《仲量联行：2024年医疗门诊建筑洞察报告（英文版）（26页）.pdf》由会员分享，可在线阅读，更多相关《仲量联行：2024年医疗门诊建筑洞察报告（英文版）（26页）.pdf（26页珍藏版）》请在三个皮匠报告上搜索。

1、ResearchUnited States| care means steady occupancy and growing interest for investment in the sectorMedical Outpatient Building PerspectiveKey findings2Medical Outpatient Building Perspective1Setting the stage:Whats driving demand?Demographic trends,technology and reimbursement changes are continuin

2、g the shift toward outpatient care,driving demand for outpatient medical buildings.Growing specialties are taking a more holistic view of lifelong health and wellness.2Fundamentals:Occupancy climbs due to steady demand and limited constructionWith the shift,demand for outpatient medical space is ste

3、ady,but rising financing costs have limited construction,pushing overall occupancy and rents upward.3Rising construction costs are creating challenges for occupiers and ownersHealth systems and providers face thin margins,so they are seeking to limit out-of-pocket costs associated with new space.Lan

4、dlords also face rising costs for maintenance and renovation.4Population and employment driving market growthSun Belt markets are seeing high rates of population growth,which in turn will drive increased outpatient volumes in those regions.5Capital markets:Slow transactions but opportunity aheadTran

5、saction volumes for outpatient medical dropped in 2023 due to financing challenges but will pick up once interest rates stabilize,as the sector is in favor with investors seeking stability.For investors Transaction activity remains slow early in 2024,but we expect activity to increase throughout the

6、 year.Cap rates have risen 100-150 bp since Q4 2022,creating more value opportunities for well-capitalized buyers less sensitive to debt and high interest rates.Fundamentals remain strong and construction starts remain slow,positioning medical outpatient buildings(MOBs)for increasing occupancy and r

7、ental rate growth,driving increased allocation from capital rotating from other asset classes.3For health systems and providers Outpatient volumes will continue to grow.A comprehensive,data-driven location strategy can help find the right sites to target for growing specialties plus optimize perform

8、ance in existing sites.With rising construction costs,occupiers can limit out-of-pocket expenses through seeking second-generation space or trading free rent for additional tenant improvement dollars.Exploring opportunities to monetize real estate or partner with developers can allow health systems

9、to free up capital to focus onpatient care.Takeaways for 2024Medical Outpatient Building PerspectiveHealthcare continues to shift toward outpatient sites,driven by technology,reimbursement changes and consumer preferences.The shift toward outpatient care is increasing the acuity level that is treate

10、d in such a setting.Today,a surgery center may be in office building,a retail center or a hospital.As these spaces become more clinical in nature,discussion is shifting to use of the term“outpatient medical,”providing a more comprehensive view beyond“medical office.”The shift in terminology reflects

11、 greater acceptance and interest by investors in the complexityand valuethat clinical tenancy brings to the property sector.In the U.S.,the baby boomer generation is aging into retirement,and the 80+population is expected to grow by 50%in the next 10 years.An aging population will require more carew

12、hile the 65+population composed only 18%of the population in 2021,they drove 36%of healthcare spending.Even as healthcare spending grows,inpatient volumes are anticipated to decline,but a growing and aging population will continue to drive rapid outpatient volume growth,with patients 80-84 expected

13、to see a 65.2%increase in outpatient volumes.-5.5%-6.9%2.9%16.5%38.9%65.2%48.2%-20%-10%0%10%20%30%40%50%60%70%55-5960-6465-6970-7475-7980-8485+Outpatient volume growth 2021-2031Sources:JLL Research,Advisory BoardSetting the stage:Whats driving demand?401Percent changeOutpatient medical growing rapid

14、ly as demographic and cultural trends shift demandAge rangeMedical Outpatient Building Perspective531%14%12%10%9%9%8%8%8%6%2%63%23%24%18%16%15%16%16%15%12%9%0%10%20%30%40%50%60%70%02004006008001,0001,2001,4001,600 2022 Volume 2027 Volume 2032 Volume 5-yr Growth 10-yr GrowthSources:Advisory Board;Mar

15、ket Scenario Planner,2023Outpatient sites expected to see rapid growthVolume growth in millionsPercent growthOverall inpatient volumes are expected to decline 0.7%in the next five years,but outpatient volumes are anticipated to grow by 10%according to forecasts from the Advisory Board.The demographi

