Andrew Dick

An interview with Connor Siversky, Research Analyst, Real Estate, Berenberg Capital Markets

An interview with Connor Siversky, Research Analyst, Real Estate, Berenberg Capital Markets

In this interview, Andrew Dick sits down with Connor Siversky, Research Analyst, Real Estate with Berenberg Capital Markets to talk about publicly traded healthcare REITs.

Podcast Participants

Andrew Dick

Attorney, Hall Render

Connor Siversky

Research Analyst, Real Estate, Berenberg Capital Markets

Disclosures:
• BCM is making a market in Ventas (VTR)
• BCM is making a market in Medical Properties Trust (MPW)
• BCM is making a market in Omega healthcare (OHI)
• BCM is making a market in LTC properties (LTC)
• BCM is making a market in Caretrust REIT (CTRE)
• BCM is making a market in Healthcare Realty (HR)
• BCM is making a market in Healthcare Trust of America (HTA)
• BCM is making a market in Physicians Realty (DOC)
• BCM is making a market in Community Healthcare Trust (CHCT)
• BCM has no company-specific disclosures on Alexandria (ARE)
• BCM has no company-specific disclosures on Welltower (WELL)
• BCM has no company-specific disclosures on Healthpeak (PEAK)
• BCM has no company-specific disclosures on Sabra Healthcare (SBRA)
• BCM has no company-specific disclosures on National health investors (NHI)
• BCM has no company-specific disclosures on Global Medical REIT (GMRE)

Andrew Dick: Hello and welcome to the Health Care Real Estate Advisor podcast. I’m Andrew Dick, an attorney with Hall Render, the largest healthcare focused law firm in the country. Today, we are speaking with Connor Siversky, a REIT research analyst with Berenberg Capital Markets. Connor currently covers nearly all of the publicly traded healthcare REITs, which gives him a unique perspective on the healthcare real estate sector. We’re going to talk about Connor’s background, the different healthcare REITs that he covers, and a variety of other healthcare real estate topics. Connor, thanks for joining me today.

Connor Siversky: Thanks for having me, Andrew.

Andrew Dick: Connor, before we jumped into the discussion, talk about your role at Berenberg Capital Markets and your background.

Connor Siversky: Yeah, sure. I was born and raised in New Jersey, town of Montclair. Stayed in the state, went to Rutgers New Brunswick as an undergrad, got a degree in finance. And then I think in the fifth grade I said I wanted to be an investment banker ski racer, so I think I got pretty close to one of those goals.

Andrew Dick: How did you end up at Berenberg Capital Markets? It’s an interesting niche covering healthcare REITs.

Connor Siversky: Yeah. For sure. For sure. I took a bit of a backdoor to get into the securities business. Immediately after college, I was doing construction. There was a little ferry New Jersey based GC called Mobile Construction. We did all sorts of projects throughout the state, a lot of municipal work. Incredible learning experience to see how those boots all work on the ground. And then I moved to a property manager called Solstice Residential in New York City. I was on the special projects team there. We had an excellent boss and mentor, in some respects. His name was Ken Lupano. We did a whole slew of projects in and around the borough, so Local Law 11 projects, roof replacements, facade replacements, leak repairs, all sorts of things like that.

Connor Siversky: I got to see a lot of different parts of the city, whether that was from the roof of 220 Madison Ave or maybe on the trains going to the different boroughs. It was a very interesting experience as well. Around spring, summer 2018 I got a recommendation from a buddy I actually went to college with and took on the associate role in the real estate team at Berenberg Capital Markets. Definitely a bit of a learning curve coming from the construction side of things, but some aspects of training fell in the right direction. It wasn’t very long turnaround before we were writing notes, building models, and all the things like that. It definitely helped that the lead analyst on the team, Nate Crossett, he’s still there today, extremely knowledgeable in remodeling and equity research in general. He was a ton of help in my development as an analyst.

Andrew Dick: And so how did you get the responsibility of covering healthcare REITs? Pretty narrow niche.

Connor Siversky: Yeah. It was a pretty fast turnaround, too. Nate had started covering the data centers, and then he moved on to the net lease group. He was up to capacity pretty quickly. And right around April 2018 or 2019, sorry, I think I had gotten the mandate to cover the healthcare names. Right after the first level of the CFA that June, I pretty much spent the entire summer working on the initiation report and launched on the eight names September 2019.

Andrew Dick: Got it. And for the listeners that aren’t familiar with how firms like yours review REITs and provide recommendations, how does that work in layman’s terms?

Connor Siversky: Typically, I mean, from start to finish, if we’re initiating on a company, we’ll read through all the 10-Ks, 10-Qs, the quarterly reports. We’ll use the financials. We’ll build out a financial model. We use a four pronged valuation systems. We have an AFFO multiple. We do a discounted cashflow with the AFFO out of 10 years. We do a net asset valuation, an appraisal of the portfolio at a point in time, and then a TV EBITDA multiple. Through the writing, depending on our opinions of maybe the intangible aspects of the company in conjunction with the valuation, we’ll come up with our rating. And we do a traditional buy, sell, hold at Berenberg Capital Markets, so a buy and sell would be a 15% upside or downside, respectively, and then the hold rating is anywhere in the middle.

Andrew Dick: Got it. And right now you’re covering most of the well-known healthcare REITs. I think when we spoke before, Connor, you said there’s really only a couple that you don’t cover. What are the two or three that you don’t cover?

Connor Siversky: Yeah, so we covered pretty much all the healthcare REITs that I would consider really coverable. I think DHC would be the last one, and then there’s another named SNR. Neither of those names have a lot of coverage, so those are ones that we’ve left off the table for now.

Andrew Dick: Got it. You’re covering a pretty wide gamut of diversified healthcare REITs, and then a number of pure-play REITs, for example, senior housing, medical office buildings, some of those pure-play REITs, but you’ve got a lot to cover there. How many REITs are you really covering today? Is it 10 or 15? I mean, the healthcare REIT sector is pretty big.

Connor Siversky: The healthcare REIT sector, we have 14 names in the healthcare REIT sector, and then four more names, the smaller cap industrial REITs, which is something that we’re going to be working on going forward as well. So, it’s 18 total at the moment.

Andrew Dick: Got it. And so when you think about breaking down the sector, when you’re talking to others in the industry, how do you break it down? I mean, I typically think of the big three that are diversified healthcare REITs: Ventas, Welltower, Healthpeak. And then there’s all these other niche players. I mean, is that the right way to think about it?

Connor Siversky: Right. It’s an interesting question because I think when you look at the healthcare REITs from an outside perspective, you want to lump them all together, but they’re really quite different, right? So, maybe if I just run down the list here, you could start with the life sciences assets, laboratory space, biotech, pharmaceutical development. And the real name there is ARE, Alexandria. And you also have Healthpeak and Ventas, which are building out life science portfolios as well. Then you’ve got medical office buildings, so outpatient medical office buildings, surgery centers, things like that. HTA, HR, and DOC are really the dedicated names in that space. Healthpeak, Welltower, and Ventas, they have some MOB portfolios as well.

Connor Siversky: And then when you look at the smaller names, say GMRE and CHCT, they chase after some medical office buildings, probably smaller assets in secondary and tertiary markets where they’re not really competing with those larger names. Of course, you have skilled nursing and senior housing. The important difference between the two of them, so skilled nursing is primarily funded by Medicare and Medicaid, right? The three main names in that sub-sector would be Omega (OHI), Sabra, and CTRE. And then LTC, NHI, they have SNIF portfolios as well. And then senior housing, again, there’s an element of diversity within senior housing in itself, so Welltower and Ventas are really the biggest names here. The interesting element in those portfolios are the operating portfolios where the REIT is the owner and the operator in effect. Sabra has an operating portfolio as well. And then they also have the net lease portfolios as do Omega (OHI), CTRE, LTC, and NHI.

Connor Siversky: You also have hospitals. The only true player in the hospital real estate space, at least in terms of the public REITs, is MPW. They take a unique approach here, an international approach, to investing in hospital real estate. They’ve been growing very quickly over the past several years. Very interesting name to keep track of. And then I think, finally, again, going back to the smaller cap names, more diversified assets, surgery centers, ambulatory care centers, some medical office buildings, dialysis clinics, things like that, and that’s where you’ll find GMRE and CHCT. And these names are interesting. I mean, they’re looking at these secondary and tertiary markets. They’re finding higher yields than some of their larger peers do. And they’re not really competing for those assets in primary market, so they can find higher yields. They have a better spread versus their cost of capital. And they’ve been growing very quickly over the past several years as well.

Andrew Dick: So, Connor, looking at all these different healthcare REITs, which ones do you find interesting right now in the world that we live? Which sectors are you focused on, or which rates do you really like right now based on the interesting world that we live in?

Connor Siversky: Right. The pandemic environment has definitely had a profound impact on healthcare in general and the healthcare real estate owners. There are a lot of different dynamics at play here. I think the names we like right now have an element of safety in them. For example, Alexandria (ARE), they have very strong tenants. Even though they can be grouped as office buildings, there’s still an element of human interaction within those facilities. By and large, all of those facilities are open. ARE has done a very good job on leasing and growing the portfolio with a 1.3 to $1.6 billion development pipeline. That’s one name we like a lot.

Connor Siversky: I do like the medical office buildings. Their share price has been depressed somewhat this year, so their cost of capital is a little bit higher. It’s harder for them to generate growth from external opportunities when they can only manage, say, a 50 to 100 basis point spread against their AFFO. But, they’re very high quality facilities. People are still going out and getting elected procedures. And for the most part, these names have been collecting all of their rents through the entire year, so you can definitely see an element of resiliency for the medical office buildings. Again, that would be HTA, HR, and DOC.

Connor Siversky: I like skilled nursing compared to discretionary senior housing. I think a very interesting name within skilled nursing is OHI. It’s one of the larger names in the space. They have a huge reach in terms of who their operator tenants are. They have the best cost of capital among the skilled nursing names, so when the time is right, when it’s prudent to do so, I would expect these guys to go out and start acquiring assets again and generate some external growth. Interestingly-

Andrew Dick: They’ve been around a long time. We’ve talked about that before.

Connor Siversky: Right. Right. They have been around for a long time. If I remember correctly, I don’t think they’ve had to cut the dividend in either 17 or 18 years. And the management team has been in place for a long time as well. They’re very clear with their messaging. They’ve done a great job managing skilled nursing assets, which is a very tough business to be in, especially in the current environment. And then one interesting takeaway there is that the skilled nursing operators have been the beneficiaries, of some degree, of government support through the pandemic. I would never want to say that they’re completely out of the woods yet, but these are also portfolios that have been collecting high-ninety percents of their contractual rents pretty much every month.

Andrew Dick: Which is impressive. Yeah. How do you look at a company like MPW? We haven’t talked about hospitals, but you made a point that, look, they’re international, they’ve been growing significantly. I find the company to be really interesting. How do you react to it?

Connor Siversky: Right. I mean, I agree with you completely there. They’re really the only name among the public REITs that are going after hospitals. And I think you can take into consideration that underwriting hospitals is quite difficult. I mean, from my understanding, you would have to go in there; you have to underwrite the patient flows to a certain degree; you have to have a familiarity with the physician groups operating in the hospital’s geography as well. And also, who are your competitors within those markets? It’s a very dynamic underwriting process. And I think MPW definitely has a bit of a strategic advantage of being able to underwrite those assets.

Connor Siversky: They’ve been growing very quickly over the past several years. 2019, 2020 in particular, they’ve done multi-billion dollars in acquisition for both years on an international scale as well: Australia, the UK, Switzerland, Germany. They’re even going into Columbia now. They definitely have wide reach. They’re definitely approaching the real estate space in general from somewhat of a unique avenue. And I would expect them … this year, I think they’re going to continue to execute on external opportunities. And it’s also worth noting, too, that hospitals, you can consider them, by and large, critical pieces of healthcare infrastructure. There’s definitely an element of social and government support for those operators and those assets as well.

Andrew Dick: Yeah. Good point. What about diversified REITs?

Connor Siversky: So, the diversified REITs, I mean, you can look at this in two ways. Maybe we could say this is the big three that have MOB portfolios. They have their senior housing operating portfolios, the net lease portfolios, but, to me, I like to look at GMRE and CHCT for these names. They have a lot of smaller assets that they can pick up in these secondary, maybe tertiary markets throughout the United States. And through this business model, which I think is very valid, particularly in the current environment where REITs are coming down, they can acquire at seven, eight, in some cases, nine, ten percent cap rates. And the math just works out as such that GMRE and CHCT, I mean, they can generate 10% AFFO growth if they continue to execute on these opportunities, not withstanding any kind of tenant issues or something like that. But, for the past couple of years, they’ve been pretty stable in that regard.

Andrew Dick: Talk about the impact of COVID on the REIT industry.

Connor Siversky: There are a lot of impacts in a lot of different places. I mean, I think maybe we could rewind to late February, early March when the issue was really coming to a head when we all started to get eyes on it. I think the most profound impacts have been in senior care businesses. In terms of skilled nursing, I mean, you’ve seen the headlines all over the place. It’s a very dangerous situation to be one of those more frail patients in this current environment. The impact has been felt there. Also, in senior housing I think one of the developments that really impacted the real estate fundamentals is that as the virus rolled inland from the coastal cities, it would force the state and the local governments to shut down admissions for these facilities.

Connor Siversky: There’s always a background rate of attrition, as much as I hate to sound morbid, but when you combine that with admissions restrictions and also an element of fear involved in maybe enrolling into one of these facilities or maybe electing to go to one of these facilities as a senior citizen, the impact on the real estate fundamentals has not been good. When we look at the Q4 NIC map data dump that came out a couple of weeks back, you see both skilled nursing and senior housing occupancy is down approximately 10% across the board. Obviously, it varies in different markets, but when you’re underwriting … let’s just say, if you’re underwriting a skilled nursing facility at 83% stabilized occupancy, and now you’re down to 75%, I mean, that’s a very profound difference in how the facility’s cashflow profile looks.

Andrew Dick: Where do you the most opportunities, Connor, for some of the healthcare REIT sub-sectors as, hopefully, over the next six to nine months, we’ll see some recovery as the vaccine is more widely distributed. Do you think that’s going to help valuations? Are these REITs going to recover or is that already priced in?

Connor Siversky: I think for the time being there are still some headwinds at play. I mean, we still see that we’re still getting an element … we’re still seeing rising infection counts in a lot of locales. Vaccine distribution maybe hasn’t gone as smoothly as we would have hoped thus far. I think safety is somewhat the name of the game right now. And I think if you’re looking for yield, you can hide out in some of the skilled nursing names, such as OHI. If you’re looking for stability of your tenant base, you can look at the medical office building names. And if you’re looking for a combination of both, I think Alexandria is a very attractive option where you can get very strong tenants. You can also get internal and external growth, albeit at a bit of a premium valuation. As we make it to the spring and summer months, I think the dynamics will change somewhat.

Connor Siversky: If we can start to see a trough in occupancy for senior housing and skilled nursing, if you can start to see these REITs get more comfortable getting back into the external environment, then we can start to see a reemergence of AFFO growth. And at the moment, these REITs are trading at depressed valuations versus where they were before the pandemic. I think there will be a time when those options become very attractive again, but for now, for safety sake, I think you remain in a holding pattern for most of those names.

Andrew Dick: Yeah. I have one question, Connor. That’s a great response. One question that we hadn’t talked about is we have a pretty diverse group of healthcare REITs that are publicly traded. We’re seeing some growth in these privately or non-public REITs. How does that affect the public REIT market in your opinion? I feel like we’ve got a number of these smaller, regional private healthcare REITs that some of the developers operate. Does that have any impact on the public REITs that you’re covering? Is there competition for investment? What are your thoughts?

Connor Siversky: I’m sorry. You cut off at the beginning of your question there. Could you run that by me again?

Andrew Dick: Sure. So, Connor, what do you think about some of the private healthcare REITs that aren’t publicly traded? Do those compete with the public REITs? I mean, we’re seeing more and more developers and investors create their own funds or REITs. Is it one or the other? Are they looking for … How do you distinguish those private and public rates? I mean, what are the investors chasing there?

Connor Siversky: I mean, I think the reality of the situation is that any investor is going to be going after a high quality asset. When we look into our primary markets, whether it’s a long-term thesis for senior housing, or maybe a shorter term play for something more stable in the current environment, like a medical office building, you’re going to have more eyes on those assets. Without digging into too much specifics where we see maybe private equity funds with these private funds getting involved in real estate, I think the intuitive answer is that you see some cap rate compression. And in one sense, that’ll benefit the revaluations in terms of the NAV. In another sense, if their AFFO multiples aren’t increasing to a level where they can generate accretion based on their financing methods, then it makes it more difficult for them to grow. It’s a bit of a double-edged sword there.

Andrew Dick: Great. Moving on to the end, we had a couple of questions. What advice would you give to someone who’s just getting into the real estate business or the equity research business? You’re still a relatively young guy. You’ve learned the business quickly. What advice would you have for someone who’s starting out in the business?

Connor Siversky: Yeah. It might sound a little cliché, but I think the best advice is just to talk to as many people as possible and act like a sponge in that regard. In finance in general and equity research in general, there’s so much to learn whether it comes from valuation or the narratives you want to push, or how stocks are traded or what kind of different funds or entities look at the stock. I mean, every time that we have a client call, or if I get on the phone with one of the corporates, you always try to take away a couple of key points that help expand your knowledge of what we’re studying and what we’re looking at. Ultimately, you can pick up a lot from reading a 10-K or a 10-Q, and we do that as well.

Connor Siversky: But, sometimes the best pieces of information will come from someone else or a message from someone else, or maybe asking to have a more clear or more detailed explanation for one of the dynamics that’s coming into the market. And that could come from maybe one of our salespeople at Berenberg. It could come from an IR conduct at another company or maybe the funds come from. There are really, I think, a ton of different ways to just keep learning about the dynamics of real estate or healthcare real estate specifically.

Andrew Dick: Great. So, Connor, I know you’re in the business of publishing research on healthcare REITs, where can folks find more information about you and your company?

Connor Siversky: Well, we are operating … I mean, as a broker dealer, the research, it goes to our clients specifically. It’s not exactly publicly available to anybody who wants it. I would definitely recommend if anybody wants to learn more about the healthcare REITs, you always go to the IR websites. You can always take up … the supplementals are full of valuable information like that. In terms of help with the industry, I mean, there’s always LinkedIn, there’s always the Berenberg website, if someone wishes to have access to our research, but I can’t exactly provide it myself like that.

Andrew Dick: Sure. Well, Connor, thanks for being a guest on our podcast. Thanks to our listeners as well. We publish a newsletter called the Health Care Real Estate Advisor. To be added to list please email me at adick@hallrender.com.

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An Interview with David Auerbach, Institutional Trader, World Equity Group

An Interview with David Auerbach, Institutional Trader, World Equity Group

An Interview with David Auerbach, Institutional Trader, World Equity Group. In this interview, Andrew Dick interviews David Auerbach, Institutional Trader, World Equity Group. Andrew sits down with David to talk about trends in the real estate investment trust (REIT) industry.

Podcast Participants

Andrew Dick

Attorney, Hall Render

David Auerbach

Institutional Trader, World Equity Group

Andrew Dick: Hello and welcome to the Health Care Real Estate Advisor podcast. I’m Andrew Dick, an attorney with Hall Render, the largest healthcare focused law firm in the country. Today, we’ll be talking with David Auerbach. David’s an institutional trader at World Equity Group. He specializes in real estate investment trusts or REITs, preferred stocks, close end funds and ETFs. He’s well-known in the REIT industry for being a thought leader, mentor and commentator on trends in the industry. Today, we’re going to talk about healthcare REITs, other REIT product types, the industry in general, and some of David’s other interests. David, thanks for joining me.

David Auerbach: Thank you for having me. I really appreciate it.

Andrew Dick: David, before we talk about your current role at World Equity Group, let’s talk about your background. Tell us where you’re from, where you went to college and what you aspired to be.

David Auerbach: I’m born and raised in Dallas, Texas. With the exception of the four years that I spent at the university of Texas at Austin, welcome Horns, I have found myself back in my old neighborhood. I did spend a couple of years going to Southern Methodist University in their grad school program at night. I have spent my entire career here in good old big D.

Andrew Dick: After you got out of college, you ended up working as a financial advisor. It sounds like you’ve always worked in the equity space, but talk about your first job out of college.

David Auerbach: Sure, so to rewind further than that growing up, I was always fascinated by Wall Street, watching CNN in the early days, learning about Warren Buffett, reading the Wall Street Journal when they used to publish stock tables on the paper. I was just drawn to it at such a young age. My parents love telling the story like six, seven years old kids are up watching cartoons and I’m watching business news just to watch the ticker. I knew at a very young age that I wanted to go down this road.

David Auerbach: I graduated from UT and joined up with a local practice, a CPAs financial advisor, where he my boss was a certified public accountant. He had a book of Wall Street clients. As a result, he brought me on. He helped me get my licenses. It was a great foot in the door to learn about the business, learn about the retail network.

David Auerbach: From there, I went to a firm called Green Street Advisors, which had their trading desk based here in Dallas. Green Street is and was considered the preeminent research firm in the country. I was very privileged to learn from some wonderful mentors, people that I’m still in touch with to this day, that they really paved the way for my entire career. The running joke with that job is that the day I started in March of 2000 was the day that the market rally officially ended. Every couple of years I’ll get an email from my former boss, just like, “You know my portfolio took a hit that day that we hired you.” I’ll never forget it. I spent about 11 years working at Green Street, just under 12 years. It was just a great spot. I’m still very close with a lot of people. It made me the trader and person that I am today.

David Auerbach: From there then I went to a firm called Esposito Securities here in Dallas. I was working on a relationships, the ETF universe. From there I’ve found myself now working with World Equity Group. I’m also working with a partner on some consulting in IR type information. We’ll get into some other things, but it was really that Green Street got me my start in this career, and I’m very lucky.

Andrew Dick: David, what does it mean to be an institutional trader for those listeners that may not be familiar with that title?

David Auerbach: Sure. That’s a great question. I do get that question very often. Institutional trader would be somebody who would talk to a family office, a hedge fund, a mutual fund, a bank, a pension plan, some type of big institution that would have multiple millions of dollars under management or more. You have to qualify to be an institutional investor. There’s various check boxes that a firm would fill out. It’s different than a typical retail broker advisor who would be dealing with what I call the mom and pop investors. Whenever I recommend a company or I’m talking about something, I always refer to the mom and pop in Missoula, Montana. That’s where I always fall back onto Missoula, Montana. It’s a whole different audience. There are high net worth individuals that can qualify under some of the accredited investor, institutional investor check boxes, but traditionally it’s firms that that’s what they manage as an institutional advisor.

Andrew Dick: Got it. When you’re making purchases or selling equities, these are presumably high, big dollar amounts we’re talking about lots of shares, not the retail investor.

David Auerbach: There are some retail investors that do trade that kind of volume, but yes, that is correct. There would be big size orders and on behalf of those guys. Correct.

Andrew Dick: Got it. Okay, so David, just to provide some more background, I met you a couple of years ago. You’ve been a great resource for me and for many others. I think, I found you because I had heard you speaking on one of the Nareit podcasts where they had an update a couple of years ago. Just want to thank you for all the information you share with the REIT community and just a great resource. If you haven’t met David, he’s always willing to help. We will talk a little bit more about that here in a little while. David, we appreciate your thoughts.

