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Nonprofit The City Of Hope In Talks To Acquire Cancer Treatment Centers Of America For $390M

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California-based The City of Hope just announced that it is in talks to pay $390 million to acquire Boca Raton-based Cancer Treatment Centers of America, a network of oncology hospitals and outpatient care centers.

The deal is expected to close in early 2022, subject to regulatory approval. After close, City of Hope officials plan to convert CTCA to a nonprofit organization.

Combined, City of Hope and CTCA have 11,000 “team members,” which includes collaborating physicians across California, Arizona, Illinois and Georgia.

“City of Hope’s acquisition of CTCA and the transition of CTCA to nonprofit status should enhance and expand its battle against cancer,” said John Balitis, chairman of the Labor & Employment Department at Jennings, Strouss & Salmon PLC law firm in Phoenix. “Unlike a for-profit business that maximizes revenue for distribution to owners, a nonprofit entity recycles what otherwise would be profit back into the entity to further the entity’s mission and purpose. Tax concessions for nonprofits also free up funds for use in pursuing goals and objectives that otherwise would be unavailable in a for-profit setting. Such a change for an organization like CTCA is positive when you consider how vital research and clinical trials are in the cancer treatment industry. In Arizona, where CTCA has four locations, we might expect an expansion in programs as well as facilities as more funds become accessible to further the organization’s goals rather than to be paid out as dividends.”

Reduce Operating Costs

The combination of City of Hope and CTCA also can provide the combined organization with the economies of scale that reduce operating costs and provide the opportunity to reinvest those dollars into research, technology and other modes of life-saving innovations that can benefit patients, said Joan Koerber-Walker, president & CEO of the Arizona Bioindustry Association.

“With missions that are closely aligned and that put the needs of cancer patients first, this looks to be an excellent opportunity to improve the lives of cancer patients and the people who care about them,” Koerber-Walker said.

Joseph Lupica, chairman of Newpoint Healthcare Advisors LLC, said City of Hope has had a sterling reputation as an outstanding provider in a high acuity setting.

“With today’s emphasis on value-based care, however, if a single-specialty hospitals has a high cost of care to go with all that excellence, they can quickly find themselves on the wrong side of history,” Lupica, a Fellow of the American College of Healthcare Executives, said. “Patients and payers demand value, which considers both quality and cost. This is especially in a market where UCLA, USC and Cedars-Sinai Medical Center all have extremely well-regarded cancer programs, but have a broader base of services.”

The last time Lupica studied that market, he found that City of Hope’s publicly-reported cost per day was almost 40% higher than other hospitals in the San Gabriel Valley, even after adjusting for case mix acuity.

“With this acquisition, maybe City of Hope has found a business proposition that will improve their value equation — quality and cost — by diversifying their base and learning from an efficient company,” Lupica said. “And they can do it without moving away from their core clinical competency.

 

Source: SFBJ

The Pandemic Has Made Healthcare More Desirable

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“The pandemic increased demand and made healthcare a more desirable asset class,” Rahul Chhajed, VP and senior director of healthcare at Matthews Real Estate Investment Services, tells GlobeSt.com about how the asset class fared during the pandemic.

For one, medical properties moved onto the list of darling asset classes, and it isn’t hard to understand why.

“It is no longer just a recession that investors are worried about. If there is another pandemic, healthcare services are something that people are always going to need. At the end of the day, everyone needs medical care,” says Chhajed.

With the exception of a temporary pause in the market at the beginning of the pandemic, when elective surgeries and other healthcare services were paused to allow healthcare providers to focus on COVID-19, healthcare properties outperformed other asset classes. Chhajed notes that many tenants didn’t need rent relief and continued to pay rent.

This year, investors have been trading out of more challenged asset classes, like retail and office, in favor of medial facilities.

“COVID really provided a proof of concept for the industry to show that this product type is here to stay. It is not only institutional, but it is an asset class that private capital should look at as well,” says Michael Moreno, VP and senior director of healthcare at Matthews Real Estate Investment Services.

Institutional capital has been the dominant player in the healthcare sector, and that is because it can be a more complicated asset class. Now, both institutional capital and private investors are competing for deals.

“More institutions have definitely entered the ring, but we are also seeing the private markets have started to buy these deals,” says Moreno.

And, there is a third player: owner-occupiers. Existing owners are looking at the demand—which has driven cap rates down significantly—and deciding to sell.

