Telehealth: A Different (but not to be Ignored) Area of Healthcare Real Estate

Healthcare providers are looking to move what they can off-site, getting what they can into lower cost real estate. Traditionally healthcare real estate (e.g., MOBs and ASCs) can be high cost, both in the initial development and in the maintenance.  The healthcare industry is information intense, service-based in many respects, and pressed to reduce costs. 

Telehealth centers can help address all of these issues, by moving certain client services to lower cost real estate.  Thus, it makes sense that we would see growth in telehealth. 

It may not be what we traditionally think of when we contemplate healthcare real estate, but healthcare real estate is not an area in which we can afford to only think of in traditional terms.  In order to help our healthcare clients succeed, we need to think outside of the same-old-same-old, and be in the know with respect to such real world solutions and opportunities.

Read more about telehealth by clicking here, here, and here.

Medical Office Space and Repurposing (but this time, it’s not what you think)

We’ve covered the repurposing of properties (mainly retail) into healthcare real estate, but we haven’t seen this before – repurposing medical office space into a non-healthcare use.  You can read about this anomaly here:  “Kingston celebrates new city hall, a former medical office building”.

Medical Office Today Talks Timeshares With Girardeau And McDermott

The lure of timesharing a medical office can be a compelling one, but attorneys Jill Girardeau and Gary McDermott talk with Medical Office Today about why it can be a complicated endeavor.

In the article, online here, Girardeau and McDermott explain that while there are certainly advantages to using a timeshare office, such as lower overhead and expanding services, the contract and logistics must be carefully thought out.

"I think the trickiest issue is protecting yourself against violations of kickback laws and the Stark Law,” McDermott said. “What might seem reasonable in a typical landlord-tenant scenario can get you in hot water when medical practices are concerned."

Read more...

MOB Financing Pointers

In the article "Tips for Pain-Free MOB Financing", Greg Vieceli gives a few things to consider when contemplating medical office building ownership and financing.  In short, they are:

1.  More MDs and specialties can mean less risk.
2.  Get the partners to have skin in the game via a lease agreement and/or personal guaranties.
3.  Financial transparency.
4.  Designating a group representative.
5.  And of course - location, location, location.

To read this article, visit Medical Office Today's website -
http://www.medicalofficetoday.com/article/tips-pain-free-mob-financing

Virtual Visits

A new study purportedly suggests that “virtual visits” to healthcare providers for certain infections may be as effective as, and cheaper than, in-person in-office visits.  The researchers’ rough estimate of the cost difference with respect to treating a patient with a reported UTI was $74 per e-visit vs. $93 for an office visit.  Query, what are the implications for proper patient screening and care; patient savings; efficiencies; return visit frequencies; over-prescribing antibiotics; access to healthcare; and healthcare real estate needs, costs, and returns on costs per square footage?

Read more at:

“Virtual visits to doctor may be cheaper than and as effective as in-person visits”

http://www.washingtonpost.com/national/health-science/virtual-visits-to-doctor-may-be-cheaper-than-and-as-effective-as-in-person-visits/2013/01/18/8237c028-601e-11e2-a389-ee565c81c565_story.html

Healthcare Real Estate Trends

In healthcare the one constant is change.  Recently we’ve seen changes in healthcare (and by extension, healthcare real estate) because of The Great Recession, lower reimbursements, healthcare reform, mergers and repurposing (to name a few).  Below are six trends for this year that Duke Realty predicted at the outset of this year.  Now that we have four months of 2013 under our belts, it’s a good time to look back and see how these have played out, and, just as importantly, look forward… and be ready for more change…

1.              Higher-acuity care will increasingly move to medical office buildings.

2.              Freestanding emergency departments will be used in new ways.

3.              Partnering will increase.

4.              The case for hospital-driven monetizations will keep getting stronger.

5.              Repurposing will expand.

6.              Compliance will become even more vital.

I encourage you to read more at:

