Medical Office Portfolios In Florida, 3 Additional States Trade For $90M

A medical office portfolio comprised of 23 properties in four states have changed hands in three separate deals valued at approximately $90 million.

Commercial brokerage firm CBRE reports that it represented the seller in the three transactions that involve more than 300,000 square feet of medical-related space.

The traded properties include the Greenleaf Center Medical Portfolio in the Chicago metropolitan Area, the Dermatology Solutions Group Portfolio in multiple markets in Florida and Alabama, and 2061 Peachtree located in Atlanta. The seller’s exclusive advisors for the three deals were Lee Asher, Chris Bodnar, Sabrina Solomiany, Shane Seitz, and Ryan Lindsley of CBRE U.S. Healthcare Capital Markets.

“We continue to see very strong interest in the market for healthcare real estate assets, and investors have allocated a substantial amount of capital to the sector this year. Consistent with previous years, pricing and demand for healthcare investment properties continues to be strong with steady cap rates year-over-year,” says Asher, vice chairman at CBRE.

The Greenleaf Center Portfolio consists of 13 medical office buildings clustered around a high traffic intersection within the Chicago metropolitan area. The buildings total 197,385 rentable square feet and were 93% leased at the time of sale, with 44% of the rentable space leased to investment grade-credit and health system tenants. CBRE reports the property was sold to an unnamed institutional fund.

The Dermatology Solutions Group Portfolio consists of eight dermatology facilities totaling 51,505 rentable square feet located in Florida and Alabama. The properties were 100% leased to Dermatology Solutions Group with a new 10-year lease which was signed by the physician practice at closing. The buyer of the portfolio was an unnamed public healthcare REIT, according to CBRE.

2061 Peachtree is a five-story class A medical office building located in the highly affluent South Buckhead area of Atlanta. The 47,936 rentable square foot building was built in 2013 and is adjacent to Piedmont Atlanta Hospital. At the time of sale, the property was 100% leased to a diverse set of tenants, including Georgia Hand, Shoulder & Elbow (GHSE), the largest hand and upper extremity practice in Georgia. The property was purchased by an unidentified REIT, according to CBRE.


Source: GlobeSt.

Medical Office Building In Broward Sells For $11M

A medical office building near Plantation General Hospital traded for $10.9 million in two transactions.

Plantation-based 4100 Hospital Drive LLC, managed by developer Bruce Chait, issued two deeds for $5.45 million each for the 37,436-square-foot medical office building at 4100 S. Hospital Drive to 4100 Hospital Office LLC, managed by Janalie C. Joseph in West Palm Beach. Keystone Real Estate Income Trust provided a $5.8 million loan to the buyer.

The price equated to $291 per square foot.

The property last traded for $3.25 million in 2017. It was built on the 3.2-acre site in 1968.

Plantation General Hospital is slated to move into a new building on Nova Southeastern University’s campus in Davie.


Source: SFBJ

Medical Office Landscape Shifts With Health Care M&As

In its most recent national medical office report, Marcus & Millichap revealed that there’s an increased demand in off-campus medical office and a rise in mergers and acquisitions is changing the landscape of healthcare systems and care delivery. Medical office property sales velocity across the entire U.S. increased 5 percent over the past year.

A key point of the report forecasts that medical office properties will sustain a positive outlook in 2019 as strong employment and aging demographics align with favorable sector trends that will boost performance.

“Demographic trends and mergers and acquisitions are accelerating demand for medical office as firms desire more modern spaces and baby boomers retire at a rate of roughly 10,000 per day,” Al Pontius, Marcus & Millichap’s senior vice president and national director of specialty divisions, told Commercial Property Executive. “Cheap financing via low-interest rates makes cutting costs a quick way to grow profits and revenues,” he added.

Acquisitions and mergers are on the rise, Pontius explained, due to regulation and cost control among insurers and providers as well as innovation at the biotech, biopharma, medical device and pharmaceutical firms.

Naturally, baby boomers are a key driver of overall demand and, as this segment continues to increase year after year, Pontius noted it will create the need for more medical office space and the services they provide. Another factor in the need for space is an increase in enrollment in medical school over the past 10 years, which means the requirement for services will grow and the need for medical office space will grow nationwide.


