Posts

As Medical Office Space Emerges From Pandemic Supply Will Be A Problem

/in , , /by

While medical office buildings sales volume declined in 2020, it was much less of a drop than the other commercial real estate sectors, according to a report from Colliers.

MOB investment decreased 12.2% year-over-year in 2020 to hit $11.1 billion, according to Colliers, while cap rates fell 20 basis points to 6.5%. By comparison, commercial real estate posted a 32% decline in sales volume overall.

Like many sectors, MOB saw an increase in activity in Q4. Sales volume rose from $2.1 billion in Q3 2020 to $3.6 billion. With 67% of total volume in 2020, private equity led the acquisition activity.

On a metro level, Los Angeles led in sales in 2020 at $812 million. It was followed by New York City at $644 million, the D.C. metro at $422 million and Chicago at $401 million.

The west paces in the country in MOB pricing at $374 per square foot. The Midwest and Northeast followed at $331 per square foot and $326 per square foot, respectively. For the Mid-Atlantic, Southwest, and Southeast, pricing ranged between $260 and $300 per square foot.

In Q4, cap rates were lowest in the Southeast at 5.9%. Next was the Southwest at 6.4%. The Northeast posted the highest MOB cap rates at 7.8%. On the best assets, Colliers says sub-6% cap rates were reported for multiple transactions. For instance, a MOB sold in Palm Beach last September 2020 at a quoted cap rate of only 3.9%.

“Cap rate stability reflects the continued desirability of healthcare as it became one of the most essential sectors in 2020,” Colliers said in the report. Investors view it as a relatively safe and durable investment even in times of economic uncertainty. Healthcare real estate continues to be firmly established as a separate asset class within the real estate sector.

As investors look to the asset class this year, they will find that supply is an issue in the medical office sector.

“Apart from new construction, the US MOB market has a relatively limited supply of investable inventory,” according to Colliers. “Healthcare systems and providers hold nearly two-thirds of all healthcare real estate.”

While 30 million new square feet of new medical office space will create upward pressure on vacancy rates in 2021, demand is still projected to outpace supply.

While there might be some conversion of other uses into medical office buildings to increase supply, these transitions are difficult.

“It’s really not that easy,” Pete Bulgarelli, president and CEO of Lillibridge Healthcare Services and executive vice president, office, Ventas, said on CBRE’s ‘The Weekly Take’ podcast.

Medical users have different demands.

“The ways that physicians deliver care and utilize their space is much different than traditional office,” says Christopher Bodnar, vice chairman and co-head of healthcare and life sciences capital markets, CBRE.

 

Source: GlobeSt.

Health System Financial Strength Fortifies Medical Office Acquisitions

/in , /by

Health systems are on track to buy $1 billion of their leased medical office buildings in 2020 between closed and announced transactions – a trend we’ve coined as “reverse monetization.”

Despite the pandemic-related operating losses sustained by hospitals in 2020, health system liquidity remains high due to CARES Act funding and abundant access to capital. In fact, 2020 will be the third year in the past five during which MOB buybacks will exceed $1 billion, representing nearly 10% of all MOB trades. Buybacks typically occur when hospitals take advantage of purchase options embedded in leases or exercise contractual rights of first refusal. However, certain buybacks are happening today with no contractual rights.

The popularity of MOB buybacks and ownership is fueled, in part, by the cash savings opportunity they create. During the pandemic, health systems are highly focused on reducing cash expense. MOB buybacks can eliminate rent payments and help cash occupancy costs. Health systems may also be able to avoid property taxes for qualifying properties – sometimes saving $3-4 per square foot. Even in the face of record high pricing for MOBs in 2020, health systems have been willing to pay top dollar – matching the most competitive real estate investors – in recognition of the significant bottom line advantage presented by buybacks.

Where does the money come from to pay for buybacks? Hospitals’ cash reserves were fortified by the CARES Act, which bridged the initial loss of patient volumes and revenue. Today, most providers report that they are back to 90-95% of pre-COVID volumes, if not more, thanks to the reinstatement of elective procedures. Though operating cash flow has been significantly impaired in 2020, days cash on hand was less affected due to other sources of liquidity and the strong performance of investment portfolios for the not-for-profit health systems.

Municipal bond issuance accelerated in 2020, increasing by 25%. Not-for-profit issuers enjoyed record low interest rates, which created cash interest savings for refunding bonds as well as new issuance. Thanks to nominal rates consistent with the direct cost of borrowing, many health systems have found structured finance products appealing to finance real estate, including credit tenant lease financing and synthetic leases.

The headiest days of monetization date to 2016, when a record $1.4 billion of MOB sales by health systems occurred. Cash generated by sales of outpatient buildings, whether on or off campus, was used to reinforce liquidity, provide access to capital for high growth systems, transfer capital responsibility for buildings to a third party and manage regulatory compliance with physician tenants.

Today, healthcare providers own 65% of MOB inventory nationally, down from 75% ten years ago, driven by the advent of new off campus outpatient clinics. Investor demand for medical office is at an all-time high, accelerated by the defensive qualities of the asset class and its proven durable performance. Investors can’t get enough MOB and now find themselves vying for investment alongside the tenants. Health systems face a happy decision – whether to buy or lease – with capital markets supporting them well, whichever choice they make.

You can more about extracting capital from healthcare real estate in JLL: A 360 View of Healthcare Real Estate Monetization. Plus, view Jll’s 2020 Healthcare Real Estate Outlook

Recent 2020 activity

  • Closed – Investment Sale – Midwest Medical Office Portfolio, 439,000 s.f. – Indiana, Illinois & Missouri
  • Closed – Investment Sale & Debt Placement – Greenpark II – 80,098 s.f. – Houston, TX
  • Closed – Investment Sale – M.D. Medical Tower – 68,285 s.f. – Midwest City, OK
  • Closed – Investment Sale – Lovelace Medical Center – 69,539 s.f. – Albuquerque, NM
  • Closed – Debt Placement – Peachtree Orthopedics – 60,578 s.f. – Cummings, GA
  • Closed – Debt Placement – San Juan Medical Center – 42,970 s.f. – San Juan Capistrano, CA
  • Closed – Debt Placement – Milwaukee Nobis – 20,383 s.f. – Milwaukee, WI

 

Source: HREI

40,000-SF Physician-Owned Medical Office Building Sells In Dallas-Fort Worth

/in /by

HREA | Healthcare Real Estate Advisors is pleased to announce the successful sale of a 40,000 SF Class “A” Physician-Owned Medical Office Building located in the greater Dallas/Fort Worth MSA.

The Class “A” medical office building was recently developed to consolidate multiple physician practice groups and ancillary services into one location. With 14 practice groups, the property provides patients with convenient access to a variety of specialties and services, including ENT, orthopedics, gastroenterology, pain medicine, family practice, and physical therapy.

HREA structured the transaction as a Hybrid Sale-Leaseback, which allowed the existing physician-owners to continue to own 24% of the building in a tax-deferred manner and achieve a valuation multiple of over 16 times. As a result, the physician-owners were able to get both liquidity in the form of distributions, as well as physician-ownership alignment between the practice (Opco) and the real estate (Propco).

 

Source: HREI