BLOGS: Womble Commercial Real Estate

Tuesday, July 16, 2013, 3:03 PM

An Ounce of Prevention (and a Dash of Technology, and a Sprig of Innovative Design)

As evidenced by previous posts, innovation in healthcare is rapid, whether it be in the arena of real estate design, apps, or a focus on wellness and prevention.  Here’s an interesting article about a “prototype medical practice of the future”, which incorporates several areas of healthcare innovation.

MD Revolution Offers Blueprint for “Health Management” Practice
Xconomy
By Bruce V. Bigelow

On the seventh floor of a medical office building near Scripps Memorial Hospital La Jolla, Dr. Samir Damani has established a prototype medical practice of the future.

The suite looks more like a spa than a doctor’s office, with modern art mounted on chalk white walls and white-washed wooden floors that bespeak understated elegance and calm. Subtle lighting illuminates enough MacBooks, iPads, and desktop monitors to stock an Apple store, and the shelves display a host of wireless health devices, including a Digifit heart rate monitor, MyFitnessPal calorie counter, and Fitbit activity tracker.

In a whirlwind tour, Damani explains the suite is both a clinical lab and a medical practice that brings together a variety of health and fitness monitoring technologies. As both a practicing cardiologist and researcher, Damani says he came to The Scripps Research Institute to complete a master’s degree in clinical investigation; he was focusing on genomics and the biomarkers of disease when he saw that cardiovascular disease was reaching epidemic proportions among older Americans. Instead of waiting for patients to develop chronic illnesses—and using medical interventions and pharmaceuticals to treat them (at a projected cost of $500 billion by 2015)—Damani says he realized he should be working to help patients improve their metabolism and cardiovascular fitness.

Damani says he founded MD Revolution to manage patients’ health by using a variety of diagnostics and sensors to track the most important indicators of cardiovascular health, and to integrate good nutrition, exercise, and other healthy practices into a holistic program. “We’re not in the game of creating the sensors and hardware,” Damani says. “What we’re doing is integrating all these different platforms into a dashboard that patients can understand and use. We have to really engage people to change their behavior.”

Integrating data from heart monitors, calorie counters, and other sources into a single platform was no trivial task, and Damani says MD Revolution has invested between $500,000 and $1 million in the effort. Since the company was founded in early 2011, it has raised $2.25 million from doctors and other high net-worth individual investors, according to Camille Saltman, who joined MD Revolution in January as president and chief operating officer. She was previously president of Connect, the nonprofit group that supports technology innovation and entrepreneurship in San Diego.

“Unlike many early stage companies, we have revenues from patients, which has enabled us to reduce our burn rate and lessened the need to raise larger amounts of capital,” Saltman says. In pioneering its clinical practice in La Jolla, Saltman says MD Revolution also was able to keep its costs down by applying software developed for the practice to the design of the software platform.
Damani is set to unveil the new software platform, dubbed RevUp, in a scheduled presentation today at the Digital Health Summit in New York. The company describes RevUp as the first Web-based software platform to aggregate mobile tracking tools, genetic and metabolic assessments, and personalized coaching for employee groups, health systems, and physician practices.

In a statement, MD Revolution says, “The system creates a personalized diet and exercise regime for each individual based on health status and goals.” A team that includes two nurse practitioners, nutritionist, and exercise physiologist track each patient’s progress. Each patient can view their own personal health profile online as well—and those who lapse in their workout routine get a call from the MD Revolution team.

By collecting and monitoring such data, RevUp says it can provide the kind of information that employers need to win discounts on medical benefits and other new incentives that are being offered under the federal Affordable Care Act.

The company asserts that over 90 percent of the patients enrolled at MD Revolution “have experienced statistically significant improvements in resting metabolism, body fat, visceral fat reduction, and improvements in cardiorespiratory fitness.” Damani says the latest scientific research shows these are the most important drivers of chronic cardiovascular diseases.
At MD Revolution, he says, “We have not just built a delivery model. We’ve built a business model for a new paradigm in health care.”

Damani anticipates franchising MD Revolution throughout the country, and tells me, “I see this as a Starbucks model for health care.” But Saltman also says a more practical market may be large companies and health care systems that are self-insured—and therefore keenly interested in reducing their soaring employee health costs.

“With the changes under the Affordable Care Act, it became very cost-effective for physicians to keep their patient population as healthy as possible,” Saltman says. So far, MD Revolution counts 250 individual patients in its pilot practice in San Diego, along such corporate clients as Pharmatek and Sharp Healthcare, the San Diego nonprofit regional health care system with more than 14,000 employees and $2.7 billion in revenue last year.

That seems like a good start, although Damani says, “We expect to have 100,000 patients under management by 2017.”

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Friday, February 8, 2013, 3:24 PM

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. 

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Saturday, December 22, 2012, 5:45 PM

Medical Office Building Built to Resist Severe Weather

Given the intense weather of late, I wanted to share this item.  Pee Dee Nephrology, in Florence, SC, is the first medical office building in the nation to earn the Fortified for Safer Business Designation.  The building is designed to resist property damage caused by hurricanes, high winds, earthquakes, wildfires, lightning and hail. 

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Sunday, September 9, 2012, 3:11 PM

Good news on the Medical Office Real Estate Front

We love to hear news like this, don’t we?  Note the mention of healthcare at retail sites – something covered in a previous post on this blog by Phil Runkel.

Medical Office Building Market Heating Up
PRWeb

Will medical office building (MOB) sales soon return to the levels of the boom years of 2006-08?

It’s too soon to tell. But recent MOB sales activity has clearly taken a step in that direction, according to the most recent edition of Healthcare Real Estate Insights™.