Construction activity for 2019 has experienced somewhat of a broad slowdown, with concentrations in sunny, retirement-oriented states such as Texas, Florida, Arizona and California. “Building facilities remain extremely modern, with locations on and off campus as service areas expand to more suburban settings,” Pontius said. “While development had been increasing over the past few years, the completions remain well below the peak of the last cycle and we will see deliveries that is much lower in the year ahead.”

The report revealed that vacancy remains broadly higher in markets seeing the most construction as developer excitement has slightly exceeded the considerable demand that currently exists, particularly in the Southwest U.S. Marcus & Millichap also highlighted that institutional investors and REITs are focused on high-quality medical office buildings that are fully occupied near major hospitals or in medical corridors.

“Other locations where development is more expensive—NorCal, NYC—or the markets are less ‘sexy,’ such as Midwestern cities, remain much tighter than the overall market. Demand is highest in the Southwest and Southern United States, where retirees are rapidly moving to,” according to Pontius.

There’s been a lot going on around the healthcare industry. Earlier this month, Healthcare Realty Trust expanded its portfolio with the acquisition of two medical office properties totaling 158,338 square feet in the Washington, D.C. suburb of Fairfax, Va., for $46 million. Also this month, Catalyst Capital acquired a medical office building that serves as a U.S. Department of Veterans Affairs outpatient clinic in Lowell, Mass., for $11.4 million.


Source: CPE

Memorial Healthcare System Buys Property For $15 Million

The Memorial Healthcare System acquired the site of its new children’s health facility in Wellington for $14.75 million.

Wellington Office Parc LLC, managed by Leon Ojalvo of Liberty Base and Alan Benenson of MAS Development, sold the 30,000-square-foot building at 3377 N. State Road 7 to the hospital system, which is part of the South Broward Hospital District. The Joe DiMaggio Children’s Health facility was completed on the 3.5-acre site in February.

The center includes advanced imaging equipment, outpatient surgery rooms, and rehabilitation services, including sports injury rehabilitation. It focuses on six pediatric specialties: endocrinology, pulmonology, otolaryngology, orthopedics, general surgery, and neurology.

This facility is part of Memorial Healthcare System’s strategy of bringing advanced care, including ambulatory surgery, to patients who don’t live near its hospitals.


Source: SFBJ

What’s Ahead For WellCare Workforce, Real Estate After $17 Billion Acquisition By Centene

At least two of WellCare Health Plans’ 12,000 employees know they will have jobs after the Tampa-based managed healthcare provider is acquired by Centene Corp.

Ken Burdick, WellCare’s CEO, and Drew Asher, executive vice president and chief financial officer, are expected to join the senior management team at Centene after the deal closes, likely in the first half of 2020.

Neither Burdick nor Asher has yet signed a contract with Centene, but that process is underway, said Michael Neidorff, Centene’s chairman and CEO, speaking on a conference call with analysts and investors.

“The additions of Ken and Drew are very positive,” Neidorff said. “We have talked with them about specific positions that will give them some increased scale and growth over what they’ve been doing. It will be very beneficial to Centene and the combined companies, but in fairness to all the employees in both companies, I’m not going to say anything more than that because it will just create an issue that over time will become very clear and positive for everyone.”

Centene (NYSE: CNC), a St. Louis-based Fortune 100 health insurer, said early Wednesday it would pay $17.3 billion in cash and stock to buy WellCare (NYSE: WCG), one of the largest publicly held companies headquartered in the Tampa Bay area. The deal is worth $305.39 a share for WellCare stockholders, a 32 percent premium over Tuesday’s closing price of $231.27 a share.

The combined company will be a leader in government-sponsored healthcare programs, including Medicare, Medicaid and the health insurance marketplace. It will have about 22 million members across all 50 states, with estimated 2019 combined revenue of about $97 billion and earnings before taxes, interest, depreciation and amortization of about $5 billion. It will be headquartered in St. Louis, with “substantial” operations in Florida, Centene said.

By the second year, the deal is expected to produce about $500 million in annual net cost synergies, a term often used by businesses to describe cost-cutting measures such as combining similar operations or systems, or job layoffs.