16、c shift toward an aging population is the largest contributor to the increase in outpatient care need,followed by population growth.Advances in technology,reimbursement policies and consumer preference for convenience also drive this shift of services toward outpatient sites.One-third of hospital re

17、venue is in the process of shifting.Outpatient sites offer increased convenience for patients,broadening access to care and improving patient outcomes as they are more likely to seek care regularly or sooner after experiencing symptoms.Outpatient care is also more cost-effective for both patients an

18、d providers.Medical offices and clinics will be the largest beneficiary of this growth volume-wise,anticipated to see an increase of 126 million visits nationwide from 2022 to 2027,according to data from the Advisory Board.The fastest site-of-care growth in percentage terms is anticipated to be in o

19、ther sites such as standalone emergency departments and dialysis clinics.Lab services are also migrating out of the hospital and into standalone sites or in multi-specialty centers,limiting patient trips.Patient care continues to shift to outpatient sitesMedical Outpatient Building PerspectiveTelehe

20、alth6During the pandemic,telehealth grew rapidly as a percentage of overall visits but declined to 11.2%of all visits by May 2021.Telehealth use for psychiatry remained around 61%.While initially set to expire with the Public Health Emergency in May 2023,telehealth coverage for Medicaid was extended

21、 to the end of 2024.Most insurance providers extended telehealth coverage as well,with many forming strategic partnerships to offer convenient telehealth care to members.Telehealth remains a key avenue for patient care.In JLLs 2023 Patient Consumer Survey,we found that 18%of telehealth visits were f

22、ollow-ups from a prior appointment,meaning that an in-person visit occurred at one point,and an additional 30%of visits led to an in-person visit.74%of physicians work in a practice that uses telehealth,according to theAmerican Medical Association.The telehealth umbrella includes synchronous care,su

23、ch as video visits,asynchronous care via email or other messaging services and remote patient monitoring.Strategic use of telehealth can help providers see patients more efficiently and reduce wait times to an appointment.Health systems typically use their current space or work-from-home settings fo

24、r telehealth,rather than undergoing large-scale renovations to create telehealth-focused spaces.However,understanding telehealth use will have an impact on future space utilization and design,especially as some follow-up and less-acute care shifts to telehealth.of telehealth visits were follow-upsfr

25、om a prior appointmentSource:JLL 2023 Patient Consumer SurveyTelehealth often stems from or leads to in-person careIn addition to the shift toward outpatient care,inpatient care is also becoming dispersed.Hospital systems are investing in neighborhood hospitals to bring care closer to patients,rathe

26、r than patients having to travel to one centralized medical system campus.While the highest,most advanced care may still be centered in the main hospital,routine levels of care and emergency care can be spread out into these satellite hospitals.And around these satellites an ecosystem of outpatient

27、care will continue to develop.Inpatient care moves to the neighborhood18%of telehealth visits led to an in-person visit30%Medical Outpatient Building Perspective7Fastest acceleration in endocrinology to treat chronic conditionsEndocrinology is anticipated to be thefastest-growing specialty nationwid

28、e as diabetes prevalence rises.New therapies such as GLP-1 and semaglutide for both diabetes management and weight loss are attracting patient interest and will likely drive increased demand for treatment.Some of this increased volume will be handled through telehealth,but increased use of weight ma

29、nagement drugs could increase volumes for other specialties such as orthopedics as people become more active.Technological advancements shift oncology closerCancer care continues to move out of the hospital and into outpatient settings.Improvements in technology and early detection are enabling less

30、-invasive cancer care,allowing patients to receive treatment without an overnight stay.To improve convenience for patients,health systems are dispersing smaller cancer care centers closer to patients in neighborhood hospitals or tied to an ambulatory surgery center.In 2023,Beckers Healthcare profile

31、d 123 cancer centers either expanding,opening or affiliating with a larger hospital system,highlighting extensive growth in the sector.Growing specialtiesWhile acute care and care for chronic conditions compose the largest portion of new demand,advances in medicine and disruptive new entrants to the

32、 space are increasing the focus on overall patient health.Medical Outpatient Building Perspective20%of Americans 65 and older were employed in 2023,double the share from 1987817.1%Anticipated growth of general surgical orthopedics from 2022 to 202719.8%Increase in commercial claims for total hip,kne

