The Outlook for Investment in Health Care Properties: Medical Office Buildings and Outpatient Facilities 2 (Jonathan Winer) - ULI fall meeting - 102811
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The Outlook for Investment in Health Care Properties: Medical Office Buildings and Outpatient Facilities 2 (Jonathan Winer) - ULI fall meeting - 102811
1. 2011 ULI Fall Meeting
The Outlook for Investment in
Healthcare Properties: Medical Office
Buildings and Outpatient Facilities
October 28, 2011
2. The following information is taken from The Outlook For
Healthcare by Economist Gary Shilling
Sponsored by Seavest Inc. and ULI
The full report can be obtained at SeavestHCP.com
1
3. U.S. Elderly Population as a Share of Total Population
12%
10%
8%
6%
4%
2%
1970 1980 1990 2000 2010 2020 2030 2040 2050
65 to 74 Years Old Over 75 Years Old
Source: U.S. Census Bureau
2
4. Annual Rate of Physician Office Visits by Age Group,
1998 versus 2008
6.9
Over 65
6.1
3.7
45-64
3.6
2.3
Under 45
2.4
0 1 2 3 4 5 6 7 8
2008 1998
Source: U.S. Centers for Disease Control and Prevention.
3
5. Social Security, Medicare, and Medicaid as a Percentage of GDP
25%
20%
15%
10%
5%
0%
1970 1990 2010 2030 2050 2070
Social Security Medicare Medicaid
Source: Congressional Budget Office and Social Security Administration
4
6. Hip and Knee Replacements in Nonfederal Short-
Stay Hospitals: Adults 45 Years and Older MRI / CT / PET Scans
50 35
30
40
25
30
20
20 15
10
10
5
0 0
1996 1998 2000 2002 2004 2006 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Total Hip Partial Hip Total Knee Under 65 years in Physician's Office and Outpatient Departments
Over 65 years in Physician's Office and Outpatient Departments
Under 65 years in Emergency Departments
Over 65 years in Emergency Depepartments
Source: U.S. Centers for Disease Control and Prevention
5
7. Insured Nonelderly Population with and
without Health Care Bill
260
255
250
245
240
235
230
225
220
215
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Without Healthcare Bill With Healthcare Bill
Source: Congressional Budget Office
6
8. Average Length of Stay
7.5
7.2 7.2
7.1
7.0
6.7
6.5
6.2
6.0
6.0 5.8
5.7
5.6 5.6
5.5
5.5
5.0
1988 1991 1994 1997 2000 2003 2006
Average Length of Stay
Inpatient and Outpatient Surgeries at U.S. Community Hospitals
20
19
18
17
16
15
14
13
12
11
10
9
1988 1993 1998 2003 2008
Outpatient Surgeries Inpatient Surgeries
Source: Avalere Health / American Hospital Association.
7
9. Share of Medical Practices Owned by Physicians and Hospitals
80%
75%
70%
65%
60%
55%
50%
45%
40%
35%
30%
25%
20%
2002 2003 2004 2005 2006 2007 2008 2009
Physician Owned Hospital Owned
Source: Medical Group Management Association.
8
10. About Seavest Inc.
Seavest Inc. is a real estate investment management firm dedicated to investing in medical office buildings and
related healthcare properties. Established in 1981, Seavest partners with qualified medical office developers and
operators, acquires properties directly and provides asset management services for millions of square feet of
medical office buildings throughout the United States.
Seavest operates through long-term, discretionary investment funds. This investment vehicle is structured to
attract health systems and the developers serving these organizations while providing superior returns to
investors. The fund structure, along with our established industry relationships, allows Seavest to access a full
range of opportunities to invest in medical office buildings and other outpatient projects.
With an extensive history of medical office investing, Seavest offers market expertise grounded by the principles
of stability, loyalty, openness and mutual success.
To contact Seavest: Jonathan L. Winer
Executive Vice President
Seavest Inc.
914.683.8474
jwiner@seavestinc.com
To obtain a copy of The Outlook for Healthcare by Gary Shilling please visit SeavestHCP.com
9
Over 65 represented 24% of all office visits in 1998 versus 27% in 2008 and the number of visits increased from 6.1 to 6.9Why; better technology, broader ‘lifestyle” solutions, better access?In 2004, the average spend for someone over 65 was $14,797 (the governments pays for about half) vs. $4,511 for the 19 to 65 age group
Even before HC reform cost were projected to explode from 10% to 25% by late in the centuryThe real culprit -- Medicare
Advances in the technology of medicine also play a significant role in increasing costs.Look at the growth in procedures and diagnostics over a 10 year period. For instance a 50% increase in knee replacements from 96 to 06 and 200% increase in advanced imaging.As technology has improved many of these procedures are done on an outpatient basis or that is where the rehab occurs.
Because most of the elderly are covered by Medicare, the 32 million increase in insured is younger and often poorer with much of the burden projected to fall on Medicaid.Starting in 2014 and fully implemented by 2019.
Here is the story line; hospital beds are shrinking and inpatient stays are shortening.Meanwhile, the outpatient procedures are growing rapidly.Hospitals are pushing series out in to the community to be closer to the patient base and more generally in to outpatient facilities to unpack their campus.MOB space can be built for half the cost of a hospital.
Here is another important trend to take note of – from 25% to over 55% in just 7 short years.This represents a sea change in the traditional physician/hospital relationship.The result for outpatient real estate; PRO - better credit, CON the business starts to look more like a traditional net lease business
Again, please get a copy of the complete paper at SeavestHCP.com