WellCare, with $20.4 billion in 2018 revenue, is one of the largest employers in the Tampa Bay area, with about 4,500 local employees. In February, the company said it expected to hire more than 1,000 new workers across Florida.

“I welcome the fact that WellCare has the strength in its employees that it does,” Neidorff said. “I have told everybody that will ever listen that I am not concerned about having opportunities for good people. I’m concerned about having enough good people for the opportunities. When you have a company that’s growing at the rate we are, we want to ensure that people are growing with us and we have those kinds of opportunities.”

WellCare has a major real estate footprint locally. The company has a 380,000-square-foot campus on 71 acres at 8725 Henderson Road, made up of five buildings, a cafeteria, fitness amenities, and covered parking and walkways, connected by scenic wildlife preserves. It also has three satellite offices in Tampa. One year ago, it renewed the lease for its local properties through 2030.

“Upon close, Centene is committed to maintaining a substantial presence in the Tampa Bay area. WellCare will operate in a business as usual capacity,” a spokesperson for WellCare told the St. Pete Catalyst.

A critical part of the decision to agree to the deal was similar corporate cultures, Burdick said on the conference call.

“Both organizations are oriented toward a strong local presence. Both organizations think about a holistic approach to members with integrated solutions, and great respect and appreciation for everybody in the organization at all levels. So in those three areas there was great alignment of the culture, which makes us excited about what we can do as a combination,” Burdick said.

There’s been a lot of speculation about succession at Centene, and analysts wondered if Burdick, who is 60 years old, would be a candidate to succeed Neidorff, 76. Neidorff, who recently extended his employment contract by five years, said the Centene board has been developing several potential successors. “I expect when I’m ready to hang up the spurs, they’ll have a choice of two or three people,” Neidorff said.

The deal was announced amid debates over health care policy at the national level, ranging from some Democrats’ calls for Medicare for all to a continued push by the Trump administration to repeal the Affordable Care Act.

On the conference call, Neidorff said he expected the judicial system to eventually uphold the ACA, and that Medicare for all, with a price tag ranging from $28 trillion to $38 trillion over 10 years, is unaffordable.

“This is a great transaction. It puts two great companies together in a very meaningful way serving a lot of audiences that you can never do enough to serve,” Neidorff said. “This really will prove to be a very successful and serious transaction.”


Source:  Catalyst

New Baptist Health Medical Center Coming To Plantation


Baptist Health South Florida has broken ground on a new wellness and medical center in Plantation that officials say will create 230 new jobs.

The 100,000-square-foot center, at 1228 S. Pine Island Road, north of Interstate 595, will offer primary care, diagnostic imaging, urgent care, multi-specialty surgery, medical oncology, physical therapy and a spine care clinic.

Broward County property records show that Baptist Health paid $4.2 million for the 258,251-square-foot property in October 2017.

“The new facility is part of Baptist Health’s mission to bring high-quality compassionate care to our South Florida community,” company spokeswoman Georgi M. Pipkin said in an emailed statement.

Pipkin declined to reveal a budget for the project, saying the information is “proprietary.” Completion is estimated in November 2020, she said.

Baptist Health South Florida is a not-for-profit, faith-based network with hospitals and medical centers throughout South Florida, including in Miami-Dade, Monroe, Palm Beach and Broward counties.

The company runs urgent care centers in Weston and Sunrise, medical plazas in Davie and Pembroke Pines, an orthopedics and sports clinic in Davie and a sleep center in Pembroke Pines, according to its website.


Source: SunSentinel

The Outlook For Outpatient Could Mean Outrageous Returns


The hospital’s monopoly on healthcare is coming to an end. These large institutions aren’t going anywhere, of course, but every year, more and more people receive treatment in medical office buildings (MOBs), retail centers and other off-campus facilities. And real estate investors have taken notice.

The drivers for this shift to off-campus healthcare are numerous. Mergers among health providers have changed how physicians interact with patients, as have emerging technologies that make it easier and cheaper to decentralize medicine.

But the biggest stimulus is access. For all its complexity, healthcare is still a consumer-facing business, and the consumers want convenience. This is why medical providers seek to place offices in neighborhoods and suburban areas, closer to where people live and where they work.