33、e and shoulder replacement from2022 to 2023Source:Pew ResearchSource:Advisory Board Market Scenario PlannerSource:Definitive Healthcare Commercial Claims DatabaseAs people live longer and seek to be active longer,increasing volumes of outpatient surgeries such as joint replacement will in turn incre

34、ase demand for rehabilitation services,the second-fastest category behind endocrinology.Orthopedics,surgery centers and physical therapy were some of the most active specialties listed by JLL Healthcare experts in a recent survey.According to a CDC study,adults aged 65 and older are becoming more ac

35、tive,with the percentage meeting aerobic and muscle-strengthening recommendations growing from 5.5%to 13.9%from 1998 to 2018.Orthopedics and rehabilitation are both necessary to promote better physical activity and receive additional volume as adults are more active.A recent study presented at the A

36、merican Academy of Orthopaedic Surgeons(AAOS)found a substantial increase in bone fractures from pickleball as the sport has increased in popularity.Orthopedics and rehabilitation growing rapidly as people are more active into retirementMedical Outpatient Building PerspectiveBehavioral health remain

37、s inexpansion modeMental health awareness increased with the pandemic,but even as the world returns to normal,demand for behavioral health will continue to increase.The Advisory Board forecasts psychiatry volumes will increase at a 3.5%CAGR over the next five years.Many large markets have gaps in cl

38、inician supply for psychiatry and psychology,including Atlanta,Dallas and Orlando,according to Advisory Board projections.Even as some of the demand for mental health goes to novel telehealth solutions,behavioral health still has strong demand for in-person space.In the 2023 JLL Patient Consumer Sur

39、vey,10%of all respondents and 13%of Millennials(27-42)sought in-person outpatient behavioral health care in the last year.Behavioral health is also one of the most active specialties in seeking new office space,as reported in a survey of JLL Healthcare.9Concierge and specialty groups are growing bri

40、ght spotHealth system margins in 2023 were very thin,at 1.9%for the year according to Kaufman Hall,which has limited the pipeline for expansions in some markets.However,new entrants into the healthcare space such as those owned by technology companies or private equity have been expanding into prima

41、ry and concierge care.These consumer-focused sites are sometimes seeking consumer-centric retail sites rather than traditional medical office buildings.For example,OneMedical,the primary care provider owned by Amazon,is 60%in retail properties,36%in traditional or medical office and 5%in first-floor

42、 retail in multifamily buildings,according to CoStar data.Convenience is key for healthcare consumers,so to compete with new entrants,health systems must prioritize this,especially for primary and urgent care needs.The indexed margins improved substantially to 5.1%in January 2024,and this better-tha

43、n-expected recovery allows health systems more opportunity to consider growth.Medical Outpatient Building PerspectiveFundamentals:Steady demand and limited construction100290%91%92%93%94%95%012345678Q22018Q32018Q42018Q12019Q22019Q32019Q42019Q12020Q22020Q32020Q42020Q12021Q22021Q32021Q42021Q12022Q2202

44、2Q32022Q42022Q12023Q22023Q32023Q42023 Completed s.f.Absorption s.f.Occupancy rateDemand has outpaced supply since Q2 2021,causing occupancy to riseSquare feet(in millions)Occupancy(%)Sources:JLL Research,Revista(top 100 markets,medical office buildings)The majority of outpatient medical inventory(81

45、%according to Revista)is in properties that,from the outside,look like office buildings(and are typically referred to as medical outpatient buildings or MOBs).However,the fundamentals,drivers and finish-outs for MOBs are substantially different from traditional office product.Occupancy has declined

46、for traditional office since 2020,but MOBs have seen the opposite.Occupancy rising as absorption remains steady and construction pipeline slowsNet absorption for 2023 stood at 16.9 million square feet,and while slightly slower than annual totals in 2021 and 2022,the pace of demand still exceeds pre-

47、pandemic levels.Absorption has outpaced construction every quarter since Q2 2021 as completions have slowed while demand accelerated.This drove occupancy up from 91.4%at the end of 2020 to 93.0%in Q4 2023.Medical Outpatient Building Perspective80.0%82.0%84.0%86.0%88.0%90.0%92.0%94.0%02468

