American Medical News
By — Posted Aug. 5, 2013
Constructing a new medical facility or hiring new employees might seem like a daunting and expensive undertaking for many physicians. But those tasks could become a little more feasible if they take advantage of the many federal, state and local incentives available to help developers, including physicians, substantially reduce taxes and slash their building, equipment and hiring costs.
In some cases, getting financial help can be as easy as filling out a form and building in the right location. Obtaining other financial incentives, such as tax abatements from local communities, can be complicated and time-consuming, often requiring a lawyer or other adviser to help wade through the political and bureaucratic waters.
The trick is to know where to look, whom to talk to and when to act. Some programs have specific deadlines. Others have limited funding.
“Incentives are only granted as long as there's money for them,” said Carol Kokinis-Graves, a senior state tax analyst in the Chicago area. “You don't want to go through the process only to discover the money's gone.”
There was a time when few doctors thought to ask for incentives, and not many incentives were offered as municipalities looked primarily to lure manufacturing and high-tech companies.
Some local and state medical associations hoped to change that and conducted studies showing the economic impact private medical practices have on an area. A 2008 study by the Medical Assn. of Georgia, delivered to the state Legislature, found that practices accounted for more than 180,000 jobs, $10 billion in wages and nearly $20 billion in economic activity in the state that year. In addition, each private-practice physician in Georgia supported 13 additional jobs, $640,000 in wages for those jobs and almost $1.5 million in total economic activity.
“As we put this study forth to legislators, we said, 'Yes, doctors make communities healthy,' ” said Donald Palmisano Jr., CEO of the medical association. “But in some rural areas, they're also the largest employer.”
The study was used mostly as a tool to bring about reform at the state legislative level. But thanks in part to such studies, governments are recognizing physicians' economic benefits.
In some instances, medical practices can get state and federal incentives just by locating in certain areas and hiring certain people. Financing options vary from state to state, and some states are more receptive than others. Check your state's economic development department website for a list of available incentives, forms to fill out, and phone numbers and contacts to call to get them.
The first place to go if you're thinking about building in Illinois is the state's Dept. of Commerce and Economic Opportunity, said Mark Huddle, a Chicago attorney specializing in municipal and state government matters. (There are equivalent government agencies in other states.)
“It has a whole staff that can put together an economic package for you,” he said. “How many jobs are at stake? The more at stake, the more incentives the state will provide.”
Huddle said the state will reimburse employers half the cost to train employees and will give some businesses low-interest loans. Other incentives are available if you're in a designated Enterprise Zone for distressed areas, which he said aren't necessarily undesirable areas.
Other tax incentives vary by state. For example, Alabama has tax-exempt bonds to build medical practices that typically provide reduced interest rates on financing costs, lower sales taxes on construction materials and marked-down property taxes over the life of a loan for a limited number of years, said Gerard Kassouf, a certified public accountant in Birmingham. However, these bonds are geared for medium or large practices with a $2 million to $3 million project cost because of the price of putting the bond issue together. Bonds are subject to funds being available and the project being approved.
California has a slew of financing options available to all types of businesses, including for hiring people in an enterprise zone, locating in a brownfield or environmentally challenged area, and installing a solar or thermal energy system.
Many states provide tax credits for hiring unemployed or disadvantaged individuals, or just hiring more people.
Hiring a veteran can produce federal incentives. Through the Dept. of Veterans Affairs' Special Employer Incentive Program, a veteran who is facing extraordinary obstacles to employment is placed in on-the-job training or a work experience with an employer. The department can reimburse the employer up to 50% of the veteran's salary for up to six months. The employer also is eligible for a federal tax credit for hiring a veteran who participated in a vocational rehabilitation program.
There are many programs for doctors who want to practice in rural areas. Huddle said medical offices are especially desired in rural communities, and the U.S. Dept. of Agriculture has a loan program and grants for developments in these areas. Several states and the federal government have loan forgiveness programs for physicians who practice in designated rural or underserved areas for a specified period.
Texas has several programs, including the Physician Education Loan Repayment Program. Physicians who agree to practice for four years in primary-care health professional shortage areas can receive up to $160,000 to repay medical school loans. The 2013 legislative session appropriated $33.8 million for 2014-15, an increase of more than 500% above the $5.7 million in the 2012-13 budget. The PELRP website features a factsheet and application for enrollment.
Dale Quinney, executive director of the Alabama Rural Health Assn., said physicians who practice in rural areas can get a $5,000 tax credit per year for five years. Medical board scholarships, which will pay off school loan debt for as many students as possible, are available through the state Legislature. Physicians need to spend six years in areas with populations up to 50,000 to complete their obligation, with less time in smaller, more rural areas.
Often, you won't have to venture farther than city hall to obtain an incentive package.
“We have to offer tax abatements,” said John Brezik, a councilman and plan commission president in Hobart, Ind. “It's the only way we can compete.”
Hobart recently offered a 10-year tax abatement, which features a graduated income tax scale over 10 years, to a physician who plans to build a $3 million multi-office facility that will be anchored by his expanding medical practice.
The physician first filled out a form with the city's Economic Development Dept., then went through the planning commission and city council for approval for both his plans and the abatement. The process took about a year.
Huddle said businesses in Will County, Ill., can get abatements of up to 50%, but they apply only to improvements made to the properties.
“Typically, they're just looking for improvements of any kind. They're happy you're investing money in their community,” he said.
Kansas physicians looking to build practices can apply for industrial revenue bonds in the city or county in which they're building, said Roger Hamm, deputy director of property valuation at the Kansas Dept. of Revenue. The bonds finance up to 100% of a practice's land, building and equipment and make the business eligible for a 100% property tax exemption for up to 10 years and a sales tax exemption for labor and materials purchased for the new facility.
Hamm said the bond is structured so either a city, county or the Kansas Development Finance Authority issues bonds to pay for a development. If the development is for a group of doctors, for instance, they would need to turn their building over to the entity that issued the bonds while they're getting the abatement. The lease rentals they pay to the entity are used to repay the bond with interest. The practice doesn't have to pay property taxes while paying back the bond. When the bond is paid off, the building reverts to the doctor group, he said.
“This program has been around for quite awhile,” Hamm said. “It's for any business, whether a doctor, dentist or manufacturer.”
In Kansas, the first step would be to go to the city council or county commissioners to see whether they would be interested in a practice coming to town, he said. Ultimately, the project would need to be approved by the Kansas Court of Tax Appeals.
In Park Forest, Ill., a physician received a 55% break on his total property tax bill — for every taxing body — for 10 years when he built a new medical office in the village's downtown. The village board would consider giving the same incentive to other doctors who build a new office or occupy a long-vacant building, provided they follow the necessary steps and meet certain criteria, said Hildy Kingma, director of economic development and planning for Park Forest.
She said the break can be renewed for another 10 years. “We look for projects that will have an economic benefit to the village either through increased sales taxes, more jobs or an increase in property values. Doctors' offices have high traffic; that's important to us, too,” she said.
After an application is presented, the Economic Development Advisory Group makes a recommendation based on whether a business is financially sound and whether there is a financial gap that needs to be filled when constructing a new building. The process takes two to three months.
Kingma said each applicant needs to show what the project will cost and the amount of money brought to the project. “We want to make sure they can afford to operate here once open,” she said.
Towns and counties can designate tax increment financing districts for underdeveloped or blighted areas, but these often are used for infrastructure improvements. Some areas also will provide incentives based on hiring.
For any incentive, the first step is always the same — asking what's available.
“You don't have to provide high-paying jobs, but there may be something in particular the city is looking for,” Huddle said.