healthcare real estate seminar
DESCRIPTION
Seminar on important factors in selecting healthcare real estate.TRANSCRIPT
HEALTHCARE Realty & Development Services
Building Foundations for the Future
Medical Practice Real Estate Strategies
HEALTHCARE Realty & Development Services
Real Estate Strategies
There are 3 components to medical real estate-
OperationsLocationDesign & Construction
HEALTHCARE Realty & Development Services
We discussed “Operations” in Part 1:
Operations determines the physical function of the proposed facility and location.
Three Components
Location Design
Operations
HEALTHCARE Realty & Development Services
Real Estate is an investment?
Your “plant” is an investment that you investmoney in every month in the form of:
Rent or mortgage paymentsUtilitiesMaintenance & repairsManagementTaxes & InsuranceCapital improvementsTime
HEALTHCARE Realty & Development Services
Maximize your investment through analysis!
Location & SiteDemographicsCompetitionAccess to servicesAccess to referralsFinancial FeasibilityOwnership
HEALTHCARE Realty & Development Services
Location, Location, Location …
• A good location provides:• Transportation Access• Easy site accessibility• Visibility & Signage• Adequate Parking• Utilities
HEALTHCARE Realty & Development Services
Here is a recent example:
HEALTHCARE Realty & Development Services
Demographics:
Age of local populationPopulation densityEmploymentPayor mixIncidence of diseaseCompetitorsPotential referral partnersPotential services partnersComplementary services
HEALTHCARE Realty & Development Services
Financial Feasibility
Own or leaseEquity & Debt requiredOperating expensesStartup expensesStaffingIncome projectionsAppreciation/depreciationTax consequencesCredit and borrowing capacityExit strategy
HEALTHCARE Realty & Development Services
Some basic questions:
How much space do you need?Do you prefer to own or rent?In what general area would you like to locate?When do you need it?How much do you want to spend?What length of term, if lease?Will you pay for improvements if needed?
HEALTHCARE Realty & Development Services
How much space do you need?
How much space do you have?Where does it hurt?Are you adding services?Are you adding physicians or extenders?Prepare a Program of Spaces
HEALTHCARE Realty & Development Services
Helpful planning hints:Physician % 1,500 sfWaiting % 18 sf/per patientReception / Intake 75 sf for first, 50 sf for each additionalExam room % 100 sfMD office % 150 % 180 sfProcedure room % 160 sfBathrooms % 60 sfNurse station % 40 sf per personStorage % 80 sf / 1,000 sfParking % 7 spaces/ 1,000 sfParking lot % 400 sf/parking space
HEALTHCARE Realty & Development Services
Ownership
Advantages:
Appreciation in valueDebt reduction %pay downprinciple each paymentTax benefitsControl over property & useStable occupancy costs
Disadvantages:
Long term debt (20 % 30 years)
Significant down payment(25%)Less flexibility- react tomarket conditionsDisposition- specialized bydesign
HEALTHCARE Realty & Development Services
Leasing
Advantages:
Equity - very little cash is requiredDebt - a lease is a financial obligation but does not require long term debt. This cash can be used to invest elsewhereTerm - leases tend to offer greater flexibility due to the shortness of the term
Disadvantages:
Cost - leased space costs more to provide a return on investment to the ownersFlexibility - less flexibility - may be required to relocate within buildingTenant Improvements - approval required for improvements to the spaceControl % less control over other occupants and uses
HEALTHCARE Realty & Development Services
How to find space:
Word of mouthAdvertisements(Craigslist, newspaper,flyer)LWDA (not MBWA)Internet searchSolicitationsHire a real estate agent
HEALTHCARE Realty & Development Services
How much space are you getting?
HEALTHCARE Realty & Development Services
How much space are you REALLY getting?
HEALTHCARE Realty & Development Services
A word about Brokers:
Commercial vs residentialLarge companies vs smallHow are they paid Benefits of using a healthcare brokerWhat to expectIncreasing broker effectiveness
HEALTHCARE Realty & Development Services
Leasing Real Estate
The nuts and bolts of protecting yourself!!
HEALTHCARE Realty & Development Services
Know how much space you are getting!
HEALTHCARE Realty & Development Services
What is included in rent?
UtilitiesSuite MaintenanceCommon area chargesAmortized tenant improvementsReal estate taxesProperty insuranceManagement feeCapital repairs & replacement (HVAC)
HEALTHCARE Realty & Development Services
What are lease terms?
Length of leaseAnnual escalationsDeposits requiredRenewal termsTenant improvement allowanceTax treatment of improvementsImportant Clauses
HEALTHCARE Realty & Development Services
Tenant Improvement Considerations
How much will owner contributeWill owner finance amount over allowanceWho pays architectWho pays impact feesIs a construction period providedHow long is construction periodWhat may I take at lease endTax treatment of improvements
HEALTHCARE Realty & Development Services
Important lease clauses!
Relocation
Exclusivity
Approved occupancies
Holdover
Restrictions on use
Hours of operation
Return to original condition
First right of refusal on
adjacent space
HEALTHCARE Realty & Development Services
Buying Real Estate
The nuts and bolts of protecting yourself!!
HEALTHCARE Realty & Development Services
Due Diligence is Required!
Need 60 % 90 days to assess property:EnvironmentalZoningUtilitiesEndangered speciesWetlandsSoils compaction / sinkholesSurvey / encroachmentsEasementsTitle defectsDeed restrictions
HEALTHCARE Realty & Development Services
Need time to arrange financing!
Can be pursued concurrent with due diligence.
Need 30 days upon completion of due diligence for commercial financing
HEALTHCARE Realty & Development Services
Buy more property than you need!
Do not constrain future growth by purchasing property that meets your current needs.
Provide additional space for expansion.
HEALTHCARE Realty & Development Services
Building a new Facility
The nuts and bolts of protecting yourself!!
HEALTHCARE Realty & Development Services
So, you want to build!
Important Considerations:
It always takes longer than you thinkIt always costs more than you thinkYou will make changes along the wayThere will be important and timely decisions requiredRemember % this is a “plant”Select the right TEAM
HEALTHCARE Realty & Development Services
Your TEAM consists of:
LenderAttorneyAccountantReal estate advisorArchitectBuilding ContractorOwner’s representative
HEALTHCARE Realty & Development Services
Development Timeline
Design period |Permitting | Bidding | Select Builder |Construction
Traditional Process
Design / Build -30% faster
Design Period | Permitting | Construction PricingMobilization
HEALTHCARE Realty & Development Services
Some typical cost considerations
Design Fees 4 % 7%Paint and flooring: $15 / sfDemolition $7/sfMinor renovations: $18 - $25 / sfNew building shell: $80 /sfStandard interior improvements: $50/sfModerate interior improvements: $65/sfSurgical / Diagnostic Radiology: $85 - $125/sf
HEALTHCARE Realty & Development Services
Key factors for success
Architect and contractor must have medical experienceMust create and adhere to a scheduleMust create and adhere to the budgetLimit changes after permitting
HEALTHCARE Realty & Development Services
Conclusion
The decision to own, lease or construct a new facility is an important practice and financial consideration.
This decision will likely impact the direction of your practice for many years and should not be undertaken without professional advice and consultation.
HEALTHCARE Realty & Development Services
For more information
Frank RicciPrincipal
Healthcare Realty & Development Services300 N. New York Avenue, #2802
Winter Park, Fl 32789
Ph: 407-947-5074Email: [email protected]