48、0200222023 Off-campus absorption On-campus absorption Off-campus occupancy On-campus occupancyOn-campus MOBs typically lead off-campus properties in occupancy.As there is limited supply,proximity to inpatient space is key for many specialties and on-campus properties are typically develop

49、ed by health systems that have limited capital to deploy.However,off-campus MOBs saw a greater increase in occupancy from 2019 to 2023,with off-campus occupancy increasing 1.9%and on-campus 1%.The shift toward outpatient care will increase demand both for on-and off-campus MOBs.To capture revenue sh

50、ifting out of inpatient care,health systems will expand outpatient services,sometimes moving care right across the street to an MOB or an outpatient surgery center in the same building.11Sources:JLL Research,Revista(top 100 markets,medical office buildings)On-campus occupancy remains higher than off

51、-campus,but off-campus saw greater increase since 2019Millions of s.f.Occupancy(%)Medical Outpatient Building Perspective12Construction starts remain slow due to interest-rate-related financing challengesSince 2020,construction starts for MOBs have remained below pre-pandemic averages,despite steady

52、 demand.In 2020 there were pandemic-related delays,in 2021 supply chain delays,and rising costs of financing and materials in 2023.On-campus MOB construction has been increasing as a percentage of the total as health systems respond to the shift to outpatient care through increased development.Off-c

53、ampus buildings accounted for 68.6%of the starts in 2016 vs.62.6%in 2023.As interest rates are predicted to have reached their peak and could decline in mid-to late 2024,economics for development and starts should rebound more to 2021 levels and will start to look more attractive.Construction starts

54、 for MOBs have slowed012345678 On-campus Off-campus Pre-pandemic averageSources:JLL Research,Revista(top 100 markets,medical office buildings)Millions of s.f.Medical Outpatient Building PerspectiveRent shows steady annual growthRental rates for medical office have posted a slow and steady increase.Y

55、ear-over-year,rent increased by 2.9%in Q3 2023 as inflation accelerated but declined in Q4 2023 to 2.25%.MOB rent growth remains below inflation,putting pressure on landlords and property managers as they address maintenance issues and fund tenant improvements amid an environment of rising materials

56、 and labor costs.13MOB rent shows steady growth but remains below inflationNNN rentPercentSources:JLL Research,Revista(top 100 markets,medical office buildings)0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%$10.00$12.00$14.00$16.00$18.00$20.00$22.00$24.00$26.00 MOB rent NNN avg MOB rent same-store growth Media

57、n consumer price indexMedical Outpatient Building Perspective-2.0%-1.0%0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%Year-over-year change in rent MOB all MOB 90th percentile Office all Office A&trophy14Sources:JLL Research,Revista(top 100 markets,medical office buildings)MOB rent increased slower than tradit

58、ional office rent until 2023.Medical outpatient tenants are more price-and cost-sensitive than office tenants at the top of the market,as many are operating under tight margins and rising labor costs.Because of the trend of office occupiers moving toward higher-quality and new product,average office

59、 rents rose rapidly in 2019 and 2020over 5%year-over-year.However,in 2022 and 2023,as office product saw increased vacancy,MOB rent growth outpaced office rent growth,4.0%to 2.0%respectively,in Q4 2023.Rents at the top end of the market have increased faster than the medianrents for the top 90th per

60、centile rose 4.2%from Q4 2022 to Q4 2023,compared with median rates rising 3.8%in the same time frame.Additionally,rent escalations are increasing from the historical 2%norm to 3%.Rent growth outpaces traditional office productTop-end of MOB rents show higher YOY growth in 2023Medical Outpatient Bui

61、lding PerspectiveEven in strong economic times,healthcare providers face thin margins as they focus on optimizing patient care.Real estate makes up 8-12%of health systems budgets,and as theyhave faced a crunch with rising labor costs,theyare looking to other areas to control costs.Overall,constructi

62、on costs are expected to increase 2%to4%in 2024,and ongoing skilled labor shortagescontinue to put pressure on prices and timelines.For MOBs,mechanical and plumbing are the largest component of materials costs and are expected to rise 3.5%in 2024.Innovative methodologies,technology and processes can

