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1、2023 Healthcare MarketplaceMedical Office Fundamentals Remain Solid,but Cost Concerns Weigh on the Healthcare IndustryColliers U.S.Research ReportOverview and ContextThe medical office sector continues to perform well,setting record highs for asking rents and sales volume in 2022.Demand is outpacing

2、 supply,vacancy remains tight,and development is picking up,reflecting confidence in the sector.This is encouraging given the challenges of the healthcare industry,but there are signs of softening as well,with cap rates showing differing trends between single asset deals and portfolio transactions.A

3、verage pricing increased compared to 2021,but eased in the second half of 2022.We have identified several important changes in the healthcare industry over the year ahead:Staffing Shortages and Labor Costs:Burned-out and skilled healthcare professionals continue to leave the industry,while some heal

4、thcare systems are cutting staff to rein in costs.Operating Margins:Profits are falling and some operators are posting significant losses.Can this be turned around?Behavioral Health:Its provision and funding have become core issues.Technology:Healthcare systems are increasingly using digital health

5、services and artificial intelligence to streamline services and reduce costs.Mergers and Consolidations:Could the current large-scale M&A activity lead to more consolidation?Disruptors:Pharmacy retail giants such as CVS and Walgreens continue to expand their healthcare presence and services.Can trad

6、itional healthcare systems compete?Private Equity:After another strong year in 2022,will PE investment continue in this challenging fundraising environment?The Economy:How will elevated inflation and a volatile banking industry impact key healthcare stakeholders?Policy Outlook:How will the healthcar

7、e sector be affected after the COVID-19 public healthcare emergency measures expire in May 2023?We explore each of these issues in detail here,after we review how healthcare real estate,and medical office properties in particular,performed.2|2023 Healthcare Marketplace ReportColliers U.S.Research|3M

8、edical Office Fundamentals:Key Takeaways Vacancy:The medical office(MOB)vacancy rate fell by 80 basis points in 2022,to 7.4%,better than vacancy in the broader office sector of 15.7%,which increased 80 basis points in the same period.Absorption:Demand for medical office space remains strong,outpacin

9、g new supply.Net absorption totaled 18.8 million square feet in 2022,up from 18.1 million square feet during 2021.Source:Revista*Top 100 Markets6.06.57.07.58.08.59.0Q1 2018Q2 2018Q3 2018Q4 2018Q1 2019Q2 2019Q3 2019Q4 2019Q1 2020Q2 2020Q3 2020Q4 2020Q1 2021Q2 2021Q3 2021Q4 2021Q1 2022Q2 2022Q3 2022Q4

10、 2022Medical Office:Vacancy Rate(%)*Source:Revista *Top 100 marketsMedical Office:Supply&Demand(MSF)*0123456782Q20183Q20184Q20181Q20192Q20193Q20194Q20191Q20202Q20203Q20204Q20201Q20212Q20213Q20214Q20211Q20222Q20223Q20224Q2022New SupplyNet Absorption4|2023 Healthcare Marketplace ReportRents:Average ne

11、t asking rents for MOB space increased by 3.7%in 2022 to$23.57 per square foot a new high for the sector.Construction:The total of 11.6 million square feet of MOB space delivered in 2022 was down from 15.1 million square feet in 2021.Source:RevistaMedical Office:Top 10 Metros-Average NNN Rents051015

12、2025303540Washington DCPhiladelphiaNew YorkMiamiLos AngelesHoustonDallasChicagoBostonAtlanta$PSF/YearTop 100 Average=$23.57Source:RevistaMedical Office:Leading Markets For Construction(MSF)00.511.522.53AtlantaLos AngelesSacramentoBaltimoreClevelandMiamiMiamiWashington D.C.New YorkHoustonMSFColliers

13、U.S.Research|5Sales:Total investment in MOBs reached$25.4 billion in 2022,up from$18.6 billion in 2021.Sales pricing rose to an average$390 per square foot,while average cap rates increased by 40 basis points on portfolio deals,to 5.8%.Cap rates held flat for single asset transactions at 6.4%.This d

14、ata is skewed by the Healthcare Realty Trust and Healthcare Trust of America merger.Numerous properties related to these entities were transacted,increasing overall sales volume.Vacancy Falls and Rents RiseFour of the 10 leading U.S.MOB markets ended 2022 with vacancy rates lower than the overall av

15、erage,while five of these achieved above-average rent growth.New York rent growth in 2022 was Source:RevistaMedical Office:Average Pricing($PSF)Source:RevistaMedical Office:Annual Sales Volume($Bn)051015202530201520162017201820192020202120223003103203303403503603703803904002018 Q12018 Q22018 Q32018

16、Q42019 Q12019 Q22019 Q32019 Q42020 Q12020 Q22020 Q32020 Q42021 Q12021 Q22021 Q32021 Q42022 Q12022 Q22022 Q32022 Q46|2023 Healthcare Marketplace Reportthe strongest,8.6%,followed by Washington,D.C.,7.6%,and Chicago,7.3%.Boston enjoys the lowest MOB vacancy rate across the major markets,6.2%,followed

