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 | Oct 19, 2023
Proportion of workforce based at home drops to lowest level since pandemic began
The proportion of the U.S. workforce working remotely has dropped considerably since the start of the Covid 19 pandemic, but office vacancy rates continue to rise. Fewer than 26% of households have someone who worked remotely at least one day a week, down sharply from 39% in early 2021, according to the latest Census Bureau Household Pulse Surveys.
Luxury Residential | Oct 18, 2023
One Chicago wins 2023 International Architecture Award
One Chicago, a two-tower luxury residential and mixed-use complex completed last year, has won the 2023 International Architecture Award. The project was led by JDL Development and designed in partnership between architecture firms Goettsch Partners and Hartshorne Plunkard Architecture.
Giants 400 | Oct 17, 2023
Top 130 Sports Facility Architecture Firms for 2023
Populous, Gensler, HOK, and HKS head BD+C's ranking of the nation's largest sports facility architecture and architecture/engineering (AE) firms for 2023, as reported in Building Design+Construction's 2023 Giants 400 Report.
Office Buildings | Oct 16, 2023
The impact of office-to-residential conversion on downtown areas
Gensler's Duanne Render looks at the incentives that could bring more office-to-residential conversions to life.
Giants 400 | Oct 11, 2023
Top 100 Industrial Sector Architecture Firms for 2023
Ware Malcomb, Arcadis, Stantec, and Gresham Smith top the ranking of the nation's largest industrial facility sector architecture and architecture/engineering (AE) firms for 2023, as reported in Building Design+Construction's 2023 Giants 400 Report.
Products and Materials | Oct 10, 2023
‘Works with WELL’ product licensing program launched by International WELL Building Institute
The International WELL Building Institute (IWBI) recently launched the Works with WELL product licensing program. Works with Well certification allows manufacturers to demonstrate that their products align with WELL strategies.
Mass Timber | Oct 10, 2023
New York City launches Mass Timber Studio to spur more wood construction
New York City Economic Development Corporation (NYCEDC) recently launched New York City Mass Timber Studio, “a technical assistance program to support active mass timber development projects in the early phases of project planning and design.”
Government Buildings | Oct 10, 2023
GSA names Elliot Doomes Public Buildings Service Commissioner
The U.S. General Services Administration (GSA) announced that the agency’s Public Buildings Service Commissioner Nina Albert will depart on Oct. 13 and that Elliot Doomes will succeed her.
Esports Arenas | Oct 10, 2023
Modular esports arena attracts more than gamers
As the esports market continues to grow to unprecedented numbers, more facilities are being developed by universities and real estate firms each year.
Higher Education | Oct 10, 2023
Tracking the carbon footprint of higher education campuses in the era of online learning
With more effective use of their facilities, streamlining of administration, and thoughtful adoption of high-quality online learning, colleges and universities can raise enrollment by at least 30%, reducing their carbon footprint per student by 11% and lowering their cost per student by 15% with the same level of instruction and better student support.