63、 also improve efficiency in the construction process for healthcare users and developers,allowing them to do more with less.Rising construction costs are creating challenges for occupiers and owners03As health systems and providers look for new space or renew a lease,many are seeking ways to limit o

64、ut-of-pocket capital expenditures.Health systems and providers also want to be able to move quickly to expand their practice and serve patient needs in growing submarkets,which built-out space enables.Some tenants seeking quality second-generation space or for a quicker move-in are looking at medica

65、l spec suites.In negotiations with landlords,tenants are seeking to turn free rent abatement into extra tenant improvement dollars.For occupiershealth systems,physicians and other care providersAdapting to rising construction costs15Medical Outpatient Building PerspectiveFor investors and ownersProp

66、erty owners are also facing pressure from increasing costs,and rising interest rates also put pressure on building owners.Escalating tenant improvement costs,fueled by rising construction costs combined with increased maintenance and operating expenses,have made many building budgets tight.Financing

67、 has become more expensive as loans become due or investors seek to purchase new assets.However,medical tenants tend to have longer lease terms and are more likely to renew than tenants of traditional offices.Because of the capital invested the space and familiarity with patients,medical occupiers a

68、re more likely to renew than to seek a new space,giving landlords some ability to push rates upon renewal.If they have capital,landlords can build out spec suites to fulfill tenant demand for speed-to-market through move-in-ready space.16Creating sustainable,patient-focused spacesHealth systems and

69、providers are increasingly setting ambitious climate and sustainability goals.Many metropolitan areas are introducing building performance standards,and the U.S.Department of Health and Human Services has released a Climate Pledge for health systems to announce their commitment to emissions reductio

70、ns and climate resilience.To improve sustainability and reduce carbon footprints,occupiers and investors can examine:Renewable energy procurement and on-site sustainable energy generationSustainable construction through incorporating renewable materials,biophilic design,natural environments and recy

71、cled elementsBuilding upgrades such as energy-efficient lighting,electrochromic technology in windows,HVAC systems and water conservation effortsBiophilic design,reducing artificial lighting and increasing natural elements can create a comforting,calm,secure environment for patients,improving patien

72、t care along with increasing quality and sustainability of the building.Medical Outpatient Building Perspective16.4%16.8%7.7%13.2%12.2%15.6%11.4%15.6%6.6%17.9%020406080100120140Dallas Fort-WorthHoustonLos AngelesAtlantaWashington,DCPhoenixMiamiSeattleChicagoOrlando20222027Population and employment d

73、riving market growth04 High rates of population growth and employment growth are driving healthcare expansion in Sun Belt markets like Austin,Orlando,Raleigh-Durham and Nashville.Dallas-Fort Worth will see the largest volume growth in numerical terms,but Austin will see the fastest expansion with a

74、23.1%growth rate.Outpatient volume growing fastest in Sun Belt marketsOutpatient volume in millionsSources:JLL Research,Advisory BoardLabels show%projected change 2022-2027Medical Outpatient Building Perspective17New YorkHoustonDallasSan FranciscoPhiladelphiaMiamiClevelandSacramentoOrlandoMinneapoli

75、sColumbusNashvilleAtlantaBostonCharlotteAustinRaleigh-DurhamCincinnatiRichmondPhoenixSan JoseDenverJacksonvilleRiversideTampaWashington DC0%1%2%3%4%5%6%7%8%5%7%9%11%13%15%17%19%21%23%25%Sources:JLL Research,Revista,Advisory Board;markets with over 100,000 s.f.under construction Outpatient volume gro

76、wth and construction rate for major marketsConstruction as%of inventoryOutpatient volume growth(2022-2027)Anticipated outpatient volume growth is translating into a faster pace of new development.Miami and Richmond,both anticipated to see 11%outpatient growth in the next five years,will expand their

77、 medical office footprint by 40%and 31%,respectively,when current product under construction delivers.New York has the largest amount of medical office space under construction to support its 19 million people,but Houston comes in a close second with 1.4 million s.f.under construction supporting its

78、 growing prominence in healthcare and life sciences.Austin has seen rapid population growth in the last few years and is anticipated to grow outpatient volumes by over 20%.However,little dedicated MOB space is under construction in the market.With the Dell Medical School nearing 10 years of operatio