HREI™, the only national publication that reports on and analyzes healthcare real estate news and trends, cited new data from the commercial real estate research firm Real Capital Analytics Inc. indicating that the total dollar volume of MOB sales increased sharply during the second quarter (Q2) of 2012. During Q2, there were 183 properties sold with a total value of more than $1.63 billion, according to RCA.

“That is the highest quarterly sales level recorded since the fourth quarter of 2010 and the fourth highest ever – at least since RCA began tracking MOBs sales in the first quarter of 2001,” HREI™ Editor John B. Mugford says. “Even during the MOB sales heyday of 2006-08, only two quarters saw greater sales volume than was recorded last quarter.”

And the rebound might continue, Mr. Mugford adds. “We don’t make predictions. But I can tell you that we are already tracking several large transactions that have either closed or are likely to close before Sept. 30 that could make Q3 another high-volume quarter for MOB sales,” he says.

“One or two quarters are not definitive proof of a sustained market recovery,” Mr. Mugford cautions. “But Q2 was the third consecutive quarter during which MOBs sales topped $1 billion, and that hasn’t happened since Q4 2007 and the first two quarters of 2008. So the recent increase in MOB sales activity certainly suggests that healthcare real estate investment and development have picked up steam.”

Other healthcare real estate trends: ambulatory strategies, repurposing and healthcare at retail sites.

 (Read on at http://news.yahoo.com/medical-office-building-market-heating-150108582.html

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Friday, September 7, 2012, 6:21 PM

Medical Groups Increasingly Turning to Real Estate Ownership

I’m seeing great deal of this lately—business owners and medical groups taking advantage of favorable factors to diversify their investments to include real estate ownership. Often, this includes the very building that they currently occupy.  The article below highlights two recent examples from California (from the Sacramento Business Journal):

Owners/users snap up office buildings

“Real estate agents say more small business owners are capitalizing on relatively low real estate prices, motivated sellers and low interest rates to buy property rather than lease.

Such is the case in Roseville, where a medical group bought a 3,650-square-foot office building at 902 Cirby Way for $614,000. The buyer intends to operate a pediatrician office, said Tom Bacci, a Voit Real Estate agent who, along with colleague Jon Walker, represented the seller, Wells Fargo Bank. Another example is on Sun Center Drive in Sacramento, where a medical-billing company bought a 31,680-square-foot building for almost $2 million. Cushman & Wakefield handled that deal.

‘Owner/users are especially active in the buying market as they take advantage of competitive pricing on higher-quality properties,’ Walker said.

Health-related businesses are particularly active, and are leading the way, especially in Roseville and Rocklin, Walker added.”

(Taken in part from Sanford Nax’s article “Owners/users snap up office buildings” in the Sacramento Business Journal, August 31, 2012.)

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Thursday, September 6, 2012, 3:11 PM

Healthcare Project Manager, Architect Reimagine Medical Office Building for New Economic Normal

We’ve been hearing this for years now:  healthcare has to reduce costs and be more efficient.  Smart healthcare real estate players will note this need and proceed accordingly, offering reduced costs and economies of scale. A recent article in Healthcare Design provides a compelling look on how this can be done:
Reimagining the Medical Office Building

Recent shifts in culture, labor, workflow, and design are challenging many of the long-held roles and criteria that dictate how healthcare facilities are developed, designed, and managed. One of the most prevalent trends taking shape as a result of these changes to the nation’s care delivery model is thoughtful reevaluation of the design of medical office buildings (MOBs) and other outpatient facilities.

Not long ago—before these sweeping changes began taking place—most MOBs were designed as multitenant facilities organized to house numerous independent physicians or medical practice groups. Typically, that meant floor plans calling for long public hallways linking numerous separate suites, each with its own entrance, reception area, waiting room, exam rooms, restrooms, physicians and business offices, records storage, staff break room, imaging center, and lab.

However, the transformation of the healthcare industry is forcing providers, designers, and developers to reconsider this sort of isolation and duplication.

In a marked change from just a few years ago, hospitals and health systems now employ more than half of all physicians—and the proportion continues to grow. The impact of this trend alone on MOB design has been remarkable.

This new reality demands that providers, architects, and developers look at MOB design in a new way. Rather than multitenant MOBs, what’s needed are multispecialty MOBs designed to better support physician integration and collaboration, while boosting productivity and efficiency.
Instead of collections of independent doctors’ offices, each with their own infrastructure, future MOBs must be designed to house complementary practices, co-located services, shared support staff, and centralized common areas.

This new breed of multispecialty MOBs will require floor plans that include fewer public hallways—or perhaps no public hallways at all. Main entrances will open into larger, shared reception areas and waiting rooms for all patients, serving as central gateways to all doctors within the facility. Waiting areas will be focal points, and will be designed to provide a soothing, aesthetically pleasing experience while they handle the functions of registration and administration.

Not all spaces can be shared, due to local regulations, American Institute of Architects (AIA) guidelines, or both. However, assuming co-location of the types of medicine being practiced is permitted, many types of shared spaces can be created.

Exam rooms will be organized into groups of standardized pods that can adapt to the ebb and flow of patient demand for particular specialties at any given time. Restrooms, storage, imaging centers, and labs will be shared. Offices for physicians practicing different but complementary specialties will be grouped, facilitating easier interaction and consultation. Break rooms and conference rooms will also be shared, offering additional opportunities for both planned and serendipitous interaction.

Business offices will be centralized—perhaps even eliminated altogether, if those functions are absorbed by employer-hospitals. Even some medical personnel and support staff will be shared, cross-trained, and cross-utilized. MOBs will increasingly incorporate shared conference centers and auditoriums, in both common areas and suites, for staff training and patient education.

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