The land use battle, as one Linn County supervisor explained, poses a tough choice for the community, which loves progress but hates change.

The Cedar Rapids City Council will hold a public hearing in August on the proposal by Physicians’ Clinic of Iowa (PCI), which  is seeking support from different civic and government groups to back a $40 million project that includes vacating a portion of 2nd Avenue to accommodate the medical complex.

For the full report from KCRG-TV, click here.

Tom Ahern is senior vice president for capital markets and health facilities for The Saint Consulting Group, email ahern@tscg.biz phone 781 836 4343

After reading my daily dose of coverage this morning about various special interests “astroturfing” the climate change legislation, I figured why not add from the ink well a bit myself. The astroturf histrionics via press, blogs and tweets around the for and against advocacy campaigns concern me because its giving legit outreach and grassroots services a bad name.

No question about it, faux letters (we all know who and what we’re talking about), deceased petition signers, fraudulent letters to the editor: Unacceptable, with a capital U.

But allocating resources — or in layman’s terms, “picking up the tab” — to identify, educate and mobilize citizens to demonstrate real people power behind an issue (yes, predominantly to help your cause): Acceptable. And Universal.

Universal, as in environmental groups, unions, faith-based institutions, corporations, not-for-profits, cause-driven groups, and on and on. They all do it and they all know how to do it well. This is why I chuckle at gotcha claims of “mirror, mirror on the wall” moral superiority in efforts to fight it out over the energy bill. As if members of the support coalition behind the bill never pulled out the credit card at a rally, public forum or BBQ that was meant to send concerned citizens into the offices of elected representatives, or as if opponents aren’t communicating and pushing employees to get involved in the process. They all have budgets for these activities.

Although each actor in the political theater we call government makes their own decision about the extent to which they will go to utilize the grassroots for their interest, it’s a common practice — and not necessarily a bad one. For us in the grassroots biz, we are constantly pressured to perform more competitively, but also more credibly. If you are a reputation-based professional service firm like Saint Consulting, one false move could ruin 25 years of building a business. As a management consulting firm, we’re also guided by our membership in the Association of Management Consulting Firms and the ethical guidelines it has incorporated into its charter. We also now incorporate many quality assurance mechanisms (i.e. video petitions) into our grassroots campaigns on land use projects.

In our 25 years-plus of experience, we have found that many of the “silent majority” citizens from towns and cities across America become more active members of their community on all issues after participating in a land use political campaign first hand. Some go on to run for local office after they’ve come to understand the power of civic engagement and its impact on local decisions. Without that nudge into the process, some may still choose to catch their favorite TV show on a Wednesday night rather than attend the latest round of local budget hearings in the municipality they live in.

Like all politics, grassroots organizing can be made to appear less than savory. However, I can think of no issue, movement, or major political debate that hasn’t benefitted by more voters being pushed into the debate. Free lunch, or not.

It’s not just the climate change debate that is spawning histrionics about astroturf politics. Ryan Sager has an excellent analysis of  allegations of ‘astroturfing’ in the fight over President Obama’s health care reform plan in Wednesday’s New York Times — link.

“Organizing isn’t cheating,” Sager correctly concludes. “Doing everything in your power to get your people to show up is basic politics. If they believe what they’re saying, no matter who helped organize them, they’re citizens and activists.”

Ben Kelahan is senior vice president for energy for The Saint Consulting Group, email kelahan@tscg.biz, phone 703 531-8274

LOL.  Sorry.  I’m laughing because the inevitable has occurred.  Opponents of the wind energy industry are now comparing them to the tobacco industry. Cathy Taibbi writes in Wildlife Conservation Examiner.com an account of birds, bats and animals “massacred” by wind farm turbines.  If only all who toiled for tobacco got a referral fee every time a “Big Industry” anti used it as an evil analogy to benchmark companies seeking to make a profit and secure policy support from government.  It’s enough that most of their conversations can’t end without a solicitation to critique Thank You for Smoking (great movie by the way). 

As a non-partisan in the energy production and distribution debate, our firm is a service provider to all energy interests (wait a minute..does that make us part of the do-it-all “kitchen sink” policy crowd?).  But I think the comparison to the tobacco industry is weak.  However, there seems to be a coordinated push recently via media, blogs and the like claiming that wind power progress is simply a shining example of bad politics over good policy and resorting to the old power of influence criticism.

Besides the fact that affiliates of the American Lung Association are in favor of wind (see last week’s post on this), here’s the difference in my view: wind energy is benefitting less by high-powered lobbyists (well, maybe a few) than serendipitous high times for renewables.

One of my favorite sayings is “life is timing,” and in many ways I feel that wind has impeccable timing.  You might say they have the timing trifecta – public attitudes and awareness about climate change, Oval Office and Capital Hill support, and a tangible “think global and act local” grassroots constituency that’s hit its stride.  The unfortunate irony for the anti-wind folks is that the wind industry is not “green” politically and they know it. 

