5 Medical Office Space Considerations

Physicians and practice administrators will determine their space needs when they move into a new building, whether they will be adding a member or ancillary service.  We find that medical practices often negotiate space considerations right around lease renewal time. These practitioners realize that an effective medical office design can reduce real estate costs, improve patient care, and boost staff performance, as well as morale. 

Because there is no simple equation, no medical office boilerplate floor plan, the healthcare professionals should consider adding an architect or space planner to the team.  Seeing that there are more than 30 specialties, in addition to primary care, there is no single set of standards that physicians can apply to calculate their spacial needs.

More recently, medical offices have taken the tough economic environment as an opportunity to streamline business operations, and are becoming more efficient by using their space more wisely and reduce square footage.

But as precaution, beware inexperienced commercial architects or designers, who have taken the tough economic environment to open up their services to the medical office sector.  By avoiding the mishap, you will save on medical development costs, confusion, among other things. Unfortunately, physicians who make poor space decisions can be stuck with them for several years. They end up spending a sizable amount of money for space they don’t really need.

That said, there are several factors that all physicians, regardless of specialty, should consider when consulting medical office real estate team to determine their space needs.

Here are a few of the main considerations for physicians when contemplating space modifications or new space design…

HIPAA impact

Expansion Needs

Space Redundancy

Ancillary Services

Records – EMRs

What Creates Demand for Office Space?

The demand for office space is a derived from a firm renting space as an input to the production of services or goods they provide to businesses and households in the local, regional, or national (and international) economy.

In most large metropolitan cities, the majority of tenants for office space are firms providing finance, insurance, real estate (FIRE), and other services, including primarily professional, business, and government services.  Within the Greater Houston market, industries such as oil and gas consume over 1/5th of the total office space, as well as medical, now close to 10%.  These growth industries have created boons in office space demand for our city.

Within a service sector, the following types of firms are office space users: advertising, computer and data processing, credit reporting, mailing and reproduction, legal and social services, membership organizations, and engineering and management services. Thus, if market demand for such services increases, demand for office space will also increase (to the extent that the additional demand for services cannot be satisfied by existing firms without using any additional space).

The aggregate demand of office space for a particular market refers to the total amount of square feet of office space demanded by all firms interested in operating within that market. This is the sum of the individual office space demands of each of these firm. The demand of an individual firm for office space depends on the size of the firm, that is, the number of its employees and the amount of office space used per employee.

Within this context, the total amount of office space demanded at the broad market level is determined by the number of firms utilizing office space, the size of each firm, in terms of number of employees and the amount of office space demanded by each firm. Actually, the aggregate demand for office space in a market is the product of these three factors (the number of firms times average number of employees per firm times square feet per employee). Also notice that the product of the number of office firms times the average number of employees per firm will provide the total office employment.

The greater the number of firms, the greater the average number of employees per firm, and the greater the amount of square feet per employee required by each firm, the greater the total amount of office space demanded within a market. Within this context, increases in aggregate market demand for office space can be triggered by…

  1. Increases in the number of office firms in the market
  2. Increase in the number of employees within the firm
  3. Increase in the number of square footage per employee

Increases in the number of office firms operating in the market can be triggered by economic, population. and/or income growth. Such growth will trigger increases in demand for services, which in turn will stimulate the growth of startup firms, and/or expansion of existing ones.  Economic growth of metropolitan markets still depends largely on how the national economy is doing, but variations are affected by a concentration of firms, unionization rates, wages, and corporate taxes. Predicting employment growth across metropolitan markets is more complex than simply recognizing the effects of these factors.

The second factor that determines total demand for office space is the average size of the firm, in terms of number of employees. This depends on the average productivity level in each industry. The term productivity refers to the number of workers required to produce a given level of output, or number of workers needed per unit of output. If firms in service industries find themselves in a position where they will need to use more workers to produce the same level of output, the average number of employees per firm will increase and demand for office space will increase too. Such a development would represent a decline in productivity, though.

