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Kaufman Hall Selected Financial Advisor To Securing Debt Financing Of Nine Building MOB Portfolio Located In Florida And Georgia

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Kaufman Hall & Associates, LLC (“Kaufman Hall”) was selected as the exclusive financial advisor to AW Property Co. (“AW”) related to securing debt financing for the acquisition of a nine-building, 348,416 square foot medical office portfolio located in Georgia (“Georgia Portfolio”) and a previously acquired two-building, 33,154 square foot medical office asset unencumbered by debt located in Florida (“Florida Asset”).

The eleven on- and off-campus medical office buildings spanning 381,570 square feet are a mix of core, core-plus, and value-add assets.  Much of the Georgia Portfolio is affiliated with a dominant, physician-owned, multi-specialty clinic in the region. AW acquired the Georgia Portfolio on an off-market basis through an existing relationship.

Kaufman Hall’s Role

On behalf of AW, Kaufman Hall undertook a competitive process to secure debt financing for the Georgia Portfolio and the Florida Asset.  Kaufman Hall approached a diverse pool of debt providers that had prior medical office building experience or were seeking entry into the sector.  Based on Kaufman Hall’s efforts, AW’s track record, and the quality of the opportunity, attractive proposals were received from debt providers, despite a challenging capital markets environment. Ultimately, AW selected a well-established national commercial bank as the lender.

About the Companies Involved

Kaufman Hall

For more than 30 years, Kaufman Hall has provided independent, objective insights to assist clients in fulfilling their missions, achieving their goals, and tackling their toughest problems. Kaufman Hall’s real estate practice provides transaction advisory services to many of the nation’s top healthcare providers and developers/investors of healthcare real estate. Kaufman Hall’s focused model provides clients with an unmatched level of relevant experience & independent transaction analysis, structuring and execution capabilities. Kaufman Hall’s real estate practice was launched in 2021 through the acquisition of Healthcare Real Estate Capital (HRE Capital). Providing both consultative and transaction-oriented services, including asset/portfolio joint venture structuring, recapitalizations, dispositions and other related real estate advisory services, the real estate practice has been involved with more than $15 billion of sector-specific real estate transactions across the United States since 2008.

AW Property Co.

AW is a real estate investment and operating company that specializes in medical office buildings in major markets throughout the Southeast United States.  Since 2005, AW has sponsored healthcare real estate investments with an aggregate market value of $800 million, constituting 3.3 million square feet of rentable space in fourteen distinct submarkets.  Headquartered in in North Palm Beach with regional offices throughout the Southeast, AW has a highly dedicated, customer-focused team of professionals with expertise in all facets of real estate acquisitions, redevelopment, finance, operations and asset management.

 

Source: HREI

Healthcare Is Entering A New Era Of Medical Office Development

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Meridian CEO John Pollock uses three words to describe the biggest trend in healthcare real estate at the moment: outpatient, outpatient, outpatient.

“As healthcare enters a new era, companies providing more outpatient services are on an upswing,” Pollock said. “We are in an era of tremendous growth in outpatient services,” Pollock wrote in an email to Bisnow. “In fact, we are so sure that outpatient services is where the industry is headed that this sector is nearly our singular focus at Meridian. I believe that as healthcare systems provide more care in a lower acuity setting, they will be able to provide a better experience for patients and at a lower price.”

Healthcare is undergoing a tremendous transformation. Healthcare is adjusting, evolving and growing rapidly as baby boomers continue to retire, millennials and Generation Z mature, and technology continues to shape the healthcare space.

“Now more than ever, bigger players and more money — especially from institutional investors — are entering the industry, CBRE First Vice President Angie Weber said. “These large providers have really taken over and the independent physician has become a thing of the past,”

Weber and Pollock are speaking at Bisnow’s National Healthcare West event June 20. Because of the growing population and the fact that most everyone at one time or another gets sick, healthcare is seen as a safe and resilient investment.

“It’s very safe and strong,” Weber said. “But it’s very expensive. The cost of managing staff and patients, tenant improvements and construction are very high.”

Outpatient demand is driving the development of medical office buildings greater than 150K SF, according to a JLL report released in May.

“No area of growth in healthcare is higher than outpatient services,” Pollock said.

There are currently 44 medical office developments larger than 150K SF under construction in the U.S., according to the report. The projects, estimated at $5.3B worth of investment, total nearly 11M SF and represent 22% of all medical office projects underway, the report states. Of the 44 projects, five are 450K SF or more, one is in the 350K SF to 449K SF range, eight are 250K SF to 349K SF, nine are 200K SF to 349K SF and 21 developments are 150K SF to 199K SF.

“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 report states. “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.”

Weber said the outpatient trend is being driven by a combination of demands from patients and medical providers. Many people, especially millennials, don’t like visiting a hospital for treatment.   Medical providers also find that it costs more to do certain medical procedures in a hospital than an outpatient setting.

“Along with preventive care options, medical providers are opening more specialized healthcare facilities, such as those that offer treatment for depression or post traumatic stress disorder and behavioral and mental health facilities,” Weber said.  “We’re going to see more of that,” she said. “I think you’re going to see these outpatient clinics in all shapes and sizes.”