Andrew Dick: Let’s talk about the healthcare REIT industry, because that’s really the space that I work in and that’s what our audience is primarily concerned about. We’ll hit on that, but we’re going to dive into some of the other REIT asset types. We just finished the third quarter earnings report for, I think, just yesterday or today was one of the last healthcare REITs reported. I saw that one of the REIT analysts just send out a note about national healthcare investors.

Andrew Dick: Let’s talk about the big three David. When we talk about the big three that’s Ventas, Welltower and what is now called Health Peak. Those are in my mind, diversified healthcare REITs big players in the space with really different models in some cases. Give us a flyover of your perspective of those REITs today. I know we’ve talked in the past about Ventas and its CEO. She’s really dynamic. She’s tough. I have no doubt that she’s going to make Ventas perform very well after we come out of COVID, but give us your thoughts, David.

David Auerbach: Sure, so first from a very high level perspective, I’ve been out on record and I will probably until the day I die, I will say that the healthcare REITs is the only sector that I can think of that will literally make money off of every single American or any individual whatsoever at some point in our lifetime. No matter how you look at it, some kind of healthcare company is going to make money off of you. Whether you have to go to the hospital, the doctor’s office, a medical office building to see a doctor, rehab, sadly, hospice, end of life, assisted living, senior housing. There are so many different segments of the industry that as a whole, the healthcare REITs combined will make money off of every single one of us. I always ended it with as they always say, “Do you know who’s undefeated in sports, don’t you?”

Andrew Dick: Who’s that?

David Auerbach: Father Time. And so I’ve [inaudible 00:08:26] Father Time, hate to say it, we are several minutes older than we were when we started this conversation. As a result, that’s why I’m such a big fan of these companies. Ventas, Welltower, good old HCP, or now Health Peak, as you comment, they are the big three. They’ve been around for so long. They run such effective companies. They make money off of every single American. What’s really interesting when you look back at when COVID started, the one industry that took a hit right off the bat was the healthcare REITs, because of them finding the cases in some of the senior housing communities.

David Auerbach: The talk from the sector has been, “Okay, this happened. How are we going to address this head on, face the pandemic inside our communities, and then deal with the aftereffects coming on the other side?” Well, we’re not out on the other side, but what did we learn from earning season? It wasn’t as bad in the third quarter as it was in the second quarter and as it was towards the tail end of the first quarter. These guys have expected to have occupancy declines this year. I was just reading the Welltower release record as we were getting on the air here, and I think their number, their shop occupancy came in down like 125 basis points, but they were projecting down 125 to 175. If you’re coming in within your expectation, it’s almost like a win in itself.

David Auerbach: If you remember going back, putting on your hat from like 10, 15 years ago, when companies would announce earnings, remember, there was always two numbers. There was the first call estimates, and then the whisper number. Remember the whisper number If you did, it was one thing to beat the first call. That’s nothing, but unless you beat the whisper number, that’s what everybody focused on. Well, for the healthcare REITs, it seems to have been over the past couple of quarters. It’s not everything that they’re doing. It’s what’s the number of the occupancy, looking at their same housing occupancy numbers, shop. If they’re able to come in at, or within a certain range or better than then that’s a win. You’re noticing that happening.

Andrew Dick: David, we’ve talked before about the big three different strategies, a lot of new headlines over the last couple of weeks. One in particular you and I were just talking about is a Health Peak, formerly known as a HCP, moving its headquarters to Denver. They were looking at Dallas …

David Auerbach: Correct.

Andrew Dick: … and Nashville. Then they ended up in Denver. Health Peak’s also been in the news because their strategy has, they’ve given more emphasis over the last couple of years on life sciences properties. Then they’ve announced that they’re going to start disposing of a large volume of senior housing assets. Maybe you could give your thoughts on Health Peak, and then we can talk a little bit about Ventas.

David Auerbach: The Health Peak news is really interesting to me. I remember when they rebranded to Health Peak from HCP just a couple of years ago, not even a couple of years ago now. People were scratching their heads trying to figure out what’s Health Peak. I don’t quite understand. Now, as you just mentioned with them announcing this big senior housing portfolio disposition, as well as moving their headquarters, this is a massive corporate and strategy shift that the company is undertaking. There’s good healthcare companies that are out there outside of the big three, thinking about what Health Peak focuses on. Then you have guys wide Omega Health, OHI, Medical Properties, MPW, where there’s guys focusing on the hospitals, there’s guys that are focusing on the medical office aspect of it.

David Auerbach: I commend Health Peak for making this change. Obviously, a lot of people are taking advantage of good relocations. I mean, Colorado has seen a massive inflow of folks recently, and so what a great place to consider building your headquarters. Everybody is relocating to Dallas too, of course. Texas has very far favorable property taxes and no state income tax. I think if you’re noticing here that this, I don’t think their strategy shift is done.

David Auerbach: I think this is just another step of things that they’re trying to evolve into, because one of the things that I love to talk to you about, and I always pester you about this is talking about Father Time, the nursing home today is different than the nursing home that our grandparents were in. Frankly, what we are going to move into down the road is going to look different than what we see today. I’m curious, thinking about the next generation. I know we’re going to talk about some more of this down the road here in a little bit, but thinking about how we are so technology oriented today by way of our cell phones, are iPads and all this other stuff. How is that going to be implemented and integrated into the nursing home of the future? How is that going to be implemented into the office building, the medical office building that we walk into into the future?

David Auerbach: I think that one of the things, and I know we’re going to talk about Ventas and the life science space and the lab innovation, but I think that just like a lot of companies, like McDonald’s has their test kitchen, I think some of these other guys have, like the hotel REITs, just to shift gears. A lot of the hotel companies like Marriott and Hilton have a lab set up on their campus where they’re working on future innovation. This is what the hotel room of tomorrow is going to look like. This is what the office building of the future is going to look like. I’m pretty sure that some of these guys and their HQs as well, I think they’re trying to figure out what’s the healthcare property going to look like 30 years from now, 20 years from now, because a gen seer who lives pretty much behind the screen, 24/7, they’re going to expect that to be implemented in their daily lives at the next chapter where they move into. These are the things that keep me up at night.

Andrew Dick: Yep. Nope. All good points. You mentioned nursing home you’re right, LTC, Omega, really good companies, what I consider more of a pure play, long-term care REIT. Talk about Ventas, because I know you really like Ventas in the sense that Debbie is a dynamic CEO and just seems to provide really great leadership, and the company historically has done very well.

David Auerbach: You summed it up great. Because when you look, as far as leaders are concerned, Debbie is always one of the first people that is always mentioned. When I was growing up in the industry, and I believe they still do today, her nickname was Diamond Debbie, because everything that she touched, turned to gold. Debbie is so well-respected, and more importantly, she’s such a nice person. I remember talking to her at a conference so many years ago. I went up to her, and I was like fan boy around her, gushing. She’s like, “Stop, just quit it. I’m a nice person.”

David Auerbach: I joke, but in all seriousness, when you achieve the status that Ventas has achieved, when you’re as big as they are, when you’re in the S&P 500, when you’ve earned this cachet, it says you’re doing something right. Thinking about how the company has evolved just in the past 20 years that I’ve been following it, they’ve done one, I want to say two or three public mergers you may may know better off top of my head, but I think three public mergers.

David Auerbach: They’ve now going towards some of these life science deals, like the big joint venture that just announced with the government of Singapore last week, with what they’re doing with One Use City in Philadelphia, I believe it’s in Philly, and some of these other places, they’re looking at the next step as well. You’ll know, it’s like Boston properties, which is an office REIT, announced this big, huge lab space deal just a couple of days ago in Waltham, Massachusetts. Alexandria who is considered to be the pioneer of life science and lab space, they’re always in the conversation.

David Auerbach: Ventas has made such a push over the past couple of years, that this is a big shift. It’s not just, we’re going to operate a bunch of communities and hospitals. They’re focusing on again, the development side of things right now. One of the other, thinking about REITs and how office REITs and healthcare REITs and where they’re in space together, it costs a lot more to build one of these properties because of the sterile nature of lab space and the white glove, white coat, wearing the hood and everything that these guys and the walls. Think about Homer Simpson where he puts his hands on the gloves to do, that’s what these guys are building.

David Auerbach: As a result, the fabrication costs of these properties are so expensive. But remember, and we’re going to talk about this in some other sectors in a little bit, who do you think pays for that stuff? Ventas is the one building the property, but guess what? That costs is going to be passed off to the tenant that’s moving in there. They’re already inherently able to charge an additional premium on the states, because they’ve gone to this effort to build out a white coat lab facility.

David Auerbach: As Debbie’s, she owns a piece of the Pittsburgh Penguins. I’m a Dallas Stars fan. I can’t blame her. Pittsburgh’s got a good team. Thinking in terms of hockey, one of the great expressions is don’t watch where the puck is, watch where the puck’s going. Keep your eyes on where the puck is going to be. That’s what they’re doing. They’re literally trying to stay ahead of the puck. This is one size matters, when you have a pretty stellar balance sheet, when you’re, I have to pull up the rate. I’m guessing they’re pretty highly rated. Your cost of capital is very small. You can go out and get 30 year money for pennies on the dollar for some of these guys and use that to build these properties that are going to be effective 20, 30 years down the road. It’s a really interesting story. Again, how can anybody not trust what she’s trying to do? That’s my opinion.

Andrew Dick: Yeah. One more, I agree, David. I agree. All good points. Let’s talk about Welltower real quick, and then we’ll transition to some of the other sectors. Welltower had a change in CEO. Tom DeRosa stepped down. The chief investment officer was promoted to CEO. Any thoughts there or how the industry reacted? Tom had been around for a while. Welltower, I think has performed over a long period of time. It’s performed pretty well. Big company. They seem to be more interested in finding senior housing opportunities when you compare that to Ventas or Health Peak. Any thoughts on Welltower before we transition?

David Auerbach: You brought up a really good point about the transition, because Tom was so well-respected. A lot of folks were speculating, “What does he know that we don’t know? Why now? What’s happening?” Mr. Mitra has been around for so long, as you had mentioned, that because of his experience, it’s a natural transition. It’d be one thing from them to bring in somebody from the total outside that had nothing to do with the company. When it’s really next up on the bench to take over, it’s not like they’re changing their strategy shifts. As you know, they also did a huge outpatient facility disposition right at the same time.

David Auerbach: This is a little bit similar to what Health Peak was doing is they’re shifting their strategy a little bit, but they’re rebounding. As I mentioned, their occupancy came in within their target people are watching, and so the question that a lot of these folks have to answer, whether you’re a retail investor listening to this podcast or an institutional guy, but the big picture that remains, and I asked you, “What’s your definition of longterm?” When I was growing up in school, when I was taking finance classes and everything, we were taught that the longterm would mean your retirement money. You’re 18, 19, 20 years old sitting in your first classes. When they define longterm, they’re talking 50 years from now, okay? If you talk to a gen Z kid, that’s coming out of college today, that’s 22, and you asked him what his definition of longterm is, two years, maybe five years. Their timeframes are different.

David Auerbach: I ask the person that’s listening to this podcast today, “What’s your definition of long-term.” If you’re thinking about something many, many, many years down the road, then I leave you this question of thinking about Welltower and what they do and their properties, thinking about Ventas, thinking about Health Peak. It’s not what’s happening today with COVID, it’s what is this going to look like 10, 15, 20, 30, 50 years down the road.

David Auerbach: Now you want my take. Here’s what I think. There’s a reason why you’ve got the big three and a lot of the other players that are out there, Capitol senior, you mentioned LTC, Genesis, Brookdale, some of these other operators that are out there. When you have so many companies that make up the sector, I was always taught to think one thing, the big get bigger, the small get smaller. In a universe that probably is dominated by an 80/20, 90/10, and they know what that means, where 20% of the folks control 80% of the properties or more, It means that these guys are going to continue to acquire their smaller competitors. If you, we’ll use Ventas as the example, as I mentioned, I think they’ve done two or three public mergers, but maybe more. When Ventas wants to grow, they’re not just going to go buy a property or two, they’re going to buy a company to grow.

David Auerbach: I think these guys are, Welltower helped pick these guys. The big three are doing a good job driving down their lanes of a highway, knowing what they know so well, that it’s pretty much everybody trying to get in their lanes. Because of their size, they can just muscle them out. I think it’s going to be really interesting to watch, especially as we get older and as this industry shifts. As we move on, I will say again, keep in the back of your head, medical office buildings, senior housing facilities, the rehab facility, drug rehab, a hospital for your x-rays, unfortunately for your end of life and your hospice care final living days, the healthcare REITs are the guys that are making money off of every single one of these people. That’s you. That’s me. That’s my mother and father, my grandmother, my grandfather, my brother, my sister. Every single one of us is going to be paying money to these guys.

Andrew Dick: Yep. Good point, David. Let’s switch gears. You and I have talked about other REIT sectors before. Give us an idea of what’s happened over the last six or eight months as a result of COVID. I mean, we’ve all heard or read the headlines about the retail sector. It’s taken a beating. You and I have talked before about companies like Simon Property Group, which happens to be headquartered here in Indianapolis, where I’m at. The company in my opinion is really well ran, has some of the best properties in the world. I think once we get through COVID, it’s going to be just fine. Give us your take.

David Auerbach: I have the most respect for David Simon of Simon Property Group. You will never hear me say anything bad about him whatsoever. There’s some great, great, great stories that go under the radar in COVID right now, because as you mentioned, everybody focuses on the work from home situation, so therefore, the office building is dead, what they read about with JC Penney and Sears and some of these retail closures and the mall is dead. Now, everything, obviously there is an asterisk pre-COVID, post-COVID. We all understand that. Let’s take a couple of different sectors at a time and we’ll hit on some different points.

David Auerbach: Okay, first things first, you and I are doing this podcast on the web today. I’m looking at you. You’re looking at me. I hear you. You hear me. This is all being run through data centers and cell towers. Data center REITs and cell tower REITs have been two of the best performing sectors this entire year. We’re all Zooming using cell towers. As a result, these are the guys that are benefiting the most from that.

David Auerbach: Take it one more step. Okay, I don’t know about you, but my wife and I, we love this little tiny website called Amazon.com. Of course, it’s great. With Prime they deliver within the hour. It’s awesome. The thing about where all that stuff is stored, all that stuff stored at big industrial warehouses that are owned by a bunch of REITs. Another sector that’s done amazingly well this year is the industrial REITs, because Amazon, Walmart, Target, all these guys have these big, huge warehouses that store their products and their properties.

David Auerbach: You mentioned retail, Simon. Okay, so Simon has been very active this year. They just had the earnings a couple of days ago. It’s a great transcript to read. If you haven’t, I highly suggest you read it. David’s really tapped into what’s going on. What Simon’s been doing, they joined up with a company called Authentic Brands. They have been going out and acquiring a bunch of retailers this year. People were like, “Why? Why are you buying JC penny? Why are you buying Lucky Brands and Brooks Brothers? What is the benefit there?”

David Auerbach: The answer is there’s a variety of reasons. The big 10,000 foot version of why they’re buying this, think about how much real estate a JC penny owns at a property as an anchor tenant. I’m just going to throw a number out there. Let’s just assume a 50,000 square foot box. It could be less. It could be more. But let’s just use a random 50,000 foot number. Why is this important? Okay. Simon will be more than happy to buy a 50,000 foot empty vacant box and then do a couple of different things. We can bring in a new tenant that’s not around there right now. One of the questions that they got asked on their call was about a joint venture they have that [inaudible 00:27:11] talked about called Allied Esports. Allied Esports is an e-sports arena that kids or folks can go and watch people play video games, participate in some of these games. Instead of watching on Twitch or on one of these online platforms, it’s a way to draw traffic back to the mall, the millennial generation, back to the mall.

David Auerbach: If that doesn’t work out, Simon would be more than happy to spend some money and taking that 50,000 foot box and breaking it up into a 20,000 foot box, another 20,000 foot box and a 10,000 foot box. Now you can bring in three other tenants to make up one space. More importantly, in the call, they mentioned that they’re signing more leases right now during COVID on the look out through on the other side here that it’s, they call it the Warby effect, the Warby Parker effect. Are you familiar with the term called showrooming?

Andrew Dick: Uh-uh (negative).

David Auerbach: Have you heard the term showrooming? For those that don’t know showrooming is I’m going to go to the store. I’m going to look at the product. I’m going to play with it, touch around with it, but then go home and order it online. I’m not going to buy it in the store. It used to be very frowned upon. It killed Circuit City. Best Buy took a big hit form it. If you go back and read some of their transcripts in the early 2000s, they talk about this showrooming effect.

David Auerbach: Well, now the Simons of the world and some of these other retailers have said, “Okay, you know what? People are going to be people. They’re going to do what they want to do. Instead of shunning it, let’s embrace it.” A perfect example of that was Tesla. If you recall, Tesla built dealerships in these malls, but you couldn’t buy the car there. You had to go home and do the process online. They put it there for you to showroom it. Come check it out, come press the buttons, come hear the engine roar or not roar exactly, and then go home and buy the car online. These guys at Simons of the world said, “You know what? Go ahead, Warby, go ahead and go to a store here. Don’t make any sales. We don’t care. You’re going to pay us rent. Then you have a chance now to expand your footprint.” I think that you’re seeing the shift in the retail landscape of the bricks and mortar enhances their online component. I’m a big fan of what’s happening in the data centers and the towers.

David Auerbach: I’ll give you one more statistic before we move on to a different sector. The former CEO of American Tower, his name is Jim Taiclet. He went off to a company called Lockheed Martin. He’s looking out for your defense. Jim had a great quote a couple of years ago at a conference I was at. I use it in every interview, because it staggers me. There’s 24 hours of content posted to YouTube every minute. That stat’s a couple of years old. If you assume things only go up, let’s say that number is now 28 hours or 30 hours. That’s a lot of content. Where is that being stored? It’s in this thing called the cloud. It just floats above us. In all seriousness, it’s housed in data centers in servers and racks and all these buildings across the country. That’s run by data center REITs, Digital Realty, Core Site Realty, Cyrus One, QTS. There’s several publicly traded data center REITs.

David Auerbach: Another interesting way to play it’s through the ETF space. If you play exchange traded funds, if you don’t know what an exchange traded fund, I call it a publicly traded mutual fund. You can buy a basket of tower and data center REITs. There’s two products out there. One is run by a company called Pacer Benchmark, the ticker is SRVR. It’s the data center and server or tower infrastructure ETF, and then Global X, which is another very large ETF issuer, just launched one a couple of weeks ago on their tickers VPN, how appropriate Victor, Paul Nancy. These are just some interesting ways to potentially play a couple of different spaces.

David Auerbach: One more sector that’s getting a lot of coverage right now is cannabis. There are several, there’s one publicly traded cannabis, [inaudible 00:31:19] pure play, and that’s Innovative Industrial, IIPR. You’ve got a couple other companies that are trying to get their foot in the door, try to grow in the warehouse side of the cannabis space. You have a big candidate. One of the first SPACs, the special purpose entities, focusing in REITs was just filed a couple of weeks, just launched a couple weeks ago. It’s involved in the cannabis space. The company’s called Subversive. You’re seeing, one of the questions I always ask when I get to talk to the analyst or the company is this, “What’s the next sector? What’s the next industry?” If you go back 10, 20 years ago, nobody would have talked about towers and data centers. If you go back 10 years ago, nobody would have talked about cannabis REITs. Now, the question becomes, “What’s the next sector?”

Andrew Dick: David, those are all good insights. You and I have also talked about some of the more novel or niche REITs that we’ve seen. One in particular, Safehold REIT, relatively new REIT that plays in the ground lease space. It’s performed very well. How do those fit into when you’re looking at the REIT industry overall? I mean, I think it’s a very interesting company.

David Auerbach: I love Safehold. I love the guys there. One of the things that I love about it is that it’s a unique play. If you look at a partner REIT, there’s 10 publicly traded partner REITs, maybe more. There’s 10 plus healthcare, 10 plus office, 10 plus lodging. There’s only one ground lease REIT that’s out there right now, and that’s Safehold. It’s an interesting story, because thinking about the Warren Buffet mantras and things that we grew up on, talking about, number one, being a first mover. They were the first mover to take advantage of this situation.

David Auerbach: Number two, building an island. When you’re out on an Island by yourself, and somebody has to literally, you build a moat around you because as a first mover, somebody is going to have to invest a boatload of capital to go and compete against you. Frankly, up in where they’re located and what they’re doing, there’s really only a handful of guys that can truly compete with them right now at this moment in time, that being Colony Capital and Starwood Capital. I know that they’re, I think they’re tiptoeing into it, but they are not diving into the effect that Safehold has done.

David Auerbach: Number three, they are backed by their parent company, iStar. Now that can both be good and bad. Why do I say that? A lot of the institutional investors in the REIT community sometimes shun the fact that it’s an externally advised company by the parents. Not that there’s necessarily collusion, but it’s not a standalone entity, because it could fall back on the parent to take care of it. But in the same breath, that’s not a bad thing because they can fall back on the parent, and also knowing that if they’re doing a deal, it’s because the parent is behind the deal. As an example, Safehold just did a secondary offering last night. They upsized the deals. It was in the market for two days. They were able to upsize it, but concurrently with it, they did a private placement to the company of a slug of stock.

David Auerbach: Rewind, going back to a COVID, Safehold was the first, one of the few companies and the first company to float a public offering during the pandemic. While everybody was on Zoom doing what you and I were doing now, they may actually get a secondary offering off on the table. At the time, the company, rightfully so, was so established that they were able to get a deal done like this in COVID right at the beginning stages of it.

David Auerbach: What’s interesting is that they have such a unique set of properties. It’s office. It’s lodging. There’s some apartment type stuff. The number one rule of real estate is location, location, location. A lot of the stuff that they’re investing is the intersection of Main and Main is what I call it. Because you have such good properties, with the way that the ground lease works, and I’ll give you the 10,000 foot. For those that don’t know the website to go check it out, it’s a safeholdinc, I-N-C, .com (safeholdinc.com). It’s a interesting story.

David Auerbach: A ground lease, what happens is pick a building. Let’s just use the Empire State Building, which is owned by a different REIT, but we’ll just use the Empire State Building. What Safehold does is they go to the guys that run the Empire State Building and say, “Okay guys, you own the building, we’ll own what’s below the ground. We’ll own the ground. You rent that from us. Upon the maturity of the lease in 99 years, Safehold will take possession of the Empire State Building.” What they’ve done is they’ve amassed quite a portfolio, above and below ground real estate, that they own, when they talk about their valuation, they equate it to like a 99 year bond. They talk about the MIT bond. It’s in their metrics. It’s just such a unique story that until somebody says, “We’re coming after,” again, who’s to fight against them.

David Auerbach: Now let’s flip it. They do their earnings based on earnings per share. Most REITs focus on FFO or AFFO. That’s one caveat to be aware of. Number two, rates traditionally have a very high dividend yield. Right now, I believe you mentioned Nareit before. I highly recommend you go check out reit.com. That’s the website for Nareit. Right now, the typical REIT dividend yield, I believe is just around 4%. Safehold is well under that. Now the company says as they go out and acquires how they raise their dividend and raise the yield. Again, thinking about the definition of longterm, Safehold is not a day traders type of game. Safehold is not a name that you’re going to want to sit here and just own for a year. If you’re buying Safehold today, it’s what is this going to look like five, 10 years from now as they continue to amass high quality real estate portfolio.