79、n and new bonds passed for the hospital district,healthcare real estate should pick up its pace of development to support the population.Anticipated growth is not always matched with medical office developmentMedical Outpatient Building Perspective18Even as population growth is a major driver of new

80、 medical office construction,the density and layout of a metro area also factors into construction.Patients value proximity and convenience.Location/proximity was the second-highest factor in healthcare decisions(behind accepts my insurance)for the 3,000 consumers surveyed in the JLL 2023 Patient Co

81、nsumer Survey.About 40%of respondents traveled 14 minutes or less to receive care.Like retail,MOB construction follows population growth,causing older MOBs in areas with less population growth to sometimes fall out of favor and health systems to pivot locations in order to serve their patients.Devel

82、opment driven by proximity and convenienceMedical Outpatient Building Perspective19$11.6$11.9$14.8$13.3$13.6$13.9$19.6$24.7$8.5$0$5$10$15$20$25$3020002120222023 Single asset Portfolio EntityCapital markets:Slow transactions but opportunity ahead2005The sharp rise in interest ra

83、tes in H2 2022 and 2023 led to pricing uncertainty and rising costs of debt,creating a bifurcated market.Properties with long remaining lease terms and facilities aligned with well-performing health systems are transacting with multiple offers,and less well-positioned assets are not trading or tradi

84、ng at a discount.Transaction volume for MOBs in 2023 was 41%of 2022s total,with portfolio-and entity-level showing the steepest drops due to increased costs of capital for large transactions.The Los Angeles metro led the nation in MOB sales with$571 million transacting,followed by the Washington,DC

85、metro area with$486 million.MOB transaction volumeBillionsSources:JLL Research,RCA,deals over$2.5 millionBuffeted by rising interest rates and uncertain pricing expectations,MOB transaction volume dropsMedical Outpatient Building PerspectiveMOB sparks interest among investors seeking alternativesREI

86、Ts such as Welltower and Ventas have seen opportunity in the space and expanded their portfolios despite the turbulent conditions.Global Net Lease,typically a retail investor,has seen opportunity in the medical space,acquiring net-leased kidney care chains and other expanding medical practices in 20

87、23.REITs expanding ownership2.8%5.7%0.6%3.8%3.8%2.6%2.6%17.3%26.4%11.9%29.2%24.8%14.3%8.5%35.7%12.2%29.0%12.2%21.1%33.2%44.9%34.4%48.2%52.3%46.7%46.3%46.1%37.2%9.9%7.5%6.1%8.2%4.0%3.7%6.8%0%10%20%30%40%50%60%70%80%90%100%20020202120222023 Cross-border Institutional REIT/listed Private Use

88、r/otherHealth systems potentially will examine real estate monetizationIn the last decade,health systems have scaled back ownership of medical office and other healthcare assets;however,they still own 45%of healthcare real estate,according to Revista.As margins have remained tight for health systems

89、,some will explore monetizing their real estate or partnering with a developer as they look to expand.Divesting real estate assets or using strategic partnerships to manage and own their real estate will also allow health systems to more fully devote their own resources toward patient care.Higher ra

90、tes are also impacting debt service coverage ratios,limiting the ability of providers to borrow to invest in new real estate.Partnering with developers can be an opportunity to expand coverage while limiting their own capital.45%11%32%13%Hospitals/Health Systems Providers/Government/Other Private In

91、vestors REITsSource:RevistaMOB ownership by type(%of total square feet)REITs increase share of investment in 2023 as private buyers scale backSource:Real Capital AnalyticsMedical Outpatient Building Perspective21MOBs have been more resilient post-pandemic,while traditional office has declined22Funda

92、mentals for MOBs and the overall outpatient medical property segment continue to position it as a strong asset class.In contrast to traditional office occupancy,which has declined since the pandemic,medical office occupancy has increased.While some services can be done through telehealth,JLLs Patien

93、t Consumer Survey found that 30%of telehealth visits lead to in-person care.Traditional office,however,is still adjusting to hybrid workstyles,and caution persists around capital investment due to economic uncertainty.MOBs also benefit from its longer lease terms and tenant stickiness compared to tr

94、aditional office product.Average terms for new medical office leases range from 7 to 10 years compared to 5-7 years for office,although some medical office leases are 15-20 years.Over 80%of tenants choose torenew at the end of their term due to the investment in the space and familiarity of patients

