been seeing Sheriff personnel, stressed educators/teachers, nurses and county employees, to name a
few between lOAM and IOPM to accommodate their work schedules. Overhead in the form of medical malpractice and
regular business insurance as well as office rents are climbing. Combined with higher impact fees it is getting more
and more difficult to stay open in this County
The Solution:
A brand new category called. "non.invasivelmedical consultation office space" should be created which should allow a
practitioner to lease regular commercial office space. The square footage can be arbitrarily set to be under 800 square
feet of office space. Psychiatrists, Psychologists, and anyone with a valid Florida State Licence providing mental
health services on a one patient at a time basis should be allowed to obtain this sort of a specialized permit to do
business in Collier County without any additional medical fees imposed.
Jay L. Temkin, M.D.,M.A.'p.A.
Adult Psychiatrist