David Auerbach: One other thing, if you’re a sports fan, and I think you are a sports fan, they happen to be locally here in Texas, because I know this. One of their partners is somebody who used to go by the nickname of The Admiral. Do you know who The Admiral was?

Andrew Dick: No.

David Auerbach: David Robinson, who was a famous basketball player, who played for the San Antonio Spurs, won many, many NBA championships and was in the Navy. He was a Naval, I believe he was an, not national, but he was very highly up in the Navy. He was on the Spurs. His company, Admiral Capital, is a partner with Safehold on some of their Texas properties here. There’s a sports tie in there for you.

Andrew Dick: Very interesting. Yeah, I think the company’s interesting as well. We see a lot of ground leases in the healthcare industry, and so I like it. I think it’s very interesting. David, let’s switch gears. We’ve only got a couple minutes left. Mentoring, last time we spoke you, you told me you’ve been spending a fair amount of time mentoring young professionals. You’ve always given back to the REIT community in terms of your time and resources. I know you used to publish a weekly newsletter. You may still do that.

David Auerbach: Still do.

Andrew Dick: Talk about giving back, mentoring, because a number of folks who listen to the podcast, they’re young professionals looking to advance their career.

David Auerbach: It’s a great topic. I really appreciate you bringing this up. I think at some point in our careers, we know that the next generation is coming up in the ranks. After 20 plus years of doing this, we learn a couple of things. If I’m able to pave the path, smooth the path for the next generation by dealing with my experiences, or if I’m able to answer some questions that they’re afraid to ask, then that gives them a little bit more sense of comfort.

David Auerbach: I’m also a big believer of karma and what goes around, comes around that when I used to interview folks, at my own shops. Whenever anyone would come in, usually there’d be interviewing with four or five, six other people. I would always say the person just to try to, first of all, throw them off a little bit, but second, just so they feel a little bit more at ease, I would always say to the person, “My job here as I sit here and interview you is to get you to ask me the hard hitting questions. You are to ask me the questions that you’re afraid to ask, because I don’t want you to come on board here and say, ‘Well, nobody told me about this. I wasn’t expecting this. How come I didn’t know that this?'” I would always say, “There’s no such thing as stupid questions just stupid people.” Have you heard that expression before.

Andrew Dick: I have.

David Auerbach: I love using that expression. I always say, “There’s no such thing as a stupid question. What you may think is stupid may actually be the secret sauce that what you should be asking that you you didn’t realize that you should ask.” It carries through to the mentorship thing that I’m trying to do, because I want people to number one, not be afraid of the interview process. A lot of people now, because they are so tied to their phones, they lose out on the face-to-face interaction. When you’re sitting across the table from somebody, and if you don’t know how to cure yourself in a face-to-face conversation, you have to understand, you may be investing in this company, be a management of this company, you could own this company, which means you’re going to be dealing with the media and all this other stuff. If you don’t know how to interact with people, what kind of message is that going to say to your boss, your partners, your shareholders, whatever.

David Auerbach: I feel like now, especially with the folks that I’m focusing on, it’s the guys that are anywhere from getting out of high school, going into college, dealing with their first intern type interviews, going into grad school, coming out of grad school, going into their next positions, whatever it is, but if my 20 plus years of REITs and ETFs is able to help them understand just a little bit more of what they’re walking into or I had somebody reaching out to me today asking me about Safehold. I got them an interview with the company. He wanted to understand what is the company. I sent him a friend’s video. I’m like, “Watch this. If you watch this, then when you call the guy and have your interview with him today, you’re able to come prepared with a roster of questions, because you said, ‘I watched your interview. You said this. Can you explain this to me? I don’t understand.'” What does that say to the person across the table from you? This guy spent his time doing his homework. He really cares. He’s really interested.

David Auerbach: When somebody calls me and says, “I’ve got the second interview, I got the job, whatever,” that’s about as valuable as a paycheck is in my opinion. More importantly, it could be a year from now, 10 years from now, a hundred years from now, that guy isn’t going to forget. He is going to remember that I helped him get to that point.

Andrew Dick: David, last question. What advice would you give to a young professional who’s looking to get into the real estate business?

David Auerbach: It’s the same, same thing I’ve heard, that I’m sure you’ve heard a million times over and I stand by it. It’s not what you know, it’s who you know. Networking as a full-time, 24 hour a day job. It’s why I lost my first job as a retail broker before I joined Green Street. My boss and I had a disagreement as far as the proper times to be networking. He thought it should be an after the stock market hours type of job. I said to him, “Wait, if a prospect says they want to have lunch with me, I have to tell him no, because my boss said I can only network after hours?” I said, “That’s the craziest thing I’ve ever heard.” They fired me the next day because I said that. As a result, you and I would have not connected if it wasn’t from networking back in the day. I wouldn’t be able to email David Simon and him email me back on a day of earnings without networking. As I say on a mentorship platform, you never know when you’re going to come across your next partner, your next boss, your next client, whoever it is. It’s all because of networking. I would emphasize get out there, meet folks, explore LinkedIn, ask questions, learn, as Red says in Shawshank, “Get busy living or get busy dying.”

Andrew Dick: Good advice. David, where can our audience, how can they reach you?

David Auerbach: I am affiliated with a broker dealer out of Chicago called World Equity Group. My email address there is davidauerbach, D-A-V-I-D A-U-E-R-B-A-C-H. @weg, W-E-G, 1.com (davidauerbach@weg1.com) If they want to ask about the daily REIT note that covers the REIT sector, please feel free to reach out to me at that email address or on my consulting address at david@irrealized.com, I-R-R-E-A-L-I-Z-E-D, and I’d be happy to chat with you more there as well.

Andrew Dick: Great. David, thanks for your time. Thanks to our audience for listening on your Apple or Android device. Please subscribe to the podcast and leave feedback for us. We also publish a newsletter called the Health Care Real Estate Advisor. To be added to that list, email me at adick@hallrender.com. 

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An interview with Andy Van Zee, Senior Housing Advisors, Marcus & Millichap

An interview with Andy Van Zee, Investment Broker, Knapp Group – Senior Housing Advisors, Marcus & Millichap

An interview with Andy Van Zee. In this interview, Andrew Dick interviews Andy Van Zee, Investment Broker, Knapp Group – Senior Housing Advisors, Marcus & Millichap. Andrew sits down with Andy to talk about senior housing trends.

Podcast Participants

Andrew Dick

Attorney, Hall Render

Andy Van Zee

Investment Broker, Knapp Group – Senior Housing Advisors, Marcus & Millichap 

Andrew Dick: Hello, and welcome to the Health Care Real Estate Advisor podcast. My name is Andrew Dick. I’m an attorney with Hall Render, the largest health care focused law firm in the nation. Today we’ll be talking to Andrew Van Zee. He is an investment broker with Marcus & Millichap. In particular, he works in their senior housing group. We’re going to be talking about his background in the industry, how we ended up where he is at today, and then we’re going to talk about seniors housing in general. Andy, thanks for joining me.

Andrew Van Zee: Hey, thanks, Andrew. Appreciate being able to have this opportunity to talk with you about this.

Andrew Dick: Andy, before we jump in to trends in the industry, tell us about yourself, where you’re from and where you went to school and what you wanted to be when you grow up.

Andrew Van Zee: Absolutely. So I’m originally from small town, Prairie City, Iowa, just East of Des Moines. I grew up there. My family still all lives there. I’m currently in Indianapolis with my family, my personal family, and went to undergrad, South Dakota State, wanted to kind of get far enough away from my parents that I couldn’t drive home on the weekend. I got a political science degree at South Dakota State and originally thought that I was going to get into politics. Did a lot of the grassroots politics route, multiple campaigns working with one of the national parties for several years to a point where let’s just say I ended up on the wrong side of the ticket and needed a little bit of a change. So I went to law school thinking that I was going to end up back into government or politics of some sort, but the Lord had other plans.

Andrew Van Zee: So I went to Thomas M. Cooley Law School, which is now Western Michigan up in Auburn Hills, Michigan. I met my wife at that time. We got married. But she was a Hoosier. So after graduating, we moved down to Indiana, where I found myself working in-house for a major skilled nursing developer and was really introduced to the senior housing industry through that timeframe doing a lot of work specializing in the certificate of need laws. I applied for a certificate of need applications in states across the country, as well as just kind of going through some of the licensing process for our group to be able to continue to grow and expand and was introduced also to some awesome operators during that timeframe, a lot of the people who we were directly in partnership with on new deals or just kind of consultants along the way, a lot of great people in this industry that when I moved on from that position, I started to do some on my own in the world of certificate of need.

Andrew Van Zee: I did a few more projects notably with a major hospital health system actually back in Iowa. Through that timeframe, real estate, that development aspect of being able to see this industry grow and be a part of that is what brought me back to or brought me to Marcus & Millichap. We had networked with them throughout the timeframe when I was doing certificate and need, also looking for beds. Jim Knapp, who is a part of the Knapp Group Senior Housing Advisors within Marcus & Millichap, the team that I’m now associated with, I had called upon him back in 2015. When I joined Marcus & Millichap, it was just a great landing spot to be able to build upon some of the knowledge that I currently had, but also be with a great group of senior agents within the firm to be able to launch and grow outward from there.

Andrew Dick: So thanks, Andy. That’s a very interesting career path, what you and I have had the chance to work together over the years, and I’ve always enjoyed working with you, and I’ve always thought of you as an expert in the long-term care space. When I heard you landed at Marcus & Millichap, I was personally excited for you. It’s a great platform and a great organization. Before we dive into some of the what’s going on in the industry, Andy for our listeners, tell us about the senior housing industry and how you break down the different asset types. I typically think of senior housing as skilled nursing facilities, assisted living, et cetera. But be more specific for maybe those who aren’t familiar with the different asset types.

Andrew Van Zee: Certainly. Well, let me touch a little bit about that and Marcus & Millichap, even the platform that I’m with. So Marcus & Millichap is a full service real estate brokerage company that we only specialize in investment sales. But each agent has their own product type, I should say, that they have really drilled down into and try to become experts within. So within senior housing, we really focus on skilled nursing assisted living, independent living, memory care, and CCRC products that obviously would encompass all of those other four components onto one campus. We only focus on real estate. However, there is times when we do come across home health companies that will be connected with an operator’s skilled nursing business or a senior housing business in some way or another, and we will work with those as well. But primarily, from our platform, we are really focused on that core of skilled nursing assisted living, memory care, independent, and CCRC.

Andrew Van Zee: Medical office space is a separate group within Marcus & Millichap. So we don’t really touch into that as well as a hospital and in those really high acuity dialysis or other dentistry, any of those types of medical type real estate components is now part of our group.

Andrew Dick: So your group is able to focus and really get into the weeds on valuation and what’s going on in the industry is my understanding, Andy?

Andrew Van Zee: That’s exactly right. We really try to become experts throughout Marcus & Millichap, but in the senior housing space, especially when it’s different than any other type of… or I should say of the most real estate components, in which when you’re selling the asset, the underlying real estate asset, most oftentimes you’re selling the business with it, and/or it’s a specially built property where the value is driven by the actual operation of that specialty, skilled nursing, assisted living that has been operated out of that space. So we really are unique in that format that we drill down in to understand both the real estate trends but also the operations. There’s a lot going on, especially in the last couple weeks, months with COVID in the health care space in senior housing specifically that if we tried to cover all of health care, we couldn’t be the experts that we really need to be for our clients.

Andrew Dick: So you mentioned COVID, Andy. I know that senior housing has been significantly impacted by the virus. What has that done, or what are you seeing in the industry as a result of COVID? Has it impacted occupancy? Has it impacted operations financially? What’s it done to sale prices, et cetera? Give us kind of a broad overview?

Andrew Van Zee: Good question, Andrew. It’s definitely had an impact. When we look at what has happened with COVID, it’s had an impact just like any other real estate asset or any other business really. What’s interesting about the health care is it’s always been deemed one of those essential businesses. So the lights have always been on. Employees have always been coming to work. People are still getting care. Even unlike some of the medical office space where a lot of those elective procedures were put on hold or even telemedicine where you could go somewhere else. In senior housing, it’s always been a truly essential part of the economy and a business that has continued to operate. From that standpoint, because it’s continued to operate, it’s been exposed to COVID in more ways than a lot of other industries, and therefore, there have been some negative press that’s come about that exposure.

Andrew Van Zee: But it’s really been six months now past the start of this pandemic. It’s really been a really strong and resilient industry and a fun one to be able to kind of watch and interact with. By and large, I would say starting with the skilled nursing aspect of it, everybody that I have interacted with, every operator has taken COVID seriously on day one. There was a time where I was visiting some facilities before some of the mandates came out back in early March that weren’t letting me. As soon as some of these just even scare started to arise, they were shutting the doors. I would say that that has been something that has been pretty consistent throughout that every operator that I would say has been in the business, and most operators in senior housing are truly in it because there’s something more than just the operation of a business and collecting a paycheck. They want to care if there’s a care component deep within them. They care for those residents that are inside their buildings. They’ve done a good job of containing it.

Andrew Van Zee: Now, that said, there’s been a lot of change. So skilled nursing, obviously, the biggest impact right away was the shutdown of the electives seizures in some of the hospitals. If you had any sort of Medicare component to your revenue model, you weren’t just a truly long-term care and relying upon Medicaid. You had an impact on day one. That was in terms of occupancy. So as occupancy goes down and you weren’t able to continue to backfill those, definitely there’s been an impact on revenue on day one. Assisted living seemed to be a kind of the next, the next group that was impacted, but it wasn’t as immediate. They were affected more through attrition and/or just marketing efforts, kind of a mixed bag, and some of the trends have shown that really, it has been a downward trend on occupancy overall.

Andrew Van Zee: But when there was a run on supplies in March and April, May, there were some reports early on that those assisted living facilities that could market appropriately through virtual tours or just kind of quickly being able to change their strategy, we’re actually seeing an increase in occupancy for a period of time as people were wanting to have more of a secure spot to be. Unfortunately, I think some of the negative press overall of mostly driven by isolation than today than the fear of an outbreak is assisted living and independent living because it is more of a choice to move into those types of facilities. They’re having a slower recovery, whereas skilled nursing, once elective surgeries have picked back up, they have shown a stronger rebound, but it’s also does come back to the quality of the operator. As a whole, overall, the industry occupancy wise, and income’s all driven by occupancy in this category.

Andrew Van Zee: It is still has ways to go to catch up to where we were. But the plus side is there’s been a lot of positive stimulus cashflow that has been pouring into the system from day one, starting with the PPP, but there was Medicare advanced payments. There were a lot of grants that are still now new grant money out there specifically targeted for senior housing operators who can develop or create isolation wings, whether that be brand new or converting still reimbursed for converting those spaces. There are been more reports now on skilled nursing specifically if there’s been an outbreak, and they’ve had to isolate and shut down any part of the organization. Medicaid even is reimbursing some of that 14-day period of time for some groups

Andrew Van Zee: So I think the upside is the government as a whole recognizes that this is a strong industry, I think, that needs to… We need to take care of our residents. We need to take care of our seniors. I think it’s going to be a really good setup for the future. This has always been an industry that has a very long runway, and we’ve always been very bullish when you just look at the aging of the population as a whole. New development has led the way I think on a lot of the growth and a lot of the change in the industry. But because of COVID and because of the focus on the quality of care, and especially in terms of isolating our residents and taking care of our staff, I’m seeing changes that I think will have some long-term impacts overall, that’ll be good, even for the established business who maybe can’t win the market share on day one because they don’t have the newest and shiniest product in town.

Andrew Van Zee: Example, I’ve got an operator that I’m working with in Iowa, done a phenomenal job, kept COVID out of the building. It’s an older property. But they were older in terms of it’s not new within the last 10 years but has still kept COVID out of the building, has kept an isolation wing, always made available for new residents to be able to come into an artificially held occupancy low because of that so that they can have those excess beds open. As a result of that you know, some of these newer advancements that are coming out just recently of COVID testing units in the buildings, because of the focus on the care of residents and staff in this building and the quality that’s been driven, this facility is one of 10 in the state that’s going to get one of those first new testing machines in the building.

Andrew Van Zee: So I think that’s what’s going to be kind of the silver lining, I guess you could say out of all of this going forward is that people have been forced to change throughout this entire process, and they were forced to change very quickly. In the last six months, senior housing has done an amazing job of taking care of the residents and adapting with it through technology of virtual tours, through technology of just virtual meetings, technology of tracking the flow of visitors, but even down to just operationally shifting very quickly, delivering meals in the rooms. You get on social media, and you see countless videos or photos of innovative ways in which family members can still see their loved one in a facility behind a plexiglass wall or something that is… things we have never seen before. Obviously, we’ve never seen this pandemic before, but all of these changes I think are going to set up this industry for a very strong run in the future.

Andrew Van Zee: That said, I’m sorry for being long winded on your question, Andrew. But that said, because of all the stimulus, there’s also been several groups that I think at the first quarter or first half of next year, we’re going to start to see some stress fractures in the operations. Obviously, not everybody in the graduating class or the top of the class. There’s always some that are just getting by. Those who are in this industry today, who have not adapted very well, and I’m not been able to either through a desire or lack of just ability economically or otherwise. I think that when all these stimulus opportunities start to wear off, and some of the cashflow that has come through that has artificially been propping up some of these groups, we’re going to start to see some of those, the fallout that’s going to come with that in terms of exchanges in the marketplace, ultimately sales.

Andrew Van Zee: Hopefully, it’s not foreclosures or anything of that nature, but I think that we’ll start to see a lot more transactions in the near future for those distressed assets than what we are today.

Andrew Dick: So, Andy, that was a great overview. I talked to Rich Anderson, who’s an equity REIT analyst. He covers the publicly traded health care REITs for SMBC bank a couple of days ago. He was comparing skilled nursing to assisted living and independent living. He said most of the stimulus money has really flowed to the skilled nursing operators. Unfortunately, independent living and assisted living operators haven’t received any funding and in most states. Has that impacted how investors look at the different asset types, Andy? I mean, I think you’re you’re right that a lot of folks I’ve talked to said, look, the federal health care programs are not going to allow skilled nursing to fail in most cases. But independent living, assisted living, they’re kind of on their own. I mean, is that a fair analysis, or what are your thoughts?

Andrew Van Zee: Yeah. A good question. You’re absolutely right. Short of the Payroll Protection Program and any type of advancements that was really more for assisted living that actually had employees working independent, depending on how involved you may have had from a staffing standpoint. Yeah, it didn’t get a lot of funding. Didn’t get a lot of help. I know there’s been a lot of talk recently about possibly sending some money in that direction of future stimulus funds. From an operator standpoint, there’s been a lot of groups that have… Well, let me take a step back. From a real estate standpoint, just in general, transaction-wise, everything was really put on hold, screeching, stop, in March. All properties that were on the market remained on the market. But our office, our group didn’t list anything, didn’t put anything new on the market for at least four and a half months.

Andrew Van Zee: That was really true of a lot of the brokerage companies that we’ve networked with or banks or anybody across the board. So there was a lot of money because of the uncertainty of what was to come that nothing transacted. When there were several groups that we were talking to in January and February who were looking at 2020 as a year in which they were wanting to acquire or sell, get out of the business altogether. So the fact that, back to assisted living this, this stimulus aspect of it of until we can actually have, even on these most recent conversations out of Washington is money coming to resonant. It’s held back the flow of inventory on the market, number one. Groups that have seen a decrease in occupancy through this timeframe are afraid to take anything to market that their properties are going to be devalued accordingly.

Andrew Van Zee: For the most part, it’s a very valid concern. The question really comes in is, how long can some of those groups last, and how long will it be before they recover, coupled with the lending aspect of it? A big piece of what we’re seeing during that timeframe of close transactions, where right at the peak of this, we had the lowest interest rates that we’ve had on record in years, and refinancing and looking at new acquisitions as a result of that was a huge opportunity. Then that became unsteady, especially in this market. So we’re starting to see the banks come around and those lending institutions come back on board, which is helping. But we’re still not seeing on assisted living and independent living the occupancies really jumped back as quickly as skilled nursing is.

Andrew Van Zee: Because of that, we’re not seeing as many groups who are willing to just jump into the game and transact as strongly. We have taken a property to market. Our group did within the last month. It was a CCRC that was mostly with no skilled nursing component, so assisted living, independent living, memory care. We did see some good market activity on it. Overall, I think that right now, there’s a lot of pent-up demand in the marketplace. There is still a good opportunity where because there’s nothing out there, and there are groups that need to be active to continue to survive and/or just wants to take advantage of a timeframe where there’s not as much competition on bidding on properties. It’s a little bit more of a buyers’… I mean, a sellers’ market in that way with that pent-up demand. But we’re still not seeing a lot of groups ready to jump into that yet, especially on assisted living and independent living because of potential stimulus money is still coming in and/or these occupancies that just haven’t come right back yet. I hope that answered your question. [crosstalk 00:24:11].

Andrew Dick: No, that was great. That was great. You hit on a couple of points there. One was what the lending institutions are doing. Talk about the capital markets. If you’re the owner of a senior housing facility, is it a difficult time to refinance? If you’re a buyer, and you need some capital, how are the banks looking at the different asset types? Is it tough to get interest, or have prices went up for the cost of capital?

Andrew Van Zee: For the most part, I think the biggest variable right now that is looking at, how hard of a hit did you take on occupancy as well as just kind of the fundamentals, age of the building, what’s your blended rate on your payer types? Financing’s coming back. It definitely pulled back. Even though we had these bottom-of-the-market interest rates, lenders in senior housing were putting floors on those to try to cover some of the risks with the biggest fear being, is COVID going to get into your building and wipe everything out between time for closing and/or shortly after you close on it. Right? So that was the number one thing is we saw floors right away. Then kind of the loan-to-value ratio started to creep up, where you could have maybe gotten a 75% loan-to-value, you were down to 70. Maybe if it’s an older building, 65.

Andrew Van Zee: So some of that amount of leverage that you can put on some of these buildings is definitely been scaled back from what it was at the beginning of the year. I think by and large, we’re starting to see that banks are coming around and slowly more and more are getting onboarded. I would kind of liken the banks to what we’re seeing even on a very macro level with some of the REITs. Some of the REITs on the recent transactions that we’ve had, the recent deals that we’ve had have been the more conservative bidders currently. We’re seeing a lot more of the private equity or just private money in this space being more active in the bidding and in the aggressiveness of those bids right now in the last two to three months. I really likened that to kind of the way the banks are. They’re institutional in that same fashion as the REITs. They’re taking the longer look. They obviously are having to deal with imminent foreclosures that are now starting on other product types outside of just senior housing.

Andrew Van Zee: So as we can have more time from the beginning of this pandemic and more space, more data to show these lending institutions that senior housing is still a safe place. It’s a very safe place to be, and there’s a lot of runway. I foresee that we will continue to have greater access to capital. Even we were projecting that some time after labor day, that it would really start to look more normal. I don’t know that we’re normal in terms of where we were pre-COVID yet. But we are certainly getting back to it much like the rest of the country is, quite honestly, in terms of we have to move on. So is there access to capital, and a very short answer to your question, yes, there is. There definitely is. It may not be as highly leveraged. But the interest rates are still low. They’ve still remained the low, and it’s still a great time to start to be looking at the future in senior housing.

