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South Florida is on the verge of a major statewide demographic shift, with impacts that will ripple through the healthcare economy in many ways. Currently home to the highest concentration of older residents in the nation, more than 3.3 million Floridians are 65 and older, with 1 in 20 now 80 years old or older.

With continuing migration into Florida and increased longevity, nearly 1 in 4 Floridians will be 65 and older in 2030, according to The Florida Legislature Office of Demographic Research.

This growing population sector will certainly increase the local demand for medical care, but will there be enough medical real estate to keep up?

Real estate development and demographics go hand-in-hand. Our aging population will require more medical care.

Medical providers will need to prepare in advance for the demographic shift. Physicians must prepare for expansion. Diagnostic and treatment centers will need additional locations. Hospitals will need to expand outpatient services, on-and-off campus offices, and possibly acquire more medical practices.

Considering these needs, the current commercial real estate market presents formidable challenges to medical providers.

Construction costs are up and vacancy rates are down, making renovating and leasing existing space more difficult and cost-prohibitive. Regarding factors limiting construction of new medical office buildings, the apartment boom has driven land prices so high that office developers cannot compete to purchase sites.

Lenders have financed many new apartment projects but shied away from speculative office development. Medical office requires more parking than many other uses, thus requiring more land for development. Will these costs be passed on to the patients or will they lower profits for medical providers?

This looming demand for property to build patient treatment facilities likely will require creative solutions such as infill development, repurposing existing properties, and utilization of nontraditional properties for medical care.

For example, there are many “big box” retail sites (think Sears, K-Mart) that could easily be converted to medical uses. The parking is there, and the structures are sound, requiring only interior renovation.

Will investors continue to bring funds to medical office REITs and other medical properties? There is lingering uncertainty about the long-term impacts of the Affordable Care Act (ACA) and the Tax Cuts & Jobs Act (TCJA), including how many people will be insured, how leases will be treated for accounting purposes and other investment considerations associated with purchasing, leasing and owning.

Another big question is how new technologies, particularly telemedicine, will reshape South Florida’s healthcare delivery system. This may upend the traditional “bricks and mortar” medical office to a degree none of us can predict.

Despite various reasons for uncertainty, the coming increase in demand for medical services should keep investment in medical properties at a high level. In fact, in 2016, 2017, and 2018 to date we have seen very healthy investment and development in healthcare real estate.

On a national scale, according to data released by Revista and Healthcare Real Estate Insights (HREI), outpatient medical real estate development projects totaling nearly

$7.7 billion in construction value and 19.4 million square feet were completed in 2016, while another 17.3 million square feet of outpatient projects with a value of almost $6.5 billion were started.

Locally, in 2018, Cleveland Clinic Florida opened its new, three-story, 73,000-square-foot Coral Springs Family Health Center. Built for about $33 million and equipped for another $20 million, the ambulatory surgical center houses 17 medical specialties, imaging and diagnostic services.

As the aging population continues to shape the future of healthcare real estate in South Florida, healthcare real estate developers will face challenges related to finding land and existing buildings at a reasonable price. End users, including hospitals, physicians and diagnostic centers, will have difficulty finding affordable space to lease and contractors who can perform at an affordable level.

Navigating this real estate landscape demands market knowledge specifically as it pertains to healthcare providers. Expect to see emphasis on creative long-term options for renewal and expansion as a hedge against diminishing supply and rising costs.

Brokers, attorneys and appraisers who are experienced in the healthcare real estate sector will be focused on guiding all players through the markets and locating “deals.”

Source: Miami Herald

The medical office building is the most stable asset in the healthcare real estate space, as Collier’s new 2018 Healthcare Marketplace report attests. The national MOB vacancy fell for the sixth successive year in 2017 to an all-time low of 7.3%.

As for investment in MOBs, according to the report, that rose from $9.2 billion in 2016 to $11.3 billion in 2017, while cap rates compressed to an average of 6.4%.

“The medical office building is the most common asset that a healthcare system or provider will sell,” Mary Beth Kuzmanovich, National Director, Healthcare Services at Colliers, tells GlobeSt.com. “The healthcare tenant is pretty consistent staying in the building, renewing their lease and paying their rent.”

