Medical Real Estate Development: Location and Site Analysis

The analysis for a location and site are two separate parameters for which to search for developable land to hold commercial real estate structure. Each type of commercial use, and each specific user, will make special demands for location and site. Access to main thoroughfares may be important to office, retail usage, while population or housing density for apartment usage, or proximity to rail lines or airports for industrial use. Medical location and site analysis tend to combine several of these factors, while consistently rely on proximity to other physicians, hospitals, surgical centers and ancillary services.

To consider a medical location and site in general terms, without specific medical use in mind, a seasoned developer, or user, will look at the following features and devise a way of rating each.

Features for Location Analysis
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Physical
  • Natural Boundaries and Barriers
  • Manmade Boundaries and Barriers

Usage Patterns

  • Growth Areas
  • Traffic Flows
  • Regulations and Controls
  • Incentives
  • Tax Structures
  • Community Master Plans

Qualitative

  • Neighborhood Image
  • Community Attitude
  • Location Image
  • Surrounding Users

Linkages

  • Employment Centers
  • Retail / Restaurants
  • Road Network
  • Transportation and Shipping
  • Residential Areas
  • Labor Pool
  • Educational Facilities
  • Recreation
  • Customers
  • Municipal Services
  • Utilities
  • Competition

Supply and Demand

  • Population
  • Employment
  • Income
  • Wages
  • Expenditure Patterns
  • Absorption/Vacany
  • Real Estate Prices
  • Competition
  • Traffic Count
Features for Site Analysis
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Land
  • Size and Shape
  • Front Footage
  • Soil Composition
  • Topography, Slope and Drainage
  • Vegetation
  • Buildable Sites
  • Engineering Requirements

Access

  • Side of Street
  • Medians and Curbs
  • Turn Lanes
  • Deceleration in Acceleration Lanes
  • Traffic Controls

Economic Factors

  • Price and Acquisition Costs
  • Development Costs
  • Taxes
  • Development Fees to Community
  • Municipal Services

Regulatory Factors

  • Zoning
  • Maximum Building Area
  • Required Parking
  • Environmental Issues
  • Permits and Licenses
  • Applicable Building Codes
  • Special Requirements (Buffers, Retention, Etc.)

Qualitative

  • View
  • Appearance

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Critical Medical Lease Negotiation Points

supportEvery element of a medical office lease can be negotiable.

For the benefit of both the landlord and the tenant, we have highlighted and defined the most frequently negotiated items within a medical office lease.

Alterations: The degree to which the tenant make make physical changes to the premises.

Assignment: The right to transfer the lease to another entity.

Buyouts: A concession where the remainder of the lease is bought out in consideration for tenant to move into another facility.

Common Area Maintenance (CAM): Extent to which tenant is responsible for property upkeep.

Condition of Premises: Repairs to the condition of the property prior to or during the tenants term; what the tenant agrees to change, pay or maintain.

Default and Remedies: Performance of contract and remedies for satisfaction; key areas are property condition, rent payment, and insurance policies.

Deposits: Security for right to use premises; provides financial requirement and interest.

Expenses and Stops: Operating expenses the tenant pays; typically plays role in complete occupancy costs.

Free Rent: A concession typically offered in a challenging market; a discount off of the aggregate lease amount.

Grace Period: Time of consideration of rent payment for purposes of grace, redemption and default.

Hours of Service: Schedule of building hours where tenant will benefit the greatest; access, lighting, HVAC, security and parking.

Lease Term: Determines length of liability, commitment, amortization schedule for both tenant and landlord.

Maintenance: Ongoing repairs or responsibilities.

Measurement: Determination of rentable area vs usable area as well as load factor; used competitively within marketplace to maximize space usage and compare amenities.

For the second half of our post, please visit our website at MREA | Medical Real Estate Advisors or call Kayla at 713.701.7900. For a highly specialized business and real estate platform to serve your unique healthcare-specific needs, contact Robert Lowery, Managing Partner, of MREA today.

Common Real Estate Needs in Medical Tenancy

ImageThe need for long term tenancy appears to be in its greatest demand in decades. This urgency will rise considerably over the next several years as investors continue to discount vacant property, rather purchasing through banks which typically transact without title objections or past, present or future litigation issues. Another factor that will improve the need for stable tenancy is that lenders are again beginning to support investors by reducing capital requirements in exchange for long-term leased, less risky investment real estate.

Understanding the importance of medical tenancy, as it relates to the stabilization of an asset for purposes of a long term hold or investment sale, also requires a basic understanding of what is standard in its tenancy. This recognition, as well as access to professionals which support the healthcare profession, is key to preservation of a leveraged real estate asset or portfolio.

