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
| Jun 4, 2014
Market update: A difficult first quarter for construction spending comes to an end
This year's unusually difficult winter took its toll on construction activity. Nonetheless, first quarter spending for all the major groups was up compared to the same period in 2013.
| Jun 4, 2014
Construction team named for Atlanta Braves ballpark
A joint venture between Barton Malow, Brasfield & Gorrie, Mortenson Construction, and New South Construction will build the Atlanta Braves ballpark, which is scheduled to open in early 2017. Check out the latest renderings of the plan.
| Jun 3, 2014
Must see: World's tallest LEGO tower built in Budapest
The tower, built in front of St. Stephen's Basilica, is topped with a Rubik's cube and was built using thousands of blocks.
| Jun 3, 2014
Great leadership comes down to one thing
While it’s often said that strong leadership is an organization’s competitive advantage, is there a single characteristic that can predict which leaders will be most effective? SPONSORED CONTENT
| Jun 3, 2014
Libeskind's latest skyscraper breaks ground in the Philippines
The Century Spire, Daniel Libeskind's latest project, has just broken ground in Century City, southwest of Manila. It is meant to accommodate apartments and offices.
| Jun 2, 2014
Registration is open for 2014 BUILDINGChicago/Greening the Heartland Expo and Conference
BUILDINGChicago is a major conference and trade expo serving architects, engineers, contractors, property owners, real estate developers, government officials and community organizations in the Midwest.
| Jun 2, 2014
Nonresidential construction spending expands in April
Ten of 16 nonresidential construction subsectors posted increases in spending in April, according to the latest U.S. Census Bureau data.
| Jun 2, 2014
Parking structures group launches LEED-type program for parking garages
The Green Parking Council, an affiliate of the International Parking Institute, has launched the Green Garage Certification program, the parking industry equivalent of LEED certification.
| Jun 2, 2014
SOM unveils plans for Miami transit hub
The elevated station will be a key portal within All Aboard Florida’s rail system, the nation's only privately owned, operated, and financed rail network.
| Jun 1, 2014
Architect license upon graduation? NCARB aims to accelerate licensing process
Incorporating internship and examination requirements into university education, the regulatory organization looks to simplify and shorten the licensing process.
