One barrier to entry for local business, though, is a limited inventory of available commercial real estate, some say.

The town has taken some steps to alleviate this, Dean said. They recently asked the Zoning Commission to place a moratorium on new self-storage facilities, which take up large areas with limited parking that make the properties difficult to recycle for other uses in the future, she said.

Researchers are off base when they claim the rate Medicare pays hospitals and health systems for services is an appropriate benchmark for commercial insurance rates. This approach ignores limitations that nearly always result in underpayments and lets commercial health insurers off the hook for intentionally increasing costs and failing to pass on savings to consumers. It is misguided and wrongly paints hospitals as the source of all problems in the health care system.

Here are a few facts:

#1. Medicare reimbursement rates do not cover the actual cost of the care provided.

This is widely acknowledged and clearly backed up by the data. According to AHA survey data, Medicare paid 84 cents for every dollar spent by hospitals caring for Medicare patients in 2020.¹ This resulted in $75.6 billion in underpayments for Medicare services in 2020. Even the Medicare Payment Advisory Commission (MedPAC) recognizes that Medicare underpays.² For example, MedPAC found that in 2020, hospitals and health systems experienced a -8.5% margin on Medicare services in 2020. MedPAC projects that this margin will fall to -9% in 2022, and it declined even further when excluding COVID relief funds.³ Put simply, Medicare rates are set too low to serve as a reasonable benchmark for commercial plans. Holding them up as an appropriate benchmark for commercial rates threatens access to care and puts more hospitals at risk of closure.

#2. Medicare rates are slow to respond to inflation, supply shortages and increases costs for staff.

Medicare payment rates are established in rulemaking. Once finalized, they are in place for a year before they can be updated. Due to data lags, payment rate changes are typically made based on older data.⁴ For example, Medicare rates for fiscal year 2022 were not adjusted for recent increases in inflation, supply costs, and growth in labor costs due to shortages, which has added significant financial pressure for hospitals. In fact, given the arcane nature of Medicare rate setting, CMS’ recently proposed inpatient payments for 2023 would be lower than inpatient payments made in 2022. This is nonsensical given rising inflation and a continued a public health emergency.

#3. Medicare rates are subject to political pressure

As policymakers attempt to balance the federal budget, they frequently rely on steep Medicare rate reductions to make up for budget shortfalls elsewhere. For example, the Budget Control Act of 2011 imposed, among other things, mandatory across-the-board reductions in certain types of federal spending, known as sequestration. The result is an automatic and arbitrary cut to all Medicare payments. Benchmarking commercial claims to Medicare payment rates mean these arbitrary rate cuts would have far-reaching ripple effects for care provided to all patients.

#4. Chronic underpayments threaten the communities hospitals serve.

One-third of hospitals already operate in the red, and the COVID-19 pandemic has only worsened the financial pressures that hospitals face. In 2020, a record number of rural hospitals closed in a single year. Arbitrarily reducing commercial rates will only exacerbate this financial pressure. Ultimately, it will make it that much harder financially for hospitals serving rural and historically underserved communities to keep their doors open or continue providing the same breadth of services.

Conclusion

Hospitals and health systems need to be able to invest in programs that improve care and support the communities they serve. Policymakers should be strengthening payment rates from Medicare, not holding them up as the gold standard. Arbitrary rate cuts that fail to address underlying cost pressures would only hinder hospital and health systems’ ability to serve their communities and be prepared for the next public health emergency.

Benjamin Finder is AHA’s director of policy research and analysis.

1. https://www.aha.org/fact-sheets/2020-01-07-fact-sheet-underpayment-medicare-and-medicaid
2. https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/mar21_medpac_report_to_the_congress_sec.pdf
3. https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/mar21_medpac_report_to_the_congress_sec.pdf
4. https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2022/03/29/what-does-economy-wide-inflation-mean-for-the-prices-of-health-care-services-and-vice-versa/

With companies rethinking both how and where they work, being a commercial real estate broker today means playing the role of therapist as much as leasing expert. Experienced agents Brian Woolsey and Ben Jensen saw an opportunity to create a new sort of commercial real estate firm—one that prioritizes psychographics over square footage. In late 2020, they left Cushman Wakefield to launch the boutique firm Monarch. 

Engaging with Monarch begins by taking a proprietary online survey the duo named the “Belonging Barometer” or B2 for short. Designed to help clients think about work holistically before choosing a space, the B2 assesses a company’s predictable growth, work styles, and technology. The survey factors in average employee attitudes about office work and company culture to make suggestions such as prioritizing access to fitness and evaluating your carbon footprint—which Woolsey and Jensen say is fast becoming an imperative to recruit and retain good talent.