17、by Miami at 6.6%.Conversely,Dallas and Houston have the highest vacancy levels in leading markets,10.1%and 12.3%,respectively.Los Angeles has by far the highest average net MOB asking rents in the top 10 markets,at$36.88 per square foot,while other rents in the top 10 metros fall below$30 per square

18、 foot.Boston and Washington,D.C.,are the next highest,at$27.48 per square foot and$27.41 per square foot,respectively.02468101214Washington DCPhiladelphiaNew YorkMiamiLos AngelesHoustonDallasChicagoBostonAtlantaSource:Revista%Medical Office:Top 10 Metros Vacancy RatesTop 100 Average=7.4%Colliers U.S

19、.Research|7MOB Construction Is Rising and Focused on Off-Campus Locations While the amount of MOB space being completed was falling in 2022,the volume underway was rising.Completions of 11.6 million square feet during 2022 were down from 15.1 million square feet in 2021.But MOB space under construct

20、ion was 39.9 million square feet,5.7%higher in 2022,reflecting sustained developer confidence in the sector.Of 713 healthcare real estate projects underway,256 are hospital developments and 457 are MOB buildings.MOB construction remains concentrated off-campus to provide readily accessible locations

21、 and outpatient clinics to accommodate the shift away from in-patient hospital care.Off-campus properties usually smaller than new on-campus facilities account for 73%of projects underway.Fourteen metros have more than one million square feet of MOB construction underway,led by Houston with 2.7 mill

22、ion square feet,and New York and Washington,D.C.,at two million and 1.8 million square feet,respectively.Across medium-to-larger-sized markets,Sacramento leads in construction,with 1.3 million square feet underway,or 15.3%of market inventory;Cleveland and Orlando follow,at 13.2%and 11.7%,respectivel

23、y.The overall average is 3.9%of market inventory.Cap Rates Rise as Pricing Falls MOB investment in 2022 of$25.4 billion was the highest total on record,up from$18.6 billion in 2021,thanks in part to the merger of Healthcare Realty Trust and Healthcare Trust of America.Despite the healthcare industry

24、s challenges,investment in the sector continues to rise,and medical real estate is no longer perceived as a niche asset class.Average MOB cap rates showed varying trends between single asset sales and portfolio transactions.Over the course of 2022,average MOB pricing increased to$390 per square foot

25、 in Q4 2022.Eleven metros exceeded$500 million in MOB property sales in 2022,led by New York,at$1.4 billion;Los Angeles,$1.3 billion;Houston,$1.25 billion;and Dallas,$1.2 billion.Source:RevistaMedical Office:Average Cap Rates(%)5.0%5.2%5.4%5.6%5.8%6.0%6.2%6.4%6.6%6.8%7.0%2016Q12016Q22016Q32016Q42017

26、Q12017Q22017Q32017Q42018Q12018Q22018Q32018Q42019Q12019Q22019Q32019Q42020Q12020Q22020Q32020Q42021Q12021Q22021Q32021Q42022Q12022Q22022Q32022Q4Cap Rate%PortfolioCap Rate%Single Property8|2023 Healthcare Marketplace ReportHealthcare Industry Outlook for 2023 As the COVID-19 pandemic shifts to endemic st

27、atus,hospitals and healthcare operators are facing numerous industry challenges.In addition,the recent volatility in the banking industry will undoubtedly affect the sector.Liquidity is expected to tighten,limiting the growth potential of both occupiers and PropertyLocationSize SFBuyerPrice$MPrice$P

28、SF330 East 62nd St.New York,NY110,000Memorial Sloan Kettering$185.0$1,682VA Outpatient ClinicPhoenix,AZ275,000Easterly Gov.Properties$137.7$501Anthem Blue Cross BuildingWoodland Hills,CA448,000Kroenke Group$115.0$257I955 W.Imperial Hwy.Brea,CA288,000Healthcare Prop.Advisors$80.0$278Anthem Blue Cross

29、 Expansion,2015 Staples Mill Rd.Richmond,VA308,0002000 Maxwell,LLC$77.2$2514800 S.109th East Ave.Tulsa,OK137,415Remedy Medical Properties$72.5$528Northwest Medical CenterAtlanta,GA153,744Lincoln Property Co.$71.8$467Integrated Health CampusAllentown,PA300,197Hammes Company$69.6$232Stanford Medical O

30、ffice Bldg.Menlo Park,CA48,397Morgan Stanley$68.0$1,405Naples Surgical Hospital.Naples,FL86,287Remedy Medical Properties$66$765Source:Real Capital Analytics Medical Office:Top 10 Single Asset Sales in 2022 Source:Revista *TTM totalsMedical Office:Most Active Sales Markets in 2022($Bn)*0.00.20.40.60.

