Healthcare Real Estate Advisory Services Representing
Healthcare Providers & Systems, Physician Groups & Independent Practices

We’re with you the whole way. We conduct an extensive upfront interview with clients, determine their unique circumstances and resolve any outstanding issues. After completing that, we present an actionable plan.  We are committed to our core pillars throughout the process of our healthcare provider real estate transactions. These guiding principles have proven successful time and time again.

• Improved patient experience
• Physician alignment & staff retention
• Efficient cost control
• Enhanced outcomes & quality of care

1. Purchasing real estate: After our initial interview and decision to move forward, we coordinate with our client’s established attorneys with offer preparations, term negotiations and offer acceptance. We continually focus on cost and time constraint details throughout the process to equip clients with powerful decision-making information.  Our services include term sheet preparation and full negotiations which can save time with attorneys.  We monitor and advance the following topics through closing:
   • Governmental approvals
   • Environmental surveys
   • Inspections
   • Appraisals
   • Loan adherence and approvals
   • Sworn construction statements
   • Architectural drawings (including bid sets)
   • Permit sets and full construction drawings
   • Titles and closings

2. Selling real estate: Our Broker Opinion of Value can help determine market value and identify strategies to increase sale price. As a part of our process, we may advise our clients to expand the functionality of their facility to include other business industries, which draws a broader buyer market and often multiple offers. We follow every detail of a sale transaction, including the buyer's responsibilities so the transaction has the highest likelihood of closing with the best outcomes. Common situations for selling real estate
   • Dispositions of excess sites
   • Monetization (sell asset and lease back)
   • Relocation
   • Consolidation
   • Merger
   • Changing demographics
   • Changing governmental reimbursement
   • Redundancy
   • Retirement of principles

3. Relocating: Delivering healthcare in a construction zone can be difficult. Often, it’s easier to relocate a clinic than it is to remodel an existing one. Remodeling can impact clinic production, or increase after-hours labor costs Whether you’re looking to buy or lease, we serve our clients through strategic relocations.
4. Lease: From site selection and lease term negotiations, we are with our clients all the way. Our process ensures the planning is in place before the lease is signed to meet or exceed our client’s timeline and quality expectations. We pay attention to provider needs, staff drivers, efficiencies and alignment.  We ensure vendors’ needs are met to allow the time and resources for an exceptional final delivery.  We believe the costs associated with opening a facility can be offset by resuming production and in turn, realize revenue quicker. Our process is designed to save time and create efficiencies.
5. Renew: Lease renewal is an often-overlooked opportunity to negotiate additional benefits from the Landlord. We help our clients remove previous amortized rental costs, receive additional tenant improvement dollars, and negotiate other rights or opportunities that benefit the provider.
6. Sublease: When a site becomes unnecessary, it may be beneficial to sublet the remaining term of a leased premises. Or conversely, it can be an economical option for a provider to sublease space. We investigate the reason for the sublease, so our clients benefit as much as possible, either way.
7. Development: Developing a facility to a provider’s exact needs can be the perfect solution. A precise location, efficient economics, and predictable long-term maintenance are the benefits of development.  We assist our clients in choosing the location; vetting the right developer and appropriate lender, negotiating lease terms and finding other tenants for the medical development.  We pay attention to all of the components of a development so the anticipated outcome is achieved.
8. Monetization strategy: An owned facility has its long-term benefits within a provider’s portfolio. However, there are times when a provider needs to liquidate their real estate to deliver care in other ways. The right solution may be to monetize (sale-lease-back) the owned asset.  We help design a marketable lease that fits our client’s exact needs.  We hand-pick the right medical landlord who can purchase the facility, providing the needed cash to our provider client. A good monetization strategy can optimize operational efficiency while unlocking needed capital.
9. Advisory: Visit the Healthcare Real Estate Advisory section.
10. Regulation compliance: Visit the Healthcare Real Estate Advisory section.