“It’s never been more critical that the office be a magnet, not a mandate,” Woolsey says. “The Belonging Barometer allows us to have a conversation about things that are not as obvious. There’s so much more that goes into creating a successful work environment than square footage and terms.” 

Minneapolis-based Monarch’s process persuaded advertising agency Griffin Archer to move from the North Loop to Linden Hills, walking distance to cafes, shops, and salons.

 “Since everyone is so used to working at home, we got used to some of those conveniences,” says Ryan Boekelheide, vice president and director of account service. “It’s nice to have those comforts near the office so it’s a place people want to come.”

For education-technology company Arux Software, the Belonging Barometer narrowed the search for a larger space, says Derek Buschow, vice president of growth and strategy. “Monarch considered everything from how close people want to sit to each other to hangout space, a lounge area, and a cafeteria.” Now settled at the 15 Building in downtown Minneapolis, 75% of its 25-person team comes in regularly.

Insights From Monarch’s Belonging Barometer

Amenities aren’t an option. The younger your employee base, the more amenities, like a coffee bar or fitness center, are expected.

Prioritize community. Team building is an important aspect of the office, so consider locations with access to restaurants, bars, and even volunteer opportunities.

Read more from this issue

Environment counts. People spend longer in spaces that make them happy and energized. Plants increase oxygen levels in the air, and access to natural light is shown to improve mood and reduce eyestrain and headaches. 

Food for thought. Data shows that providing employees with food is a big bang for the buck; particularly as employees return to the office, gathering for food and drink will become a key part of office culture. Healthy choices help to control energy flow. 

HELSINKI — A southern city hosting China’s newest, transformative spaceport is pushing to become a hub for commercial and international space activity.

Wenchang International Aerospace City will accelerate efforts to establish a commercial launch site and rocket assembly plants, according to ThePaper.

The efforts aim to put in place infrastructure to allow regular commercial launches by 2024. The Wenchang International Aerospace City project, established in 2020, will consist of three areas, focusing on launch, commerce and industry, and tourism. 

The commercial area seeks to attract space startups and will include rocket and satellite assembly and testing plants and satellite data application centers.

Institutes belonging to China’s main space contractor, CASC, the Chinese Academy of Sciences (CAS) and other state-entities, as well as commercial launch companies iSpace and Deep Blue Aerospace, have signed contracts to establish a presence in the city.

The city, on the island province of Hainan in the South China Sea, already hosts the Wenchang Satellite Launch Center. The coastal spaceport was constructed specifically for launches of large, new-generation launch vehicles to allow China to undertake major space projects. 

Rockets are delivered to Wenchang by sea from Tianjin, north China, circumventing railway networks used to transport smaller launch vehicles to inland launch sites.

Since opening in 2014 Wenchang has hosted 16 launches, including a space station module and cargo missions, a lunar sample return, and the country’s first interplanetary expedition, Tianwen-1. 

Wenchang also facilitates launches of the Long March 8 rocket for commercial rideshares, and the Long March 7A. The new launchers could replace aging, toxic hypergolic Long March rockets which drop spent stages over land.

New, dedicated launch towers for the Long March 8 could be constructed to allow greater launch cadence, according to the rocket maker, China Academy of Launch Vehicle Technology.

Wenchang, which is also part of the Hainan Free Trade Port scheme, hosted China’s seventh national “space day” on April 24. During the event Wu Yanhua, deputy director of the China National Space Administration (CNSA), inaugurated an international cooperation center for satellite data and applications, and a data and application center for the BRICS remote sensing satellite constellation.

Chinese precedent and general secretary of the Communist Party of China Xi Jinping visited Wenchang Satellite Launch Center April 12, calling for the site to become a world class spaceport.

“I hope you will vigorously carry forward the spirit of ‘Two Bombs and One Satellite’ and the spirit of manned space program, eye the frontier of global space development to meet the major strategic needs of China’s space industry,” Xi said.

Wenchang is currently preparing a Long March 7 rocket to launch the Tianzhou-4 cargo spacecraft. The mission, expected to launch in early May, would be the first of six launches in 2022 to complete the construction phase of China’s Tiangong space station.

The moves in Wenchang reflect an explosion in Chinese launch plans and space activities. China launched 55 times in 2021, with more than 60 planned this year, including commercial actors. In comparison China made 19 orbital launch attempts in 2015. 

China is also developing sea launch capabilities with facilities at Haiyang in the eastern province of Shandong, a new commercial launch site in Ningbo, and new launch complexes at the national Jiuquan Satellite Launch Center.