“The sale-leaseback market is really picking up, and a lot of that has to do with pricing,” says Moreno.

Over the last few years there has been significant cap rate compression, and owners would rather take the proceeds and put it back into the business and grow.

“Private buyers love those deals because they typically contain long-term leases and they are triple net,”  Moreno says.

On the lease side, retail owners are finding new users in healthcare. Many clinics and ambulatory centers are signing leases in retail facilities as part of the trend from in-patient care to out-patient care.

“Retail-centric healthcare is great for providers because the care is coming to the consumer,” says Chhajed. “A lot of these healthcare systems are looking for ways to provide ease of access, and retail centers meet those needs to make healthcare more accessible. The confluence of these trends is creating a heyday for medical assets after the pandemic. Now healthcare is looking stronger than ever.”

 

Source: GlobeSt.

Unprecedented Growth Projected In Outpatient Care In The Next 10 Years

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The U.S. population is projected to grow by 22.5 million people, or just shy of 7%, between 2020 and 2030.

Remarkably, three-quarters of the population growth, or 17 million people, is in the 65 years or older cohort. Nearly 4 of 5 healthcare expenditure dollars is spent by this older group. With the aging population increasing from 17% of the U.S. population in 2020 to 21% of the U.S. population in 2030, medical encounters will be on a rapid rise.

Forecasted growth in patient care volumes between 2020 and 2030, however, show divergent trends between inpatient and outpatient utilization. Inpatient admissions are expected to decline in absolute number from 34.9 million stays to 34.6 stays, or a drop of 0.9% in this 10-year period.

Outpatient care stands in sharp contrast with estimated growth of more than 20%, representing an added 540 million annual outpatient visits over the 10 year period. In 2030, outpatient encounters are expected to top more than 3.2 billion serving the expected U.S. population of 355 million individuals in 2030, or 9 visits per individual a year.

The trend towards outpatient care and away from hospital stays is a decades-long shift. Today, more than 50% of health system revenue comes from outpatient visits, a radical change from hospital-centric care to patient-centric care. In the past 20 years, inpatient admissions per 1,000 population dropped from 120 to 103, a reduction of 14%. During the same time, outpatient visits per capita grew 26%.

Advances in technology and medicine have enabled care to grow and thrive outside the acute care facility, a trend that has been accompanied by better healthcare outcomes, lower mortality and greater patient safety. Outpatient care has fueled the growth of medical office buildings, both on campus and in the community, supporting the shift to the “patient-centric” mode of healthcare delivery.

The pandemic in 2020 and 2021 put a spotlight on the jeopardy with delivery of U.S. outpatient care in an acute care setting. Thus, the healthcare crisis accelerated the trends in increased care in locations such as urgent care centers, ambulatory surgery centers and other outpatient medical buildings. At the same time, telehealth exploded in use during the pandemic given the obstacles to safe visits at the height of the crisis. Telehealth visits grew from 1% of outpatient encounters pre-pandemic to 12.5% at the peak in April 2020 to 6% today with widely varying utilization by medical specialties.

The aging and growing U.S. population and the overarching trend towards outpatient care is strongly supportive of increased demand for healthcare real estate and for the growing clinical intensity and value of medical office buildings of the future. Quality buildings occupied by major healthcare providers serving patients with greater and more acute services means durable, long-term occupancy with growth in revenue that can support the operating costs associated with occupancy. Medical real estate is expected to grow and perform in the same resilient manner in the future which will be positive for the owners of the properties.

Recent Activity – New Listing – Investment Sale

Central Illinois MOB Portfolio – 321,355 s.f. – Decatur and Peoria, IL
Closed – Debt Placement

Hoag Health Center – MOBs & Urgent Care – 159,235 s.f. – Irvine, CA
Closed – Debt Placement

114 Pacifica Court – 110,392 s.f. – Irvine, CA
Closed – Investment Sale

Brookfield Commons – 91,186 s.f. – Richmond, VA
Closed – Investment Sale

Omega Medical Center – 77,511 s.f. – Rockville, MD
Closed – Equity Placement

Thomas Park Investments – 55,608 s.f. – Haverhill, MA
Closed – Debt Placement

Oakwood Medical Park – 36,419 s.f. – Round Rock, TX
Closed – Investment Sale

Fertility Centers of Illinois – 30,264 s.f. – Glenview, IL

 

Source: HREI