Tenancy items relative to medical professional are many; most outlined in a lease rider. To keep this blog passage succinct, we have outlined the most common needs below.

Utility expense can be one of the highest cost components of medical occupancy. Practice tenants often have higher utility usage than standard office tenants because many have equipment and hygienic requirements which consume large amounts of utility service. Medical professionals typically consume extra water from examining rooms with sinks. They also may utilize extra electricity from diagnostic or therapeutic equipment that requires more electricity than standard office equipment. Some medical uses, such as surgery centers, require the continuous use of uninterruptible power and, consequently, the extra expense of back-up power generation and data transmitters. Because of these items, it is best for the landlord to seek calculations relative to the variety of medical professionals that are considered for tenancy. 

Medical uses often will limit or require specialized janitorial and waste removal services. Special attention may be provided to medical and infectious waste maintenance and storage. These issues sometimes focus on the method for isolating medical waste and used equipment, the kinds and qualities of waste containers, and the process for removal and disposal of such waste.

Medical tenants will frequently have more intensive water and electric needs. Special machinery and furnishings may require special floor/pad accessories. Equipment may also require special fixturing and unique buildout. If the tenant expects to retain ownership of the equipment at termination of the lease, it be necessary to address this in the lease. Another consideration is to the waiver of lien or security interest in equipment which is owned or pledged, especially if there are hazardous materials involved, which is the case in laboratory and radiology services. The examination rooms in a healthcare facility may also be good only for the single use by the healthcare tenant, with no likelihood of a secondary need by a subsequent tenant. Equivalent issues apply to extra work needed to install and remove ADA accommodations.

Some special medical practices will may require special improvements. Ambulatory surgical centers typically require the need of the first floor. Maternity and birthing centers typically require the closest proximity to reserved parking. Psychiatric centers typically require separate and secured access. Plastic surgery clinics typically require separate and less visible access corridors.

The are just a few of the common needs relative to medical tenancy. For more information or submission of a request for our healthcare real estate services, please contact your MREA representative.

Healthcare Bankruptcy & Receivership – Real Estate Services

MREA is dedicated to improving the health and wealth of ita clients through several varying healthcare real estate competencies, many of which are located on our website. Our specialization within this narrow, niche sector provides our physicians, investors, owners and medical center customers with direct exposure to healthcare real estate opportunities. Currently, our firm is fielding a greater number of inquiries for the assistance of distressed real estate property offerings.  So, we offer a quick post of our services.

As most are aware, an unfortunate reality exists in today’s real estate marketplace.  The financial system is working on ways to deal with those that relied too heavily on leverage and debt instruments to fund real estate purchases during the middle to latter years of last decade.  This reality haunts the medical real estate industry that, just 5 to 7 years ago, expanded greatly to accommodate forecasting models that placed significant emphasis on serving a growing, health-conscious population, especially that of the baby boomers.

As the commercial and healthcare real estate industries are in the initial stages of coping with an abundance of over-leveraged property, our firm is well positioned to capture a lion’s share of these opportunities.  It is because our firm has developed “across-the-board” relationships within the healthcare real estate sector whereby delivering property offerings (lease, sale, redevelopment) directly to the doorstep of an actively managed database of medical tenants, investors and hospital owners.

MREA Distressed 

The Medical Real Estate Advisors (MREA) have the expertise required to effectively manage a variety of distressed situations involving non-performing loans, as well as the management, leasing, disposition and redevelopment of Real Estate Owned (REO) property.  Our professionals are actively involved in loan workouts, mortgage possessions and foreclosures and we seek avenues to eliminate overexposure by directing any offerings to a secure database of medical professionals and investors.  Along with traditional distressed real estate services, our specialized competencies include judicial and non-judicial foreclosures, court-appointed receiverships, bankruptcies and deed-in-lieus.

Receivership Services

Mr. Robert S. “Bob” Lowery and his team of associates are versed in court proceedings that involve the foreclosure and appointment of a receiver.  Our comprehensive real estate solutions for the medical industry play a vital role in the efficient transition of the asset from its current position to that of significant value to the marketplace. Services include:

Strategic Planning – Stabilization of Property — Tenant Retention — Property Management — Marketing & Advertising — Leasing — Exit Strategies

Bankruptcy Services

To complement an expansive list of healthcare real estate services, MREA is involved in working with bankruptcy trustees to assist with businesses that are financially troubled, either directly or indirectly, from their real estate holdings.  Our services:

Assisting Turnaround Management Companies — Monetizing Assets — Advising Lender Workouts — Creditor Assignments — Representing Buyers & Sellers — Real Estate & Recapitalizations – Equipment, Furniture, Business Item Liquidations

Robert S. “Bob” Lowery is Managing Partner of MREA | Medical Real Estate Advisors

Comprehension of a Medical Lease Contract

Statement:  After auditing countless medical leases through our firm, its CPA and attorney partners, we want to make fully aware the consequences of any real estate agreement that is executed (signed).