The outlook for productivity declines and increases in the average number of workers employed by office firms is highly debatable, given a long-term trend of rising productivity. Normally, automation and technological advancements make each employee more efficient and more productive, increasing the output produced per worker and reducing the total number of employees needed to produce a given amount of output. Economists and real estate analysts have expressed fears that rapidly rising productivity (output per worker), due to advancements in technology and information processing, may limit office employment growth and demand for office space in the future. An alternate view is that most possibilities for dramatic improvements in office worker productivity have been exhausted.

Non-price factors that influence office space requirements per employee include the type of services provided by the firm, the growth prospects of the firm, and the profitability of the firm. Within this context, increases in the square-feet-per-employee requirements of office firms can be triggered by:

  1. Employment growth in service activities that require a greater amount of space per employee
  2. Expectations for faster growth in the future
  3. Increases in office firm profitability

8 Proven Medical Moving Tips

Moving — The word alone conjures up horribly strenuous experiences both personally and professionally.   But, given the turbulent commercial real estate market where your landlord yesterday is not your landlord today and given the number of doctors  considering ownership, it is a necessary evil.

While moving is certainly a major undertaking, it can by systematic and seem effortless given a proper relocation team. The Robert S. “Bob” Lowery representation group has provided some of the biggest mishaps that physicians make when embarking on a move, and how to avoid them.

1. Schedule proper time to plan and execute the move.          

Don’t wait until four months until your lease expires to call any relocation team.  Personally, we prefer to have two to three months just to assist in the planning of a move, given it relatively moderate size office space with around $1 mil in equipment.

If the relocation includes design, construction, and/or furniture and equipment purchasing or installation, nine to 12 months is an ideal time frame from site selection to commencement of lease.

In real estate relocation and expansion, we have not determined a month that is better than another.  We allow the medical practitioners to provide us with a window. For instance, may there be a slower period for your organization in which it would make sense to devote time and effort to a move?

2. Be involved in the process.

Many physicians will appoint the entire moving project to administration or staff members to be concerned, typically during the 11th hour, with the execution of the original process undertaken.  Keep in mind that it’s your business, not the employees you hire.  From a broker perspective we are always searching for decision-makers to control the process.  We have seen way to many expansions scrapped because of poor planning from administration.

Administrators may come and go, but the doctor remains a staple. At the very lease, schedule and be present at project-planning meetings, touch base with your administrator or office manager at least once a week (either in person or via email) so you’re up-to-date on moving details, get to know any moving consultants you may hire, and be involved in the process.

3. Pay close attention to the details.

Don’t sweat the small stuff, phooey.  The relocation expansion process is where the sum of the parts actually make the whole, rather than the opposite.  For instance, it is important to make sure IT and telecommunications systems are installed and tested prior to move-in to ensure claims processing upon your organization having the grand opening.

Notify the community of your address via marketing; postcards, letters, emails and/or phone calls—that includes patients, couriers and other vendors, as well as payers if you bill in-house. Post a sign in your waiting room with your new address and contact information, moving date and the date your office will reopen, and give patients business cards with your new information as soon as it is possible.

We recommend having your administrator confirm with the appropriate vendors, the appropriate licenses and permits you will need to run equipment and store chemicals and/or medications. Depending on the size of the building, the percentage of medical tenants and your lease terms, your building management may monitor the status of licenses and permits, but the responsibility ultimately lies with the docs.

Also, make sure your administrator coordinates the insurance needs for the new location with a preferred insurance broker. Insurance requirements vary based on the value of resident equipment, technology and specialized build-out.

4. Hire a moving company that is experienced in ‘medical office’ moves.

Medical offices have a large amount of data files, handling them during the relocation is important so as not to violate HIPPA regulations. Companies that have moved similar file material and medical equipment successfully reduce the risk to the project and have developed proven systems for ensuring the confidentiality of the data and the re-installation of the equipment.  This may sound like a stretch, but at the end of the day, it is comes down to entrusting a relocation team with the most private information.

Hiring a moving company that specializes in moving medical technology and equipment will ensure that it is up-and-running when you re-open. These companies are competitively priced with other movers, and they may be worth their weight when dismantling, boxing and recalibrating sensitive medical equipment during the move. Their proposal should clearly outline their experience.  You may contact your references or chose to work with an educated medical real estate broker referral.