Andrew Dick: Yeah. That was a good summary. I’ll tell you what some of the experts I’ve spoken to remain bullish long term on senior housing, given some of the demographics that we’ve all seen in the news with the aging population. In fact, some of the… I talked to some folks who said they’re looking forward to picking up more of the senior housing assets as things settle down. They just think that the demographics support long-term growth in the industry. Andy, would you agree with that and maybe also weigh in about, some of the critics have said there’s too much supply?

Andrew Van Zee: Sure.

Andrew Dick: Specifically in the independent assisted living areas, but-

Andrew Van Zee: I definitely am very bullish on senior housing in terms of a solid investment, a good long-term investment. I think there’s a lot of runway still here. I believe a lot of groups are believing that as well. We’re starting to see it. Like I said, the Knapp Group within Marcus & Millichap, we’ve successfully put three properties on the market now within the last two months, and I’m actually getting ready to have a call for offers on a skilled nursing facility here in the Midwest next week, and I’ve had some very strong activity of groups, honestly of more groups that have not played in this region before that are looking to grow and expand their footprint. Long term, I think that there definitely is a great time still to even look at senior housing. Early on, within Marcus & Millichap, especially with the retail sector, the retail sector getting a lot of a lot of pressure and even into the multifamily sector. We’re starting to look at some of the lockouts on evictions and the fear of people not making payments in the near future.

Andrew Van Zee: As we were talking to investor groups during the slow time for us as brokers, not the slow time for the industry as they deal with the pandemic, but the slower time for us, we were getting a lot of questions from groups who had never really looked at the space before wanting to see deals, wanting to know what’s going on, wanting to understand it. To that end, it will continue to be a strong space for future growth. Just as you mentioned, there’s a lot of baby boomers still that are aging. The aspect of what it looks like is changing overall. So when you say independent living, assisted living, what’s that look like? Development has slowed, and there was a lot of development in that space, and you could argue that the industry was perhaps becoming over bedded in certain areas. But I don’t really see that that was the case.

Andrew Van Zee: I think it was really certain markets. When you look at the country as a whole, there was obviously been a lot of development in certain metropolitan pockets, some of the hotspots just in real estate in general, Texas, Florida. Those two markets especially have had a lot of focus over the last several years, but some of the more tertiary markets, the secondary markets of the Midwest, the more rural Southeast, some of the West, the mountain region, been a lot of still growth out in those areas. Predominantly, that’s where a lot of the population that is aging is aging in place. I think that what’s going to take place out of this pandemic, what we can look to see is slower development in those categories. But we still have to have development in those areas just to continue to meet the oncoming future demand.

Andrew Van Zee: As far as evaluation is concerned, we have kept our valuations and our cap rates that we’re applying to a lot of these properties that we’re underwriting and listing steady throughout this entire pandemic. Most other brokers are doing the same. Appraisers are doing the same. I think that speaks volumes to this industry as far as where it’s going as well as where the value even is today, even despite some downward pressure from occupancy due to the pandemic. Cap rates have not changed. In some ways, depending on the product type, I think you could argue that those investors, and I can’t back this up a hundred percent yet, there’s just not enough data of transactions yet, but in some ways, some of those investor groups who are transitioning over, maybe from multifamily housing over into assisted living or independent living, I think there’s a possibility that some of those cap rates could even be driven down a little bit as we see capital migrate from different parts of the country or different sectors of the economy into senior housing.

Andrew Dick: All right, Andy. Tell us about the capital markets. Are lenders still willing to make loans to owner-operators to investors? How have the lenders and the equity sources reacted to the current state of the market?

Andrew Van Zee: Good question, Andrew. There’s definitely money available. There’s definitely capital flowing through the industry. By and large, it’s starting to pick up it’s. If we go back to the end of this pandemic back in March, we had record low interest rates across the board and a lot of refinancing, a lot of groups looking to acquire new properties as a result of that, and even some talk about, what are these low rates going to do to cap rates accordingly? Are they going to continue to be driven down with the interest rates? Unfortunately, the brakes were put on pretty hard during that point in time, starting with the banks putting floors on those interest rates, and then with that, also starting to scale back the loan-to-value ratio. So instead of possibly being able to get 7% leverage on a new product, a new property, you might be looking at 70, or in some cases, down to 60 and even 55%.

Andrew Van Zee: That seems to be where a lot of the pullback was coming from the capital markets was the amount of money that they were really wanting to go at risk for on a property. Most of that had to do with just the fact that this overall fear of what happens if we get COVID in the building, what happens if we have an outbreak, and we lose all of our occupancy, all of our residents, all of our income? For the most part, that has not happened. There obviously has been some hotspots, and those hotspots have made the headlines that have tainted a little bit of what we just previously talked about, where I think the industry has been and where it’s going.

Andrew Van Zee: But for the most part, I think the further away that we get from the beginning of this pandemic, the more the whole country even starts to just get into what is the new normal. We’re seeing on the lending side that some of that banking as usual is starting to come back into play. We were projecting that after labor day, we were going to see more of a normalcy in the capital markets area. I don’t know that we can really say that we’re 100% there yet across the board of what pre-COVID was. But we definitely are seeing lenders who are willing to extend capital and who are wanting to get into the game. When it comes to who are looking at deals right now, we as a group, the Knapp Group within Marcus & Millichap, we’ve now launched three new properties onto the market over the last two months and has some really strong interest in all the properties that we’ve put out there.

Andrew Van Zee: There’s definitely some pent-up demand in the space. To that end, what we’re seeing though, from those who are actually bidding on it, it seems as though it’s the private equity, it’s the private owner operators, it’s those who are wanting to take advantage of this timeframe where they don’t have to be bidding as heavily. I shouldn’t say that, where they’re more bullish overall on the marketplace. That’s where we’re seeing more the aggressive bids come in and aggressive to the point where we just had a property, a CCRC with a lot of skilled nursing beds up in the State of Maine. We had a call for offers on a couple of weeks ago, and we had over eight offers on the property, four of them at or above list. Those groups who were bidding on it were the private equity groups who were really pushing that envelope.

Andrew Van Zee: Some of the other properties that we are marketing right now, I’ve got one in the Midwest, a skilled facility in the Midwest, and I’ve got everybody looking at it again, the REITs, the private equity, local groups out of the region, and it seems to be following that trend a little bit more, that the groups that are more interested and a little bit more aggressive in their conversations up until this point are those in the private equity space. So there is definitely money to be had in those groups. I do take advantage of leverage through the capital markets. But from an institutional standpoint, it seems as though that those lenders, whether they were REITs originally or the banks, they were definitely conservative overall but are picking up again. There is money flowing back in the industry, to answer your question.

Andrew Dick: It’s good to hear. I think as real estate professionals, we always worry that the capital markets will slow down, and the lenders and the equity sources will hit pause. But I think what you described is what I’ve experienced as well. I think we’re starting to… Well, we’ve continued to see activity, but we’re seeing even more activity over the past few weeks as everyone starts to realize that this is the new normal. Andy, let’s switch gears. When I’ve talked to you in the past, we’ve talked about trends in the industry, unique concepts that some of the operators have launched, whether it’s a lifestyle type center or a high-end independent or assisted living facility. What type of trends are you seeing like that in the industry, and do those type of products tend to… Are they attractive to investors, or how do the investors react to those kind of niche product types?

Andrew Van Zee: Good question, Andrew. I would say probably that there’s no… So everybody’s looking for the silver bullet, that one product you can continue to punch out over and over and over again. It’s going to be the home run every single time. I always chuckle a little bit when I kind of hear some of those types of conversations thrown around a little bit because there’s not one type of housing products on the regular housing across the country. We are dealing with housing. It’s senior housing. But it’s ultimately still housing. From a niche aspect though, I think that what has been growing and something that is honestly in a little bit of an interest to me, so maybe a little biased when I say this is I really think that some of the smaller facilities that the small house design, the greenhouse design, those types of concepts are going to continue to grow across the country, especially as we look to the more affordable concepts that Welltower has been pushing quite a bit, trying to find solutions for.

Andrew Van Zee: Some of the bigger investment groups are wanting to look, shift a little bit of their focus to, what’s sustainable? What’s a sustainable model, and what’s sustainable in the country long term is getting to that middle class or even, in some degrees, the lower class that are aging at the same rate as the upper class? So some of these smaller types of concepts I think are very attractive for somebody who wants to move into those parts of the country, that middle America, if you will, that traditionally would be overlooked because you can’t plop down a 180, 200-unit facility right there. Now, that said, our cities are also growing. There’s still a lot of growth that needs to continue to happen on a large scale and some of the cities. I think that when you start to look at more of the metropolitan areas and you start to see some of the, let’s just call it an evolution of the villages down at Florida, ultimately, right, that was a very innovative concept of creating a community around a single age group. Senior house is always trying to create community.

Andrew Van Zee: How do you do it? How do you do it in a unique way? I think the wellness center and the intergenerational approach that is starting to pop up, not everywhere, but here and there I think is also becoming more attractive as you start to get into areas where maybe you have a lot of other box assisted living or independent living structures in your market area, and you want to create that niche. What’s one way to do it? I know obviously, a lot of groups have been talking about the wellness model of, how do you incorporate a true wellness lifestyle into it so that you can age in place?

Andrew Van Zee: I really see it as more of an evolution of what the CCRC model started out as, as a means for somebody to age in place, but taking it a little bit further and focusing more on wellness. So there’s a couple of unique developments that I’ve seen over the past several years. There’s one of them in the Midwest where they really focused a lot on the intergenerational aspect of a community with it still being anchored as senior housing, incorporating a wellness center that would allow moms and daughters and grandkids to come in and do yoga classes together or the culinary aspect of having a restaurant, a really good culinary staff that’s quite honestly more open to the public to get a restaurant style dining that’s true restaurant style, open to the community, flowing through there.

Andrew Van Zee: So I think there’s still going to be niches and growth in those types of categories. From an investment standpoint, bigger is always better. Economy of scale is always better. So early on, as those groups are looking for those niche markets, I think, I think that the long-term investment is still probably better for a larger project versus some of the greenhouse model, unless some of the greenhouse style products can be coupled with a portfolio or on a campus, where you have multiple buildings on the same campus, and maybe one of them is memory care. Maybe one of them is assisted living, and maybe one of them is a skilled nursing component and so that you can still create that economy of scale from the operational standpoint. So as we get back to the very beginning of our conversation, I think that the number one thing that’s holding that model back from going large scale very quickly as a lot of people are very interested in it.

Andrew Van Zee: A lot of people are very interested in, I think, and are looking at it is just operationally, how do you make it efficient when you are doing one building at a time in places? So when we start to get some scale and a tipping point of those facilities out there and the operational expertise of knowing how to run those, I think that’s a very unique model that hasn’t had its spotlight to the extent that it probably should yet, especially in terms of investment.

Andrew Dick: Yeah. The greenhouse model is something I’m very interested in. In fact, I talked to Susan Ryan a couple of days ago from the greenhouse project, and hopefully, we’re going to have her on the podcast soon, a very interesting concept, and it seems like it’s performed very well during COVID in terms of… In some cases, the greenhouse model has almost a zero infection rate.

Andrew Van Zee: Absolutely. I think-

Andrew Dick: But again, you’re right. Smaller scale. Some investors say it’s too small, right, to really pique their interest. But yeah. Andy, let’s switch gears. You’ve been in the business for quite some time at this point in the senior housing business. What advice would you give to someone who’s new to the industry looking to meet folks and learn about the industry? What advice would you give someone in that position?

Andrew Van Zee: Yeah. I think the number one thing, if you want to move into senior housing, you have no experience. Maybe you’ve heard about it, maybe just happened onto a podcasts like this one, Andrew, and you hear that it might be a strong area to invest in. I would say there’s an acuity spectrum that we talk about in the industry and starting at the hospital and then working its way down to independent living. Of course, in our focus of senior housing, we start that acuity spectrum of skilled nursing and work your way down. For somebody who’s coming in, I think if you have no experience at all in the service, it’s actually provided inside some of these buildings is to learn about that and learn about those different acuity levels and really start to understand what the differences are in licensure, what the differences are in staffing, what the differences are on reimbursement.

Andrew Van Zee: A lot of these things, especially at the upper end, at the skilled nursing end because there’s so much government reimbursement that comes out of it. A lot of this, you can actually find out if you’re diligent enough. You can do some of your research on those types of reimbursement things and licensing on your own. It comes down to the economics of the lower acuity, the assisted living, maybe the memory care, the independent living that you need to network. You need to find somebody who’s doing it. There’s plenty of good groups out there that you could get in touch with to learn more about it. Contact a local broker. I mean, that’s probably one of the easiest ways. We’re real estate brokers. But I’d call ourselves the Knapp Group Senior Housing Advisors of Marcus & Millichap. We’re advisors predominantly for those who are already in the industry.

Andrew Van Zee: So find a local broker that is maybe willing to spend some time. But be serious. Don’t waste anybody’s time as well. There’s a lot going on in the industry. To be able to find somebody who can be able to really share some of the details with I think is important as long as you’re sincere about it and as long as you’re serious. That said, senior housing has been around for quite some time, and there’s starting be, I think, an evolutionary shift internally just from the age of management, the age of operators who are out there. There are a lot of smaller groups that are retiring or moving on and/or handed the Baton on to the next generation internally, and that leaves us with a lot of mentors, a lot of sages that have been through it before and a lot of opportunities to just be able to grab a cup of coffee with somebody.

Andrew Van Zee: I’ve done that many times both starting out as an attorney in this industry, but then also as a broker, just wanting to continue to learn and grow my craft as well as don’t be afraid to reach out and ask somebody a question. I think that everybody in senior housing that I’ve encountered for the most part loves people. They love working with people, caring for people, serving. There’s so many servants hearts in this industry that if you are sincere about wanting to know, and you want to know for the right reasons, you don’t just want to know to come in to make a buck, but you want to make a difference, there are plenty of people to be able to get to know. But learn the industry first. It’s not the same as any other just real estate investment class.

Andrew Dick: Agreed. Agreed. Well, that’s good advice. Andy, where can our listeners learn more about you and the Knapp Group?

Andrew Van Zee: Yeah. No, thank you. In two ways. The easiest way obviously is going to be going directly to either our website within Marcus & Millichap, kgseniorhousing.com, K as in kite, gseniorhousing.com, and/or just going directly to the Marcus & Millichap website, and you can eventually find this that way. It’s just marcusmillichap, marcusmillichap.com.

Andrew Dick: Well, Andy, thanks for joining us today. I want to thank our listeners as well. On your Apple or Android device, please like or rate our podcast. We also publish a newsletter called The Health Care Real Estate Advisor. If you would like to be added to that list, please email me at adick@hallrender.com.

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An Interview with James Winchester, Lead Financial Analyst, CMAC Partners

An Interview with James Winchester, Lead Financial Analyst, CMAC Partners

An interview with James Winchester. In this interview, Andrew Dick interviews James Winchester, the Lead Financial Analyst with CMAC Partners. Andrew sits down with James to talk about physician-owned real estate strategies.

Podcast Participants

Andrew Dick

Attorney, Hall Render

James Winchester

Lead Financial Analyst, CMAC Partners

Andrew Dick: Hello, and welcome to the Healthcare Real Estate Advisor podcast. I’m Andrew Dick, an attorney with Hall Render, the largest healthcare-focused law firm in the country. Today, we’ll be speaking with James Winchester, the Lead Financial Analyst for CMAC Partners, a firm that works with physicians to maximize the value of their real estate investments.

Andrew Dick: James has been with CMAC Partners for a number of years. Prior to joining CMAC Partners, he worked for a number of companies, including Siemens. We are going to talk about his role at CMAC, some of the issues faced by physicians that own real estate associated with their medical practice and a couple of other items. James, thanks for joining me.

James Winchester: Thanks for having me Andrew.

Andrew Dick: James, before we talk about your role at CMAC, let’s talk about your background, tell us where you’re from, where you went to college and what you aspired to be?

James Winchester: Great. Well, I’m actually from the UK. I often get confused for being Australian, which I think is probably because I’m starting to pick up some of the Orlando Twine, and I’m becoming this strange little hybrid. But I am actually from London, originally. I did my undergrad education in the UK.

James Winchester: I was actually trained to be a mechanical engineer and decided that that was not for me. Or perhaps it was the other way round, engineering decided that I wasn’t for it. And then I decided that I would make a transition. And I came over to the U.S for grad school, and went to a school down in Florida called Rollins College. And I decided I couldn’t leave the palm trees, and I’m still here today.

Andrew Dick: Terrific. So how did you ultimately end up at CMAC Partners? And then tell us about CMAC in general and what its mission is?

James Winchester: I was actually introduced to CMAC by one of my school connections and I was kind of intrigued by them. They work in a very unique space. And I’d spent some time working at some larger organizations previously and decided I really wanted to work for a smaller organization where I could really be impactful to the bottom line. I was also interested in the fact that they serve clients the whole way through the U.S even though they’re based in Winter Park, Florida.

James Winchester: CMAC is an organization that was started around 16 or 17 years ago now. And really had the mission of assisting physician groups with their real estate financing. And it started off with helping them with bond financing. And there was kind of a unique instrument that groups were able to capitalize on. And when the financial crisis hit in 2008, those bonds became a liquid, and CMAC really had to pivot a little bit. And they were able to really create the same value for their clients, but more using conventional financing with banks and credit unions.

James Winchester: I think that the business has become even more interesting for me. And one of the reasons why I was attracted to it in recent years, is because it’s changed and it’s evolved ever so slightly where we realized that that physician groups, a lot of them are struggling with the same issues across the country. And we’ve created a bunch of solutions that use the financing. And that financing can facilitate some structural changes within the way they operate the real estate. And it’s really become a value-add when we’re going through our process. So we’re not only saving them money, but helping them structure it in a little bit more of a thoughtful way.

Andrew Dick: I like it. Very narrow-niche. Which tells me that you and your colleagues can probably serve the physician clients very well because you’re seeing some of the same issues over and over.

James Winchester: For sure. And we are really specialists in our space. We really only work with one type of group, and that is Independent Physician Practices that have, or are thinking about real estate ownership.

Andrew Dick: Okay, got it. As a financial analyst, tell us what you’re doing on a day to day basis for some of these physician groups?

James Winchester: My role has really evolved into being quite client-facing. I have the opportunity to travel around the country when it’s safe to do so. It’s been a little bit prohibited recently. I really see myself as somebody that really tries to find out the objectives of the practice in the real estate, what are they trying to achieve and what issues may they be encountering at the moment.

James Winchester: And kind of as a by-product, we assist those groups with the real estate financing and save them money in doing so. But really, the primary driver, a lot of the conversations that I have with groups are the issues that are inherent with the way that they’ve been set up historically.

Andrew Dick: So for example, the docs may have set up a partnership or a limited liability company and most practices evolve over time, physicians are buying in and out, and sometimes the way it may have been set up initially may not have been optimized for really what they’re trying to accomplish today. Is that, in a nutshell, what you’re working through with the docs?

James Winchester: Absolutely. We’ve owner-occupied medical real estate. It’s a little bit different from a traditional real estate investment. And there are some ways in which groups can really capitalize on their returns and reduce their risks simply by the way that they structure their real estate. Because the real risk is determined by the credit quality of the operating entity that is occupying the building.

James Winchester: And because that really is in control of the owners of the building of the physicians that own it, they can really, if they have good alignment between the real estate and the practice, they can really maximize their risk adjusted return. And really, a lot of the conversations that we have is helping groups that have gone and entered into good real estate investments at the time. But those real estate investments have really strayed from the objectives of the practice, and suddenly, they become a little bit more risky and the returns are not necessarily as good as what they could be if they looked at it from a holistic lens.

Andrew Dick: Let’s just back up before we do a deep dive into how some of these partnerships and LLCs are set up. Talk about the value of a physician group actually owning their real estate. It sounds like you come in and oftentimes they own their medical office building, for example. But do you also work with groups when they’re thinking about either building a new building or maybe investing in a new medical office building for their practice?

James Winchester: We do. And a lot of the conversations that we have are really helping groups understand what the risks are of them going into a new investment, how to mitigate those risks and what kind of return they’re going to be expecting to receive. And we’re really big advocates of groups investing in the real estate from which they operate for a number of reasons. I think they’re both economic, simply it’s a really good risk-adjusted return. Most of the groups that we work with, if the deal is structured correctly, they’re able to earn cash-on-cash returns of the low to mid teens.

James Winchester: And really, we see it as very advantageous for the groups to be paying rent for themselves and building up their value over time rather than paying it to a third-party. I think even more important than that though, is the non-economic factors, as we like to call them. And one of those is recruitment, for example. One thing that independent physician groups can really offer that a lot of their competitors can’t is some of the ancillary services such as the real estate that are very attractive to the new partners if they can enter affordably.

James Winchester: I think that, for a lot of groups, it can create glue within the partners that are involved in the real estate and something that really binds them together as a group. Probably the last thing is the ability to control the group’s destiny. And a lot of the times, having ownership within the building that the group practice allows them to make expansions, if they decide that that’s strategically important for the practice, or have the ability to control the lease that they’re operating out of to, maybe, reduce their expenses or…. There are a number of different things that I think groups can take advantage of with real estate ownership that they don’t have the opportunity to without it.

Andrew Dick: I think you hit on the two points that I’ve seen over my career. Which has really… You mentioned the glue that can keep a group together, which I think is right. And also the recruitment benefits of bringing in younger or newer physicians, I should say, into the practice. It’s a nice bonus for those docs to be able to buy into the real estate as well.

Andrew Dick: That’s something that many of the health systems can’t offer when you’re competing for newer physicians because the health systems typically don’t allow physicians to invest in real estate opportunities that the health system is undertaking. So I think you’re exactly right. It can be also a powerful wealth-building tool for the physicians.

Andrew Dick: So when we talk about setting up a real estate company or a partnership, what are the things you and your colleagues think about, James, when putting the deal together, if you could start from scratch?

James Winchester: We think that… Firstly, probably, as I mentioned before, the alignment of the ownership of the practice and the real estate entity can be really important. We work with a lot of groups that when they first go into exploring whether they’re going to invest in their real estate, they may have 50% of the physicians interested in participating. We think that that is not necessarily desirable. And if we can increase that number and you may be in a situation where you can’t get everybody involved, that if you can get a solid amount of the practice involved in the real estate, it can reduce some of the problems that are inherent along the way.

James Winchester: There are often conflicts of interest as you see the diversion of those two ownership groups. Because it is an economic asset. And oftentimes, it can be contentious if rents are set at certain levels or leases are negotiated in certain ways that are going to impact individuals within the group disproportionately because of that disparate ownership.

James Winchester: So I’ll say first and foremost, we’re really looking to try and create that alignment. I think a lot of that becomes really an education process. And if the transaction is put through and structured in the correct way, a lot of the times, it can be very desirable. And that’s not necessarily understood from the onset. So if we can really explain that, make it transparent, I think most of the groups that we work with feel pretty comfortable that they can get the vast majority of physicians on board.