“What our hospital CEOs are telling us is that there is a general move away from inpatient toward outpatient care, not just for financial reasons, but also for the convenience of the patient,” said John Abuja, senior director at Marcus & Millichap.

New, single-tenant MOBs remain attractive to both private and institutional buyers, according to a recent Marcus & Millichap report. If a property has the backing of major medical providers or hospital systems, leases trade at a premium, with first-year returns in the high-5 to low-6 percent range on average.

Developing a medical office asset off-campus can lead to higher rents as the high-quality submarkets where service providers want to set up shop have higher underlying base rents in general. Also, there is a trend toward more opulent build-outs that the end users seem to desire.

“The rise in rent can in part be attributed to the additional cost and sophistication and demand now for higher levels of service and patient comfort,” said Abuja. “Some of these facilities have wider hallways, larger exam rooms and really they have Class A finishes. Ironically, a lot of that is being driven now by the patient, more so than even the physician.”

Though MOBs are attractive to investors and are therefore under development at a rapid pace, there are opportunities in retail locations as well. The types of medical uses that a community shopping center or even a power center can support create some limitations, but there are prospects for suitable location/use matchups.

“Retail locations are going to find it very difficult to attract certain healthcare tenants because of the need for backup generators or surgical suite amenities,” Abuja said. “That said, there are a lot of non-invasive, MRI imaging and other tenants that are a great fit for a storefront location.”

However, locating a medical use in a retail environment will put the property into competition with other asset classes. The premier locations where they want to be are also where everyone else wants to be—a situation that can lead to higher development costs.

“If a developer is building into a retail center where they are in competition with other retail rents, then the cost of being there is higher because they’re competing with other retail tenants for the same location,” Abuja said. “Some of the retail rents, especially restaurants, far exceed what you typically pay on an office space.”

According to Abuja, while a $65 per square foot buildout cost years ago was relatively standard, now it could be upwards of $150 per square foot to redevelop a retail location for a medical office use. However, if and when the fit is right, getting closer to the end user can justify these additional costs.

Erected in the mid-1970s and with a gross leasable area of more than 164,000 square feet, The Oak Mill Mall in Niles, Illinois was always a hybrid. It’s anchored by a Jewel-Osco grocery store and has the look of a large strip mall from the outside, though it actually has everything that a ‘70s-era mall would have: two levels, storefronts within an enclosed space and even an indoor water fountain.

As retail tenants began to move out, however, the property rebranded as “Oak Mill Plaza” and began targeting healthcare providers. Now, approximately half of the retail tenants are medical purveyors of one stripe or another, including pediatrics, oncology, dentistry and a travel clinic.

This location is a deviation from the norm, however. Most retail centers max out at one or two healthcare tenants, typically in an outlot location. And for the financial backers, the real money is in MOBs.

There are strong consumer forces pulling medical office properties away from institutional campuses and out to Main Street. However, there are strong forces keeping MOBs in orbit around a hospital as well.

“There is comfort to investors knowing that they are on or near a hospital campus where supply characteristics are insured. If I had to make a choice between an on-campus or an off-campus building, I would still rather be on campus or tangent to campus just because the doctors are already there,” Abuja said. “It’s not ‘build it and they will come.’ They’re already there. That’s why most investors, if they could choose, would still rather be on campus or near campus with an MOB.”

According to the Marcus & Millichap report, many physicians are bringing buildings to market in order to cash in on increased equity; properties tenanted by a private physician typically trade 100 basis points above those leased by major medical groups.

Sale-leaseback opportunities with private physician groups often require personal guarantees of leases, so investors should be mindful of lease terms as many buyers prefer to have major hospital system or healthcare group backing as they lead to longer lease guarantees.

As investors seek stabilized, multi-tenant medical office properties in primary and secondary markets, the yield spreads between on-campus and off-campus assets have compressed. In today’s market, private investors and institutions alike expect similar returns regardless of an assets’ proximity to an established hospital.


Source:  RE Journals

Florida Lawmakers Load Wish List For Health Care Money



Health care costs in Florida are under a microscope as House Speaker Jose Oliva pushes an ambitious goal of scaling back state health spending.