5. Understand there are undisclosed costs for a move.

We recommend getting an itemized invoice or statement that tells you exactly what the movers will do for you and how much it will cost. Then you may decide what makes sense for your staff to perfrom versus having the movers perform it.

Ask plenty of questions: Is there cost in changing contracts for in-office clinical or office equipment? Can you get a price break if you move some items yourself? How much does moving insurance cost or is it included—and what does it cover?

It’s also wise to get more than one bid so you can compare apples to apples for moving. Our team will provide your group with three bids that will provide you good sense of what the going rate is and which company is offering the best value for their services.

6. Eliminate or downsize unneeded items before the move.

If you have not used it in 5 or 10 years, be sure to rid yourself of it, because you’ll spend unnecessary time and money figuring out what to do with it on the back end.

Allow your team to consider what should stay or go

7. Have a “go-to” person on staff.

Have one person who is capable of being in charge of all the details for the move, even if several people are providing input.  It is intelligent to appoint a backup to the point person so that your staff and the moving company can get answers in a timely manner during the planning and moving process.

8. Have a “backup” for emergencies.

The unimaginable will happen.  The phone system will not be ready for your new office.  Your point person will be out sick on the day of the move. We will help plan for every possible disaster.  Through our experience, we can imagine every unpleasant scenario that can occur.  We have seen it.  It’s this type of strategic planning that can make the difference.

Office Relocation Plan – Robert S. “Bob” Lowery

Below is an office relocation plan as implemented by Robert S “Bob” Lowery’s Tenant Representation Group.

The most streamlined and effective approach is summarized here:

  • Establish a relocation team to coordinate the move. This may also include an advisory team consisting of real estate and relocation professionals and real estate attorney.
  • Determine your needs.  How much space do you require?  What type of building fits your business?  What is your preferred geographic location?  Do you need to be located near restaurants, hotels and/or public transportation?  Lastly, you’ll need to prepare a budget.
  • Identify potential properties. Obtain a list of available properties from your tenant representation broker.  Narrow the list by excluding properties that are unsuitable.  Schedule a tour of the remaining facilities.  Determine which locations could be appropriate for your business.
  • Prepare a preliminary space plan. With the help of a space planner or architect, determine the most efficient use of space at your two or three top building choices.  For construction cost estimates, establish a general type and amount of changes required.
  • Develop a Request for Proposal (RFP).  Your tenant broker will prepare and distribute an RFP to the landlords of your top building choices.  Based upon response, determine which space would be the best alternative for your business.  Once determined, your tenant broker will submit a letter of intent to the landlord outlining the terms you intend the lease to be based upon.
  • Finalize space plan. Get input from departmental representatives and have a formal blueprint created to represent your new space should remodeling/construction be necessary.
  • Negotiate the terms of your lease. Once a lease is obtained and reviewed by decision-maker(s) from your company, get input from your tenant representative and attorney.  Renegotiate and/or accept lease terms.

Now, having conceptualized the process, you’ll need to dive a bit deeper into the details required for planning your move.

  1. Identify dedicated resources. This should include a relocation coordinator and departmental representation.  Each participant should understand occasional evening and weekend work may be necessary.  The team should also plan to attend weekly progress meetings, once details begin to materialize.
  2. Develop an advisory team:

A Tenant Real Estate Representative:
Choose someone experienced in lease negotations and specialized in similar types of space (e.g. office, industrial, retail, etc.). Understand how he/she finds available space. Ask how this person will get paid for providing services. Also ask for 2 or 3 references of similar clients.

A Real Estate Attorney:
He/she should help in determining rights of both parties and understanding the significance of all lease terms. Should also recognize and leverage the goals of the business with those of the landlord.

An Architect/Space Planner:
Relocation is an excellent opportunity to design a more efficient working environment. This person can help in determining the correct amount of space required, taking into consideration current/future employees and growth expectations.

A Furniture Consultant:
If buying new furniture, bring a furniture vendor into the process to help with the type of configuration of workstations and individual office furniture. Design services are typically offered at no charge to you, depending on the type of and quantity of furniture ordered.

