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
Office Buildings | Jun 9, 2015
Hines planning $300 million office tower for Denver skyline
Designed by Pickard Chilton, the 640,000-sf tower is geared for large-scale tenants, with features like floor-to-ceiling glass, a 5,000-sf fitness center, a tenant lounge, and a series of outdoor terraces.
Architects | Jun 3, 2015
LEGO: An introduction to design
LEGO has changed a lot over the years, but has that been a good thing for encouraging creativity?
Cultural Facilities | Jun 2, 2015
Snøhetta and Dialog to revitalize Willamette Falls area in Oregon
As part of the plan, an abandoned paper mill will be repurposed, while landscaping and running trails will be added.
Office Buildings | Jun 1, 2015
SHoP Architects unveils dual-glass-box scheme for Uber HQ
The plan involves two glass buildings connected with criss-crossing bridges.
Contractors | Jun 1, 2015
Nonresidential construction spending surges in April
Nonresidential construction is up by a solid 8.8% over the past year, consistent with ABC's forecast of high single-digit growth.
Office Buildings | Jun 1, 2015
Can you make a new building as cool as a warehouse?
Just as we looked at that boarded up warehouse and thought it could be something other, office towers can be reborn, writes CannonDesign's Robert Benson.
Fire and Life Safety | May 27, 2015
7 bold applications and innovations for fire and life safety
BD+C’s roundup features colorful sprinklers for offices, hotels, museums; a fire-rated curtain wall at a transit hub in Manhattan; a combination CO/smoke detector; and more.
BIM and Information Technology | May 27, 2015
4 projects honored with AIA TAP Innovation Awards for excellence in BIM and project delivery
Morphosis Architects' Emerson College building in Los Angeles and the University of Delaware’s ISE Lab are among the projects honored by AIA for their use of BIM/VDC tools.
Healthcare Facilities | May 27, 2015
Rochester, Minn., looks to escape Twin Cities’ shadow with $6.5 billion biotech development
The 20-year plan would also be a boon to Mayo Clinic, this city’s best-known address.
BIM and Information Technology | May 26, 2015
Lego-like model building kit was created by an architect for architects
Arckit, as the system is called, was designed to a 1:48 scale, making it easy to create models accurate to the real-life, physical building projected.