Real Estate for Health Care or BioTech

CHC Ofc

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Real Estate For Clinical Health Care or Biotech Use

Revenue for a healthcare practice can be uneven, pending results of billing vs collections.

% cash per visit

% private pay

% Insurance collections

% from medicare or medicaid collections; if applicable.

If space changes are planned for your practice, how will your revenue fit with space costs?  Analyze to make the right choice.  Apply Occupancy Cost Ratio, some principles from CAHIMS, and project management via CAPM.  Occupancy alternatives are Lease, Buy, Like-Kind Exchange or Sale-Leaseback.

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Lease

Leasing space affords relatively (predictable) fixed costs, includes outsourced management (from the landlord); most of the architectural services, fees and construction costs are borne by the landlord, yet amortized over the life of your lease.  Rent (that often includes electricity) is a business expense, reducing income subject to tax.  The business terms of lease (and renewal) should match the occupancy needs of your practice.

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Own

Pros: Owning has deductible tax advantages: i) mortgage interest, ii) depreciation, iii) property maintenance and groundscape expenses.  Investment advantages: I) equity appreciation, ii) asset appreciation, iii) adds financial value to your practice.

Cons: I) office space is fixed unless you lease extra space until ready to use, ii) you pay/manage construction/rehab to ready the property for use, iii) unexpected repairs [needing funding and project management] lower profits, iv) months to sell vs move at lease expiration.

Other important space expenses are I.T., phones, furniture, fixtures & equipment (their financing rent, maintenance), gas, electric, water/sewer and trash.

If its cost-effective, property management duties can be outsourced to a fee-based vendor.  The vendor typically explains the terms of their engagement in a Service Level Agreement (SLA). SLAs should be more specific about remediating disputes and what service are not included.  Your business manager should manage the performance of that relationship.

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Like-kind Exchange

If moving to sell / buy is preferred, you can defer the capital gains taxes by making a Like-kind exchange; I review the activities necessary to complete this type of transaction.  In general, you must invest all proceeds of sale into the exchanged property within six months of closing on your existing one to defer capital gains taxes from sale.  There are business rules, tax rules and procedures to comply with.

Sale Leaseback

Remaining in your location may be the best choice, yet you want to exit property management to focus on patient care (and practice operations).  A sale-leaseback sells your property to an investor in exchange for a long term lease (7 years or more); business terms of the lease will be negotiated.  You get a big check for your property and flip property management to the investor.  Some doctors have chosen this route over others in 2011 because loans are available for properties supported by reliable rent from creditworthy tenants.

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Real Estate Analysis

How would you know which choice is best for your medical practice?  Applying Occupancy Cost Ratio and vendor analysis methods from CAHIMS helps to sharpen your short list of choices.  BREG Health Care (with transactional contributors to the 7-Point Service) offers an unbiased neutral perspective of your real estate costs, free from fees of a transaction.  We review your space operating costs to produce a complete, cogent report to suggest tangible ways to operate lean and efficiently.  The team reviews market conditions, runs draft analysis to present a rough idea of market conditions to consider.  You get a financial picture of your options with strategic advice of which option to choose.  (You decide how to apply the net proceeds of sale to your medical practice.)

BREG has brokered 19,000rsf of long-term leases on behalf of health care providers and landlords.  If BREG Health Care and Biotech can be of help to your business, please click “Request A Consultation” at the upper right of the screen, write “Health Care of Biotech” in the subject line; add your comments, name, email address and direct dial number to reach you; I reply within 24 hours.  Thanks for reading, perhaps we’ll talk with each other soon. ###

Lease Medical Office Space

If you’re a healthcare services provider facing a need for medical office space, there are multiple moving parts of a lease to consider. (The project is akin to a patient researching / preparing to experience a lengthy procedure with a short recovery time.) The Landlord’s review of your space use, needs of buildout and financial stability of the practice will be evaluated, as a loan officer of a bank would review your loan application; its a large financial investment to make relative to the income expected. Knowing a) your needs, b) how to mitigate the risk, and c) guarantee rent payments, will sell the landlord to accept a lease with your practice. For example, specialty medical chains or hospitals offer the guarantee of a large, financially strong corporation, that rent will always be paid for the duration of the lease; such guarantee is attractive to the landlord (their investors and/or lenders). BREG has leased office space multiple times for established practices and specialty chains that required new building installations; select Case Studies at this link show examples. The outline below offers takeaways to apply to your next office lease deal.

