Medical Office’s New Twist Is Flex Space

/in , /by

Medical office is beloved by commercial real estate investors, operators, and owners because tenants typically stay for years and have good revenue and credit, allowing rent increases over time.

The medical business never really slacks, and demand is constant. Just ask Amazon why it’s expanding efforts in broadening virtual and physical medical clinics.

According to Shawn Janus, national director of healthcare services in the U.S. at Colliers, there’s a new trend of medical coworking, like a cross between medical and flex office types.

“Medical coworking spaces are shared work environments designed specifically for healthcare professionals, including doctors, entrepreneurs, therapists, and researchers,” James wrote. “These spaces provide a flexible alternative to traditional clinical settings, enabling practitioners to rent office or clinical space on-demand, often equipped with state-of-the-art facilities and medical equipment.”

He mentions a number of companies — ShareMD Suites, Clinicube, and MedCoShare — that offer such space for medical practitioners. Optix, a software vendor for coworking spaces in general, mentions Lina and Wellshare,

The market factors that make the approach potentially attractive are the negatives that independent practitioners face. Starting a practice is expensive. So is expanding one into a new geographic area. There are the costs of equipment and buildout, nursing staff management, appointment and billing management, cleaning, maintenance, and the price of real estate in a desirable location with easy access to parking. If a coworking space is doing billing, it may already be credentialed with insurance companies, a process that could otherwise take months before being able to request payment.

Instead of one business having to underwrite the total cost, a medical coworking facility can amortize the expenses across multiple practitioners. Optix says that thet ype of practitioner who might find a medical coworking space useful includes family doctors and general practitioners, but also mental health therapists, acupuncturists, dieticians, and others. Clearly, the type of tenant a space looks to attract will affect the layout of the space and necessary equipment and facilities.

“Most medical coworking spaces have multiple rooms specifically designed to fit a wide variety of practitioner needs, including therapy rooms, medical rooms, and cosmetic rooms, all under one roof,” they write.

Practitioners get a number of benefits from the arrangement including  affordable space, networking and referral opportunities, more time with patients and less with operations and independence and flexibility.

There is a considerable amount of expense and operational effort necessary in running a medical coworking space, so the decision to invest in the property type is a significant one.

 

Source: GlobeSt.

Nashville-Based HCA Healthcare To Invest $5.3 Billion To Help Build Market Share

/in , /by

Nashville, Tenn.-based HCA Healthcare may be coy about giving guidance for 2024 but it has big plans for the next few years as it seeks to build its market share to 29% by 2030.

To help do that, the 183-hospital system is investing $5.3 billion in already approved projects. That figure came out of the company’s investor day Nov. 9.

Included in the $5.3 billion figure, HCA has 62 approved outpatient projects to build freestanding emergency centers and ASCs, totaling $1 billion, and has an additional 200 projects under consideration. HCA is aiming to grow its freestanding ER footprint by 36% over the next two years.

In addition to those investments, the for-profit system expects to drive growth through cost savings and improved benchmarking where facilities can share best practices to improve outcomes and reduce variable costs.

“All in all, management expects $600 million to $800 million of savings over the next five years,” Ben Hendrix, analyst at RBC, said in a research note. “Those savings can help HCA drive EBITDA growth toward the higher end of its targeted 4% to 6% over the next few years.”

HCA is also investing heavily to address labor shortages, building its Galen College of Nursing from five to 20 campuses, according to the research note. An additional 10 campuses are expected to open by 2026, increasing nursing enrollment from 13,000 to 29,000.

HCA, which reported operating income of $1.63 billion for the third quarter on revenue of $16.2 billion, expects its targeted EBITDA growth of the next few years will be met in 2024.

“While our planning process for 2024 is not complete, we currently believe that our 2024 expectations will fall within the targeted ranges above,” HCA CEO Sam Hazen said in a statement ahead of its investor day.

 

Source: Becker’s Hospital Review

Substance Use Disorder Treatment Facilities Attracting Investors

/in , , /by

With funding support from the federal government and the growing need for mental health facilities nationwide, this niche commercial real estate sector is evolving and emerging as a viable investment opportunity, including drawing the attention of REITs.

The Substance Abuse and Mental Health Services Administration noted in a 2021 survey that nearly 1 in 4 adults 18 and older, and 1 in 3 among adults aged 18 to 25, had a mental illness in the past year.

“The fastest growing sector in this asset class has primarily been the substance use disorder treatment facilities,” writes Justin Butler, leader of the Healthcare Valuation Practice Group for Colliers.

Most facilities that treat substance abuse disorder are not purpose-built, according to Butler, and many are adaptive reuses of nursing homes, assisted living facilities, hospitals, schools, large homes, and sometimes even apartments and office buildings.

 “The behavioral health industry is currently riding a hot wave in terms of funding from the federal government,” Doug King, Vice President and Healthcare Sector Lead at Project Management Advisors, tells GlobeSt.com. “While this could always turn around if the political winds shift, it’s great to see so many behavioral health and addiction centers opening in communities across the country right now.”

Unlike other medical facilities, which often require specialized technology and higher power needs, behavioral health clinics have about the same requirements as the average office, albeit with the addition of specialized anti-ligature devices and additional surveillance for patients of higher acuity, according to King.

“When looking to lease space for behavioral health centers, the ideal clinic should be located in a centralized place that’s easy to get to on public transportation,” King said. “Especially for behavioral health clinics that focus on addiction, it’s important to find a property with space for socialization, which can be essential for recovery. That’s why we see a lot of behavioral health clinics feature outdoor areas (as many patients are smokers), cafes, and even diners where patients can mingle with each other before and after treatment.They also need to be designed with mental health in mind — lots of natural light, comfortable seating and biophilia, and an array of private areas to accommodate different kinds of patients.”

When it comes to adaptive reuse, one area of opportunity for the CRE industry is the conversion of former retail properties in strip malls and downtown areas into behavioral health centers, King said.

“Not only are these spaces already sufficiently embedded into the community, but they also have enough space for clinics to expand and partner with other community organizations, such as medical nonprofits and housing programs,” said King.

Avison Young’s Brooks Hauf tells GlobeSt.com he has seen an increase in the demand for behavioral health services nationwide.

“The largest challenge for the sector is staffing related as the supply for talent is more specialized and not as deep as other labor sectors,” Hauf said. “With demand for behavioral health services expected to continue, staffing will remain very competitive and will drive decision-making on specific locations that have deeper talent pools.”

Butler said the costs for purpose-built facilities compared to adaptive reuse are considerable, and the increased cost often doesn’t provide comparable increased utility. However, there have been purpose-built facilities in operation.

Sale leaseback transactions generally see year-one yields in the 8% to 10% range, Butler said, but this can vary above and below that based on rent levels, tenant strength, quality of the real estate, and location. Rents are commonly in the $30 to $40 PSF NNN range, and many operators can afford rent at these levels, according to Butler.

“We would expect to see more purpose-built facilities, as well as larger operators with national networks and in-network insurance relationships,” Butler said. “There already have been some publicly traded healthcare and net lease REITs that have been purchased these facilities, “and we would expect that to continue.”

 

Source: GlobeSt.