 

Source: Bisnow

Helping Kids Or Building Empires? Why Children’s Hospitals Are Popping Up In Dallas Suburbs

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When it comes to children’s health, can you have too much of a good thing?

That’s worth asking after two leading health systems announced they’re building big children’s facilities in Prosper, near the Dallas North Tollway and U.S. Highway 380. The two projects, about 35 miles north of downtown Dallas, are just 3 miles apart.

Cook Children’s of Fort Worth plans to build a hospital in Prosper, just 3 miles from an even larger project planned by Children’s Health of Dallas.  (PHOTO CREDIT: Cook Children’s Health)

Cook Children’s, whose flagship hospital is in downtown Fort Worth, unveiled plans for a hospital on April 25, hours after Children’s Health in Dallas announced plans for a new campus on 72 acres.

While the additions would greatly increase the offerings in specialized pediatric care, that’s just the half of it. About 8 miles to the south in Frisco, Texas Scottish Rite Hospital for Children opened in October. Not far away, there’s Children’s Medical Center Plano, which opened in 2008.

With the two latest expansions, there would be four children’s facilities within 8 miles of Frisco City Hall. For some context, the entire Dallas metro region had four children’s hospitals for years: Cook’s in Fort Worth and three in Dallas: Children’s, Scottish Rite and Medical City Children’s.

Will this new competition help reduce health care costs in North Texas, which are among the highest in the country? Or will it drive up spending because hospital companies must recoup their investments one way or another? And what does it say about the priorities of two respected nonprofits devoted to improving the health of kids?

Each system has billions in assets, hundreds of millions in cash and strong profit margins at its flagship hospitals. What they’re doing is following the money — and the families with good insurance coverage.

“The economics are driving this, not health care public policy,” said Britt Berrett, a former hospital administrator who teaches health care management at the University of Texas at Dallas.

The companies are also tracking population growth. From 2016 to 2018, Frisco added over 20,000 residents, a 14% increase, according to a report by Moody’s Investors Service. Frisco’s property tax collections, a reflection of the area’s rising wealth, grew 24% over the same period, far faster than in Dallas and Fort Worth.

But Frisco, Plano and the surrounding area have many hospitals already, including recent additions such as Baylor, Scott and White’s sports therapy center and Texas Health Frisco. Last year, Medical City Plano started a $107 million patient tower with 90 beds.

So what to think about putting four children’s facilities in such a concentrated area?

“We call it saturation,” said Berrett, a past president of Texas Health Presbyterian Hospital Dallas. “Beware the medical industrial complex.”

Executives at both Children’s Health and Cook Children’s were not available to talk about such issues, according to the companies’ spokeswomen.

“Unfortunately, schedules did not align to arrange an interview for your story,” wrote Children’s Health in an email. The company included a statement about “serving patients in the fast-growing area around Prosper and our mission to make life better for children.”

That’s a noble mission, to be sure, but it’s still fair to ask whether the new investment is more about protecting market share from Cook Children’s, which is clearly reaching beyond its usual customers. Neither company would disclose how much it plans to spend. Children’s Health wouldn’t even confirm it’s building another hospital on the site, although its rendering appears to have a big one.

Texas does not require a “certificate of need” to add hospitals or nursing home beds. It lets the market decide, which means booming, affluent areas get more attention and investment.

In an email, a Cook Children’s spokeswoman said the administrators “best fit to speak about this” were out of town. She requested questions in writing — and some answers were less than direct.

So are we building too many children’s facilities in the area?

“We see a growing and unmet need plus a lack of coordinated care for the children in this important service area, which Cook Children’s will accommodate through its expansion plans,” wrote Nancy Cychol, chief of hospital services.

Will there be enough demand to recruit specialists, such as pediatric heart surgeons, and to develop true centers of excellence?

“Cook Children’s is very thoughtful in evaluating all relevant market information to determine where to locate services and the scope of services offered,” Cychol wrote.

Children’s Health and Cook are nearly the same size. Both have over 7,500 employees, and reported over $1.7 billion in 2018 revenue and over $3 billion in assets, including gifts from donors.

One big difference: Children’s in Dallas had twice the share of Medicaid patients, whose payments for care tend to be much lower than customers with private health insurance.

Cook’s operating income was nearly $139 million last year, 63% higher than Children’s, according to the companies’ annual financial filings.

“Most children’s hospitals have great leverage with insurers because they almost always have to be included in  employers’ network of providers. They offer expensive specialized care that isn’t available elsewhere, and they can get a premium for primary care,” said industry analyst Allan Baumgarten. “The big buildup near Prosper raises several questions and the most important is: “Who’s gonna pay for this new capacity?” In states that require regulatory approval for new hospitals, some proposals were rejected with the support of employers that feared they would have to cover much of the bill.”

How would Cook’s respond if local players — worried about rising health prices — pushed back on its plan?

“We don’t believe employers or insurance companies would ever object to competition in the marketplace,”  wrote Cook’s Cychol, “especially if the competition drives better value, better quality and convenient, coordinated care.”

Presumably, that’s at any price.

 

Source: Dallas News