James Winchester: I think alongside that, especially for new groups that are new to real estate, they may not be aware of some of the issues that come along the way of having a dynamic ownership group. Which is very different from what we see from a traditional real estate investment where you have new partners coming in and you need to be able to buy existing partners out. So we really look for structures and help groups through structures that make sense and are sustainable for as long as possible.

Andrew Dick: You hit on some really important points, the conflicts of interest that can exist as a big one. You’re exactly right that if only a handful of the physicians in the practice invest in the real estate company, there can be a number of conflicts when you go to negotiate the lease terms and negotiate renewals or talk about the future of the practice. I think you’re exactly right. That alignment is huge. And to the extent that you could get all of the physician partners in the practice to also invest in the real estate, I think that would make the transaction much easier and eliminate a number of conflicts.

Andrew Dick: One of the issues you and I have talked about before is the buy-in and buy-out process for a number of these practice groups. Especially if it’s a real estate partnership or company that’s been around for a number of years and buying in can be very expensive for a newer physician that maybe doesn’t have the capital to buy in or access to capital.

Andrew Dick: Talk about that process, the buy-in and buy-out and some of the things you think about to make sure it can work. Because if you’re going to offer a new physician, for example, an opportunity to buy in, it’s got to be set up in a way that it’s truly an opportunity where that physician can afford to buy in. Maybe talk about that just a little bit, James.

James Winchester: You’re absolutely right. It generally occurs as the real estate investment matures. Most groups will look at kind of an 80% loan-to-value structure or thereabouts, maybe a little bit higher in some cases. And it therefore means that, at the inception of a project, the partners are collectively having to come up with around 20% of the equity, maybe 15% of the equity, based off of the financing that they’re able to achieve.

James Winchester: And what we see is, as the real estate matures and that debt is paid down, and most of the time we’re looking at buildings that are appreciating depending on the market that they’re in, there becomes a widening movement and a delta between the assets and liabilities that’s increasing to the point where, as you mentioned, it can become not achievable for new partners to be able to buy-in based off of the traditional way with which these buildings are valued.

James Winchester: And we’ve seen groups where those buy-ins can be above a million dollars. And you’re looking at the physicians that are typically going to be the most highly leveraged because they’re at that stage of their career where they may have student debt, they may be looking to make their first home purchases. It’s just a difficult conversation for a lot of groups as that number goes up.

James Winchester: And we certainly see, for different groups, that that number can be different. And some are happy to, and don’t see any problems if the buying is quite substantial relative to what other groups see. And they can really struggle much earlier on in the process. We certainly recognize that as an issue. What a lot of groups, I think, don’t recognize it. I think that they recognize the buy-in side much more quickly than they recognize the other side, which can be equally problematic.

James Winchester: And that’s buying out partners. Especially as we’re seeing an aging population and many of the physicians that have been working to build up their equity in these real estate investments are looking to leave the practice and therefore liquidate their shares in the real estate ownership, that there can often be a real struggle to be able to facilitate that process. Especially if that buy-out of those physicians is paid over a short period of time.

James Winchester: And if there are a number of buy-outs that are occurring at the same time without adequate buy-ins occurring at the same time, it can be a real drain on returns. And we’ve seen many groups that have gone from a nicely-yielding investment, where they’re getting reasonable returns to actually having to put money into the real estate in order to be able to buy some of their partners out. Which is not necessarily desirable.

Andrew Dick: All good points. Talk about the algorithm that you and your team has developed called True Course. I was intrigued by that when we talked before. It sounds like it’s a program that helps predict timing of buy-in and buy-out of partners in the real estate company or in the partnership. Maybe just give us an overview of how that works and what it is.

James Winchester: For sure. Really, the genesis of the True Course came from really witnessing what most groups do when they start a new real estate entity or even groups with an existing real estate entity will manufacture an operating agreement, and they will put a certain buy-in and buy-out parameter in there, and they will decide to value their building. And they have these sequence of events that occur for them to get to each of these.

James Winchester: The reality of the situation is typically, for the first three or four years, they can get through and be relatively unscathed. And these buy-ins and buy-outs in the structure that they have in place works. And at some point in time, they reach a roadblock. And one of two things happens, new partners are really turned off by the fact that they’re having to come up with this large sum of capital in order to be buying into the real estate entity or the group’s really struggling to get partners to be able to buy out.

James Winchester: And really, they go through the same process again. Where they will go and look at the operating agreement and adjust it in the best way that they can. And sometimes, groups do a great job in doing that. But we really wanted to look at a process that actually looks at the probability of issues occurring and for groups dependent on the structure that they have in place when these issues are likely to occur based off of the probability of buy-ins and buy-outs occurring and what will be the severity of the issue of these problems occurring.

James Winchester: And typically, we see groups that have a large real estate value, relative to each physician, are going to be the ones that are really prone to this. Because they’re going to see a bigger build up of equity more quickly. And there are some ways, there are some methods that we found by using this program, that can really help groups mitigate these issues and make them occur less frequently.

James Winchester: And I really don’t think it’s an issue that you’re going to completely avoid, but as long as groups understand the different risks that they have, and when those risks are likely to occur, they can really apply some sound financial planning to be able to deal with them and be ready to deal with them when they do occur.

Andrew Dick: So, James, what are a couple of the factors that you look at when you’re inputting the data into that program? Age of some of the owners, value of the building or…? Give me a sense of some of the factors you’re looking at?

James Winchester: Age of the owners is very important. We try and put as much information in as possible. I think there’s something along the lines of 37 different variables that we try and model for. The pace with which the debt is repaid can often be an important one because that can create a trigger event a little bit earlier. We also try and identify what market the group is in. And what that really tells us is, what are the chances of new physician partners joining that market.

James Winchester: If you’re in a growing geographic area, then I think is a little bit easier from the recruiting side. And that generally tends to mitigate some of the issues that you’re going to see on the real estate buy-in and buy-out side because you’ve got more partners coming in than you perhaps do on the way out.

James Winchester: For stagnant or more stagnant markets, it can be more of an issue. Because you may be on the other end of the scale where the size of your practice may be reducing emphasis slightly, and suddenly you’re trying to fund buy-outs when there’s no capital coming into the entity.

Andrew Dick: Interesting. It sounds like it’s a very novel approach to an issue that comes up quite a bit in real estate holding companies involving physicians. One item we’ve alluded to already is, it can be challenging for newer physicians to buy in. You talked about how much, I think roughly, capital a physician may need to bring to the table, whether that’s 20% of the value of the buy-in.

Andrew Dick: Talk about maybe some strategies that younger physicians should think about when they’re trying to buy into a real estate partnership or company. Sometimes it’s easy for them to get loans from a bank to buy in, sometimes it’s not. What are your tips you would give to a younger physician looking at an opportunity like to buy into their real estate entity?

James Winchester: Sometimes, I think younger physicians will become turned off by the value of the buy-in without understanding the true investment of that buy-in. If I enter in with a $500,000, for example, that is really there to provide me a return on investment, which I think needs to be explained first and foremost. Even that being said, I think it’s important for those younger physicians to continue having conversations with the leadership, to see whether there is a structure that really suits that particular group.

James Winchester: And we see a few different models that groups use. And I certainly don’t think it’s a one-size-fits-all. And I certainly don’t think that there’s a perfect answer when it comes to buy-ins and buy-outs. But, there are certainly different methodologies that groups used that can be desirable in certain circumstances. For example, there is a model that’s quite widely used that really bifurcates the ownership with two levels. One would be a voting share, and the other would be an investment share in a class A and class B model, for example. That can be something that is of interest for certain groups.

James Winchester: I think that the downside to that is that it doesn’t necessarily fix anything on the buy-out side. Which can be equally as problematic. Especially if you’ve got some physicians that are investing more heavily, they’re usually going to be the ones that are closer to retirement and therefore going to have a larger amount of buy-out that’s going to be required at the time that they do retire. But it certainly can help with attracting new partners to be able to get in.

James Winchester: We also see certain models that look at vesting the real estate ownership over time and they may have a very minimal requirement for the buy-in to start off with. But the investment really increases as the physician partner contributes more time with the practice paying rents and therefore their ability to be in the real estate. One thing that we certainly see a lot of groups doing is going through cyclical recoup of their investment.

James Winchester: One thing that I think a lot of the time is missed when we’re looking at these real estate investments is, although the real estate investment may have been 80% loan-to-value at the time that it started, when a new physician is buying in, their return on investment is going to likely be reduced as that time goes on, because they’re having to put more capital in for a very similar distribution that they would be receiving.

James Winchester: So a lot of the times we like to say to groups, well, if you have new partners that are coming in and they were investing in this building today and you weren’t occupying this building at the moment, would they come up with 50% of the value of the building to put into it? And the answer usually is no. They’ll probably use more of the bank’s money in order to improve their returns and essentially risk less of their own money.

James Winchester: So sometimes, just framing in that narrative makes groups realize that they need to do something in order to assist these new partners so that they can make it achievable, and they can make the investment desirable.

Andrew Dick: All good points. Let’s let’s switch gears. When you and I have spoken before, we talked about the fact that the healthcare real estate market is really hot right now. A number of investment groups and developers are out there pitching physicians to build new buildings. And the developers, in some cases, will want to own a hundred percent of the ownership interest in the real estate. In some cases, these developers and investors will offer the physicians the right to buy in.

Andrew Dick: I’ve seen a lot of different opportunities being pitched right now. Sometimes, the physicians feel like they need to give the developers and ownership stake in the project. Maybe you could give us an overview of some of the pros and cons of whether or not physicians that partner with the developer. What should they consider, in other words?

James Winchester: Andrew, I think this is a great question. We see it a lot with independent physician groups. I think one of the important things to address, to start off with, is that there is often a difference between development and investment within a medical office building. And they’re often conflated when groups go out and they decide that they want to be involved in new construction. And I think that there are certainly times where it can be beneficial to provide developers a piece of the pie.

James Winchester: But it should be looked upon as really a separate issue from going out and the developer developing the building and more as an equity partner that’s going to provide something throughout the life of the lease when you’re in the building. we see that sometimes groups find it advantageous if the developer is able to share in some of the guarantee risk at the start of the project. And if they are struggling with equity capital shortfalls and they need a contributor, then they may lean upon the developer in order to provide that shortfall and assist in their capital stack.

James Winchester: I would say that more often than not, a long the real estate investment, there becomes conflicts of interest between developers and independent physician groups. Because, simply their objectives are not aligned. And I think that there are some great developers that become good partners with groups. But that’s not always the case.

James Winchester: First and foremost, I think it’s important for groups to identify who’s got control of the asset. And if you’re getting involved with a developer and losing control of that asset, and losing control of the lease that’s in place, that may seem fine at the time that you’re starting the development. But can be something that is not desirable at all, and can leave a group hamstrung once the building is up. And really the developers value diminishes. Because, the value derived from these buildings is really concentrated in that lease that’s in place, because it’s an income-generating asset.

James Winchester: I think that that really leads to a misalignment of the value and compensation as time goes on. We work with many groups that have perhaps got involved with a developer for one of these reasons where they’ve also become an equity partner. But they found that three or four years into the project, they’re looking for ways to be able to exit that developer share or buy that developer out. And they almost always are having to do so at a premium, and they are still able to get some good returns on the building by capitalizing on a hundred percent of that control.

James Winchester: But more often than not, their comment to us was, well, I wish we didn’t give so much of it away at the start. And we’re a little bit more thoughtful as to what this would look like after the construction was completed.

Andrew Dick: Okay, James, let’s let’s talk about the capital markets. That’s really one of the areas that CMAC has a lot of experience in when physicians are going to seek, whether it’s debt or equity financing for a real estate transaction. Talk about what you’re seeing in the markets right now. Is it a good time to seek out capital? Talk about what’s going on in the market.

James Winchester: For sure. My overarching comment was, it’s been a little bit choppy. But it’s starting to settle as everybody understands the implications of COVID a little bit more and banks are able to predict what the next six, 12 months is going to look like. We saw… It was kind of interesting at the onset of COVID. We were seeing, just before it, some very aggressive pricing and spreads. And most of the transactions that we complete, the bank is providing a spread over liable.

James Winchester: And what we saw as COVID here was that banks started to widen their spreads a little bit over liable between the 50 to 70 basis points mark. We were in continuous conversations with the lenders, trying to find out exactly what was going on and why. And they were really explaining to us that some of the indexes from which they were previously pricing on were no longer reflective of their cost of funds. So they were seeing that it was costing them more to be able to borrow the money to provide it for these loans than was reflected in liable, which was usually a pretty good index to be able to measure their costs for providing that capital.

James Winchester: What we’ve seen since is, those spreads have started to come down. I would say that they’re still not at the same levels that they were pre-COVID. And certainly banks have become more selective with the opportunities that they’re going after. We still have a couple of large national banks that are having real difficulty being able to bid on new transactions and some banks that are finding it difficult to bid on new construction projects.

James Winchester: In general, we’re say that we’re seeing most coming back to some level of normality. And because there’s been so much intervention with the fed and rates are so low right now, even though the spreads are a little bit wider than what we saw before COVID, there are still some great opportunities to really capitalize on low fixed interest rates because the underlying market and the index is from which these loans are priced upon are really low and therefore there’s really aggressive rates available.

Andrew Dick: Yeah, it sounds like maybe things are starting to smooth out a little bit, but we have ways to go in terms of the capital markets leveling out. Where do you think the healthcare real estate industry is going in the future? Do you think we’re going to continue to see growth and opportunities? It truly seems like it. But I would welcome your thoughts.

James Winchester: I think that it has, again, proved its resilience. Certainly, if you look at it and compare it against other real estate assets like retail and hospitality, it certainly stood well above those in terms of its performance over the last few months. I think that it’s really going to be based on the underlying performance of the healthcare industry in general, which most people I think expect to remain pretty strong.

James Winchester: And certainly, in terms of values of these assets, we’re seeing actually capital move towards the space. Which almost is counterintuitive considering that real estate in general has been as competitive over the last few months, but because certain investors and real estate investment trusts are moving away from what are deemed to be more risky investments and moving that capital towards the healthcare space, which is deemed as more of a safe haven, we’ve seen on the buyer and broker side some really aggressive proposals come out in recent weeks.

Andrew Dick: Good to hear. Where do you see the most opportunities for physicians interested in investing in real estate? I know that at CMAC you’re focused on physicians often investing in the real estate associated with their practice. Are there any other opportunities out there that you’re working with groups on? What advice would you have when a physicians interested in investing in real estate?

James Winchester: We see a lot of, specially groups that can create real estate investments that really compliment the underlying practice. And I think those are the ones that we like to recommend for four groups. If it’s something where they may be able to… If they’re an orthopedic group and they’re able to invest in physical therapy on-site, for example, that can be something that’s really advantageous.

James Winchester: When physicians at an investment strays into the into other areas where there is a different risk profile for the investment, I think it really comes down to understanding the balance between risk and returns. You can often get into desirable real estate investments that are going to yield a high return, maybe as high as the medical risks that you’re investing in with the practice. But it’s not likely to carry the same level of risk. And that’s an important thing for a physician investing to be aware of.

Andrew Dick: I think that’s a good point because when your practice is the tenant and a so long as you’re practicing within the space, the risk pro profile should be quite a bit lower for the real estate that your practice is using. So, good advice.

Andrew Dick: James, what would you tell someone who’s trying to get into the healthcare real estate business? What advice would you have for someone who’s new to the industry? How can they learn more and grow in the industry?

James Winchester: I would say, especially for independent physician groups, there’s a great resource called the Congress of Physician-Owned Medical Properties that was started a few years ago, and really was put into place because there are so many groups that really don’t the opportunity to discuss with each other what works and what doesn’t work when it comes to their real estate.

James Winchester: Many of these groups are sitting with assets of 40, 50 million-plus. And it can become extremely important for them to be structured in a way that increases their success in the long run. So I would say that that is certainly one resource that I would tap into if I’m a new physician partner and an executive that’s new in the space for sure.

Andrew Dick: James, as we wrap up here, where can our audience learn more about you and CMAC Partners?

James Winchester: I think, probably, the best places to visit our website, which is www.cmacpartners.com. We are pretty much always available to speak and answer questions that groups have, and we’re happy to do so. I really like to think of us as a group that wants to help the industry become stronger. And we understand that our role or our success is not going to be anywhere near as good if the industry doesn’t succeed with us.

James Winchester: So if there is any opportunity for us to put groups in touch with industry experts, like Hall Render and yourselves that really specialize in this space and can really offer some value, then I think that we love doing that. So we would be happy for anybody to reach out

Andrew Dick: Great. James, thanks for joining us today. I enjoyed the conversation. Thanks to our audience for listening to the podcast on your Apple or Android device. Please subscribe to the podcast and leave feedback for us. We also publish a newsletter called the Healthcare Real Estate Advisor. To be added to the list, please email me at adick@hallrender.com.

 

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An interview with Alfonzo Leon, Chief Investment Officer for Global Medical REIT

An interview with Alfonzo Leon, Chief Investment Officer for Global Medical REIT

In this interview, Andrew Dick interviews Alfonzo Leo, Chief Investment Officer for Global Medical REIT. Andrew sits down with Alfonzo to discuss health care REITs.

Podcast Participants

Andrew Dick

Attorney with Hall Render

Alfonzo Leon

Chief Investment Officer, Global Medical REIT

Andrew Dick: Hello, and welcome to the Health Care Real Estate Advisor Podcast. I’m Andrew Dick, an attorney with Hall Render, the largest healthcare focused law firm in the country. Today, we will be speaking with Alfonzo Leon, the chief investment officer of Global Medical REIT, a publicly traded equity REIT that trades on the New York stock exchange under the ticker symbol GMRE. Alfonzo has been a real estate and investment banking professional for a number of years. Prior to joining Global Medical REIT, he worked for an investment banking firm, helping hospitals and healthcare providers on strategic real estate transactions. Alfonzo along with his colleagues have grown Global Medical REIT to a respectable healthcare REIT. And today we are going to talk about his career and his current role at Global Medical REIT. We’re also going to talk about the Global Medical REIT portfolio and healthcare real estate industry in general. Alfonzo. Thanks for joining me.

Alfonzo Leon: Thanks for having me.

Andrew Dick: Alfonzo, before we talk about your role at Global Medical REIT, let’s talk about your background. Give us a little bit of information about where you’re from, where you went to college and what you aspired to be.

Alfonzo Leon: Sure. Great. So I was born in South America. I came to the US for college, went to the University of Virginia, studied to be an architect initially. Right after I graduated from UVA, I lived in Martha’s Vineyard for a year. While I was on the Island, I enrolled in the center for real estate program at MIT and went to that program for a year. Coming out of that program, I started a job with LaSalle Investment Management, out of their Baltimore office. That was a great opportunity for someone that’s in essence, starting their career. I had a chance to work with a lot of acquisition officers across all asset types, office industrial retail, medical office and hotels. I actually sat next to the acquisition portfolio manager for LaSalle, that was starting a medical office fund.

Alfonzo Leon: So I did a good amount of work with the director of that MOB fund over the years. So I did that for about five years. In 2005, I decided to look for other opportunities. I joined a boutique healthcare investment banking firm called Cain Brothers, out of San Francisco. And it was a pretty, a unique opportunity. At the time, this is 2005, medical office was still considered a very niche investment class and there weren’t really that many people that were in the space. I joined a group within Cain Brothers that was dedicated to MOB monetizations on behalf of health systems. That was the core business model. So over the years, Cain had built many relationships with small health systems across the country, health systems with two, three, four hospitals within their network, which were too small for the big wall street banks.

Alfonzo Leon: The founders of Cain, two brothers actually formed the company in the mid ’80s with a goal of servicing these smaller health systems. So when I joined in 2005, Cain Brothers had completed about a handful of monetizations in the past couple of years. And it was that they were in many ways pioneers in the space. The first monetizations happened in 2001, 2002, when Ascension started, engaged Ernst & Young to evaluate their real estate holdings and they were looking for ways to raise cash, to help their credit ratings. So that in essence started the industry that I’ve been in since in essence 2000 when I joined LaSalle, and Cain Brothers was one of the pioneers. So when I joined them, it was a group of about six bankers, never really grew beyond that number.

Alfonzo Leon: But over nine years from 2005, in 2014, I worked on over $2 billion worth of transactions in the healthcare space. So I spent a lot of time over those years working with health systems, working with physician groups and also interacting with a lot of the buyers in the space. So all the public REITs, the private REITs and the private equity companies that have joined over the years. So it gave me a very unique perspective, in a sense, I had a chance to observe and learn from other investors in the space over nine years. I also had a chance to interact with health systems at the board level, where they were actually making decisions on healthcare. Also I had a chance to work directly with physicians and then most importantly, Cain Brothers, since they had a focus on healthcare for nine years, I had the opportunity to hear from other colleagues who were in the home health business, senior housing business, who were in the managed care business.

Alfonzo Leon: And the medical device companies, IT, I mean a pretty wide spectrum. And Cain Brothers also had a pretty active tax exempt bond business. The guy who ran the real estate group within Cain Brothers, he also ran Cain Brothers, their M&A practice for hospitals. So I also had some exposure to that process when a hospital is acquired by another hospital. I had a chance to observe kind of their thinking and what goes into that process. So very unique perspective that I had prior to joining Global Medical REIT.

Andrew Dick: So Alfonzo, it sounds like when we spoke before you were happy working at Cain Brothers, you had a very good experience. You liked the variety of work and generally weren’t looking for new opportunities. So how did you end up making the move, or what prompted you to make the move to Global Medical REIT?

Alfonzo Leon: Sure. And you’re correct. I mean, I had no plans on either looking for opportunities outside Cain Brothers or leaving San Francisco, which it’s not a bad place to live. So really it was a coincidental, I got put in touch with somebody that was, a person who was the former CEO of Global Medical REIT. He was starting the company, looking for the first acquisition. And I struck up a conversation with him and realized that there was an opportunity to join what in essence was a startup REIT. And while it came over nine years, I saw a lot of funds start with zero assets, and within a two, three year span, grow their portfolios significantly. At one point I sat and counted all the funds that I had seen grow to billions over the years and I counted over like 13 funds.

Alfonzo Leon: I’m not sure how often you have that phenomenon in other sectors but it did catch my eye. I saw a lot of groups grow big funds. So when I met Dave, the former CEO, it was intriguing. And it involved moving to Bethesda, Maryland which I also thought was coincidental because I had lived in Bethesda, Maryland during high school for a couple of years and I knew the area very well. Things moved pretty quickly after that first meeting. I found myself moving to Bethesda, Maryland to join Global Medical REIT in August of 2014.

Andrew Dick: And Alfonzo, did you join as the CIO or what was your initial role within the company?

Alfonzo Leon: Sure. So the startup of the company was very unusual. So Global Medical REIT was actually one company of many that were run out of the Bethesda office. So the company that I joined was actually called Inter-American Management, which in short and in essence was the Bethesda, Maryland office for a family office run out of Singapore. One of the things that this family office out of Singapore wanted to do was become a REIT incubator and Global Medical REIT was actually the second REIT that they had started. The first one was a single family home REIT. So I was joining their second REIT. So when I joined it, there was about a dozen people working out of the office, but really the only two people that were working on Global Medical REIT was Dave and myself, which was interesting.