Healthcare Real Estate Advisory Services Representing
Medical Investors & Landlords

1. Broker Opinion of Value (BOV): Investors and Landlords need to determine Market Value for various reasons. It may be for lease rate, renewal terms, or a building sale or purchase price.  For an investor or landlord, a thorough BOV provides information about market lease rates or property value. Our analysis also identifies strategies to retain tenants, stabilize assets and increase value. Our BOV helps identify the true opportunity of an asset.
2. Healthcare Real Estate (HCRE) Investing: We work with buyers and sellers of medical facilities or medical office buildings (MOBs). We provide buyers options in a recession resistant asset class.  Often HCRE has long-term leases (10+ years) and high credit/low risk tenants. Healthcare leases are usually triple-net; meaning tenants pay property taxes, building insurance, and most maintenance expenses.  We represent buyers and sellers for all medical assets from Class A to value-add with their healthcare real estate investments..
3. Landlord Lease Listing: We know the target audience and what is attractive in lease opportunities because we’ve worked extensively with medical tenants as clients. We understand medical tenants’ perspectives and have many relationships with landlords and medical vendors in the industry. We believe it’s important to identify medical tenants that have synergy with other medical tenants in the building and their hospital affiliation. This synergy creates referrals, enhanced patient experience and longer-term tenancy. We are experienced with new leases and lease renewal negotiations. We have a thorough understanding of market rental rates and net effective rates.  Real Estate legalities such as the Anti-kickback Statute and Physician Self-Referral Laws (Stark Laws) are a part of our processes when applicable to factor in with the strategy.
4. Gap Analysis: Gap analysis is important for all in healthcare real estate.  A provider may look for areas that have a high quantity of patients, less competitors, or available work force.  A landlord may have healthcare facility vacancies and look for missing specialties in the area where the facility is located to better market and attract tenants. A developer or investor may want a Gap Analysis to understand long-term implications of varying demands on their projects. Regardless the perspective, we conduct an extensive upfront interview with clients, dissect their unique circumstances and translate them into actionable decisions. Gap analysis determines:
   1. Where holes are between competition, or other providers that may align
   2. Ideal Locations for doctors, staff, patients and communities
   3. The demographics to support a particular specialty

5. Tenant mix study: Tenant Mix can be important for efficient care delivery.  For example, an OBGYN clinic who operates a Mother Baby center, may choose a hospital connected medical building (MOB). It enables doctors, staff and patients to transfer between their clinic and the hospital with ease, such as through the skyway. Another consideration in tenant mix is leveraging synergistic practices. Some types of practices benefit by neighboring others, especially within the same health care system.
6. Advisory: Visit the Healthcare Real Estate Advisory page

Healthcare Real Estate Advisory Services

We offer real estate advisory services for healthcare providers, investors or landlords. We use robust software tools provide precise data, taking out the guesswork to make resourceful real estate decisions.

