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Medical Office Building Investors Will Be Chasing Deals In 2020

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As we prepare to swing into the new year, the outlook for the medical office sector is good…largely.

Underpinning the market, as it always has, is the continual aging of the population and the increased medical services that come along with it.

But, despite this sure-bet demand, the sector is not without its challenges, as Al Pontius, SVP and national director of Marcus & Millichap’s Office and Industrial divisions, makes clear. Those concerns arise as a result of the massive industry trend toward consolidation and the move on the part of many formerly independent care providers to saddle up with national care brands.

The firm’s second-half Medical Office Buildings Report defines the growth of the merger movement:

“Hospital and health-system merger activity continues to transform the medical office sector, driving a reduction in physician-owned practices in recent years. In 2012, nearly half of locations were physician-owned practices, but in 2018, just 31 percent were owned by doctors.”

And therein lie the concerns for the existing stock of medical office buildings (MOB).

“There’s a lot of older-vintage product that’s not located where the health systems want to be,” says Pontius. “Some assets may not accommodate the desired configuration of services that the major health systems see as appropriate, modern enough or technologically supportive enough. Consequently, there are a number of buildings that will under-perform relative to newer properties in the sector as well as other asset classes.”

But while there might be assets that sit on the sidelines as healthcare needs grow, few investors, be they institutional or private, are doing the same.

“The consolidation has supported investor sentiment as major providers create efficiencies and broaden service coverage,” says the report. “A sizable pipeline of new space and major expansions by high-credit tenants will sustain elevated investment activity through the end of this year.”

 

Source: GlobeSt.

Growth In Outpatient Demand Drives A Surprising Number Of Buildings Greater Than 150,000 Sq. Ft.

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With the opening this month of the 10-story, 250,000 square foot MOB at the new Sutter Health CPMC campus in San Francisco, the market is heralding a new era of large format medical office development with building size over 150,000 square feet.

This new trend is a function of the well-recognized growth in outpatient care with its focus on the patient experience and physician convenience with critical services and specialties housed under one roof, with the added goal of accountable care in a lower cost setting. The timing couldn’t be better given the surge in capital seeking investment opportunities in healthcare given the quality of tenancy and durability of medical office properties.

There are currently 44 medical office development projects larger than 150,000 square feet under construction in the United States, a total of 10.9 million square feet, representing 22% of all medical office projects underway. In aggregate, the large format projects represent $5.3 billion of investment or $480 per square foot. Six developments alone are over 400,000 square feet and the ten largest projects have a total budget of $2.3 billion. JLL estimates that the mark-to-market valuation of these projects, once completed, is $7.8 billion.

The largest medical office development under construction and near completion is located on the Upper East Side in Manhattan – the 750,000 square foot, David H. Koch Center for Cancer Care. Interestingly, two of the top four largest medical office developments are located in New York City. Over forty percent of the active development projects larger than 150,000 square feet are located in the Northeast and Mid-Atlantic regions. The Southeast is the least active region with only one project under construction that’s larger than 150,000 square feet.

Providers dominate the ownership of the 44 projects. Only 10 buildings, representing approximately 20% of the square footage, are owned by third party investors. However, the surge in large format outpatient buildings and the staggering scale of capital required to support these developments is an encouraging sign for institutional real estate investors as the capital intensive business of healthcare is expected to eventually turn to real estate investors to augment health system access to bond markets and philanthropy.

 

Source: HREI

Capital Partnerships Are All The Rage In Healthcare Real Estate

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In the early days of the medical office building (MOB) sector, companies that had started to focus exclusively on developing, acquiring and managing such facilities often relied on a network of high net worth individuals, friends and family included, to invest in their projects.

In today’s growing, highly capitalized and sophisticated healthcare real estate (HRE) market, where capital often needs to be deployed quickly and at the lowest cost possible, that type of so-called “country club” capital stack can still work for certain firms and on certain projects.

However, a growing number of growth-oriented companies focused exclusively on HRE facilities, including MOBs, are turning to and aligning with large, deep-pocketed institutional capital partners and fund managers to invest in their developments and acquisitions.

A good example is Anchor Health Properties, a more than three-decades old HRE developer that, beginning with a new management team in 2015-16, embarked on a growth strategy based on expanding three verticals in order to offer wider array of services for its clients, including health systems: management, leasing and investments.

“These all play well off of each other and contribute to the growth of the other verticals,” said James Schmid, Anchor’s chief investment officer. “When we were starting to grow those three verticals, I would say we had modest means to build our platform, and so in order to do a large volume of transactions we knew we had to bring in institutional partners to be able to chase more investments and bring more flexibility, including being able to close quickly on deals, in order to work with best-in-class operators.”

Mr. Schmid, who helps run Anchor with CEO Ben Ochs, made his comments during a panel session at last week’s BOMA International Medical Office Building + Healthcare Real Estate Conference in Minneapolis. The panel, moderated by John Nero of Hammond Hanlon Camp (H2C), was titled: “Investor Strategies: Aligning with Capital Providers.”

He, as well as the other panelists, noted that large, institutional capital partners who want to own MOBs need to be willing to make investments that can start at prices in the $15 million range.

 

Source: HREI