Alfonzo Leon: So that was from August of 14 to I’d say the end of December 15, it was just the two of us. I ended up right around, at some point in 2015, I hired in essence our first support person that dedicated to Global Medical REIT. This person helped me tremendously and he’s still with us, helped me tremendously at that beginning phase. So with Dave, we bought our first two assets and that was in June of 14, just prior to my joining, in September of 14, that was the first one I acquired. We spent a lot of time trying to raise capital within the US, we did a capital raise in Singapore as well. And by July of 15 we got capital from through the Singapore family office, this group gave us 30 million to put together a portfolio that we could take, that put together a $100 million portfolio that we could use to have an IPO to start the company.

Alfonzo Leon: So with the money we got in July of 2015, we quickly put it to work. And by March of 16, we built a $100 million portfolio and that between March of 16 and June of 16, we ran pretty hard towards an IPO. We put together a team. We got the legal team as well. We did our road show in June and we completed it in the month of June. So things moved pretty quickly, after we got that first a $30 million SLUG and we’re able to put together a portfolio quickly as well.

Andrew Dick: So Alfonzo, do you remember what the first few assets you acquired were, what type of healthcare assets they were?

Alfonzo Leon: Sure. So the first one we acquired was a LTACH in Omaha, Nebraska, 21.7 million. The second asset we bought was a surgery center in Asheville, North Carolina, that was 2.4 million. The third asset we bought was ophthalmology clinic with a surgery center in Pittsburgh. That was about 11 million. The fourth asset we bought was actually a portfolio of six MOBs in Germantown, Tennessee. And it was a sale lease back with a gastro group, that the largest one in the area, that was 20 million. In February of 2016, we completed the acquisition of a surgical hospital in Dallas. That was 18 million. And then in March and concurrent with getting financing, CMBS financing on the entire portfolio, which was in that sense kind of a triple back flip because we were rolling in the portfolio we bought in December from the gastro group and the surgical hospital in Dallas, plus closing on a surgery center in Detroit 4.5 million and closing on a medical office building in Melbourne, Florida for 14.5 million. So that was a very tricky thing to do and one that I swore I’d never tried to do again.

Andrew Dick: I bet it was exciting though. I mean, starting as you described it, a REIT startup that had to be a lot of fun.

Alfonzo Leon: It was fun in the sense that it felt like you were going down a roller coaster with no breaks.

Andrew Dick: Well, tell us about the portfolio today, when you and I spoke before you’ve got a wide range of healthcare assets. In my mind, Global Medical REIT is a diversified healthcare REIT. You’re not a pure play. You’re not focused just on MOBs or hospitals. Do I have that right and talk about kind of the breakdown of the portfolio.

Alfonzo Leon: Sure. So from the very beginning our goal was to build a portfolio of purpose built healthcare facilities. We used a strong healthcare systems and physician groups with leading market share in secondary and tertiary markets with the goal of producing reliable, rental revenue with rent bumps and a diversified footprint and with the goal of having this portfolio be triple net or absolute triple net. So just recently we announced we reached a billion dollars in assets, with about 80 million of annual base rent or triple net rent or NOI if you want to call it that.

Alfonzo Leon: So over 115 buildings with over 100 tenants with an average rental increase of 2% over three square feet of space and with an occupancy of 99.7% and current NOI divided by purchase price, a cap rate of 8%. And with a weighted average lease term across the portfolio of about 8.4 years. So that’s our portfolio currently. In terms of the asset types we buy, I mean, primarily it’s medical office buildings, the bulk of it is medical office buildings but we also buy inpatient buildings. So we’ve got the balance of the portfolio is a mix of inpatient with other asset types.

Andrew Dick: Got it. So talk about your role. You’re now the chief investment officer. What does that entail? What are you doing on a day to day basis? And then take us into what is the ideal opportunity you look for when analyzing assets that come across your desk?

Alfonzo Leon: Sure. So one of the things that I enjoy the most about my current role is that no day is the same. I mean, every day has been very, very different. And even when I think about what I’ve worked on a quarter by quarter basis, it’s evolved quite a bit. Largely due to the fact that the company has been growing as much as it has and at different sizes, there were different challenges and different things that I had to focus my energies to address or to manage. I mean, we went from two people working for Global Medical REIT to today we’ve got 20 people. So it’s been quite a ride and quite a process and that every quarter there was a different set of challenges that we had to overcome. In the early years, it was capital raising and I spent a mind numbing amount of hours working on PowerPoints and making pitches to a wide range of investors.

Alfonzo Leon: And then there was the phase that I remember where we were trying to close on that $100 million portfolio. And then finishing that we moved into conducting the IPO. Then once we got that done and we raised $150 million, we switched into ramping up our acquisition strategy. So that was the second half of 2016. Then in 2017, it was a lot of things happened one of which was, we started, our credit facility with 75 million capacity, with an accordion feature as well. Continued executing our acquisition strategy, 2017 was also a year where we had a turnover of our CEO. That’s when Jeff, our current CEO stepped into the role. We also changed our CFO and we also changed our general counsel. So it was quite a bit for a new REIT, new company. And 2017 was a bit of a blur, I mean, there was a lot happening that year, but we ended up on a high note.

Alfonzo Leon: We raised money in June of 17, about 35 million. And in December, we raised additional funds, 75 million of preferred equity. Just in time for 2018, which was when rates started increasing, the FED started jacking up rates, which really changed the REIT landscape for the year. Fortunately we came into the year with a lot of capital and in 2018, we supplemented that capital, with acquiring buildings, with operating partnership units. So we did about $36 million of deals in that fashion. And 2018 was really sort of, for us, it was a year of us showing to our investors that our business model is working and that we can continue growing this company. 2019 was a great year all around. We hit a lot of milestones. The biggest of which was in, right around Thanksgiving, we got to add it to the Morgan Stanley index, which really increased our volume and our share prices started going from an average of nine, 10 up to 11, 12 and 13.

Alfonzo Leon: So that was a very, very big milestone. In 2019, we did a lot of acquisitions, very, very busy year. And in many ways we were kind of hitting our stride and came into 2020 with a lot of wind in our sails, with a very big pipeline. And when we did our earnings call in February… Sorry, our year end quarterly call with investors at the beginning of March, sorry. After our call, our stock actually went up to almost 16. So it was in large part due to the fact that 2019 we really hit our stride, hit a lot of milestones, had very good pipeline, very good deals. A lot of things came together for us in 2019. So when I think quarter by quarter, I mean, what I’ve had to focus on has changed dramatically. So to reiterate like no week is the same, every day is pretty different. In terms of my responsibility, what I think my primary role within the company is to make sure that I generate as many opportunities to invest capital as I can. In many ways I want to have more opportunities to invest than capital at all times.

Alfonzo Leon: So my team of three acquisition people, we spend a lot of time trying to get ahead of our capital raising efforts so that we can, not just be more selective, but we can… whenever there’s an opportunity to raise capital, we’re never short on pipeline, given the fact that capital raises, to have a successful capital raise, you have to have a pipeline. So what I view my principal role within this company is to make sure that we’re generating the maximum amount of opportunities for the company to grow.

Andrew Dick: And Alfonzo. So when you’re looking at opportunities, what is your sweet spot? What is the return you’re looking for, asset types? Give us just a quick overview of your approach.

Alfonzo Leon: Sure. So our strategy really hasn’t changed since IPO. We focus on buying high quality real estate and desirable secondary tertiary markets, least profitable healthcare providers that are leaders in their respective fields. We focus primarily on acquiring medical office and outpatient treatment facilities in the five to 15 million range and opportunistically acquire inpatient facilities, typically in a 20 to 40 million range. To go back to our composition of our portfolio, I have a breakdown here for you. So 57% of our portfolio is MOB of which 20% of that has surgery centers. 24% of our portfolio is inpatient rehab hospitals. 8.5% of our portfolio is surgical hospitals.

Alfonzo Leon: We have 3% of our portfolio is LTACH. 3% of our portfolio is acute care hospital. 3% of our portfolio is administrative space. And 1.2% of our portfolio is freestanding ERs. Geographically across the country, we have 20% of our portfolio in Texas, 10% of our portfolio in Ohio, 8% in Pennsylvania, 8% in Arizona, 7% in Oklahoma, 7% in Florida, and then the numbers spread out across many other States after that.

Andrew Dick: Very interesting and it sounds like a pretty diverse portfolio. Let’s switch gears. When we spoke before you talked about the fact that Global Medical REIT was at one point managed externally. And recently you and your executive team made the decision to internalize the management function. Give us just a brief overview of how that process worked and what the strategy that’s involved there.

Alfonzo Leon: Sure. So when I joined the company it was… I joined Inter-American Management. So most of the REITs in the universe are internally managed REITs. There are a few and I don’t know if it’s less than five or right around 5% or more, of the REITs in the universe that are externally managed. And really what that means is the employees who run the company are not employed by the REIT but by the manager. So the agreement we had with the manager was the manager provided all the human resources in exchange for a 1.5% fee. Historically, there’s institutional investors do not like externally managed REITs very much. At the heart of that is concerns around governance. There’s also been some bad actors in the REIT space that have not always had the best interest of shareholders in mind when they were running their business.

Alfonzo Leon: So we at the very beginning we set it up to be externally managed really because in outside of the US and in Singapore and Japan, for example, the REITs over there are externally managed. So it was set up from the very beginning to be externally managed for that reason, given the source of funds, the initial source of funds. When we were doing our IPO process, it became pretty clear to us that having the external manager model was going to make it harder for us to access institutional investors. So what we did at the beginning was set a milestone when the board of independence would start the internalization process. So we looked at a lot of case studies that our bankers and our lawyers provided, and we settled on a $500 million market cap threshold upon which when we get to that point, we would ask the independent board would start the process of internalizing the manager.

Alfonzo Leon: So in December of 2019, we raised about 80, $85 million of equity at $13 a share. That got us over the $500 million market cap threshold. So by the end of the year, the board started engaging their consultants, the manager engaged their consultants and attorneys, and the process kicked off in earnest [inaudible 00:26:44] in Q1 of this year. So pretty much for the first half of the year the board, a committee of the board that of GMRE negotiated with the manager Inter-American Management. I mean, really what they were negotiating is the breakup fee. Ours at the very beginning was set very formulaically. It was just three times the 12 month average fee. That number was competed to be about 18.2 million. We had a press release on that at the beginning of July when the process was concluded. And these, the best way to think of it is, this is in essence an M&A transaction.

Alfonzo Leon: If you read through the filings, Global Medical REIT in essence acquired Inter-American Management and Inter-American Management became a subsidiary of Global Medical REIT and all the employees, including myself moved, are now employees of Global Medical REIT. So at high level, it seems like a straightforward process, but nonetheless it is an M&A transaction, and there is a lot of back and forth that happens in normal course of business. In our circumstance, the fact that we had COVID and a lot of market volatility also extended the process longer than it probably should have run by maybe a month or two. But ultimately we got it done and announced that at the beginning of this month.

Andrew Dick: Very exciting. I know that that’s a big milestone. Talk about the leadership’s team, the vision that you and your colleagues have over the next three to five years for the organization. Are there any financial milestones or what are you looking to accomplish over that period of time?

Alfonzo Leon: Sure. So simplistically, I mean, we plan to continue growing and building a diversified portfolio. Every company needs to play to their strength. We’ve built a real estate investment platform to find execute deals in our niche. So our plan is to continue leveraging our experience and knowledge of healthcare real estate to identify deals with good risk adjusted returns at cap rates that allow us to invest our capital creatively. Every stage of growth comes with unique challenges. I consider our internalization that we announced at the beginning of this month as a book and to our startup phase. So the way I see it, we are now a $600 million market cap company in a growth phase, in a market sector with very good fundamentals. So in short, I mean, our strategy is to continue executing our business plan that we’ve had since IPO and continue growing this and continue matching capital raised with opportunities within healthcare real estate.

Andrew Dick: So Alfonzo as you’re executing on this strategy, how has COVID impacted your operations, your facilities, and some of the tenants you’re working with routinely? Give us a snapshot of how the last four or five months of have went for Global Medical REIT in terms of rent collections. And what are you seeing and hearing as you’re working with tenants?

Alfonzo Leon: Sure. So the last several months has been one that we’ve all lived through and it’s been very intense. When I think of the last several months and I compare it with the financial crisis of 2008, in a sense that you had housing. like in 2008, if you think about it, you had a housing bubble, combined with a credit crisis, and both are subject matters that are very relevant to what I do. This time around you had a healthcare crisis and a capital market crisis and the impact on real estate has also across many sectors has also been very dramatic. So in many ways the last several months I’ve been reading obsessively and trying to learn as much as I can about the impact COVID is having across many aspects of what I do for my job and what I do for my career.

Alfonzo Leon: And it’s definitely, I have to believe kind of a once in a lifetime kind of event. It’s been very dramatic. Having said that, we’ve reported our numbers in terms of collections and in terms of occupancy. And in the next week, we’re also going to report our Q2 earnings. And if you compare what we reported thus far with our peers, I mean, our portfolio has performed in line with other medical office portfolios. The month of April was very intense. There was a lot of uncertainty about how this was going to evolve. I mean, if you didn’t read the news for half a day, you were behind the curve in terms of staying current with the news. There was just a lot of new things that we all had to get accustomed to quickly. In discussions with our tenants, we spent a lot of time talking to them.

Alfonzo Leon: I spent a lot of time talking with other companies in our space, a lot of people that I know in the space. I walked away with a few kind of I guess a picture things. I mean for starters, the one thing that I think is clear to everybody is that healthcare is essential. It is an industry that needs to be defended. It’s an industry that is critically important to the country and not just the country, but to the economy. I mean, without a robust functioning healthcare system, you compromise many other aspects of the economy in the country. The other thing that I took away from the last several months, healthcare operators are very resourceful. You’re looking at a group of people that are very smart, very hardworking, that are very mission driven, that are not afraid of to work around the clock, have access to a lot of specialists and consultants that can help them.

Alfonzo Leon: Also as a group, they are very good at managing bureaucracy and paperwork when you think of healthcare reimbursements and if you think about in your own personal life having to deal with insurance companies, it’s tedious, but the healthcare operators are incredibly good at running and managing all that bureaucracy. So I would say in terms of characterizing kind of what I’ve seen, I mean, it’s just a resilient group of professionals in a healthcare space that have adapted quickly. They got a lot of support and help from the federal level and from CMS and from various other sources. So where we are today in terms of where we were even a month ago, I mean, it seems like healthcare providers have found ways to make it work. I mean, by no means, are we out of the woods on this one?

Alfonzo Leon: I mean, I think everyone’s acknowledged and are braced for the fact that this is going to be a long, long process measured. I think folks are thinking, we’re going to be living with this well until the end of the year and very likely through most of 2021. But it’s been remarkable to see just how hard the healthcare professionals have been working, not just in taking care of people, but also in running their business. So my hat goes off to them. I mean, it’s been remarkable to watch.

Andrew Dick: Agreed. I think the industry has fared pretty well given all of the challenges and in most parts of the country, electric [inaudible 00:35:49] procedures are continuing. And some of the providers that had to shut down are open back up, which is good to hear. In terms of opportunities, where do you see opportunities for healthcare REITs or for Global Medical REIT in particular, as we work through the crisis?

Alfonzo Leon: Sure. So within healthcare real estate specifically, among the many things that I’ve been thinking of lately. I mean, it’s pretty well known that there’s been a shift from inpatient to outpatient. I mean, that hasn’t changed if anything, it [inaudible 00:36:28] probably, you’re looking at a scenario where things have accelerated up a little bit. Telemedicine also something that I’ve heard people talk about for a very, very long time. We had an amazing opportunity to see that implemented in an aggressive way. And on the other side of that, I mean, it’s not totally clear how much of an impact that’s going to have on the space. I mean, I had folks in the telemedicine space say it this way, it’s not a replacement to healthcare real estate, but a compliment.

Alfonzo Leon: And as I pulled together, everything I’ve heard on that front, I mean, it definitely seems that rings true. I think actually it’s made some things more efficient. In terms of how healthcare gets delivered or how it evolves over the coming years. I mean, I think there is a lot to be said for convenience. And when you think of large medical office buildings with multiple stories, five, 10 story buildings with elevators versus a single story facility that is a lot more convenient than more single use focus, there’s pros and cons to both, most of what we have is that the latter. It’s a single story or two story facilities that are more… the focus of care within those facilities is more single purpose than multipurpose like you would find on an on campus building.

Alfonzo Leon: I think, there’s going to be, continue to be opportunities and a space as it has in the past. My experience in healthcare for the past 20 years is things don’t change radically year to year. I mean, it’s more of a gradual evolution. I can’t remember any time in the past where I think I’ve seen things evolve rapidly. I mean, it’s more of a gradual change. When I think of healthcare systems and how they think about delivery of care and how they think about their real estate, they also… it’s more of a gradual move and it’s more incremental instead of sort of a change. But all that, to say that I don’t see the healthcare real estate landscape changing dramatically over the next few years. I think a lot of the trends that have been in place for the past couple of decades are just going to continue, maybe accelerate slightly. But what it means for investors, I mean, I think there’s still plenty of opportunities in the space.

Alfonzo Leon: One thing that’s really worked in favor of investors in healthcare is the amount of supply that’s coming to market. And I compare that with where it was 10 years ago, or 20 years ago. 20 years ago, the volumes were fractions of what they are today. And when I thought about the question of why the supply has gone up so much, no perfect answer. I think it has to do with the fact that investors have come in and provided liquidity and you’ve seen cap rates go down and it made it more attractive to sell, and it’s been sort of a circular dynamic that’s evolved over the years. And every year I do get the sense that there’s more inventory, higher quality inventory and more investors.

Alfonzo Leon: So it kind of feeds itself, but when I think of the volume today versus even five years ago, I mean, it’s very robust. One of the things that’s been surprising over the past four months is April, May was slower than average, but by June and July the market pretty much snapped back the pre COVID levels. I mean, it’s been very active. There’s a lot of deal flow. The quality of the deals coming to market are pretty good. As I think of the next a few years and into the future, I mean, I don’t see that dynamic changing dramatically.

Andrew Dick: That’s good to hear, especially for those of us that work in the industry. Alfonzo talk about advice that you would give to someone who’s getting into the healthcare real estate industry. I asked most of our guests, what would you tell someone who’s just getting into the business, what should they read or who should they talk to, or what advice would you give them?

Alfonzo Leon: Sure. So one of the things that attracted me to the industry is the fact that you’ve got real estate, which I liked. And then you’ve got this overlay of healthcare industry on top of that, that makes it a lot more complicated than other asset classes. Prior to me joining into space and dedicating myself to healthcare in 2005, I had done a lot of apartment investments with LaSalle. And when I compare just those two on its own, like apartments versus healthcare, it doesn’t take that long to get your head wrapped around multifamily investments. Whereas with healthcare, I felt like even after two years of dedicating myself to the space and trying as hard as I could, reading everything I could about the space, I still felt like I was a beginner.

Alfonzo Leon: It takes a long time to really get a sense for the industry and the dynamics and the investors and the systems. I mean, there’s just a very, very large knowledge base, which is attractive to me. So I would start by saying that this is an industry with a very high knowledge barrier to entry, which is taxing at the beginning. And a lot of folks that I see started in the space, they are… it works against them, as they’re trying to figure out the industry and trying to figure out who’s who and why things are good, or why things are bad. But once you get on the other side of it, once you’ve got enough knowledge that you sound credible and sound like you know what you’re talking about, it helps because there is a barrier to entry. I would also say that the sector is not very large when you look at the BOMA, MOB conference and you’ve got a 1000 attendees.

Alfonzo Leon: I mean, you’ve got the lion’s share of people that are in the space and have committed their careers to the space. And within that group, I mean on the investment side, I mean the way I think of it, there’s about 100 people on the investment side. So it’s not a very large industry. And when I compare the MOB, healthcare real estate investment crowd with like the apartment investment crowd, or like the senior housing investment crowd that I’ve also had a chance to experience. I mean the one thing, the way I would characterize it is, it’s on average, you’ve got a very institutional mindset. You’ve got a lot of the people in the space are very smart. They’re very good people, very friendly. So I would say, this is an industry that’s, I would characterize as one with a lot of very smart people, hardworking people, very ethical people and good people to work with.

Alfonzo Leon: So one that I enjoy very much, and I guess last thing I would say for anyone that wants to join the space is I would focus especially at the very early start of your career into space is trying to find a good mentor. In my career, I feel very fortunate that I’ve had very good mentors, and so I can’t stress that enough. I think it makes a world of a difference. And I would say, I would pick a better mentor in spite of, the type of job you might have because I think longterm you get more dividends.

Andrew Dick: Good advice. Alfonzo, I’ve enjoyed our conversation and I’m getting to know you. Where can our audience learn more about you and Global Medical REIT?

Alfonzo Leon: I would encourage folks to check out our website. We’ve got a pretty good investor decks that are also posted on that website. I think, I would just highlight the fact that we’re a new REIT. We did our IPO in June of 16. We’ve grown pretty fast but we love what we do. Our group in Bethesda is very united. We’ve got a very strong esprit de corps and very much a lot of the folks that are with us have been with us since the beginning. So it’s been an exciting journey, one that has been very rewarding for me career wise and one that I hope to continue watching grow over the years.

Andrew Dick: Terrific. Thanks to our audience for listening to the podcast on your Apple or Android device. Please subscribe to the podcast and leave feedback for us. We also publish a newsletter called, The Healthcare Real Estate Advisor. To be added to the list please either email me at A-D-I-C-K, adick@hallrender.com. 

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An interview with Rich Anderson, Managing Director/Senior REIT Analyst, SMBC Nikko Securities America

An interview with Rich Anderson, Managing Director / Senior REIT Analyst, SMBC Nikko Securities America

An interview with Rich Anderson. In this interview, Andrew Dick interviews Rich Anderson, a Senior REIT Analyst with SMBC Nikko Securities America. Andrew sits down with Rich to discuss health care REITs.

To view relevant and current price charts and the history of changes in SMBC Nikko Securities America investment rating(s) and/ or target price(s), click here

Podcast Participants

Andrew Dick

Attorney, Hall Render.

Rich Anderson

Senior REIT Analyst, SMBC Nikko Securities America

Andrew Dick: Hello and welcome to the Healthcare Real Estate Advisor podcast. I’m Andrew Dick, an attorney with Hall Render, the largest healthcare focus law firm in the country. Today we will be speaking with Rich Anderson, a managing director and senior REIT analyst with SMBC Nikko securities. Rich has been covering equity REITs for many years and is a well known name in the business. Over the years, he’s focused on a number of different REIT sectors including healthcare REITs. A number of our listeners are REIT investors who work in the healthcare REIT industry and I thought it’d be interesting to get Rich’s perspective on equity REITs in general, along with healthcare REITs. Rich, thanks for joining me today.

Rich Anderson: Thanks for having me Andrew.

Andrew Dick: Rich before we talk about your role at SMBC, let’s talk about your background. Tell us where you’re from, where you went to school and what you aspire to be.

Rich Anderson: Okay, I’m from the great state of New Jersey so Jersey boy through and through. Bruce Springsteen fan perhaps. Went to school at the University of Maryland. Not perhaps by the way. Definitely Bruce Springsteen fan. Went to school at the University of Maryland and studied aerospace engineering. Not quite a real estate background, at least from an education perspective, but happy to report to you that standing before you is a rocket scientist. As I always say, you’re welcome.

