Though news reports and predictions painted a gloomy picture, the U.S. economy actually ended 2013 with a record setting year on Wall Street. The Dow Jones Industrial Average finished up 26.5%, its best return since 1995, and the S&P up nearly 30%, shattering previous records.
(See past articles from CBRE Healthcare)
Momentum continues to build in the housing market with positive trends in pricing, new housing starts, and inventory volume across the country. The U.S. economy added 74,000 jobs in December, as the unemployment rate fell to 6.7%, according to the Bureau of Labor Statistics.
With an improving economy and an unprecedented stimulus from the Federal Reserve continuing through 2014, the macro-economic outlook is good.
Healthcare Reform
Meanwhile, the healthcare industry has been rapidly evolving under the Affordable Care Act (ACA). Healthcare reform has compelled health systems, hospitals and physician groups to rein in sky-high costs while improving the quality of care, often coping with more regulatory requirements and less money.
Changes to reimbursement methods and reductions in healthcare provider compensation combined with an increased demand for healthcare services over the next five years, from an estimated 79 million aging baby boomers and 30 million newly insured patients, is forcing health systems to rethink their approach to balance sheet assets and liabilities, including health care real estate.
As health systems and physician groups change their delivery network, both healthcare service operators and owners of healthcare real estate are repositioning their portfolio requirements based on their growth needs. This has led to the highest medical office sales volume in the healthcare capital markets since 2007.
Healthcare reform incentives are driving consolidation of services in the industry, which has produced a robust mergers and acquisitions environment. As hospitals and healthcare organizations face mounting competitive, regulatory and financial challenges, leadership is seeking ways to capitalize on the increase of privately insured patients and Medicaid expansion while effectively serving the interests of their communities.
Healthcare operators need to diversify and expand their patient base while also becoming more efficient and leaner. This is most effectively achieved through greater economies of scale by merging with other health systems, hospitals, and physician groups, leading to a consolidation in the industry.
Consolidation is taking on two forms that are impacting real estate. First, is a unification of real estate assets as a result of health system mergers and physician employment, which has caused a consolidation of physician practices into fewer facilities that are strategically dispersed throughout the community. The other is consolidation among the hospitals and health systems seeking to concentrate operations in a single Metropolitan Statistical Area (MSA), region or state.
Off-Campus Healthcare
Healthcare investors are monitoring the consolidation trends and strategically aligning themselves through real estate transactions with market dominant hospitals and health systems, specifically those with investment grade credit ratings. Historically, investment in medical office properties revealed an institutional and REIT investor preference for core on-campus properties only.
However, over the past 12-18 months, we have witnessed little difference between core on-campus and core off-campus medical office buildings with meaningful hospital tenancy. This is a direct result of the health system shift to high quality healthcare delivered in outpatient facilities further away from traditional acute-care hospital campuses.
The care delivery network is moving from the busy, compact hospital campuses to off-campus outpatient settings with convenient access where patients live, work and shop. In response to healthcare providers commitment to off-campus destinations located near traditional retail properties and close to residential neighborhoods, investors have modified their investment criteria with a focus on off-campus properties.
The buyer pool for healthcare real estate has steadily increased over the last couple of years as investors continue to realize the inherent stability and higher returns for medical properties when compared to the more competitive multi-family, office, retail, and industrial real estate markets.
Public healthcare REITs have historically dominated the medical office investment market share, but in 2013 the private healthcare REITs and private capital investors took over the top slots. Listed and non-listed U.S. equity REITs (including both Public and Private) raised a total of $76.96 billion of equity and debt in 2013, an amount that surpassed 2012’s prior record of $73.33 billion, according to the National Association of Real Estate Investment Trusts (NAREIT). Nearly $9.3 billion, or roughly 12% was attributed to the Healthcare sector.
Conclusion
We anticipate another active year in healthcare capital markets for 2014. All investors will have stable access to capital and interest rates will likely remain at historic lows.
The favorable macro-economic outlook and consolidation among healthcare providers and continuous modification of the healthcare delivery model will continue to fuel the investment engine for what could be another record year in medical office sales.
About the authors
Lee Asher (Lee.Asher@cbre.com) and Chris Bodnar (Chris.Bodnar@cbre.com) are both Senior Vice Presidents with CBRE Healthcare Capital Markets Group. For more on CBRE Healthcare, visit www.cbre.com/healthcare.
Related Stories
Codes and Standards | Jun 2, 2022
New design guide for hybrid steel-mass timber frames released
The American Institute of Steel Construction (AISC) has released the first-ever set of U.S. recommendations for hybrid steel frames with mass timber floors, according to a news release.
Mass Timber | Jun 2, 2022
Brooklyn is home to New York City’s first mass timber condo building
In the Brooklyn neighborhood of Park Slope, the newly completed Timber House is New York City’s first mass timber condominium building and its largest mass timber project (by height and square footage).
Codes and Standards | Jun 1, 2022
HKS, U. of Texas Dallas partner on brain health study
HKS and The University of Texas at Dallas’ Center for BrainHealth are conducting a six-month study to improve the way the firm’s employees work, collaborate, and innovate, both individually and as an organization, according to a news release.
Building Team | Jun 1, 2022
Pennsylvania’s Longwood Gardens to get a $250 million transformation
Longwood Gardens, a botanical garden with about 1,100 acres in Pennsylvania’s Brandywine Valley, recently announced plans to transform its core area of conservatory gardens.
Mass Timber | May 31, 2022
Tall mass timber buildings number 139 worldwide
An audit of tall mass timber buildings turned up 139 such structures around the world either complete, under construction, or proposed.
Hotel Facilities | May 31, 2022
Checking out: Tips for converting hotels to housing
Many building owners are considering repositioning their hotels into another property type, such as senior living communities and rental apartments. Here's advice for getting started.
Museums | May 31, 2022
University of Texas at Dallas breaks ground on new 12-acre cultural district
The University of Texas at Dallas (UT Dallas) recently broke ground on the Crow Museum of Asian Art, the first phase of a new 12-acre cultural district on campus.
BAS and Security | May 26, 2022
Can your intelligent building outsmart hackers?
ESD's security services studio leader Coleman Wolf offers tips, advice, and lessons for protecting real estate assets from cyberattacks.
Sports and Recreational Facilities | May 26, 2022
WNBA practice facility will offer training opportunities for female athletes and youth
The Seattle Storm’s Center for Basketball Performance will feature amenities for community youth, including basketball courts, a nutrition center, and strength and conditioning training spaces.
Multifamily Housing | May 25, 2022
9 noteworthy multifamily developments to debut in 2022
A 1980s-era shopping mall turned mixed-use housing and a mid-rise multifamily tower with unusual rowhomes highlight the innovative multifamily developments to debut recently.