Establish a Committee. Establish a committee to assemble needs, goals and objectives three (3) years before the go-live date for the new space; the time passes fast factoring patient visits, personal lives and project planning. This committee will create the criteria for the space search, office operations equipment, space aesthetics, parking needs, move-in and go-live dates. Members will include a decision maker(s), a project manager versed with construction of medical space, a proofreader of content, a face of the committee (as Single Point of Contact) to the project’s players. Decision members sign off internally or publicly on key aspects of the project; avoiding misunderstood assumptions. This committee keeps the search and secure process moving forward until complete; doctors add input/make decisions when not involved with patients. All committee members (doctors included) must communicate calmly / thoughtfully through the move in date despite unforeseen dramas from the project. (Planning and lead time dilute the impact of these dramas.) When the space is fully prepped for use, add time for all staff to prepare their respective space for use plus a full test drill to ensure everything works as expected for opening day. There should be nominal downtime from opening day of the newly built space.

Identify your needs, goals and objectives of the project. Pre-planning puts time on your side to identify the right location and space, at financial and legal terms favorable to the practice. This is a sizable investment to the landlord; your interests must meet theirs to shake on a deal you’ll mutually accept. Physical attributes are space layout, waiting room size,clerical space, exam rooms, lab rooms, procedure rooms, management offices, community space, locations and sizes of entry/exit doors, proximity of space to building parking, HVAC, lighting. Aesthetic needs are cosmetic ambiance of space (wood, carpet, paint, furniture, display monitors, clerical counter to patients, musaq); the mood of the entire space contributes to the experience you want your patients to have from each visit. Technical needs include computers, phones/fax, medical equipment, plumbing, electricity, medical gas for equipment and for patients, HVAC. The project manager of the committee ought to be from an architectural firm with niche serving healthcare providers. It would be cost-effective to hire an architect to create a rough drawing of the space to your specifications and collect a rough estimate to build the space. The result is discussed with the practice’s accountant to identify a budget to lease the space; that investment contributes to project planning. A Tenant Rep realtor with niche in serving healthcare providers, works with your accountant to factor the construction estimate into a financial projection of leasing costs (both initially and over the term of the lease). The Tenant Rep should advise the committee on the lead time needed to source a space, build and equip it and begin operating from the space.

Lease Term. Conventional office space rents at a discount to medical office space, typically for a five (5) year term. Medical office space typically rents at a $7-$10psf premium to office space to factor in higher traffic use to the building and space and construction costs; an average ten (10) year lease amortizes the up-front investment to build the space. These aspects should be discussed in committee to budget the rent costs and project practice operations ten years forward. (Note: this approach is indifferent to the space size you secure.)

Tenant Rep = Advocacy. The nature of the search criteria and details of project execution necessitate hiring a Tenant Rep realtor. They advocate for the search/secure needs of the practice and the business terms of the lease until 45 days after the move-in date. This approach produces a best outcome of the project, enabling doctors and support staff to remain focused on patient care. The Tenant Rep will prepare a simple representation agreement to review for signature. Ask your practice attorney to review it to advise the committee of its implications and your rights.

Construction Management. The project manager within your committee is responsible to oversee “all” construction efforts to ensure the space is built to your specifications, on-time, at or below budget. Advocacy of construction for your practice is essential to project outcome; do not skimp on advocacy nor expect the landlord to complete “as discussed”.

Real Estate Attorney. Your Tenant Rep ought to recommend or refer a Tenant Rep attorney with niche serving healthcare providers. Such specialty will protect your rights in the lease; avoid a business attorney lacking years of experience negotiating office leases for doctors. The attorney’s job is to work with your Tenant Rep and the Landlord’s attorney to ensure your legal rights in the lease are protected. (Note: a lease gives you strong rights of possession and use during its term.)

Moving trades, equipment providers, Information Technology and phone/fax. The construction project manager oversees liaising with the commercial mover, medical and office equipment providers, cabling installers, and IT installers. Ask your IT provider to oversee the installation of your phone circuit and phone/fax equipment.

