Healthcare real estate has become a more widely recognized asset class by both the domestic and international investment community. And despite uncertainty over the future of healthcare reform such as the repeal of the Affordable Care Act, value-based reimbursement and changes to healthcare delivery setting, demographics will dictate increasing for healthcare services for years to come.
A panel titled: “The “Real Deals” of 2017: Lessons Learned and Implications for What’s Next” at RealShare Healthcare, held here on Thursday, dove deeper into that discussion, noting that the increasing demand for modern, well-located space and a corresponding expansion of investor interest in the asset class and the pressures on operational efficiency and the rise in potential investors have lead many health systems and physician groups to monetize their real estate assets.
When moderator Gino Lollio, senior director of IPA, a division of Marcus & Millichap, asked panelists about how they source their opportunities—whether it be a buy, sell or equity placement—Jason L. Signor, CEO and partner at Caddis, said that senior housing aside, while they will always pay a broker, they prefer to go direct on acquisitions. For developments, while Caddis has won its share of RFPs, they prefer to go to relationships.
“It may not be from the client, it may come from a former partner, and we try to reciprocate that.”
Darryl E. Freling, managing principal of MedProperties, said that his firm is invested in a lot of ground up development and doesn’t recall of development through an RFP process.
“We always go through direct and have developed a lot of our own provider relationships.”
In terms of acquisitions, whether value add or stabilized acquisitions, MedProperties prefers to do an off-market deal.
“As a seller, and we are often sellers, we prefer to sell through a qualified broker because you get better pricing and it is a competitive process,” said Freling. “As a buyer, we don’t mind competing, but everyone looks at assets a little different. We do a lot of post-acute assets, and a lot of buyers don’t.”
As for how that compares to the past, panelist Ann Atkinson, SVP of acquisitions at Healthcare Trust of America Inc., said that there are way more brokers now than there were five years ago. And Signor said that today’s market is much more efficient than in the past.
“The efficiency has been the biggest change and in the last three or four years, the market has tightened.”
Jim McMahon, SVP of Capital One Healthcare, said that his firm has a lot of direct relationships and are really indifferent in how a deal comes to them.
“We are looking to drive volume and provide debt to the industry.”
As for competition, Signor said that healthcare has changed from being an opportunistic investment to being a core investment.
“I think the big thing we have seen is new competitors. From a development perspective, we are competing with the core build-to-suit giants. The equity coming in is now core equity… It is overseas. It is from pension funds who have never looked our way before and now we are getting calls from them on a weekly basis.”
Atkinson said that there is a big disparity today between quality and a lack of overlap between some of the buyers that might be looking to find different assets with different risks and different yields.
“They aren’t competing for the same types of assets. There is a big difference in pricing and buyer profile.”
According to Freling, the quality assets are very competitive.
“On a risk adjusted basis, healthcare real estate is still probably less expensive than some of the other food groups but that gap is narrowing. It is very competitive on the core side.”
But Freling pointed out that there are a lot of A-type assets that can be bought, that were maybe improperly marketed, or are just a unique situation, and they can be turned into a core asset.
“There are relatively less players with the expertise or willingness to go after value-add.”
/wp-content/uploads/2020/08/florida-medical-space-logo.png00ADMIN/wp-content/uploads/2020/08/florida-medical-space-logo.pngADMIN2017-12-12 01:46:362017-12-12 01:46:36Healthcare Market Is Tight But Not Unworkable
Innovative Industrial Properties Inc.—a leading provider of creative real estate capital solutions to the medical-use cannabis industry—will acquire an Arizona-area asset comprising more than 350,000 square feet of greenhouse and industrial space in a $15 million sale-leaseback transaction with a subsidiary of The Pharm LLC.
The firm will also enter into a long-term, triple-net lease agreement with The Pharm subsidiary, which is planning certain tenant improvements, for which Innovative Industrial has agreed to provide reimbursement of up to $3 million.
“The Pharm is pleased to enter into a long-term partnership with Innovative Industrial Properties through a real estate sale-leaseback transaction that will help capitalize our plans for national expansion. Innovative Industrial Properties’ flexible, long-term capital solutions have enabled The Pharm to unlock the equity it had invested in real estate to be redeployed back into our core business, where we expect to generate higher returns,” said Randy Smith, founder & CEO of The Pharm LLC, in prepared remarks.
LONG-TERM AGREEMENT
The initial term of the lease is 15 years, which can be extended for two additional five-year periods. The lease provides for an initial annualized aggregate base rent of $2.5 million or 14 percent of the sum of the purchase. The tenant improvements are subject to an initial partial rent abatement. The aggregate base rent is subject to 3.2 percent annual increases during the term of the lease. The Pharm subsidiary is also responsible for paying Innovative Industrial Properties a property management fee equal to 1.5 percent of the then-existing base rent.