On behalf of the associates of this firm, the declaration above is about as harsh and opinionated that we, as advisors, can be without crossing the line whereby disassociating ourselves in our mission to coordinate the healthcare real estate markets; physician, hospital, investor, owners.

But, speaking from the perspective of a landlord (lessor), the largest impediment that a landlord sees is the lack of commitment and foresight from the lessee’s principal founders with regards to their own organization’s goals and objectives.  The landlord has to take into account that the necessary financial due diligence has been performed and the organization is prepared for the legal ramifications if ANY PART of the contract is broken.  Thus, it is essential when provided any document that requires signature that it is taken to someone else for further review.  Take it to your spouse, your associates, your financial partners, your attorney, your accountant, your shareholders.  If your firm is fortunate enough to have real estate representation that will not charge you an arm or leg, take it to your broker.

Typically, the mistakes that we see from physicians (especially independents) is that of discounting the lease instrument and the level of sophistication and comprehension necessary to interpret this contractually-binding obligation effectively.  As an example, if there are 10 items that are conveniently written to control one party of a transaction, does the other party know all 10, or just 5, or 2?  Remember, it is already popular culture that a physician is not a savvy businessperson, which does not speak of their collaborative efforts.  All kidding aside, it is of paramount importance to fully comprehending any contract or, at the least, obtain verbal or written interpretation through fiduciary relationships.

Now, for the really bad news.

The field of experts that truly understand medical contracts and can convey its purpose, as well as its fine print requirements to your organization, are few.  Because most healthcare real estate real estate experts understand this, they will typically work for a 5 to 10 percentage premium over the traditional brokerage firm’s marketed commission or consulting fee.  You may be fortunate to locate a highly skilled healthcare unit, but beware the temptation to accept their services for both sides of any transaction for reasons that I do not need to explain further.

To summarize, our readers should be acutely aware of the needs of their organization first, prior to contracting with any commercial or medical real estate agreement.  They should also make sure they have brokerage or counsel that can perform the necessary tasks associated with YOUR transaction, which should be compensated by their firm.  Until then, we can keep combing over the mistakes, some of which will cost our clients bankruptcy, until lessens are learned.

This article was written by Robert S. “Bob” Lowery, Managing Partner with MREA | Medical Real Estate Advisors.

Houston Office Relocation Made Easy!

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.
  3. 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.

  1. 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.

Houston Business Headlines: Money Morning

Continental CEO vows to forgo salary, bonus

told workers Monday that he will forego his $730000 annual salary and any bonus until the Houston-based carrier earns a profit for a full calendar year. …

MarkWest Sells Starfish Pipeline Stake to Enbridge

… to $30.03 in afternoon trading. Shares of Enbridge, which like Starfish is based in Houston, Texas, fell 34 cents, or 0.74 percent, to $45.88.

France’s Total enters Barnett Shale gas play

French energy giant Total will enter Texas’ Barnett Shale natural gas field under a $2.25 billion joint venture with …

Cold and Signs of Stronger Economy Drive Oil Above $81

A combination of frigid weather, expectations of an improving economy and new tensions between Russia and Belarus catapulted …

Collaboration formed to develop fuels from algae oil

‎Endicott Biofuels, LLC, a Houston-based, next-generation biodiesel producer, and TransAlgae, Ltd., an algal biotechnology company, have signed a Memorandum…

Ultra boosts Pennsylvania Marcellus stake

Ultra Petroleum Corp., Houston, plans to buy 80000 net acres prospective for Devonian Marcellus shale gas in central and…

Houston company faces $1.47M fine following fatal explosion

Services Inc. willful and serious citations after an investigation into a fatal explosion at the company’s Griggs Road facility in Houston. …

WCA Waste Corporation Completes Its Largest Acquisition to Date

WCA Waste Corporation (Nasdaq:WCAA) announces it has completed the purchase of the subsidiaries and certain assets …

Godwin Ronquillo opens Houston office

Trial and appellate law firm Godwin Ronquillo PC has opened a Houston office to focus on civil litigation and appeals. The new office, which officially …

Trash to Gas: Landfill Energy Projects Increasing

… plant in the world; this plant produces 13000 gallons a day of LNG,” said Jessica Jones, a landfill manager for Houston-based Waste Management. …

Continental says traffic rose 6 pct in December

Continental Airlines Inc. said on Monday that its traffic rose 6 percent in December as it flew more planes with more passengers. …

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Robert S. “Bob” Lowery
Real Estate Representation for Houston Business
832-275-6514
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