There are headwinds, of course, as there are in every asset class. There are the perennial issues around healthcare reimbursement including the recent weakening of the Affordable Healthcare Act, the aging baby boomer generation and that impact on increased Medicare enrollment as well as the increased use of high deductible plans by employers.
More recently, new trends have emerged that could also have an impact on medical office buildings. For example, Kuzmanovich notes that employers have been becoming more innovative in their attempts to stabilize the employer cost on healthcare.
Perhaps the most ambitious of these attempts is the decision announced earlier this year by Amazon, Warren Buffett and JPMorgan Chase to create a company to provide their employees with high-quality, affordable care. Little details have been provided and whether it will have an effect on medical office buildings is still unclear. It does seem though, based on the broad outline of the endeavor, that real estate will play some role in providing this service.

“All of these variables create an ongoing uncertainty,” Kuzmanovich says.

Other players as well are entering the health care space, intent on creating new patient care delivery models.

Realigning The Pharmacy Net Lease Sector

Last week, for instance, it was reported that Wal-Mart and insurance company Humana were having early-stage talks about strengthening their existing partnership, including a possible acquisition. There have been other proposed and completed deals that could align healthcare real estate, especially in the net least space. Cigna and Express Scripts, Optum Rx and United Healthcare, Optum’s acquisition of DaVita Medical Group last year for $4.9 billion and, of course, CVS’ acquisition of Aetna for $69 billion and Walgreen’s $4.3-billion purchase of 1,932 stores, three distribution centers and inventory from Rite Aid.
Not all of these deals have been finalized yet and there is always the specter of antitrust regulators stepping in. The American Antitrust Institute, for example, has warned the Justice Department about the CVS and Aetna merger.

The Changes That Tech Will Bring

Even so the trend is clear: disruption in the form of new healthcare models is on the horizon.

Another disruptor is technology, Kuzmanovich says. “I think technology continues to be a game changer across the industry. The advent of portable devices and wearable tech is making seeing a doctor more accessible.” It will be interesting to watch, she says, how the mainstreaming of telemedicine or the ability to Skype with a nurse or doctor or the ease of downloading medical information from a Fitbit or other device will affect the medical office building. “That technology is compounding to potentially reduce the demand for medical offices in the long run.”

On the other hand there is the example of Mercy Hospital in St. Louis, which has set up a telemedicine hub to provide primary care and other services, Kuzmanovich continues. “There will be demand in the healthcare space to support these emerging technologies, creating a new opportunity within the sector.”

Source: GlobeSt.

As technology continues to penetrate the business of health care, more hospitals and physician groups are working to adopt and modernize their practices, introducing features such as telemedicine to offer convenience.
Jupiter Medical Center, a not-for-profit institution with capacity to treat more than 500 patients at a time, is the latest organization to launch an online platform to treat patients remotely – think Skype, but for when someone needs help with a sudden cold or rash.
The regional hospital announced Monday the launch of Care Anywhere, a private remote-access platform that can be downloaded on both Apple and Android app stores and accessed via desktop, tablet or smartphone.

“In today’s busy world, there are times when getting to the doctor’s office just isn’t possible – either it is after office hours or you’re simply unable to make the trip,” said Judy Magalhaes, Jupiter Medical Center’s VP of Ambulatory Services.

Founded in 1979, Jupiter Medical Center has about 1,600 team members, 615 physicians and 640 volunteers. The hospital has the capacity to treat more than 300 patients simultaneously on-site, in addition to offering care at three urgent care facilities. The debut of Care Anywhere is the latest, and most tech-oriented, move by the hospital to be more accessible.
Miami Children’s Health System followed a similar route in April with the launch of MCH Anywhere.
The telehealth market is projected to be worth more than $38 billion by 2022, while a consumer survey found that seven out of 10 patients are comfortable with seeing their doctor virtually, instead of in person. Meanwhile, more than 25 states have passed bills requiring insurance companies to cover telehealth appointments.
Source: SFBJ