“The Pharm’s team brings together decades of management and business execution success and we believe they are very well-positioned to continue their strong growth in the Arizona medical-use cannabis market, which as of October 2017 had nearly 150,000 registered patients being treated for numerous qualifying medical conditions, including chronic pain,” said Paul Smithers, president & CEO of Innovative Industrial Properties Inc., in a prepared statement.
Earlier this year, Innovative Industrial Propertis Inc. purchased a a 72,000-square-foot cannabis cultivation facility in Capitol Heights, Md.
The deal is expected to close by the end of the year.
At a growing number of hospitals across the country, it is now possible to have a cappuccino with your CAT scan. Mixed-use real estate is coming to healthcare, and more hospitals are integrating shops and appealing public spaces into their designs.
Northwestern Memorial Hospital in Chicago’s Streeterville neighborhood is one such place. Just over seven years ago, Northwestern Medicine set an ambitious goal to be a top 10 academic medical center by 2020. As part of the plan to achieve that goal, it committed to improving retail offerings and public spaces within Northwestern Memorial Hospital.
With nearly 10,000 employees, 67,000 neighborhood residents and 3,000 hotel rooms within a five-block radius, Northwestern Memorial was well-positioned for incorporating retail. Through a detailed retail market assessment and study, the hospital determined there was an unmet demand at the campus for about 50K SF of retail composed of mostly food and beverage shops.
The shift toward experienced-based design and programming that has reshaped the retail landscape has started to impact healthcare real estate. Patients demand convenience, modern technology and speedy treatment when seeking care. Convenience can be boosted significantly in a mixed-use environment.
The line between healthcare and retail is blurring. More than 1,600 retail locations in the U.S. house healthcare clinics and an increasing number of pharmacies, supermarkets and retail chains have entered the healthcare space.
At Northwestern, the redesign called for bringing a neighborhood feel to the city-block-sized campus. Ground-floor retail with welcoming storefronts draw people in while a 9K SF restaurant concept met the demand for quality dining in the area. Additionally, the premium spaces on the active second floor of Feinberg-Galter Pavilions were transformed from internal administrative spaces to an eclectic mix of restaurants offering healthy foods.
Retrofitting existing administrative and other spaces not originally designed for the demands of food service presented Northwestern with challenges on multiple fronts, and the hospital turned to the project team of KHL Retail, Stantec, Kiku Obata & Company and Skender Construction to help tackle these problems from the beginning.
Major infrastructure improvements were required to complete the project, including modifications to the base building structure, installation of new electrical service for future tenants, black iron ductwork and extensive plumbing alterations.
“As anyone who has worked in healthcare knows, finding a space for anything in an existing hospital is a challenge, let alone major structural and MEPFP [Mechanical, Electrical, Plumbing and Fire Protection] elements,” Skender Construction Project Executive Brian Simons said. “Extensive investigation and pre-planning before the design was completed allowed for the team to determine the most feasible and cost-effective means of designing and installing the infrastructure improvements. This allowed for minimal design and construction rework once construction was underway.”
Introducing a project of this magnitude into an active hospital required communicating and interacting with the Illinois Department of Public Health. The preparation work that had to take place before the infrastructure improvements, the multiple phases of infrastructure construction, public area renovations and the multiple iterations of tenant build-outs all had to be communicated and coordinated with IDPH to ensure its requirements were satisfied.
Understanding the intricacies of not only healthcare design and construction but also in the infrastructure, civil, retail and office/administrative aspects proved to be critical in the successful execution of the project, Simons said.
While not every healthcare real estate project will require the rigor or scale that Northwestern’s renovation needed, mixed-use healthcare development is taking hold.
U.S. health insurer UnitedHealth Group Inc. will buy DaVita Inc.’s physician group in a cash transaction for approximately $4.9B.
DaVita Medical Group has approximately 280 clinics, 35 urgent-care centers and six outpatient surgery centers that operate in California, Washington and Florida. The acquisition will expand UnitedHealth’s healthcare services platform throughout the U.S., allowing it to compete as a larger player in the medical services industry, the Wall Street Journal reports.
UnitedHealth’s health-services arm, Optum, has been actively working to build a larger roster of clinics and medical centers; in January it acquired Surgical Care Affiliates Inc. for $2.3B, adding around 200 medical centers to its portfolio.
The takeover comes at a time of financial distress for DaVita, which recorded a net loss of $214M in Q3. The company will use the proceeds from the UnitedHealth transaction to pay off debt and for stock buybacks, among other purposes.
The pending transaction falls on the same week as CVS Health Corp.’s $69B Aetna Inc. buyout. The deal will solidify it as the second-largest company in the country in terms of revenue. CVS plans to leverage its retail footprint to create one-stop-shop healthcare clinics across the U.S. With a portfolio of 9,700 retail pharmacies and 1,100 walk-in medical clinics, called MinuteClinic, CVS is the largest retail pharmacy chain and retail clinic operator in the country.