Rich Anderson: Then for about six years or so, I worked as an aerospace engineer for a government contractor, also in New Jersey, by the way. In South Jersey supporting the FAA Technical Center. Did that for, as I said, six years. In the meantime, was getting my MBA at night at a small school in Jersey called Monmouth University in finance and made the trip to Wall Street. It all makes sense at that point. This is the mid 90s and I worked for an aerospace defense analyst. I figured I had the business degree and the practical experience in aerospace engineering that this would be my career.

Rich Anderson: But at some point early on, I took note of the REIT industry which the REIT model has been around since the early 60s, but as a trading industry really didn’t get started in what we call the modern day era of the REITS until the late 80s, early 90s. The real estate team was physically sitting next to us. I inquired about a job opening and lo and behold, I moved over there in 1996 and started my career covering the REITS and have been doing it ever since. 25 years in now, straight on through as a REIT analyst and here I am with you today as a result of all that.

Andrew Dick: Great. Well Rich, talk about the sectors you’ve covered and what you’re actually covering today?

Rich Anderson: Sure. Over my career, I’ve pretty much covered every asset class that make up the US REIT industry, maybe about 150 different REITS. There are all sorts of walks of life in real estate as you know and all of them behave differently from one another. The fact that I’m a REIT analyst is one thing, but I truly believe we cover many different industries because malls bear very little resemblance to data centers, of course, and so on. My history is quite a wide net in terms of the properties that I’ve covered.

Rich Anderson: Today I cover as you mentioned, the healthcare REIT space, but I also cover the industrial REITS which are known for the Amazon exposure and the logistics of E-commerce and all that that’s going on. The office industry, which is interesting today because of all the work from home and whether or not that’s going to have an impact on things. The multifamily industry, which should benefit from work from home, I guess, if you think of it that way. But I’ve been covering the multifamily sector for quite a long time.

Rich Anderson: Most recently picked up coverage of a relatively new REIT asset class and that’s the gaming sector. There’s three REITS that make up that space that obviously own casinos around the country. Then finally, there’s the one and only Ground lease REIT Safehold. I am one of a few analysts that cover that one. I find it very interesting. It’s, as I said, no other company really does ground lease investing, specifically as Safehold does. It’s been a very interesting story out of the gate coming public in 2017 and really having a breakout year last year as they market their product to the real estate community.

Andrew Dick: Yep, and as we talked about before, SAFE is a very interesting REIT. We monitor it primarily because a number of our hospital clients frequently use ground lease structures when they lease part of their campuses to medical office building owners and investors so yep, very interesting model. Rich, for our listeners that aren’t familiar with what a REIT analysts does and the type of information that they publish, talk about the ratings process, how that works and the different designations. So buy, sell, hold. You said that your company has its own terminology.

Rich Anderson: Right, our terminology, the equivalent of buy, sell, hold would be outperform, underperform and neutral. It’s just a different word same logic. As an analyst, my job is to be as smart as I possibly can about the commercial real estate industry in all its walks of life. What I love about being a REITs analyst is there’s no script. Whatever it takes for you to be smart about the industry you are willing, within reason or you’re allowed to do.

Rich Anderson: That means property tours, that means staying in touch with what’s going on around the country. Whether it’s specific to real estate or the forces that create value in real estate. I always feel like I’m a generalist when I think of the Midwest and manufacturing and technology in the Bay Area and financial services in New York and Boston. These are all the forces of nature that create value in the bottom line bricks and mortar execution of the REIT industry.

Rich Anderson: Staying smart on the space and then drilling down into individual property sectors and then to individual companies. When I’m producing my ratings that I try to keep as balanced as possible, and always testing myself whether a rating change is warranted or what have you, I’m comparing against the S&P 500 because we do have general investors that invest in REITs so that would be perhaps their benchmark. Then I’m comparing an individual REIT against the REIT industry.

Rich Anderson: So just that specific element of the comparison because of the REIT dedicated investor community, really it has to be in that space. There’s a more finer line in terms of thinking about ratings. Then within individual property sectors, what do I think of the management teams relative to their most comparable peers? What do I think about balance sheets? What I think about geographies and for whatever reason, what’s going on around the country how is that affecting this real estate portfolio, whether it’s in the urban core, whether it’s in the suburbs or rural areas? How is, as I mentioned, work from home as an example, how is that going to affect office? How is E-commerce going to affect Industrial? How is COVID-19 going to affect the healthcare industry long term?

Rich Anderson: There’s many, many ways to peel back the onion here. It quite frankly makes my job very interesting because there’s nothing very mechanical about it. You can be very creative in the process and I think you get rewarded for that creativity by applying whatever it is that you think is necessary to be smart and to think about your constituents and who’s reading your research and what matters to them. I try to lump that all together and appeal to the masses as much as I can. Understanding that everybody has a different role from one another that is talking to me or reading my research reports.

Andrew Dick: Rich, two follow up questions. How do you decide which companies and sectors to cover and then who is using your information that you publish?

Rich Anderson: Right. The sectors and the companies that I cover is my decision and where I think I can create value to my end users of my research. Exactly how I come up with those decisions perhaps requires another podcast, but suffice to say I am thinking about where can I make the biggest difference? Where do I have maybe the brightest ideas that I could share that I think are differentiated from my competition that does the same thing that I do? For example, I don’t cover the malls right now. The mall business has been tough. I don’t know exactly how I would create incremental value there where I think I can create value. I know we’re going to talk about health care in that space or multifamily where I’ve been covering it for a very, very long time.

Rich Anderson: That’s the thought process. Kind of a vague answer but the answer nonetheless. My end user is the portfolio managers and anybody for that matter that invests in REITs. That could be the Fidelity’s and Wellington’s of the world. That could be pension funds. That could be insurance companies. That could be endowments. Anybody who is investing money, might ask to read my research and hopefully compensate us for that. That’s how it works. Of course, the companies that I cover are interested in what I’m having to say about them. But that’s the other side of the house.

Rich Anderson: That’s the investment banking side of the house and I have to have as… For legal reasons have to have my blinders on about conflicts of interest and all those things. I really have to be thinking about my end user. If I have a sell rating on a stock and my firm has a relationship with them on the other side of the house I can absolutely not pay any attention to that and of course I don’t. It’s a very important line in the sand that I must never cross. The so called Chinese wall.

Andrew Dick: Very interesting. So Rich, let’s move into the healthcare REIT space. Talk about the different… What I call sub sectors. Healthcare REITs have been around for a long time. There are a number of different REITs that fall under the health care REIT category. How do you break down this sector?

Rich Anderson: The interesting thing about the healthcare REIT space is it is a collection of different asset classes. Whereas most property sectors, at least the way the US REITs are structured are focused in our asset class. You don’t have a whole lot of diversity in the multifamily sector, the office sector or the industrial sector. That’s their corner of the sandbox and they play it well. In the healthcare REIT space, you don’t have that advantage because there’s different types of healthcare real estate.

Rich Anderson: There’s life science, there’s medical office, there’s senior housing, which itself can be broken down between assisted living and senior and independent living. There’s skilled nursing and of course, there’s hospitals, rehab facilities and so on. There’s many, many derivatives of healthcare real estate. What I described earlier about how I go about thinking about asset classes, I do that in a microcosm sort of way when I cover the healthcare REIT space.

Rich Anderson: If I were to pecking order the different asset types within healthcare real estate, I would start with life science. Life science is obviously a solution to the COVID-19 problem. All the tendency of those assets are working around the clock to try to find therapies and work on testing and of course, God willing, a vaccine. There is some great public relations potential there. We all want to see an end to this but there’s also a lot of activity going on within the four walls of a life science facility.

Rich Anderson: That asset class one, one of the larger names in that business, of course is Alexandra real estate which is primarily a pure play life science REIT has outperformed in 2020 substantially. Because of so much activity going on, unlike for example, the malls where people were told to leave and can’t… By the way, can’t go to a mall or can’t go to whatever facility where there’s a lot of crowd gathering. The 180 degree opposite conversation is happening in life science facilities.

Rich Anderson: I would put them as a solution. Then you have medical office which is not quite so much of the solution to the story but is working alongside hospitals and opening up beds to care for people so there’s a lot of activity still in medical office. You are seeing elective surgeries being stopped in this environment. A little bit of a hiccup in terms of the operating business of a medical office facility but nonetheless, still a part of the solution in that sector which has quite a bit of cash flow visibility relative to other property types. Has also outperformed so far in 2020. Both of these have been our calls, by the way, going in speaking about how we think broadly about covering the real estate space.

Rich Anderson: Then the next level is skilled nursing. Skilled nursing obviously a lot of terrible things happening in some assets. Very vulnerable, older folks catching the virus and unfortunately passing away in some cases. You would think as an asset class, would you want to invest in that in this environment? The answer for me is maybe yes. The reason I say that is because skilled nursing like hospitals has access to the various government stimulus programs. They are able to fund themselves and support their themselves financially which in turn is a good thing if you’re the landlord, A.K.A the REIT collecting rent from these operators.

Rich Anderson: In a perverse way, I guess, as a capitalist, this asset class skilled nursing, actually works okay in this environment. Certainly not great for all the reasons we could talk about for quite a long time, but at least you’ll able to meet the rent obligations. Then finally senior housing which will be a great asset class over the long term for maybe reasons we’ll discuss later in this conversation. But for the time being, they too take care of old folks but they don’t have access access to the stimulus programs. It’s mostly a private pay option.

Rich Anderson: So occupancies have been ticking down quite substantially. With that, their ability to pay rent or keep their operations above water in this environment. They do not have the benefit of the stimulus programs that skilled nursing does. In the present tense, I’m somewhat worried about senior housing. Longer term, with demand coming as the aging of the population manifests itself in that business over the next 15 or 20 years. Could be a fantastic opportunity, but for the year now it’s a little bit tougher. A lot tougher.

Andrew Dick: Rich, that was a great overview. I have two follow ups. In terms of other categories, you talked a little bit about hospitals, when we think of REITs that play in that space, there are a number but there’s one that’s really… What I consider more of a pure play hospital REIT. That’s medical properties trust. How are they doing?

Rich Anderson: First of all I want to say they… I don’t cover medical MPW so I want to be a little bit careful about talking too much about MPW. Maybe I could speak generally. I think that perhaps the same rules apply in hospitals as they do in skilled nursing. With the one exception being we are probably over hospitaled, if that’s a word. Over hospitaled in the United States. Perhaps something that might come out of this is a retrenchment of the hospital industry longer term.

Rich Anderson: I am a little worried about that in the sense that you could have some consolidation. You could have some low market share, rural hospitals closing and redirecting patients to another hospital in the area that has better market share, better systems and so on. I guess I’m just a little worried longer term about the hospital more so than I am of the skilled nursing space. The hospital industry is dealing with COVID-19 which is not really a profit center.

Rich Anderson: You might come out of this a little bit weaker in the hospital space than what I might suggest with the skilled nursing space. But nonetheless, for the time being, it is being supported as I suggested with skilled nursing. One other thing I would say, importantly, we have long thought of government regulation for hospitals and skilled nursing is to be a “liability” for those two asset classes, because you have a tough time predicting what Medicare is going to do every year, what the 50 states in terms of Medicaid are going to sign.

Rich Anderson: We’ve had some surprises to the downside in the past that has derailed that business because it so much relies on government reimbursement to run. But now, you would think that the government, state and federal government are unlikely to do anything that is perceived to be taking money away from that industry. The counter to my comment about hospitals long term is the government is probably an asset now, because it is unlikely to take money away from these heroes that have been on the front line doing all this for all of the people that are suffering from this disease. A lot of things to think about. Hospitals and in the healthcare real estate space in general. It’s going to be interesting on the other side of this for sure.

Andrew Dick: Let me bounce around a little bit in some of the different sectors. One, I don’t know that it’s really a sector but at least the way I think of a couple of the big healthcare REITs Ventas, Welltower, Healthpeak. I think of those as the three.

Rich Anderson: Sure.

Andrew Dick: I think of them as diversified healthcare REITs. What are your thoughts about those big players in the industry? We’ve seen some dividend cuts. Some of them have exposure to senior housing, what are your thoughts on how they’re performing today?

Rich Anderson: All three are fantastic organizations. The very fact that they’ve been consolidators and grown to the size that they have become is evidence of the quality of these organizations. Now they have certainly had their difficulties and some headwinds as of late because as you mentioned, they have exposure to senior housing, but taking that matter even a step further, they have exposure to operating senior housing. Very often we talk about triple net leases. In the triple net structure, the operator simply paying a rent to the REIT and it’s very much a passive investment from the REITs perspective.

Rich Anderson: In 2007, laws were passed to allow for the ownership and operations of healthcare real estate, namely senior housing facilities. That was a sea change in terms of how the REITs acted and played in the senior housing space. Now, fast forward to today, Welltower about 45% of its total portfolio is operating senior housing facilities. Not triple net, but literally the operations on their balance sheet. Ventas, about 35% of their portfolio is senior housing operating facility.

Rich Anderson: They’ve taken that law and run with it. They’ve done it because there has been growth over the years. It’s come back to bite them in this environment because they now are feeling the hit directly from occupancy laws in that space. Healthpeak is the third of the big three as you describe them which is what we all describe them as. They have performed relatively better than Ventas and Welltower. I think that’s because their exposure to senior housing operating is significantly lower.

Rich Anderson: They play in senior housing, but they have a fair amount of triple net. They do have senior housing operating less than 20% of the portfolio but they play big in life science. They’re another life science player. They’re benefiting from that and they’re big in medical office. So too is Ventas and Welltower. The lion’s share of the peak story is life science and medical office and that’s why they’ve been a better performer. To that end, my my ratings on those three are outperform for peak and neutral for Welltower and Ventas.

Andrew Dick: Yeah, it’s interesting. I think of those three the same way and I assume the law-

Rich Anderson: That’s right.

Andrew Dick: What we call in the industry the idea type structure where the REITs can be involved in management operation.

Rich Anderson: To be clear not the management. The physical management of the assets has to be run by a third party. What happens is REIT owns all the business but part of their cost structure is to pay a management fee to somebody who’s physically bathing and feeding people because that wouldn’t be considered a real estate activity. They still separate a little bit, there actually structured a lot like hotels where they pay a fee to a flag like a Marriott or Hilton or so on. That’s how the healthcare remodel a set up when they do do a REIT data structure.

Andrew Dick: So they’re getting a piece of the operating income through that structure. The other point you made, which I thought was a good one was about peak. The fact that it has more life sciences assets compared to the other two. It seems to be really working on a number of new development projects in the life sciences space as well which I find exciting. For a while I think it went through a rebranding and now it seems to be really coming into its own and doing well. I tend to agree with you. I like [crosstalk 00:24:28].

Rich Anderson: That’s an interesting company. The management team there has come together over the past five years led by Tom Herzog who I know very well and for a long time. He actually cut his teeth in the REIT space in the multifamily sector but he’s a very smart guy and he’s built a team of very smart people around him. In doing that, restructuring a legacy company into what it is today they’ve really done a fantastic job there.

Andrew Dick: Going back to MOB’s and some of the pure play MOB REITs, I think you cover HTA-

Rich Anderson: That’s right, yeah.

Andrew Dick:  Healthcare Trust of America and then healthcare REIT trust. Is that right, rich? I really like… Both those companies seem to be doing well. Is there any concern that there’s been so much demand for assets that it’s becoming harder to find good product at a good price to make a good return for those players?

Rich Anderson: Yeah it’s always a problem. Particularly in normal times, in low interest rate environment you do have a lot of interest in asset classes and particularly medical office that appeals to a wide spectrum of investors because as I mentioned earlier, it’s such a visible cash flow stream. It’s almost like an annuity and appeals very well to private equity and a lot of different types of potential investors outside of the REIT space. So yes, competition for that asset class has been fierce over the years.

Rich Anderson: We haven’t seen any disruption in terms of cap REITs on medical office facilities, even in this period of time. Now, we’re not seeing a lot of transaction activity but where we have seen it, there hasn’t been a whole lot of disruption in terms of property value. That’s always a good thing if you’re long on the sector which both of those companies are, but if you want to grow it, it becomes challenging. That’s always the difficulty. Now, healthcare REIT and also HTA both have a fair amount of development.

Rich Anderson: The way you get a better return is by taking on the incremental risk of development and you get 150 or 200 basis points return spread over what you’d be able to do as an acquisition. That’s one way to approach growing the portfolio, by going the development route. Of course development comes with its own risks. That’s always a trade off. That’s one way that the two of those companies are managing that issue specifically.

Andrew Dick: Great. One question about life sciences, Alexandria in particular I know recently had a share offering. Raised something like a billion dollars, I believe, which was huge. Then I think Blackstone may have raised a couple billion dollars from one of its life sciences funds. How does a publicly traded REIT like Alexandria… I mean, there’s so much interest in life sciences now and I know they have deep roots in the industry. How do they compete with some of the private equity players in that space?

Rich Anderson: That might be better question for them because I’m sure it’s a doggy dog world out there when it comes to a question like that. Alexandria cost of capital is quite attractive and fantastic balance sheet. I think there’s more than enough to go around. Of course, the best cost to capital perhaps in the planet is Blackstone. It’s a double edged sword when they come into the space. They took BioMed private a few years back and have been managing that portfolio ever since.

Rich Anderson: You’d like to have the stamp of approval of a Blackstone in your space but then you have a pretty sizable competitor as well. I think what Alexandria comes to the table with is reputation. Their portfolio is spectacular in many respects. It comes from mostly their development business and so if you see an Alexandria asset, you almost recognize it before you see the name on the door because they just do such a good job. That reputation precedes them.

Rich Anderson: They have relationships up and down the board throughout the bio pharma industry, they themselves can be characterized as a life science company in many respects. They are not real estate people only. If you meet the management team, you will find scientists and PhDs that are very knowledgeable and interface specifically with their tenants. That’s the differential for Alexandria. They are not just a money machine, they are actually very intellectual when it comes to the underlying business. they host forums with all their tenants.

Rich Anderson: They even have a VC arm where they’re investing into early stage development companies. They run the gamut in the life science business and I think that’s a separating characteristic for Alexandria when it comes to competition.

Andrew Dick: Great. Switching quickly to senior housing, you mentioned earlier, you think the sector will recover over time and may be an attractive investment. A couple of the long term care REITs playing in that space, which ones do you like [crosstalk 00:30:19].

Rich Anderson: Well so I have an outperform rating on SABRA, S-A-B-R-A. That’s about 60% skilled nursing 40% senior housing right now. I’m getting my fix I guess I will say, through SABRA. I get senior housing exposure with Peak even though it’s smaller than the others. I’m still getting it that way. The day may come. Obviously I can’t say when or how that I’ll flip more of aggressive approach into senior housing. Part of the reason for that is fairly simple.

Rich Anderson: If you look at a birth chart in the United States, in 1935 births troughed Right in the midst of the Great Depression. That’s 85 years ago. That’s about the time people go into senior housing facility differently. We are actually at a dearth of demand for senior housing at this very moment in time because of what happened 85 years ago. But then if you also look at that birth chart, from that point forward to call it 1950, or 1955, birth rates hockey sticked up. I guess people got happy. The Great Depression was over with.

Rich Anderson: This doesn’t take a whole lot of analysis to know that over the next 15 to 20 years, you were going to have people entering those years where they start to consider senior housing facilities. Which has a voluntary element to it, particularly in the independent living side where you want to have a little bit more ease of life but you don’t necessarily need a whole lot of care in terms of being fed or all that kind of stuff. Assisted living has more care element to it of course and then memory care unfortunately can play a role in assisted living facility as well.

Rich Anderson: But nonetheless, that demand profile is coming. That question is is it going to be like watching paint dry or is there going to be a real resurgence of activity? That is why I said senior housing probably comes much more interesting in the aftermath of all this because we can plainly see the demand coming.

Andrew Dick: Rich, do you have any concern that some of the independent living facilities, some of those in many states don’t have to be licensed. They’re private pay as you mentioned earlier, which is attractive to many investors but it may be a little easier for competitors to enter the market for those reasons. Any concerns about when you compare that to a hospital or a skilled nursing facility, often those have to have a license, maybe a certificate of need in certain states which are barriers to entry. Is it a double edged sword because you have the private pay which is a good [crosstalk 00:33:13].

Rich Anderson: Well, it has been a problem [inaudible 00:33:16]. Perhaps a silver lining if there could ever be one in this environment is supply getting shut down in the senior housing space, but you’re right. There aren’t barriers to entry. We were worried about… Just to back up for a couple seconds, we were worried about supply in the multifamily industry when it was running at about 2% of existing stock in senior housing and specifically assisted living. It was running five or 6% of the existing stock. That’s real competition from supply.

Rich Anderson: I mentioned earlier a dearth of demand in the present tense was happening at peak levels of supply. Senior housing was really getting it from a couple of different angles. I think, again, the demand comes back but perhaps supply shuts down at least for a period of time. The REITs that traffic in that space will have a little bit of a breather from a competition standpoint. But all bets are off longer term because developers see what we just talked about in terms of demand.

Rich Anderson: You have to be able to balance that and know how supply will work itself into the conversation longer term. Your point is spot on. You don’t have the regulatory environment that skilled nursing has from a supply perspective and hence you’re exposed to supply should that start to turn on again.

Andrew Dick: Rich let’s switch gears. Let’s talk about the healthcare real estate industry in general. It seems like I’ve noticed Nareit put out some reports over the past few weeks on rent collections, generally for the healthcare REIT sector. Rent collections have been pretty strong compared to other property sectors. It seems like the healthcare REITs are performing reasonably well given what’s going on in the world. What are your thoughts [crosstalk 00:35:20]?

Rich Anderson: It depends on the asset class, of course I mentioned the stimulus that’s helping in the skilled nursing space. I think the operators want to stay current in the face of declining occupancy. There is a vested interest to maintain one’s credit and all of that. But there’s also the realistic side of this. If they simply don’t have the money, particularly in the case of a triple net execution, the fortunes of the operator accrue to the REIT. The REIT has to be careful about bullying too much because you can be aggressive and demand rent payments at their current level.

Rich Anderson: If that disrupts the credit of the operator, the REITs, at least in a triple net structure are going to be judged by that. They become a proxy of the health of that operator. You might see rent deferrals depending on how long this situation last. You might see actual rent cuts perhaps in exchange for a lease extension. From a REIT perspective, you don’t want to just blindly cut rents if you can avoid it, you might want something in return for offering that assistance.

Rich Anderson: We’re seeing things like extension of leases or other, what I would call assets as a compromise in that negotiation. But you’re right. To this point, the numbers have born out to be okay. Even though we’ve seen occupancy drifting down so much. There have been two significant… Actually three significant dividend cuts in the healthcare REIT space namely Welltower, Ventas and Sabra have all cut their dividend in this environment perhaps in anticipation of seeing rent come down to some degree.

Andrew Dick: Any predictions from management on whether they’ll increase the dividends once things start to get better?

Rich Anderson: Well I think that will always be the attempt. The REITs have been generally great when it comes to dividend policy and managing their capital and doing it wisely. Generally seeing dividends step up across the REIT industry generally and I think we’ll see more of that. In this time, this is something none of us have lived through perhaps ever. I don’t know how many of your listeners were around in 1918, but maybe.