But Oliva’s promises to lower health-care costs have not prevented House and Senate members from requesting money for everything from hospital construction projects to increased access to medication-assisted treatment for opioid addiction to providing care to survivors of human trafficking.

Lawmakers have submitted hundreds of millions of dollars in funding requests for health-care related projects during the legislative session that starts March 5. The proposals are filed for communities across the state and target programs for poor, elderly and disabled Floridians and people with substance-abuse disorders and mental-health needs.

One proposal, for example, would provide $10 million to UF Health Jacksonville hospital to help renovate its trauma center, while other proposals would send $1.6 million to Doctors Memorial Hospital in Bonifay for a rural health clinic and $4.2 million to Mount Sinai Medical Center in Miami Beach to redesign space to accommodate four additional generators.

The News Service of Florida reviewed hundreds of funding requests that were submitted by lawmakers and labeled as being for health and human services. House and Senate committees and budget negotiators ultimately will decide during the session whether the proposals will be funded in the 2019-2020 budget.

As of Monday, more than $223 million had been requested by senators for 178 different proposals, according to a tally maintained by Senate budget staff.

Sen. Aaron Bean, a Fernandina Beach Republican who chairs the Senate Health and Human Services Appropriations Subcommittee, said the number of requests will continue to climb.

“I think it’s going to be a huge number,” Bean said .

Bean said he’s been warning members that they could be disappointed given the state’s latest financial outlook.

“It’s going to be a challenge to meet the needs of everything for health care,” he said.

State economists met last week to analyze Medicaid enrollment and spending and to develop estimates that lawmakers will use in drafting the budget for the fiscal year that starts July 1.

Economists concluded that continuing to run Medicaid at current levels will cost $28.1 billion in the upcoming fiscal year. That means lawmakers would need to come up with $164.2 million more in state money than what they currently are spending if they want to avoid cutting programs.

The most-current projections were higher than what was originally estimated. Economists attributed the difference to an increase in the number of patients being served in Medicaid program and to higher-than-anticipated payments for the Medicaid managed-care program and community mental-health services.

The requests for more funding also come as House leaders focus on driving down overall health-care costs. Oliva wants to lower costs by increasing the numbers of providers who can offer care and giving patients alternatives to hospitals.

During public appearances, Oliva often bemoans the amount of state health-care pending. He says that 48 percent of the state’s overall budget will be spent on health care, a broad collection of costs that include everything from state employee health-insurance to prison health to Medicaid.

Bryan Cherry is a lobbyist for Doctors Memorial Hospital, which has put in two requests for funding this year. Cherry said he is aware of Oliva’s concerns about health care spending but said he hopes he can win over skeptical legislators.

“From everything I’ve been told, the speaker views rural hospitals in a different category, if you will,” he said.

One of the requests from Doctors Memorial Hospital is $1.6 million to help construct a 6,000-square-foot medical office facility to serve pediatric cardiologist specialists’ needs in Holmes County.

“It is a critical access rural hospital,” he said. “There’s a critical need for it.”

Lobbyist Paul Hawkes, who is trying to get money for UF Health Jacksonville, is also cognizant of the speaker’s sentiment and acknowledged it could cast a shadow during the session. Hawkes job is to convince the Legislature to sign off on proposals that, if approved, could mean $43 million in increased Medicaid funding for the hospital without additional state funds.

Noting that the facility has thin operating margins and provides large amounts of Medicaid and charity care, Hawkes said he’s confident he can make a persuasive argument for the increased spending authority, which involves using local and federal money but shows up in the state budget.

“The speaker has never said he’s opposed to important health care sending or quality health care spending,” said Hawkes, a former lawmaker. “He said he was opposed to more wasteful health care spending.”

Sprinkled along with requests for money dedicated to hospitals and opioid treatment is a request to help pay for the Ms. Senior Florida pageant. The pageant is for women 60 and older of “good moral character,” according to a website promoting the event. The contestants must compete in a talent competition and agree to don evening wear.

“It’s an activity for the older people in this community,” Sen. Oscar Braynon, D-Miami Gardens, said of his $500,000 funding request .

“It’s not about the actual beauty pageant,” he said. “it’s about giving these elderly people something to do.”