The UnitedHealth Group deal is expected to close in 2018.
Miami Jewish Health Systems is moving ahead with its major expansion plans and has earned preliminary approval from city commissioners.
Phase I is set to begin next year and include construction of a cutting-edge memory care facility to be called Empathicare Village, a substantial addition to the medical campus in Miami’s Little Haiti neighborhood.
The health system has been operating from 5200 NE Second Ave. since the 1940s, and the updated master plan is for the next 30 years and beyond.
The city commission recently voted favorably on four items tied to the expansion, including a street closure, land use changes, zoning changes, and an amended development agreement with the City of Miami.
The street closure was approved, and the other three items passed on a first reading with a final vote yet to come.
The first item allows the health system to close part of Northeast First Avenue (Northeast Miami Place) and Northeast 52nd Terrace within the Miami Jewish Health Systems’ properties, and seven easements also within the medical campus site.
Outgoing Commissioner Frank Carollo got a promise from the health system to hire a good portion of employees from Miami, for both temporary construction jobs and long-term staff positions.
Some of those details are to be fine-tuned before the final votes.
The expansion plan is to unfold in several phases, and Mr. Carollo said he wanted to make sure there are requirements to hire local residents for each phase and to have a third party regularly audit those employment numbers and report compliance to the city.
Commission Chairman Keon Hardemon noted that Miami Jewish Health Systems is proud of providing long-term jobs to locals.
“I’ve seen it. Thank you for that,” said Mr. Hardemon, whose District Five includes Little Haiti.
In a letter about the expansion, attorney Iris Escarra on behalf of the health system speaks of the impact of jobs the redevelopment will bring to the community.
The increase in capacity will allow the health system “to provide more jobs, and to better serve the community through new programs and more room for patients.”
She said an economic study shows the average development construction phase employment will be for about 1,174 employees, and the project management is expected to employ eight people for ongoing oversight of the site and marketing during the development phase.
The expansion will also lead to an increase in recurring jobs totaling 170 employees throughout the multiple-phase project.
“Development jobs will range from construction to truck transportation and marketing research, and operation jobs will include hotel and hospital workers,” Ms. Escarra wrote.
The health system’s expansion plans are included in a requested Special Area Plan.
The city’s zoning code, Miami 21, says the purpose of a Special Area Plan is to allow parcels of 9 abutting acres or more to be master planned to allow greater integration of public improvements and infrastructure, and “greater flexibility so as to result in higher or specialized quality building and Streetscape design.”
The medical campus of about 20 acres provides 24-hour-a-day services for its patients, including on-site hospital and ambulatory health clinic, specialized centers for biofeedback, mental health, rehabilitation, and memory centers, and assisted living facilities.
Miami Jewish Health Systems currently provides 104 assisted living facilities with the proposed addition of 99 beds, for a total of 203 assisted living facility beds.
The nonprofit senior health care provider has hired c.c. hodgson architectural group to design the new master plan for its property, border by Northeast 53rd Street, Northeast Second Avenue, Northeast 50th Terrace, Northeast Miami Place, Northeast 52nd Street and North Miami Avenue.
The architectural firm specializes in wellness-based design services.
The overall master plan shows the construction of 11 buildings and facilities, improvements to more than a half dozen existing structures, and demolition of five buildings and one pavilion.
A significant aspect of the master plan is consolidating parking into new multi-level garages, freeing old surface parking lots for new buildings and expanded open space.
In her letter, Ms. Escarra says the proposed Special Area Plan will enable the health provider to expand its impact on the community by providing the Empathicare Village, an institute to promote research, and lodging for visiting researchers and families.
The Empathicare Village includes a 142,708-square-foot, three-story facility and a 135,576-square-foot, three-story garage accented by murals from local artists.
Ms. Escarra wrote that the Special Area Plan was designed to:
• Promoting a neighborhood/campus for short- and long-term patients and their families.
• In addition to on-site green space provided for residents, patients and families, provides more than an acre of civic space for the public.
• Introduce the Empathicare Village, along the western portion of the campus, to meet the needs of an aging community.
• Revitalize the neighborhood through design and innovation, along with providing needed support for the community’s healthcare needs.
• Utilize sustainable technology and strategic initiatives and concepts.
The complete build-out of the master plan is to include a hotel and conference center.
/wp-content/uploads/2020/08/florida-medical-space-logo.png00ADMIN/wp-content/uploads/2020/08/florida-medical-space-logo.pngADMIN2017-12-01 03:21:382017-12-01 03:21:38Miami Jewish Health System Pushes Vast Expansion