There are similarities between the anti’s strategy and that taken by anti-smoking advocates years back, however.  They faced a brick wall at wholesale anti-tobacco legislation at the federal level.  State level too.  So they took their experts on the road to every city and town they could find in an attempt to write anti-tobacco local ordinances against the industry.  It’s a death by a thousand cuts strategy, but that would be a bad comparison here (whoops, too late).  And now we see Nina Pierpont, Jon Boone and others submitting official testimony opposing wind farms across the country to local elected officials that make land use siting decisions and organizing residents to oppose them at public hearings.  In many cases, the ire of anti-wind NIMBYs and special interests is based on suggested local impacts to wildlife and residential health and welfare. Take a  look at this Indianapolis Star story by Jeff Swiatek for example: http://bit.ly/kPs55

Let’s see how the anti’s strategy plays out.  I’d be remiss to point out, after the advent of federal FDA regulation of tobacco, that with time the tables do turn.  That brings us to opposition delay tactics.  But that’s for another post.

Ben Kelahan is senior vice president for energy for The Saint Consulting Group, email kelahan@tscg.biz, phone 703 531-8274

Much has been written, spoken and ruminated lately on the implosion of the US commercial property market. More specifically, many retail and commercial developers are just hoping to keep their heads above water until 2010 when, they hope, the US has pulled out of recession, and consumers are buying towels, video games and other consumer goods.

If there is a bright light of the property development industry right now, health care may be one of the leading contenders for the crown. The combination of an aging baby boom population, continued growth in outpatient specialty surgeries like hip replacements and knee/shoulder arthroscopy and growing need for cardiology services like angioplasty, are still fueling the development of medical office buildings and hospital expansions.

At the recent Interface Medical Office conference in Chicago, speakers gathered to discuss the current state of the industry and how best to navigate the increasingly difficult credit markets to ensure capital is available to developers.

Certainly the past 12 months have been a rough time for developers of medical office and hospital projects to acquire permanent financing for their projects. In a prior post, I detailed hospital projects that have been shelved or postponed on account of dwindling or disappearing capital.

Many medical-related projects today are acquiring their funding from pension funds, life insurance companies, community banks (many of which are not saddled with sub-prime mortgages) and patient private equity investors. One panel of debt and equity investors signaled that the credit risk of a project — when or if it will get built — is a prime consideration for financing in these times.

Still, there are some bright lights in this industry. As noted, the appetite for outpatient surgery remains high. For many hospitals and doctors networks, these procedures provide high margins that offset the dwindling state and federal Medicare and Medicaid reimbursements. Additionally, medical office projects seem to encounter less public opposition from local communities, further enhancing their attractiveness as a viable development opportunity.

The Saint Report wants to hear from medical office and hospital developers — what has been your recent experience with getting local approvals?

Tom Ahern is senior vice president for capital markets and health care, The Saint Consulting Group, email: ahern@tscg.biz phone 781 836-4343

Senior Vice President, The Saint Consulting Group

The global economic slowdown, exacerbated by tight credit markets, flat retail sales and rising unemployment in the United States, has moved beyond commercial real estate to claim its first victims in the healthcare sector.

New hospitals, medical office buildings and outpatient surgery centers, which only months ago were slated for starts in 2009, have been shelved indefinitely as money woes cause hospital administrators and foundations to rethink their spending plans. The result for these decisions is a slowdown in one of the last development sectors in the US and an uncertain future for the healthcare industry.

The evaporating margins at both non-profit and for-profit hospitals in the US has also caught the attention of bond rating agencies, which have been lowering the outlook on debt issued by both large and small hospitals. The lower ratings have increased the cost of borrowing at a time when credit is already scarce. A November 2008 survey of over 700 hospitals by the American Hospital Association found that 58% of hospitals in the US were planning to delay or cancel new development projects and 45% were considering canceling equipment purchases.

One notable example of the global credit and economic crisis touching the healthcare world includes Penn State Hershey Medical Center, which announced in December that it was delaying construction of its planned, $235 million Children’s Hospital project. Hospital officials cited the global economic slowdown as a driving force in its decision to put off the January groundbreaking. The Detroit Medical Center also recently announced the delay of their own much-needed renovation and expansion project.

The slowdown in healthcare projects has also been accelerated by investors’ concerns about the financial viability of these developments. Medicare reimbursements from the states are facing cuts, rising unemployment has led to more Medicaid and charity care cases, and profit margins at leading hospitals have been adversely affected. Add to that the losses faced by many charitable foundations through investments in the equity markets, and our nation’s healthcare development prospects have slowed to a crawl.

At a recent Real Share conference focusing on the development of medical office buildings, experts from healthcare, development and the financial markets seemed to agree on one thing- the combination of a prolonged economic slowdown, scarcity of debt and financing opportunities and lower earnings and profits has created a trifecta of heartburn for those responsible for building the nation’s advanced healthcare facilities.

For related news, see the Business Journal of Greater Milwaukee’s story by Corrinne Hess and the BBC’s report on credit warning for hospitals in Britain.

What about you? Have you seen evidence of a slowdown in the medical facilities sector?

Tom Ahern is senior vice president for health care and equities, email ahern@tscg.biz or call 781 749 7290 ext 7144.

Megan Myers reports in the Argus Leader that high-stakes competition between health care providers — Sanford Health wants to build a $50 million hospital in Aberdeen, a proposal contested by Avera Health — has reopened a debate over the need or lack of local and federal regulations to rein in expansion plans.

Saint Consulting division manager Darden Copeland, who is based in Nashville, spotted this story and comments: The absence of a CON in various states leads to more competition being waged at the local land-use and planning stages. For hospitals, they set up “health planning” agencies, similar to a planning commission, and this story details the competition among hospitals in the non-CON state of South Dakota.