An IT Consultant:
This is crucial in helping to design and setup telephone/data services, esp. if you are planning to move significant existing equipment. Key considerations include building ample capacity for phone/data networks with appropriate access points throughout the new office. This resource may also be helpful in coordinating external vendors, such as utility providers, ISPs, phone companies, etc. and renegotiate contracts.

  1. Determine the budget. Consider the costs of professional advisory fees, hiring a moving company, relocating your equipment and computer network, replacing office furniture and printing costs for new business cards, stationary and other printed material, including relocation announcements for customers.
  2. Establish a Time Line. A typical move can take anywhere from 6 to 12 months of planning.  In general, your facility selection and lease review process will take the longest amount of time.  It’s important to continue working through other facets of the move, choosing a moving company, researching furniture options and office equipment during the facility selection process.

Key Considerations

Evaluate the feasibility of renewing your current lease before making decisions to relocate. If you choose to move, interview tenant representation brokers. Be sure to check references as well as companies/properties they represent. Establish a moving date well in advance, ideally in less busy period of the business to ensure ample time for the relocation process.

Action Steps

Depending on size of the organization, anywhere from 6-12 months prior to the move you should: Appoint a relocation coordinator, interview and select a tenant representative, engage services of a real estate attorney, select the rest of your advisory team including an architect or space planner as well as furniture and IT consultants. Next develop your relocation budget, including estimates for professional services, moving expenses and the cost of new furnishings and equipment. Lastly, schedule the prospective moving day, knowing that this may be a moving target until the office space selection and other factors are determined.

Contact us today to assist in the implementation of a relocation plan.

PWC/ULI 2011 Report: Houston Real Estate Rankings

The PricewaterhouseCoopers (PwC) and Urban Land Institute (ULI) report, entitled “Emerging Trends in Real Estate 2011″, was released last week and according to the 75-page report, Houston, along with other 24-hour ‘gateway’ cities will continue their economic and real estate domination over secondary markets in 2011.  Due to the fact that Houston offers a low cost of doing business when compared to other major metros, a forecast of a continued return from recession lows is likely to occur.  With regards to Houston’s current and future prospects, the report mentions:

Intellectual capital and talent in the global energy business concentrate in the city, the de-facto world oil and gas business capital, and Houston has one of the country’s premier medical centers. NASA’s downsizing plans and Continental Airlines’ merger with United Airlines take the edge off office tenant demand. Nevertheless, downtown’s vacancy rate in the low teens stands below the national average. The increasingly strategic port expands in preparation for augmented shipping traffic from the Pacific through the widened Panama Canal, scheduled for 2014. Population inflows help keep apartment occupancies up. Interviewees like the “business-friendly Texas government” and low taxes (no state income tax). “We should come out stronger from the recession than most other states, which creates more demand for real estate.”

Houston’s commercial real estate sector

While optimism of an economic recovery abounds, the report notes that the commercial real estate market will see a cleansing in 2011 and 2012, in which properties will be purchased from the FDIC , lenders, and special servicers at prices far below the transactional market in 2007/2008;  some cases as much as 50% less.  Whether you call this ‘strengthening of a balance sheet’ or the ‘ratcheting down of expectations’ the market prices will move to reset over the coming years.  Therefore, the report suggests that market cap rates will rise to high single-digits in core locations and double-digits for suburban and outlying markets in 2011.

According to the forecast, the current bifurcated market remains a ‘head-scratcher’ to researchers and analysts, specifically with regards to investors that are overpaying for commercial real estate.  The financial market demonstrated a shock in 2007 and a stock market collapse in 2008, but pooled and raised investment capital remain willing to hunt for 5% cap rate deals and ‘trophy’ office space, attempting to tilt the market in their favor.  But, paraphrasing the report, because of the sheer weight of the opposite end where the distress lies, those investors that did not pay mind to the simple supply-demand fundamentals for investment real estate will face negative returns or the more likely scenario: foreclosure.