Construction Punch List. When your space is about 95% ready for occupancy, (about 4 weeks from the move-in date), the committee, Tenant Rep, General Contractor and Landlord should meet to tour the space to identify open items to close within the budget of the buildout. These items makeup a written “punchlist” for the general contractor to complete. After the tour, have your project manager meet with all moving trades to carefully label the space where items will be placed; agree on a delivery/install date and time to complete. Another tour should be made by the same entourage to view completion of the punch list; arrange a formal meeting to accept in writing that the space is ready for move-in. Your project manager should notify the moving trades to confirm the space is ready to accept their work. This careful tedious approach ensures a smooth outcome, on-time.

Your project manager should be on-site during the move-in process, overseeing the effort agreed to. Once complete, the entourage should visit the space a last time to accept (in writing) that the space is ready to use. Implement a day(s) for the staff to prepare their respective spaces for use (as outlined in the paragraph above about establishing the search committee). Your Tenant Rep and project manager should work collaboratively, over the next 45 days, talking every few days to ensure the space is operating as expected. Let them talk with any trades to close holes in space operations during that time, enabling doctors and support staff to focus on patient care.

I trust this post has been helpful to you and offered takeways to implement in your healthcare practice. If you’d like to discuss BREG’s Tenant Rep services for healthcare providers, please click “Request A Consultation” link in the upper right of the screen. Enter “BREG Medical” in the subject line; please include your name, email address and telephone number in the message body; I reply within 24 hours. Thanks for reading and listening. ###

Navigate Your Next Real Estate Transaction

If your CXO suite is planning a change of its real estate, learn to navigate market conditions effectively. There’s many moving parts to source and secure the right space and business terms to meet the operating needs of your company. Learn which questions to ask or how to position your business to get the deal terms it needs. I am currently offering conference room presentations as special guest to CXO meetings for businesses employing up to 150 staff. Request a topic from the blog posts here in “Mayer’s Blog” relevant to your needs.  Two presentation formats are available.

  • 15 minute presentation of basics, take a business card to ask questions via a planned follow-up call or meeting.
  • 30 minute presentation of full topic, plus 15 minutes of Q&A.

Should your CXO decide to discuss Tenant Rep services from me, all exploratory discussions of your needs are interactive via a white board, whether held in your conference room or via Skype.

If you’d like to invite me to present in your CXO meeting, click “Request A Consultation” link in the upper right of the screen. Enter “CXO Presentation” in the subject line; please include your name, email address, telephone number and topic subject in the message body; I reply within 24 hours. Any presentation requires five (5) business days lead time to schedule into my meeting calendar. (Any requests for custom made topics require fifteen (15) calendar days’ lead time to research and prepare for.)  Thanks for reading and listening, perhaps I’ll hear from you in the future. ###

Business Analysis = > Tenant Rep

Corp Advisor(Post updated 01/26/2019) If your COO thinks its time to change the space your business uses, a great deal, in a seemingly good space, could become a (operating and financial) debacle you’ll seethe from long-term. (i.e. bad layout, a long inflexible lease, construction cost/time overruns, poor construction finishes, unexpected extra fees in the monthly rent bill). Blah, blah, blah you say? I’ve seen it happen many times; some clients were referred to me to solve such problems with their space.

A space debacle is avoided through planning – AND – using time to your advantage. When neither of these two elements are used, you pick the short straw and overpay. Analyzing your business carefully, to identify its needs [from workflow] and resources, become the baseline to negotiate the deal that meets the operating needs of your company.

Basic “Business Analysis” questions to ask:

  • How is the business operating today from its space?
  • Does the space facilitate productive workflow for ALL your staff (from baseline workers to C-level executives)? Is the work environment functionally collaborative and comfortable?
  • Does the space layout, location and rent bill foster productivity and profitability?
  • Can your space size change as your business does?
  • Does your office furniture, equipment and phones foster your comfort, efficiency and work pace?
  • Does your lease (or sublease) protect your occupancy rights? (this is more a business term that legal advocacy guides you to secure).

These questions are basic yet with privately held businesses, I’ve often seen little thought, planning and execution done in 24+yrs as commercial Tenant Rep. The best plan to change your space is a flexible one that’s able to make reasonable compromises as they arise. Identifying why your business is failing to meet executive vision, with worker comfort, leads to a baseline of expectations for new space. Let your Tenant Rep interview executive management, mid-management plus a few line workers; the data gathered will lead to an understanding of information flow, what defines a) a comfortable, efficient working environment, b) flexible occupancy, c) a flexible lease, d) sufficient utilities to meet operating needs.