31、81.01.21.41.6BostonMiamiChicagoIndianapolisPhoenixAtlantaDallasHoustonLos AngelesNew YorkColliers U.S.Research|9innovators.Private equity investors,in particular,could face pressure.Conditions are changing rapidly.Weve grouped emerging trends into two primary categories:Costs and Consolidations.Cost

32、s From staffing shortages and labor costs to pinched operating margins and funding for behavioral health,costs are top of mind for the healthcare industry today.Inflation remains entrenched in the U.S.economy,even though it has shown signs of cooling.Technology is considered part of a potential solu

33、tion.Insurers,networks,and individual providers are facing a Catch-22,including,on the one hand,substantial employee burnout and fatigue.Seniors care,for example,faces substantial talent gaps.Hospitals average 100%turnover every five years,notes the 2022 NSI National Health Care Retention&RN Staffin

34、g Report,hurting not only patient care but also those forced to pick up the workload.Costs of recruiting,retention,and training are other factors.Yet higher costs are also forcing staff cuts across the country.According to data from Kaufman Hall,for-profit hospitals seem to be faring better than non

35、profits in todays environment.As awareness of behavioral health emerges and continues to grow,surveys show that hospital CEOs understand its increasing importance.However,because of numerous cost challenges and staff shortages,patients struggle to find a provider and pay for care.And not all clinici

36、ans take all insurance,frustrating patients.The Advisory Board notes workforce shortages in behavioral healthcare,as well as mismatches between available clinicians and the needs of a community.Practitioners are retiring at a high rate and new physicians are entering the profession at a low rate.Phy

37、sicians are challenged by both reimbursement processes and burnout.The expiration of the federal public health emergency on May 11 will affect the healthcare industry in a variety of ways,including reimbursement rates at hospitals,telehealth reimbursements,and Medicaid redeterminations,COVID-19 test

38、ing and access,and waivers and flexibility for hospital staff.These and other factors have led Kaufman Hall to predict a year of depressed margins in 2023.At the same time,per a Gallup poll,patients are delaying care at the highest rate ever,due to cost concerns.10|2023 Healthcare Marketplace Report

39、Technology is one potential solution.Bain&Company,along with Klas Research,note that hospital and healthcare systems are spending more on technology and software to improve productivity and reduce costs and labor pressures.Digital health also attracted an abundance of venture capital in recent years

40、,and while those investments slowed in 2022,they were still greater than the inflow experienced in 2020.Consolidation The healthcare industry has been experiencing mergers and acquisition(M&A)activity,private equity investment,and overall disruption,providing an opportunity for innovation and change

41、 within the industry.Per data from PitchBook,private equity investment in the healthcare space was estimated at 863 deals last year,well ahead of the pre-2021 pace.It should be noted,however,that rising interest rates slowed private equity investment during the latter part of 2022,a trend experience

42、d across most of the economy.IPO activity also stalled,which was not surprising.Meanwhile,M&A activity remained strong,attracting groups that want to interface with healthcare consumers,such as CVS,Walgreens,Amazon,and UnitedHealth.This could result in offering medication prescriptions online,or con

43、necting to virtual primary care and behavioral health services.With billions of dollars invested,these groups will become larger players in the healthcare space,creating further disruption in the industry.Expect to see continued consolidation and innovation in healthcare in 2023 and beyond.The lucra

44、tive healthcare market,with an aging population,expanding population,and underserved communities,offers attractive investment targets.ConclusionLong-term trends in the medical office sector,and the healthcare industry as a whole,remain positive.Demand for space is outpacing supply,rents are rising,a

45、nd the broader issues affecting the commercial office sector are not trickling down to medical properties.Investment sales volume set a record in 2022,thanks to the HR/HTA merger,while other asset classes experienced a decline.Innovation in the industry offers opportunities for providers and hospita

46、ls to evolve and find new ways of servicing patients.Technology creates expanded access to care and cost savings.The healthcare industry is well-positioned and will continue to evolve.Colliers U.S.Research|11This document/email has been prepared by Colliers for advertising and general information on

47、ly.Colliers makes no guarantees,representations or warranties of any kind,expressed or implied,regarding the information including,but not limited to,warranties of content,accuracy and reliability.Any interested party should undertake their own inquiries as to the accuracy of the information.Collier

48、s excludes unequivocally all inferred or implied terms,conditions and warranties arising out of this document and excludes all liability for loss and damages arising there from.This publication is the copyrighted property of Colliers and/or its licensor(s).2023.All rights reserved.This communication is not intended to cause or induce breach of an existing listing agreement.Healthcare ServicesShawn JanusNational Director,Healthcare Services+1 312 612 ResearchStephen NewboldNational Director of Office Research|U.S.+1 202 534 Aaron JodkaDirector,National Capital Markets Research+1 617 330