Source: News4Jax

AdventHealth To Expand Downtown Emergency Department


AdventHealth has plans to further expand on its main downtown Orlando hospital campus with additional emergency department space.

The health care provider filed documents to build a 45,000-square-foot expansion of the Ginsburg Tower’s emergency department. The expansion will include 21 adult emergency bays, a resuscitation room and three isolation rooms, AdventHealth spokesman David Breen told Orlando Business Journal.

The cost of the project and a construction timeline were not immediately available.

The move follows the health care provider announcing a 13,200-square-foot expansion to its cardiovascular institute back in October. That expansion, dubbed the Center for Living, includes a genomic center focused on cardiovascular issues. Construction is expected to start in first-quarter 2019 and be completed by the end of 2020.

The Alan Ginsburg Family Foundation donated $3 million for the facility. The foundation, named after area real estate developer Alan Ginsburg, previously donated $20 million in 2007 toward the $255 million, 440-bed Ginsburg Tower.

AdventHealth’s parent company, Adventist Health System, is the second-largest employer in the area with more than 83,000 employees for 2018. The health care system operates nearly 50 hospital campuses and hundreds of care sites across the U.S. in almost a dozen states and serves more than 5 million patients each year.

Founded in 1908, the $3.36 billion nonprofit AdventHealth’s holdings in the area include:

  • 10 local hospitals in downtown Orlando, Altamonte Springs, Winter Park, east Orlando, Celebration, Kissimmee, Longwood and Apopka
  • The freestanding emergency room in Winter Garden, which now has a 72,000-square-foot, three-story medical office building and plans to build a 100-bed inpatient hospital tower there.
  • 24 Centra Care (urgent care) centers and 2 Kids Urgent Care centers
  • 24 imaging and diagnostic centers
  • 15 Lab Care locations
  • 18 Sports Medicine & Rehab locations2,500-plus doctors in 123 medical specialties


Source: OBJ

Miami Plans Possible $125 Million Project To Build STEM Facilities

Miami University is currently seeking builders and designers to plan two potential new buildings: a health sciences facility and a STEM/innovation building. The project is estimated to cost Miami a total of $125 million.

These facilities would provide opportunities for research and collaboration between scientific disciplines. In planning these projects, Miami hopes to expand its nursing, technology and engineering programs, among others.

The plan is a result of Miami’s Boldly Creative Initiative, which was announced by President Greg Crawford in 2018. The initiative “will emphasize data, analytics and programs that span traditional disciplines to create engaged citizens and workplace leaders to benefit the Ohio economy,” according to a report by the Cincinnati Business Courier.

David Creamer, vice president for finance and business services at Miami, said that the $125 million price tag is not definite.

“The estimate is just to convey the size and scope that the project would entail,” Creamer said.

Construction of these facilities would most likely cause an increase in student enrollment at Miami due to demand for these expanded programs, Creamer said. However, he does not anticipate a need for additional student housing to accommodate this possibility.

The new facilities would be designed with sustainability in mind, as all new construction at Miami is held to a minimum standard of LEED Silver certification, Creamer said.

According to the U.S. Green Building Council, a building that earns at least 50 points in rating categories such as water efficiency, indoor environmental quality and innovation is certified Silver. However, whether or not these buildings are significantly more sustainable than regular ones is up for debate. Some environmentalists argue that a Silver certification is easily reached through simple feature modifications.

Jamie Kent, a senior zoology major with a pre-medical studies co-major, is involved in undergraduate research at Miami through the Broadening Undergraduate Research Participation (BURP) program. Kent said it was difficult to find a research opportunity on campus, but that her experience has helped her explore the different career possibilities available to her as a STEM major.

“Having facilities that present more research opportunities would allow more students to gain valuable research experience,” Kent said.

The possibility of collaborative research across multiple disciplines also piqued Kent’s interest. She said that working within a broader variety of subjects would allow students to more easily discover their passions.

“Lots of students feel confined to their majors, so interdisciplinary research would be a great opportunity for them to break out of their usual studies,” Kent said.

While the university has not yet determined whether it wants to go forward with these projects, it is actively soliciting applications through a request for qualifications.

“The university dedicating funds to facilities such as these demonstrates its commitment to undergraduate research,” Kent said.

Source: The Miami Student

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