If your business occupies 7Ksf [or more] of space, budget at least 2 years prior to occupancy to address your change vision at a leisurely pace; that puts time to your advantage to secure the right deal for your business (vs. a good deal for the landlord).  A virtual test-fit (1) of your space helps to create a short list of spaces/properties to focus on.

If you agree these suggestions are sensible for you, request a free 45 minute consultation with me by clicking the link at the right. Please put in the subject line “Business Analysis meets Real Estate.”; I reply within 24 hours. We hold a substantive face to face conversation, and see if our personalities are compatible to work with each other. Thanks for reading, perhaps I’ll hear from you soon. ###

  1. Kirsch, B. (2016). The value captured through a faster tenant test-fitting process, REFM, 03/15/2016.

How to Hire Me

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-After substantive conversation, if you choose to hire me, the principal of your firm signs an “Exclusive Right to Represent Agreement” from me that designates me to handle your firm’s real estate needs, regardless of how the space is identified.  I also offer analysis or consulting services through your service providers (i.e. CPAs or Attorneys) through a Consulting Agreement.

-My commission /fee  is borne by the landlord/seller you buy space from or at an hourly rate that we agree to, paid by your firm.

-I can work by sole transaction, by multiple transactions with a strategic goal, provide strategic planning advice or as project consultant.

-Rate: Without commission, $50/hr for the first 3 projects (prove service), then usual rate of $225/hr.

-Four hour minimum for initial project review ($50 rate), paid upon submittal of the review.

-I prefer clients to furnish me their accurate financial data after I sign an NDA (which I can provide).  This helps to budget real estate into your finances.

-In consulting assignments, I can present results you approve to parties of the transaction as needed, at the hourly rate.

Highly Successful Helping Businesses Grow

Learn Real Estate Costs Ahead of Needs

Small-Mid size users of commercial space (5K-100Krsf) often analyze their space needs just before starting a search; such timing would likely cost your business the wrong space size, overpriced deal terms and bloated operating costs. Also, merely comparing market rates to your rent [or mortgage] does not accurately measure the economics of your space. Do you know how much your occupancy costs take as a percentage of revenue [generated from the space ]?

The costs to operate space are: rent (or mortgage and property taxes), utilities, IT network and phones. The one-time costs to expand/relocate can include: movers, architectural and/or project management services, construction (beyond landlord’s work), furniture & fixtures, voice and data wiring, phone and computer equipment. If changes to your space are in-review [among executives], knowing both the revenue generated from the space and its occupancy costs will help expedite planning and decision-making within budget.

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A triumvirate of academics and experience are blended to deliver this service; it sets me apart from conventional real estate analysts. i) a complex understanding of commercial real estate, ii) academics and hands-on experience assembling/interpreting the economics of business operations, iii) training/experience with spreadsheet software.

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I often performed this analysis for clients as commercial realtor; I was a virtual real estate department to emerging businesses with 5-100 employees in metros New York and Atlanta, 1995-2007. (Figures and space needs came from collaborating with the Comptroller and CEO). The results enabled me to source the right spaces and negotiate the sharpest of terms a landlord could afford; those business terms matched or cut the client’s projected occupancy costs.   I deliver this service in five steps:

  1. Identify gross revenue from space / current occupancy costs (by category) = % occupancy costs claim from revenue.
  2. Estimate future space needs and occupancy term; scrub to market conditions.
  3. Project revenue from new space. How much more revenue could be kept as profit if occupancy costs were less?
  4. Identify space costs for the next occupancy term via a projection of entry costs, rent and operating costs (mentioned above).
  5. Compare sales projections to projected occupancy costs to reveal how much space is needed and what to budget for it. Add one-time relocation expenses outlined above.

(Note: Your results from this service will be most effective when completed two (2) years before operating from new space (up to 20Krsf; up to 4 years prior for 100Krsf). The lead time positions your business to negotiate from strength.)

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I can work directly for your company, collaborating with your Comptroller, or as subcontractor to the CPA firm you work with. I work per diem or by project; I estimate 24 hours per assignment; the work is completed in 5 consecutive days. If you’d like to talk with me, please click “Request a Consultation” at the mid right of the screen and fill out the form; I’ll reply to you within 24 hours. I trust that the content of this post was helpful to you. ###

Investment Sale: Atlanta Community Office

Q3/2006 Facilitated sale of two-story community office property, 50% leased, to local business on behalf of private investor/owner. Property appraised and sold for initial list price that was +/-$25psf over market. Customized new contract of sale from Real Estate Trade Association and advised Seller to negotiate results of inspection period . 4000sf property sold for $700K.