1. Broker opinion of value (BOV): Providers, Investors and Landlords all have the need to determine Market Value. This can be for STARK Law/Anti-Kickback Statute compliance, lease rate, renewal terms, building sale or purchase price.  For an investor or landlord, a thorough BOV can help you understand market lease rates and property value.  Our analysis also identifies strategies to retain tenants, stabilize assets and increase value.  For a Provider, Buyer or Lessee, it ensures the rate, price or terms are at market. For all of our clients, our BOV can help identify the true opportunity of an asset.
2. Strategic planning: Creating a strategic, long term plan will make the most of your resources as you grow. We collaborate with our clients to outline key values and objectives, identify opportunities and build a sustainable strategic plan.
3. Portfolio optimization: After a deep-dive of a client’s current real estate assets, we provide recommended adjustments to enhance overall portfolio performance. We study existing leases, owned assets, and when applicable the asset mix. We consider what services are delivered – where and to what populations – for the best real estate method to deliver our client’s healthcare services. This study may include strategic planning (long term view) or stand alone.
4. Transaction management: Throughout transactions, we remain conscious of all the details and variables to remove barriers, which accelerates the process to resume patient care quickly. The shortened timeline direct effects early realization of production revenue, offsetting improvement or relocation costs.
5. Lease administration: Our lease administration includes abstracting and monitoring lease details throughout its term on behalf of our clients. Key examples are notice periods and deadlines for intent to renew or vacate, or utilizing all tenant improvement dollars available funded by landlord.
6. Demographic & GIS analysis: Our technology provides rich data, and visual charts and maps from geographic studies of populations to guide location decisions. Leveraging GIS tools can benefit patients and staff with precise placement of where people live and work, as well as community and amenity considerations.
7. Buy vs. Lease analysis: Many of our healthcare clients need to determine if they should buy or lease a facility. This is an important exercise to review because overtime, owning vs. leasing can financially balance out. Clients may want control of owning their real estate or want the ease of leasing and working with a landlord. Owning can give a perception of more control, but ultimately adds a burden with additional responsibility. However, owning may have tax advantages and management savings. There are many different motivators and criteria to consider, including factors beyond money. We consult with clients to evaluate their unique circumstances and how the economics play out in relation to their strategic long-term plan.
8. Gap analysis: Gap analysis is important for all in healthcare real estate.  A provider may look for areas that have a high quantity of patients, less competitors, or available work force.  A landlord may have healthcare facility vacancies and look for missing specialties in the area where the facility is located to better market and attract tenants. A developer or investor may want a Gap Analysis to understand long-term implications of varying demands on their projects. Regardless the perspective, we conduct an extensive upfront interview with clients, dissect their unique circumstances and translate them into actionable decisions. Gap analysis determines:
   • Where holes are between competition, or other providers that may align
   • Ideal Locations for doctors, staff, patients and communities
   • The demographics to support a particular specialty
9. Tenant mix study: Tenant Mix can be important for efficient care delivery. For example, an OBGYN clinic who operates a Mother Baby center, may choose a hospital connected medical building (MOB). It enables doctors, staff and patients to transfer between their clinic and the hospital with ease, such as through the skyway or tunnel. Another consideration in tenant mix is leveraging synergistic practices. Some types of practices benefit by neighboring others, especially within the same health care system.
10. Presale lease analysis: Often, when an Investor wishes to sell a building or a provider who owns a building may wish to monetize the asset (sell the facility and lease it from the new owner), the existing leases may need to be reconstructed.  We analyze leases and create a strategy that serves a tenant’s practice while supporting the seller’s interests. Whether the asset is being prepared to sell or leases need to be realigned, we have the expertise to improve overall performance.
11. Monetization Strategy: A provider who owns a facility may wish to pull equity out of the building to grow, expand locations, attract staff or update equipment. Continuing the same care delivery within the asset, the transaction includes changing to a lease model. Our service starts with a presale analysis, constructing a customized lease, hand-picking your landlord, and selling your building. We have several successful client experiences that benefit long-term goals while attracting a select buyer and future landlord.
12. Regulation compliance: We are well-versed in the latest real estate regulations including those specific to health care transactions for full compliance. We value integrity in all real estate exchanges to avoid under the table deals, kickbacks or leases exceeding the cost of ownership.
    • Stark Law – a healthcare fraud and abuse law prohibiting physicians from self-referral of Medicare and Medicaid patients to entities sharing a financial relationship.
    • Anti-Kickback Statute (AKS) – a health industry statute prohibiting transactions intended to reward referrals for products or services reimbursed by the federal health care programs.
    • Capital Lease – we facilitate an intentional strategy and recognition of the accounting treatment for capital and operating leases. To meet the challenges of financial accounting rules, our healthcare clients often re-examine their current lease practices and review criteria:
      • Own or lease
      • Lease length
      • Balance sheet asset or liability
      • Operating lease
      • Capital lease/finance lease
      • Impact on income statement
      • Profit and loss results