“Six Healthcare Real Estate Trends to Watch in 2013”

http://www.dukerealty.com/media-releases/2013/01/six-healthcare-real-estate-trends-to-watch-in-2013/

BOMA’s 2013 MOB Conference

This will be the fourth year in a row that Phil (one of the other contributors to this blog) and I have attended this conference.  It’s a great conference for all of us healthcare real estate people.  Here’s a good, brief summary of this conference, from BOMA:

“Join more than 700 healthcare real estate executives, CFOs, developers, investors, lenders, facility managers, advisors and architects as they come together to discuss current issues and trends in developing, leasing and managing medical office buildings and other ambulatory care facilities. This comprehensive two-day conference focuses exclusively on healthcare real estate and includes case studies, roundtables, panel discussions, interactive sessions and keynote addresses focused on issues and trends in healthcare and their impact on healthcare real estate.”

I consider it the year's “can't miss” healthcare real estate event.

BOMA’s 2013 MOB Conference is May 1-3, 2013, in San Francisco, CA. 

For more details and to register, go to: http://www.boma.org/TrainingAndEducation/MedicalOfficeBuildings/Pages/default.aspx

“bombarded with inquiries”

If you’re a player in the healthcare real estate arena, then you have to love hearing about a developer getting “bombarded with inquiries” from potential healthcare tenants after announcing a second phase of a medical and retail development.  To read about this, the “hub and spoke” model that we hear so much about in healthcare real estate, expectations of a continued growing market for certain healthcare real estate, and how that good old fashioned adage “location, location, location” seems to still ring true, go to http://www.nashvilleledger.com/editorial/Article.aspx?id=61845.

The Health and Trends of Healthcare Real Estate

I recommend this quick read on healthcare real estate.  Although it’s not an extremely recent article, I believe that it still captures some of the healthcare real estate trends well, and it will serve as a good foundation for some coming blog posts.  Some of these then coming trends were discussed years ago at the BOMA MOB Conference (e.g., the push for ambulatory care facilities because of crowded, costly ERs).

Market remains ripe for medical real estate

October 01, 2012 | James Ellis and Aaron Razavi

http://www.healthcarefinancenews.com/blog/market-remains-ripe-medical-real-estate

Healthcare Providers Push Forward with Significant Construction or Renovation Projects

Some healthcare providers are making large capital investments in their facilities.  Here are some articles evidencing this:

For plenty of good news from Kentucky, see Hospital Boom Continues in Kentucky at http://www.lanereport.com/10881/2012/09/hospital-boom-continues/. 

For some good news from Florida, see Florida Hospital to announce $270 millions plan for three women’s health towers at http://articles.orlandosentinel.com/2012-09-18/health/os-florida-hospital-womens-health-20120917_1_orlando-health-towers-capital-investment.

And of course we can’t forget the $1.1 billion project by Johns Hopkins, which some have called the “hotel-like hospital project”.  Here is just one of many articles on this project:  Johns Hopkins unveils new hospital, at http://www.baltimoresun.com/health/bs-hs-new-hopkins-hospital-20120126,0,5336130.story.

Healthcare Real Estate and the Affordable Care Act

The US Supreme Court has ruled regarding the Affordable Care Act (the “ACA”), and Obama has won a second term in the White House.  Now that much of the big picture uncertainty regarding the ACA is gone, it’s time for healthcare providers, healthcare real estate developers, investors, and other such players in this arena, to move forward with the ACA’s effects in mind.

Below is a link to a reasonably quick read that I think you will find worth your time if you are ready to start thinking about healthcare real estate with the ACA in mind (which you should, if you haven’t already).  Teasers: “Many [healthcare] systems have already taken steps to expand their real estate needs to accommodate this anticipated increased demand for care” and “This uncertainty fueled today’s pent-up demand for medical real estate that is now being released.”

Affordable Care Act boost for medical offices

Dec 22, 2012 | Written by Mark Alexander

http://www.news-press.com/article/20121223/RE/312230035/Affordable-Care-Act-boost-medical-offices?nclick_check=1