Pricing Property to Sell

As the economy improves incrementally, commercial real estate is regaining attention as a stable, reliable investment [vs equities or bonds]. Its published knowledge that American businesses (including private equity) kept over $1 trillion in cash profit from sales since the depths of the [Great] Recession; currently cash is king. Banks are lending cautiously, yet in measured amounts. Investors are searching for choices that offer a mix of stable cash flows and future upside. Complete rehabs of functionally obsolescent buildings are an alternative investment, if handled shrewdly.

Plan and Prepare Basics

If you’re considering to sell a property you own, strategy and planning are key to a successful sale and use of proceeds. Stick to your plan; leave a bit of room for flexibility. Recruit multiple offers to assure the sharpest sale terms; have alternate buyers ready to fill sales that break up unexpectedly.

Seasoned, experienced, savvy service providers to process the transaction include a real estate analyst, Public Engineer, CPA and attorney.

a.  Real Estate Analyst. This knowledge worker, whether support staff or private contractor, will project an opinion of value of the property from accurate income and expense figures. (This is my service niche.)

b.  Pre-Inspection. Its to your benefit to hire an engineer (P.E) or commercial inspector to report on the physical condition of the property before bringing it to market. Leaving the inspection report up to the buyer could put you in a materially weak negotiating position, creating a lower perception of value by the buyer.

c.  MAI Appraisal. Order a professional appraisal of the property before sale, approved by an MAI; scrub the results against the opinion of value from your analyst. No buyer can argue with the results of an appraisal from a licensed appraiser and MAI.

d.  Legal. Assure the contract of sale fairly protects you and the buyer; read a sample copy from your attorney before they customize it to your transaction.

Four Essential Questions

Prior to bringing your property to market, ask yourself:

  1. What’s it worth?
  2. Where to place the sale proceeds?
  3. If you make a like-kind, tax-free exchange, identify the replacement property (ies) before bringing your property to market.
  4. Paying capital gains taxes on the sale proceeds? Talk with your CFO or CPA about profits’ affect on your P&L before bringing the property to market.

These preparatory steps include expenses and time worth investing in to avoid losing a sale, or negotiating unexpected material hurdles of sale that could lower the closing price you envisioned. These steps map a path to a smooth close, with flexibility as needed.

1.  What’s it Worth?

These facets of value, some of which are severable from the whole, work in-unison to generate an accurate value for the property:

  • Integrity of income (eg. rent from tenants, billboards and antennas, parking income)
  • Projected rents from lease renewals and potential vacancies
  • Does rent from long term leases (10yrs or more) sustain, lock or step-up revenue?
  • Does the building operate efficiently?
  • Is maintenance effective and costs sharp?
  • Is the assessed value of the property reasonable?

Additionals:

  • Are there hazmats behind walls needing abatement at relet?
  • Do floor plate sizes help/inhibit lease up?
  • Could select floors be re-positioned for better uses at higher rents or sold as condo?

The tangible and intangible variables of a property directly affects the capitalization rate applied to NOI to produce an accurate property value. Some are:

  • Building features (common area cosmetics, telco wiring, green skin and mechanicals)
  • Property’s ability to compete in the community for tenants.
  • Does the legal ease of your lease help, hurt or inhibit property value?
  • Credit of larger tenants

Uses for Sale Proceeds

Sale proceeds are substantial, you’ve agreed with your senior staff about where to place them (i.e. re-invest, pay debts, fund new development, etc). If you’re a single user of owned property, is this sale a leaseback to free-up cash? Proceeds may be divided among facility expenses, short term rent and to fund growth.

Like-kind Exchange. If you’re planning a like-kind, tax free exchange of properties, identify a list of replacement properties that meet your investment goals and core portfolio. Hire an experienced, neutral agent to handle the exchange of properties.

Capital Gains Taxes. If capital gains taxes are to be paid from sale proceeds, have a detailed discussion with your CFO or CPA about how the net profit will affect your P&L.

My Services

If your real estate investment business needs a savvy analyst for a sale project, who can also present the results with charisma, please contact me to discuss your specific needs.  If my skills fit the needs of your sale project, my hiring terms are: