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
| Dec 22, 2014
Skanska to build Miami’s Patricia and Phillip Frost Museum of Science
Designed by Grimshaw Architects, the 250,000-sf museum will serve as an economic engine and cultural anchor for Miami’s fast-growing urban core.
| Dec 22, 2014
Studio Gang to design Chicago’s third-tallest skyscraper
The first U.S. real-estate investment by The Wanda Group, owned by China’s richest man, will be an 88-story, 1,148-ft-tall mixed-use tower designed by Jeanne Gang.
| Dec 19, 2014
Zaha Hadid unveils dune-shaped HQ for Emirati environmental management company
Zaha Hadid Architects released designs for the new headquarters of Emirati environmental management company Bee’ah, revealing a structure that references the shape and motion of a sand dune.
| Dec 19, 2014
Chicago Architecture Biennial to hold 'Lakefront Kiosk Competition'
The first Chicago Architecture Biennial will take place from October 2015-January 2016, with a theme of "The State of the Art of Architecture."
| Dec 18, 2014
Frank Lloyd Wright's Taliesin West to be recreated—with LEGO
Containing more than 180,000 LEGO bricks in 11 colors and 120 different shapes, the model measures eight by four feet and is made entirely of standard LEGO parts.
| Dec 18, 2014
11 new highs for tall buildings: CTBUH recaps the year's top moments in skyscraper construction
The Council on Tall Buildings and Urban Habitat cherrypicked the top moments from 2014, including a record concrete pour, a cautionary note about high-rise development, and two men's daring feat.
| Dec 18, 2014
International Parking Institute and Green Parking Council collaborate with GBCI
The new collaboration recognizes importance of sustainable parking facility design and management to the built environment.
| Dec 18, 2014
Top 10 sports facilities of 2014: Designboom ranks the year's best projects
The list includes some of the year's epic stadiums, such as World Cup Stadium Arena de Amazonia in Manaus, Brazil, and smaller projects, like the Spordtgebouw Sports Centerin the Netherlands.
| Dec 18, 2014
In response to ultra-open and uber-collaborative office environments
Susan Cain’s bestselling 2012 book, "Quiet: The Power of Introverts in a World That Can’t Stop Talking" has made an impact on how we understand our current workforce, recognizing that at least one-third of the people we work with are introverts, writes SRG Partnership's Susan Gust.
| Dec 17, 2014
USGBC announces 2014 Best of Green Schools honorees
Houston's Monarch School was named the K-12 school of the year, and Western Michigan University was honored as the top higher-ed institution, based on environmental programs and education efforts.