What will the commercial real estate landscape look like in 2011?  Keep in mind my specialty is in the office market. These two recent office transactions should help you understand my own, as well as the researchers of the PWC report reasoning; here and here.  Both transactions have several similarities.  Both had investors that overpaid for their respective buildings.  Both buildings went into some sort of foreclosure.  Both retained new ownership which purchased an asset(s) at a significantly reduced price when compared to marketplace.  Both buyers lured national tenants to consolidate and reduce operational costs within their building at a reduced effective rental rate.  This will continue to occur as tenants leases ‘come due’ over the next few years and properties are forced onto the market.

So how does Houston rank in real estate?

Houston commercial/multifamily investment market ranks 8th among large metros.  This was slightly above a ‘fair’ rating for investment.

Houston commercial/multifamily development ranks 8th among large metros.  This was slightly below a ‘fair’ rating  for development.

Houston home-building sales rank 4th among large metros.  This was exactly ‘fair’ for new home purchases.

According to the report, 2011 will remain a decent ‘buyers market’ for apartments and industrial in Houston.  The hotel and retail will require significant deleveraging before consideration of buying is to occur.

  • Houston Office: 44.8% Buy, 37.9% Hold
  • Houston Apartments: 52.7% Buy, 29.7% Hold
  • Houston Industrial: 52.1% Buy, 40.9% Hold
  • Houston Retail: 29.7% Buy, 56.8% Hold
  • Houston Hotel: 25.5% Buy, 56.9% Hold

While the information above would indicate that it may be an opportune time to purchase industrial and apartment product, we see a trend that suggests otherwise.  In the report, Houston’s buyers and sellers of multifamily are active; holders just a small percentage.  This would suggest that 2011 will be the year of many apartment sales.  As apartment specialists within our brokerage now suggest, multifamily is becoming too crowded and sellers willing to wait for higher bidders or those willing to overpay; thus a seller’s market is occurring as we speak.  This is not the case for office and industrial.

Like to view the entire report?  Click here for pdf version or view below.

Have a Space to Lease? 55 Franchises Experiencing Huge Growth

These young companies have seen tremendous growth in a five-year period.  All of the franchises listed are less than 6 years old.

For those who have identified an area to locate their franchise, we can be of assistance.  For owners and brokers that are in need of a tenant to occupy an empty space, we have provided the list below.

Click for website…

  1. Healthsource Chiropractic
  2. Any Lab Test Now
  3. Murphy Business and Financial Corporation
  4. Roni Deutch Tax Center
  5. Pet Butler
  6. Mister Sparky
  7. Elements Therapeutic Massage
  8. NRgize Lifestyle Cafe
  9. OxiFresh Carpet Cleaning
  10. Premier Rental-Purchase
  11. Massage Heights
  12. 1-800-Pack-Rat
  13. Mr. Sandless
  14. Facelogic
  15. Brightstar Healthcare
  16. Five Star Painting
  17. The Utility Company
  18. Senior Helpers
  19. Bella Bridesmaid
  20. Fresh Coat
  21. Hurricane Grill
  22. Real Deals on Home Decor
  23. Seeking Sitters
  24. Monkey Joe’s
  25. DesertSun Tanning Salons
  26. FRSTeam
  27. BounceU
  28. Door-to-Door Dry Cleaning
  29. Lillians Shoppes
  30. Snap Fitness
  31. Happy Nails and Spa
  32. Accessible Home Health Care
  33. The Tutoring Center
  34. Instant Tax Service
  35. FocalPoint
  36. Seniors Helping Seniors
  37. SanSai
  38. Shane’s Rib Shack
  39. Home Care Assistance
  40. Paciugo
  41. LA Boxing
  42. Synergy Homecare
  43. Sola Salon Studios
  44. Fast-teks
  45. Salad Creations
  46. DUCTZ
  47. GolfTEC
  48. Stratus Building Solutions
  49. FETCH! Friendly Neighborhood Pet Care
  50. Which Wich?
  51. Cosi
  52. Goin Postal
  53. Mathnasium Learning Centers
  54. Bearclaw Coffee
  55. Billboard Connection

From Franchise Times: The 2010 Fast 55