Healthcare real estate has been changing and evolving according to payment reimbursement changes and increasing demand for medical office space due to growing patient populations since the passage of the Affordable Care Act and the entry of baby boomers to the Medicare population.
Cushman & Wakefield Senior Director in San Diego Travis Ives asked panelists at Bisnow’s San Diego Healthcare and Life Science Summit how increased demand for healthcare services and disruptive technology are impacting healthcare real estate. He said over the past six to eight years, the healthcare sector has enjoyed increasing absorption and declining vacancy.
“There’s more demand space, but type of space is the focus,” said Scott Mackey, a principal at local design and engineering firm Lionakis.
The ACA was intended to create value, so it allows patients to make informed decisions about where they want to receive care based on preferences like location, convenience, facility efficiency and timing, he said. So delivery of care became more patient-focused, with providers placing medical office buildings and clinics in neighborhoods close to the patients they serve.
Providers are motivated by cost containment, Mackey said. So when construction costs shot up, they began looking for ways to deliver care more cost-effectively. Providers began putting healthcare facilities in all types of spaces people frequent or congregate, beginning by backfilling retail space vacated by brick-and-mortar retailers as e-commerce gained market share and in grocery stores and big-box retail stores like Walmart.
Healthcare providers are beginning to take advantage of the drive to add outdoor spaces and other amenities in the workplace, according to Swinerton Project Executive Elizabeth Hawkins.
“Healthcare is sidling-up next to that,” she said, noting providers are adding on-site outpatient services as workplace amenities.
Mackey cited Scripps Health’s new clinic on Qualcomm’s office campus as an example, and said Hoag Health recently opened a clinic at a 24-Hour Fitness center, which also provides the flexibility to offer other programs like weight loss.
Mackey said in building out spaces, providers are looking for value and are moving to modular wall systems that provide the flexibility to change the use quickly and cost effectively. He said even complex uses like surgery centers and imaging facilities are moving in this direction and cited a mobile surgery suite created by Cedars Sinai for battlefield use. Mackey said this prototype could be adapted to civilian use and is the ultimate in flexibility, because it can easily be moved to different locations as needed.
Nationally there is a trend toward the merger of healthcare systems. Mackey said doctors once wanted to own their own buildings, but now work for health systems, which are buying out physician groups and other independent providers. As a result, big hospital systems own the majority of healthcare real estate and control delivery of care in their markets, which is impacting the build environment and providing them leverage for negotiating reimbursement deals with insurers.
Hawkins said San Diego is unique in that the huge life science/biotech sector is converging with hospital systems to create the biggest system of healthcare in the nation.
“The future is about tailoring care to a patient’s specific DNA makeup,” she said. “We’re in a better position to do that than any other place in the nation, because we have all the key pieces needed in San Diego.”
With value and volume the top priorities for providers, sustainability continues to be an important aspect of designing healthcare facilities, Hawkins said. She said it is commonplace and integral to the building process.
Mackey said inclusion of sustainable features comes down to cash flow — it has to make sense and provide a return.
“Utility bills at healthcare facilities are enormous, and anything you can to do lower costs is important,” he said.
This is why infrastructure in old buildings is being replaced with more efficient systems, he said, noting that as providers pursue ownership, they anticipate a 30-year horizon for new buildings, so LEED makes good sense.
Disruptive technology like Skype, which allows patients to have a video appointment with a doctor anytime via mobile devices, will eventually impact the medical office building footprint, Mackey said. Hawkins said providers are already pulling back on space commitments. But due to low MOB vacancy and changes in reimbursements by the Centers for Medicare and Medicaid Services, her company is still building ground-up MOBs and refurbishing or repositioning existing buildings in the community as MOBs.
She said legislation made reimbursement site-specific by requiring the CMS to reimburse providers based on type of license, with higher payments for services provided at hospital facilities. This legislation is driving hospital systems to expand MOBs on hospital campuses, rather than off-site, she said.
Disruptive technology, such as the Skype appointments, is making healthcare more accessible, consumer-friendly and cost-efficient, as well as improving price transparency. Hawkins said patients can take a picture of a rash, send it to a physician service via a mobile device and get a diagnosis for $9, or perform an EEG that would cost hundreds of dollars at a hospital inexpensively on an electronic tablet. She said technology will increasingly dictate where people get care and lower costs. Providers cannot ignore this trend and will shift to accommodate it, she said.
Transitioning to electronic medical records is also about adding value, but EMRs are not attaining their full potential for data generation, which could improve outcomes across populations, because paper copies are being scanned into the system rather than entered as data, Mackey said. He said EMR data could also provide greater price transparency and help providers determine where to locate facilities.
Mackey also noted rumors that Amazon may plan to enter the healthcare arena, partnering with patients to provide access to medical records and access to low-cost healthcare services. Amazon’s involvement could provide a big data resource for medical researchers with collection of medical records data, if patient privacy issues regulated by the Health Insurance Portability and Accountability Act can be resolved, he said.
Ranked three times in the Top 100 “Most Wired Hospitals in America” with the most advanced computer systems, according to Hospitals and Health Networks Magazine, Major Health Partners relies on state-of-the-art technology to provide quality care. This commitment to technology for patient well-being extends to the healthcare provider’s choice of building controls for its MHP Medical Center. The Alerton Ascent building management system they rely on, along with other building design features, helps MHP save close to $360,000 in energy costs annually while providing a comfortable indoor environment for patients and staff.
The new MHP Medical Center – opened in January 2017 – replaces the 59-year-old Major Hospital in Shelbyville, Indiana. The full-service, replacement hospital occupies 305,000 square feet and houses 55 inpatient beds and 38 outpatient rooms, along with operating rooms and medical office suites. The hospital outside Indianapolis serves patients from throughout southeast Indiana, and beyond.
MHP’s design objectives for the new medical center included using conventional heating and cooling systems in unconventional ways, for significant energy-efficiency gains. To this end, the project team targeted an aggressive ENERGY STAR goal of 95 or higher. “It will be one of the more efficient hospitals in Indiana,” says Douglas R. Hundley Jr., PE, principal with CMTA Consulting Engineers. Hundley predicts the facility will use 53% less energy than the national average for hospitals (125 kBtu/sf/year vs. 266 kBtu/sf/year).
img src=”http://automatedbuildings.com/news/sep17/articles/alerton/pumps.PNG” alt=”Pumps” align=”right” />One of the key challenges in meeting the project’s energy saving goals is the new building connects to an existing 46,000 square foot cancer center. As the existing building was designed as a more conventional system, and energy was not a significant consideration when it was built, the new hospital central plant had the challenge of back feeding the existing heating and cooling systems.
“Some minimal upgrades were added, to help improve the system efficiency at the existing cancer center, and Btu metering was added in the hot and chilled water mains feeding the cancer center, so we could monitor energy usage, and inform the owner if additional system adjustments need to be made,” says Hundley.
CMTA recommended numerous control strategies to help achieve the energy savings goal for the new medical center. Among these was integrating operating room occupancy sensors with the supply and return air terminals in those spaces, to allow for the airflow to be reduced, while maintaining a positive pressure. The project team also specified a heat recovery chiller to reclaim waste heat generated from chilled water production and provide the hot water for all summer time reheat.
To help cost effectively optimize building operations for energy savings, the project team chose the Alerton Ascent building management system. Alerton Ascent includes Ascent Control Modules, Compass software, and Microset 4 wall units. “Ascent’s features and ease-of-use were the perfect fit for a sophisticated building owner operating a critical facility,” says Ed Ransom, vice president of operations for the Envelop Group’s Open Control Systems (OCS) division. Of particular benefit to the hospital are Compass software’s alarm management, scheduling, and trending capabilities, notes Ransom.
”The owner and entire project team were sold on Ascent, and MHP Medical Center uses Alerton controls top to bottom,” adds Travis Ihnen, president of Envelop Group.
We couldn’t have achieved the energy targets we set for this buildings without a sophisticated building management system like Alerton Ascent,” says Jeff Williams, vice president of facility operations for Major Health Partners. “This is a critical facility that will be used around the clock, and we wanted to ensure energy savings and comfort throughout – from the ORs to patient rooms to physician offices. Alerton is the brains of the entire system.”
Commenting on the power of the Alerton Ascent product suite, Hundley notes, “Recently, I was on site helping the owner evaluate a system deficiency, and using the controls, we were able to quickly diagnose the problem, and fix it in a matter of hours. Typically, we would have had to have the controls contractor, mechanical contractor, and T&B contractor on site to correct this problem. With just some phone support from OCS, we were able to make the adjustments needed, and address the problem.”
With six months of operating data, MHP Medical Center is well on its way to meeting or exceeding CMTA’s projection of $360,000 in annual energy savings.
Source: Automated Buildings
Anchor Health Properties, a national, full-service healthcare real estate development, management and acquisitions company, is partnering with The Villages community in central Florida to develop The Center for Advanced Healthcare at Brownwood, a 285,000-square-foot multi-specialty building that will be connected to a 150-key hotel, conference center and spa.
The project is slated to break ground in early 2018 and will take about two years to complete. The Center for Advanced Healthcare at Brownwood will be built on a 31-acre site in The Villages Brownwood Paddock Square Town Center. It will be integrated with the Brownwood Hotel and Spa, which will have 10,000 square feet of conference space, a multipurpose courtyard for meetings and events and a restaurant run by celebrity chef Wolfgang Puck.
“We are thrilled to be part of this project, which is a continuation of our long-term relationship with The Villages Health. This project will extend the mission of The Villages Health to provide high-quality, patient-centered care that is accessible to the community,” Paula Crowley, chairman of Charlottesville, Va.,-based Anchor Health Properties, said in a prepared statement.
Anchor Health Properties began working with The Villages Health in 2011, when the company helped to develop a primary care model that changed delivery of service to patients within the community, home to than 120,000 residents and one of the fastest growing areas in the country.
The center will have more than 25 clinical specialties such as oncology, imaging, ophthalmology, dermatology and plastic surgery, along with an ambulatory surgery and rehab surgery center. Other specialties represented will include cardiology, neurology, orthopedics, general urology and rheumatology. A retail pharmacy and lab will also be part of the facility.
The managing operator of the hotel and spa is AHC + Hospitality of Grand Rapids, Mich. The architect for the project is Earl Swensson Associates of Nashville, Tenn.
In July, Anchor Health Properties opened its first West Coast office in San Diego and also acquired Fletcher Parkway Medical Center, an 82,024-square-foot medical office building in the San Diego suburb of La Mesa, Calif. The asset is adjacent to the campus of the Sharp Grossmont Hospital and features tenants such as Sharp Healthcare and United Healthcare Group.
Medical office building sales are on pace for a record-breaking year, according to the latest research from JLL.
JLL reported that in the first half of 2017, the country saw nearly $5.5 billion in medical office building sales. How big is that number? It’s nearly the total volume of medical office building sales recorded in 2012 through 2014 in the United States.
The biggest sale in the first half of the year was HTA’s $2.2 billion acquisition of the Duke Realty healthcare portfolio this June. There are other major sales in the pipeline, though, with JLL predicting that 2017 medical office building sales will shatter the 2015 record of $9 billion.
The best news? The market has not been slow to respond to the increased demand for medical office properties. JLL said that developers have been quick to create new medical supply, pointing to the large developer-built portfolios offered by companies such as Duke Realty and Meadows & Ohly.
JLL only predicts good things for this segment going forward. Saying that new capital from investors seeking high yields will only provide a greater boost for this segment of the commercial real estate industry.
Source: RE Journals
Industrial REIT Duke Realty has completed its $2.8 billion sale of 72 medical office buildings to Healthcare Trust of America as it ramps up its bulk-space strategy.
“I am happy to announce that we have substantially completed the previously announced sale of our medical office business, generating $2.45 billion in proceeds to date, with the remaining properties expected to close during the third quarter,” said Duke CEO Jim Connor in a second quarter results statement.
Duke used some of the sale proceeds to pay down its debts and placed $796 million in escrow to finance future acquisitions and development, according to Mark Denien, Duke’s chief financial officer.
Source: Real Estate Weekly
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