95、 withtheir locations.70%75%80%85%90%95%Q22018Q42018Q22019Q42019Q22020Q42020Q22021Q42021Q22022Q42022Q22023Q42023 MOB occupancy Office occupancyOccupancy(%)Source:Revista(top 100 markets,medical office buildings)Medical Outpatient Building Perspective23Opportunities exist to convert traditional office

96、 to medical,but this is not a panaceaWith the strong performance of outpatient medical space,speculation has circled around converting traditional office to medical as a solution to rising vacancy in many office markets.While there will be some leakage of less specialized healthcare tenants to tradi

97、tional office buildings,a full conversion to an MOB requires extensive renovations,including increasing plumbing capacity and potentially building out speculative space to attract tenants.Like office,MOBs in non-core areas with declining populations and limited amenities are also facing declining oc

98、cupancy.Convenience to the target population is key for the success of an outpatient medical building,and additional proximity to referring and referral providers provides additional synergy and stickiness for tenants.Investors considering a conversion toturnaround occupancy need to carefully consid

99、er if the location and layout are suitable and if they have the capital to make the property competitive.Transaction activity to increase in 2024Interest rates appear to have peaked,and as conditions stabilize or rates fall,sellers that put marketing processes on hold in 2023 will take these to mark

100、et in 2024.Deal volumes should rebound in 2024 as the bid-ask spread narrows and buyer and seller expectations come more in line.Given improving economic conditions and debt markets opening up,most JLL Healthcare experts see the number of buyers and deal volume increasing.Cap rates are anticipated t

101、o either stay the same or decline slightly.Experts in fast-growing healthcare markets such as Dallas-Fort Worth and Los Angeles were more likely to predict declining cap rates.How do you see the investment sales for medical office buildings trending in your market over the next year?17.9%48.1%50.0%3

102、2.1%-10.7%-7.4%-39.3%-10.7%71.4%44.4%10.7%57.1%-100.0%0.0%100.0%Deal volumePrice PSF(or unit)Cap ratesNumber of active buyers Decreasing Staying the Same IncreasingSource:Survey of JLL HealthcareMedical Outpatient Building Perspective52.1545.0431.9830.8830.7027.9327.8826.2525.7020.9220.1018.4817.061

103、5.1814.1614.0113.4412.6612.3212.1511.9211.8511.7611.6011.5711.4111.2311.1410.308.767.576.816.806.705.975.755.011.720.79-20 40 60ChicagoDallas-Fort WorthHoustonAtlantaPhiladelphiaNew JerseyMiamiBostonLos AngelesSan FranciscoMinneapolisPhoenixDenverBaltimoreCharlotteSan DiegoColumbusPortlandNashvilleR

104、aleigh-DurhamRiversideWashington,DCCincinnatiClevelandAustinPittsburghSeattleTampaOrlandoSacramentoSilicon ValleyHartfordVirginia BeachSalt Lake CityIndianapolisJacksonvilleRichmondManhattanOuter boroughs(NYC)Millions of square feetLocal market statisticsTo dive deeper into this data,view the JLL He

105、althcare Medical Outpatient Building Dashboard.1.471.371.140.850.850.690.660.580.470.460.440.370.330.320.280.270.250.250.250.230.230.220.190.180.160.150.110.100.090.040.040.010.010.000.000.000.000.000.000.01.02.0ManhattanHoustonDallas-Fort WorthSan FranciscoPhiladelphiaMiamiClevelandSacramentoOrland

106、oMinneapolisColumbusNashvilleAtlantaBostonCharlotteAustinRaleigh-DurhamCincinnatiRichmondPhoenixSilicon ValleyDenverNew JerseyJacksonvilleRiversideTampaWashington,DCChicagoBaltimoreVirginia BeachPortlandPittsburghSan DiegoHartfordIndianapolisLos AngelesOuter boroughs(NYC)Salt Lake CitySeattleMillion

107、s of square feetExisting inventory(s.f.)Under construction(s.f.)Sources:JLL Research,Revista,CoStar;includes only medical office buildingsMedical Outpatient Building Perspective24$114.44$69.67$49.32$43.68$41.06$40.14$39.06$31.57$30.72$29.88$27.64$27.53$27.12$27.07 26.95$26.67$26.13$25.98$25.68$24.81

108、$23.18$22.94$22.92$22.78$22.44$21.84$21.61$21.36$21.15$21.08$20.32$19.72$19.34$18.90$18.67$18.29$16.91$16.74$16.56$0.00$50.00$100.00$150.00ManhattanOuter boroughs(NYC)San DiegoLos AngelesSilicon ValleySan FranciscoSeattleJacksonvilleMiamiOrlandoAustinHoustonWashington,DCCharlotteBostonRiversideSacra

109、mentoTampaRaleigh-DurhamPortlandDallas-Fort WorthAtlantaIndianapolisPhiladelphiaPhoenixNashvilleMinneapolisDenverBaltimoreRichmondVirginia BeachNew JerseyChicagoPittsburghSalt Lake CityHartfordColumbusClevelandCincinnati2531.9%17.7%14.8%14.0%13.4%11.1%10.7%10.6%10.5%10.3%10.1%9.4%9.2%8.5%8.5%8.5%8.4

110、%8.2%8.1%8.0%7.9%7.7%7.7%7.1%6.3%5.9%5.9%5.8%5.8%5.8%5.8%5.7%5.5%5.5%5.5%5.5%5.4%4.0%3.9%0.0%10.0%20.0%30.0%40.0%Outer boroughs(NYC)Washington,DCHoustonChicagoDallas-Fort WorthOrlandoPhoenixDenverAustinLos AngelesIndianapolisJacksonvilleRichmondBaltimoreNashvilleManhattanColumbusMiamiNew JerseyAtlan

111、taPhiladelphiaVirginia BeachSilicon ValleyMinneapolisSeattleClevelandHartfordCincinnatiSacramentoTampaBostonSan FranciscoSan DiegoCharlotteRaleigh-DurhamPittsburghRiversideSalt Lake CityPortlandAvg.direct asking rent(NNN)Total vacant(%)Medical Outpatient Building PerspectiveSources:JLL Research,Revi

112、sta,CoStar;includes only medical office authorKari BeetsSenior Manager,Industries ResearchJLL HAbout JLLFor over 200 years,JLL(NYSE:JLL),a leading global commercial real estate and investment management company,has helped clients buy,build,occupy,manage and invest in a variety of commercial,industri

113、al,hotel,residential and retail properties.A Fortune 500 company with annual revenue of$20.8 billion and operations in over 80 countries around the world,our more than 106,000 employees bring the power of a global platform combined with local expertise.Driven by our purpose to shape the future of re

114、al estate for a better world,we help our clients,people and communities SEE A BRIGHTER WAYSM.JLL is the brand name,and a registered trademark,of Jones Lang LaSalle Incorporated.For further information,visit .Jay JohnsonU.S.Markets LeaderJLL HAlison Flynn Gaffney,FACHEDivision PresidentJLL HJohn Chun

115、Senior Managing Director&Medical Properties Group LeaderJLL Capital MEvan KovacSenior Managing Director&Medical Properties Group LeaderJLL Capital M 2024 JONES LANG LASALLE IP,INC.This report has been prepared solely for information purposes and does not necessarily purport to be a complete analysis

116、 of the topics discussed,which are inherently unpredictable.It has been based on sources we believe to be reliable,but we have not independently verified those sources and we do not guarantee that the information in the report is accurate or complete.Any views expressed in the report reflectour judg

117、ment at this date and are subject to change without notice.Statements that are forward-looking involve known and unknown risks and uncertainties that may cause future realities to be materially different from those implied by such forward-looking statements.Advice we give to clients in particular si

118、tuations may differ from the views expressed in this report.No investment or other business decisions should be made basedsolely on the views expressed in this report.Research at JLLJLLs research team delivers intelligence,analysis and insight through market-leading reports and services that illumin

119、ate todays commercial real estate dynamics and identify tomorrows challenges and opportunities.Our more than 550 global research professionals track and analyze economic and property trends and forecast future conditions in over 60 countries,producing unrivalled local and global perspectives.Our res

120、earch and expertise,fueled by real-time information and innovative thinking around the world,creates a competitive advantage for our clients and drives successful strategies and optimal real estate decisions.Andrew MilneSenior Managing Director&Medical Properties Group LeaderJLL Capital MTo find out more about JLL services,contact:Andrew QuirkPDS Industry Lead JLL H