Rich Anderson: Nonetheless, this is uncharted territories and I think you have to do the right thing and sometimes the right thing is to reset dividends and put yourself in a position to succeed in the future. An interesting quote, and again, not to make light of this, but Rahm Emanuel once said, “Never waste a good crisis.” That is not to be funny at all. What it does mean is maybe this is a time to look at yourself in the mirror as a REIT and fix things that were perhaps a little broken in front of this so that you do emerge from this healthier, and you do have the opportunity as you suggested to grow the dividend and get back to some level of normalcy. This could be a time to reset, rents and reset balance sheets and do things necessary to be a healthier entity longer term.

Andrew Dick: Rich, switching gears what advice would you give for someone looking to get into the real estate or the REIT business? You’ve been doing this for many years? What should folks be reading, who should they be talking to or trade organizations? What advice would you give to someone?

Rich Anderson: If that doesn’t do it for him which should be unbelievably surprising. Just kidding of course. The NARI, The National Association of Real Estate Investment Trust. They have a fantastic website, REIT.com, and you could get a lot of information about the REIT industry there. REIT 101 type of information about all the language. It can send you in a tailspin a little bit. We don’t talk about EPS in the read industry, we talk about funds from operation or FFL.

Rich Anderson: You have different tax consequences. You don’t pay corporate tax if you pay enough in the way of dividends. There’s a lot to understand about what a REIT is relative to other industries and other C corpse. I think that’s a good starting point. You can really get a lot of knowledge out of NARI REIT. They’re there in part to teach the world about the real estate industry.

Andrew Dick: Rich, where can our listeners learn more about you and your research?

Rich Anderson: I work for SMBC, a very large bank based in Tokyo. Its stands for Sumitomo Mitsui Banking Corporation. Our broker dealer is the Nikko Brand. So SMBC Nikko is my company. I’ve worked for various shops along the way, starting way back PaineWebber, then Citigroup and Bank of Montreal, VISA [inaudible 00:41:06] before this, another Japanese bank and now at SMBC. I imagine I’m an easy find out there on the internet. I’m probably not going to give out my cell phone right now but certainly anyone’s more than willing… I should say I’m happy to field questions and talk to people about the space to the extent there’s time. I’m happy to be an advocate for an industry that’s been my career for the past 25 years.

Andrew Dick: Well Rich, thanks for being on the podcast. I enjoyed the discussion very much. Thanks to our audience as well for listening on your Apple or Android devices. Please subscribe to the podcast and leave feedback for us. We publish a newsletter called The Healthcare Real Estate Advisor. To be added to the list please email me at ADICk@HallRender.com.

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An Interview with Greg Gheen, President and Co-Founder of Realty Trust Group

An Interview with Greg Gheen, President and Co-Founder of Realty Trust Group

An interview with Greg Gheen. In this interview, Andrew Dick interviews Greg Gheen, the President and Co-Founder of Realty Trust Group. Realty Trust Group is a national healthcare real estate firm that provides advisory, development, operations, transaction and compliance services.

Podcast Participants

Andrew Dick

Attorney, Hall Render

Greg Gheen

President and Co-Founder, Realty Trust Group

Andrew Dick: Hello and welcome to the Healthcare Real Estate Advisor podcast. My name is Andrew Dick. I’m an attorney with Hall Render, the largest healthcare-focused law firm in the country. Today, we’ll be speaking with Greg Ghee, the president and co-founding member of Realty Trust Group. Greg is a seasoned healthcare real estate professional who started his career working for a hospital system, then decided to start Realty Trust Group, a healthcare real estate consulting firm which is an affiliate company of PYA, a national healthcare consulting and accounting firm.

Andrew Dick: Greg has a great story to tell. I’ve known Greg for a number of years and really admire the company he’s built and he’s a man of integrity, always enjoy catching up with him. We’re going to talk with Greg about the state of healthcare real estate, where he sees opportunities in the future, and a little bit about how he started his business and how he’s grown it to what it is today.

Andrew Dick: Greg, thanks for joining me.

Greg Ghee: Hello, Andrew. Thank you. Good hearing your voice and thank you for the introduction and the very kind words. I would also like to say about you, I appreciate our friendship over the years. I want to thank you for not only the opportunity to join you today and talk a little bit about our company but I also appreciate what you and your firm have done for the healthcare industry over the years and the thought leadership. As you know, Andrew, and what I’d like our audience to know is you’re one of the go-to people that not only myself but other professionals at Realty Trust Group rely on when there’s a question that is really complicated and complex before we call our client back with our opinion, we like to use you as a sounding board. So thank you for your friendship, professional and personal, over the years.

Greg Ghee: Now, as to your first question, I’m a product of where our corporate headquarters is located. I’m in Knoxville, Tennessee. I was actually born at the hospital where I work and I was born here and other than leaving for college, have spent my entire life here in East Tennessee. When I graduated from high school, I worked construction for a couple of years and I was a general laborer and also a brick mason apprentice. After a couple of hard, cold winters in East Tennessee, I decided that the classroom looked pretty inviting and so I went back to school at a community college called Roane State Community College. There, I studied and received my associates in business administration, and then following that, I went to Maryville College and Liberal Arts School, probably 30 minutes away from Knoxville, and got a BA, Bachelor of Arts degree in economics in 1983.

Greg Ghee: My first job out of college, I was a land-use planner working for the State of Tennessee and it was a great experience working in the regulatory side of land development and after spending two years there at the state in that job, I went back to UT-Knoxville and got an MBA in finance and new venture analysis and then my first job out of graduate school was with the local health system here and now, 32 years later, I’m blessed to still be working in healthcare.

Andrew Dick: Greg, it’s a great story. I’ve known you for years but didn’t have all this background information. I found it really interesting that you were a land use planner and then you started to work in the healthcare industry and talk a little bit about that because I think you started in the healthcare real estate business as it was taking off. Today, what we see in the healthcare real estate world is a very mature market. Healthcare real estate, in terms of asset classes, is a mature class, not as mature as some of the others but it’s been around and it’s well recognized but talk about how you stepped into your role working for a health system and helping that health system build out their real estate platform.

Greg Ghee: Okay, and as I think about my real estate career, I’ll rewind a little bit and talk about that, the land use planning job that I mentioned earlier. I had actually written my senior thesis in college at Maryville College on the 1982 World’s Fair and my thesis was what was the impact of the World’s Fair and the government spending in infrastructure to prepare Knoxville to host the world coming here for the World’s Fair, what was the impact of that on the local taxpayer? And that really got me interested in real estate infrastructure of how do communities prepare to welcome people and in that case, the real estate was for the World’s Fair, which the World’s Fair site is still very integral to Knoxville, Tennessee and I was very lucky to have a person in career planning and placement that helped me take that experience from my senior thesis and say you maybe really interested in working as a land-use planner. And so that’s kind of how I got into the land use planning part of it.

Greg Ghee: And when I think about how my land-use planning prepared me to step into the shoes or into the job I had in healthcare when I look back on it, I think about the old adage that that may look good on paper as it relates to a development plan or a regulation but here’s why it doesn’t work in the real world and so, Andrew, that was so impactful on me in my career as it relates to what are the governmental entities and the policy decisions that are being made, how are they being implemented and how does that prepare you for healthcare.

Greg Ghee: When I came out of graduate school, so after land-use planning, two years in graduate school, and then I went to work in healthcare for Fort Sanders. In graduate school, when I came out, I was actually going to be a commercial mortgage originator for a large life company and that was in 1988 and there was quite a bit of real estate in receivership and vaguely do I remember having a candid conversation with my wife about another job offer I had that I ultimately took and that’s how I wound up in healthcare. So, I would like to say that I can take credit for really planning out a very direct linear approach for getting into healthcare but the truth is and the fact of the matter is it was divine intervention. I was blessed that I just liked the people that I interviewed with at Fort Sanders and took that job.

Greg Ghee: And one of the things I’ve thought about as I’ve prepared my notes for today that I want to speak to if there are young professionals thinking about getting into real estate or in our profession, some of the things is one of the first things I want to mention is be flexible in your thinking and always be prepared for an opportunity that you didn’t even really plan for to present itself to you and then follow your heart.

Andrew Dick: That’s good advice, Greg. That’s something I think we’ll talk about a little bit more at the end of our conversation as well because I get a lot of questions from younger folks who are thinking about different career paths and seem to be intrigued by healthcare real estate and I often provide similar advice. So Greg, you get this opportunity to work for Fort Sanders Health, which I think you said is now Covenant Health, talk about that opportunity because you really got in at a time when the health system was growing and you were able to help the health system plan out it’s longterm real estate strategy and execute on that strategy. Talk a little bit about that.

Greg Ghee: I would love to. Went there my first day of work at Fort Sanders, was June 28, 1988. So you can see, Andrew, I remember it. It was a great 10 years there and how I got there was through an opportunity in graduate school, along with two of my friends, Roger McFalls and Mark Fioravanti, and Roger’s the one that actually picked up the engagement and then got Mark and I to help him. Roger and Mark and I put together a business plan on how to execute on real estate operations for a new ambulatory care campus in West Knoxville that was being built by Fort Sanders Health System. The ambulatory care campus was probably two to three miles away from a large hospital that, at the time, was owned by HCA. We ultimately bought that hospital in 1990 or ’91 from them but we were going to compete in our market with ambulatory care services.

Greg Ghee: And so in 1988, Andrew, that was a very risky endeavor and we, Fort Sanders and Covenant Health to this day is still a not for profit with local board leadership and governance and they said this is a good model and let’s pursue it and it really changed our community. But getting back to what we did in graduate school, we prepared a business plan, made a presentation and after the presentation, one of the executives there named Larry DeWine asked me to leave a copy of my resume and long story short, got to interview with Larry and others there. Larry offered me a job as a project manager for the outpatient campus. I accepted it and spent 10 wonderful years working with Larry and a lot of other people there at Fort Sanders and ultimately, it became Covenant Health.

Greg Ghee: That was probably one of the most impactful and productive periods of my career working with Larry and others and that’s also where I met Ed Pershing, who’s co-founder of RTG with other people back in 1998. So let me continue, Andrew, talking a little bit about that because there’s some other things I wanted to mentioned as it relates to that ambulatory care campus. So, I was 15 years there and we not only grew the ambulatory care campus, it was 62 acres and it’s still 62 acres but it’s pretty much well-developed today and we worked not only on an ambulatory care strategy which was complementary to the acute care strategy, but they had a very robust … Fort Sanders had a very robust physician alignment strategy in place as well.

Greg Ghee: So, if you think about my career at the time, I was directly involved with acute care. I worked with the … Excuse me, I was directly involved with the ambulatory care. I had reporting relationships with the acute care, the hospital presidents, worked with strategic planning teams, the finance folks, the attorneys and many others to help grow that network that, today, is one of the more compelling networks in the East Tennessee Region compared to others, but it includes not only the Covenant Hospital locations but the ambulatory and the physicians.

Greg Ghee: One of the things that we did, and I just don’t recall the exact year but one of the things we did is we helped the local orthopedic practice develop a facility for them to relocate and at that time, and this still happens today in certain communities, a lot of medical office buildings are beside the hospital or across the hospital. In Knoxville, in 1990, 90, and those periods were about the same. We helped relocate an orthopedic group that had been on the campus of one of our competitors onto the Fort Sanders West campus and that really changed not only the trajectory of what Fort Sanders and Covenant was able to do but it actually changed our marketplace because other physician practices saw that they were able to work at multiple hospital campuses and multiple hospital sites without being right across the street, if you will, from the hospital, and so that was very impactful and a great learning experience for me.

Andrew Dick: Greg, talk about that transition. So you worked for the health system for a number of years and then ultimately made a transition to starting RTG. How did that happen? How did that transition occur?

Greg Ghee: I had been invited to be a panelist on a national survey that one of the … I guess it was big eight, maybe big six back in the day was putting together and I had colleagues from across the country that were on this panel and I say panel, we provided a very detailed survey as to how we manage real estate and what was interesting is we were one of the few companies that domiciled our real estate operations in the for profit arm of the not for profit health system and I think that was one of the attractions that got the national accounting firm to want to include Fort Sanders in that survey. And so Larry DeWine and I participated in that and me directly and Larry indirectly and met a lot of people across the country and really became enthusiastic if you will about taking some of the things I’ve learned and experienced in doing at other places.

Greg Ghee: And I was being recruited away from someone and decided that I just wanted to stay at home and had an opportunity to stay in Knoxville and help start a company with my colleagues and partners at PYE and so we did that March 1, 1998 is when we stood up Realty Trust Group. What I think about when I think about those early days coming back to your question is really, I guess, what I brought from my experience to the company in addition to the great resources that PYE already had in place and Ed Pershings’ experience but what I brought was really my experience working with physicians and understanding alignment of physicians and how important physicians as stakeholders are in all of your real estate decisions.

Greg Ghee: Secondly, I tried to always have a holistic mindset even today, 22 years after starting Realty Trust Group and 32 years after my first day of being in the business. I try to keep a holistic mindset about the continuum of care. I’ve already mentioned it a couple of times from the community and the ambulatory and physician and now, Andrew, we’ve got urgent care, we’ve got telemedicine. We’ve got a lot of other care models out there and so my holistic mindset has even broadened more. And then the other thing is thinking about the capital that’s available and is necessary as far as growing healthcare real estate.

Greg Ghee: I’ll tell you, I was a little spoiled coming from a large, well-positioned, well-funded, very successful health system and the balance sheet they had and I was a corporate vice president doing things only for Covenant Health and then when I transitioned into the company, Realty Trust Group, and going out and helping physicians do certain things, the first project we ever did was integrated three discrete physician practices into one LLC operating model and then helped them build a surgery center, a single specialty surgery center called Tennessee Valley Eye Center, we probably started that project in late 98 or early 99 but my point there is, what I’ve really learned now with RTG is how important capital is and the different sources of capital that are available for healthcare real estate.

Andrew Dick: Yeah, you’re exactly right and there are companies that are out there just specializing and providing capital to healthcare real estate projects and it’s become a very important part of the development process. Greg, before we talk about what RTG is like today, talk a little bit about the early days when it was really you and co-locating your office with some of the PYE folks. What was that like? I mean it had to be exciting. Talk about the early days a little bit.

Greg Ghee: Yeah, I appreciate it and I’d love to. I’m employee 001 for the company. Today, we have 91 employees across six different offices and so the first day I walked in, I don’t want to leave the impression I was by myself, although I was the first employee at RTG because, as you mentioned, I was co-located in PYE and essentially part of their team and was able to leverage the infrastructure here and to this day, we’re still co-located and do a lot of things together that really helps us leverage some fixed costs and other things. We’re also co-located with PYE in Tampa and Nashville and so that model, from day one, continues to work today 22 years later and 90 employees later, and it’s also really rewarding to be part of a larger enterprise.

Greg Ghee: Andrew, you’re blessed to work with a big law firm, that’s also very great and vibrant if you will to be able to talk to other people that are in different segments of your law firm as well and that’s … I able to draw upon the other folks at PYE. We set up RTG from day one as a real estate company and under standards of practice of real estate and we are a separate company and not … And we are a separate affiliate company and not a subsidiary and I say that because PYE practices under AICPA standards. They do a great job across the board in strategy and attest and taxation and have a huge consulting evaluation practice but RTG is a separate, distinct real estate company.

Greg Ghee: We’ve been able to not only help PYE when they’re assisting their clients where facilities or real estate or location services maybe necessary for PYE to bolt that on if you will to the delivery to their clients but the inverse of that has worked very well. When we’re helping physician clients stand up new medical facilities and many times, we’re a joint venture partner with them, we’re able to bring tax services and we’re able to bring strategic planning services that PYE offers to those clients that are coming to us for real estate.

Greg Ghee: And so, to your question, what was it like in the early days? In the early days, it was … And this is a true statement, it was on the back of a napkin that I had written out a few bullet points as to what the plan of attack and the business plan ought to look like. I have that napkin still in my jewelry box and with the PYE people and now the other people that have joined us and RTG over the last few years, we’re able to still continue to execute on some of the fundamentals that we thought about in 1988.

Andrew Dick: So, Greg, what type of services were you offering in the early days? Was it consulting type services? Was it development services or all of the above?

Greg Ghee: No, we were offering advisory services and that’s a great question and it’s one of the things that when we talk to new clients, when we’re talking about our company, we’ve grown our services following our clients’ request of us or evaluating what the future maybe in our industry and then running to add those services and compliance is one of those that I’ll talk about a little bit deeper here as I explain what I mean by that.

Greg Ghee: We were engaged very early on to help the health system in an advisory engagement go through due diligence for the acquisition of seven hospitals from HCA that was part of the 1988 divestiture and they sold I forget how many hundreds of hospitals across the country and PYE’s client was picking up several … PYE had several clients but the one that I worked on specifically was in Tennessee and so we helped them with the due diligence which meant going through all of the leases, flagging anything that we saw that might not meet either an FMD or a commercial reasonable standard, flag those, bring them up to the internal legal council, which ultimately went to external legal and then once we helped them with due diligence and the acquisition was closed, to help them stand up a property management company.

Greg Ghee: So, Andrew, day one, we were pretty much advisory. Within a year, we were still an advisory and had gotten into the operations, what we call operations, it’s property management. Within that year as well, we were asked to help those three physician groups come together and so we stood up our project management arm, which probably we only did owners rep/project management for the first four years and probably in the fifth or sixth year of us being around, we were asked to do our first [inaudible 00:23:15] where we were at risk and we built a cancer center for a hospital up in Virginia and owned that and then after a certain period of time, when they were ready to go to the bond market, we allowed them to buy that facility back from us and they aggregated it and took it to the bond market and so first was advisory, then project management.

Greg Ghee: And I want to tell you that part of the advisory did start us into the compliance and over the years, we had worked episodically on client engagements, helping with fair market value, rent studies, maybe giving opinion letters on acquisitions, working for either the board or the executive team before they were ready to either buy or sell either one asset or three or four, primarily, medical office buildings but before they were going to sell a portfolio of assets, is this a fair deal to the organization and so we did that quite a bit and then we did … This was one of the service lines where we really anticipated the emerging trend and the importance of having people that fundamentally understand real estate and Andrew, you know because you know us but 95-98% of our total revenue is healthcare real estate.

Greg Ghee: We have a few clients who we serve through relationships that are non-healthcare but we are a healthcare real estate advisory and services firm and so when we’re doing any of the work in compliance, those people know that we’re not out that morning doing a Walmart or a Target or some other food type of the advisory work. We are healthcare. Everybody in our company is working healthcare throughout the day but we saw PYE rapidly growing their compliance arm as well as it relates to valuation services and some of the other compliance/regulatory and so we decided to invest in our resources, people, processes and technology to significantly stand up a compliance, a real estate compliance arm and today, we’ve worked on some pretty nice projects. Most of those, we keep confidential but we’ve worked on some national level projects in our compliance service line.

Andrew Dick: So, fast forward to today, Greg, talk about how the business has grown, where you’re located and new services that you’re offering.

Greg Ghee: As I sit here today, we’re in Atlanta, Greensboro, Johnson City, Knoxville, Nashville and Tampa. And I say that because we have plans for a couple of other locations and we have some people working with us on a contractual basis that may take us before the end of this year into a couple of other markets. When people look at our footprint, you can tell we’re generally a Southeast company but we are growing our footprint. I think we’ve worked in 32 or maybe 33, it may be 35 states over the years and as I mentioned a moment ago, we have 90 employees and our services lines, our three primary service lines are as they were back in 89, advisory development, which is our capital projects and then operations, which is our property management and then the other two service lines that we have are transactions and the compliance and the reason I mention three primary versus the other two is the transactions is a function of what we’re doing in our operations and compliance is essentially a function of what we’re doing in our advisory work.

Greg Ghee: When you ask about our company today and maybe what makes us a little different than others, I have my own opinion and others, our clients have their opinions about us but what I hear when I’m asking our clients at the end of an engagement or a project why they selected us, one of the things that comes to mind to them quickly and it is repeated is the RTG difference. The first characteristic is we are healthcare. We are healthcare real estate day in and day out. A lot of people really appreciate the relationship, the affiliate relationship that we have with PYE because they know that we have additional resources to call upon if we need those and we also understand how to operate as a professional services firm, which PYE is as well.

Greg Ghee: And we also tend to do most of our work as objective advisors. We go over budgets and we go over fees and we go over scope of work with our clients on the front end and if there are any contingency or condition related aspects or tasks to that, we separate our work, our deliverable and our opinions from that additional work, and so many of our hospital clients appreciate the way that we do that but that also honors any relationships that they may have locally. So they want a healthcare advisor with a national footprint and national experience to bring them an objective, independent business plan or plan of action and if they need us to help them execute, we can do that or if they want to use something local to help them execute, we can certainly do that and that’s always been part of our value proposition to our clients and also part of our delivery platform.

Greg Ghee: Then the second thing, Andrew, is our clients tell us just the breadth of our services platform, they don’t have to go get someone else if they want to manage a project. If we’ve helped them with a site location and they want to put an urgent care center or something else there, their internal resources are stretched, they need some help, through a separate engagement, we can help them with the construction and the project management on that and they don’t have to go get another firm and get them up the learning curve and everything is still under a very discrete engagement with them with the confidentiality and everything in place. So, I’ll tell you the second is just the breadth of our services platform.

Andrew Dick: So, Greg, tell me about typical clients. You’ve talked about physician groups, hospital systems, what’s the breakdown in terms of amount of work or revenue in terms of those different categories?

Greg Ghee: That obviously changes from quarter to quarter, although it stays within a bandwidth, a pretty close bandwidth. So, as I mentioned, around 95% of our work is healthcare and I would say 60% of that today and it could be 60-65% of our work today is through health systems and then 30-35% is physician groups and then there’ll be 5%, could be 3-7%, there’ll be a percentage there where we may be working with a banking client and that may either be an RTG relationship or it could be a client of PYE that has said we need some help from a real estate professional group on a new branch location, and so we do a lot of work with banks but it’s interesting how closely aligned, when you’re thinking about locating a bank branch or locating an urgent care center or primary care group, how important the real estate part of that is but that’s generally it. About two thirds hospitals/health systems, one third physician groups.

Andrew Dick: So, Greg, let’s switch gears a little bit and talk about the industry of healthcare real estate, because you’ve been working in the industry for a number of years, have grown RTG doing work all over the country, where do you see the industry going in the future, what type of trends are you seeing?

Greg Ghee: We are as busy today as we have ever been and in a moment, you and I may be able to talk a little bit about COVID, because that’s certainly an area right now in history that’s different for me and you and everybody else in this business but if we had had this conversation in January of this year or February, I would tell you generally about the same thing that I’m telling you right now, that we’re very busy and I don’t mean necessarily the volume of work as much as I mean the pace it’s playing.

Greg Ghee: What I mean by that is we are doing a lot of work today and we’ve done a lot of work over our last 22 years and Andrew, this may be the same for you, so I’d kind of like to ask you this question when I finish but it seems that our clients, the pace of play and how competitive it is, not only in the hospital sector and whether you’re working for profit or not for profit but even with physicians and venture capital coming in, the pace of play, how quickly they want to not only understand the plan and execute on the plan and know what the plan is and get the physicians aligned, that really is about as busy as it’s ever been in my career.

Greg Ghee: As it relates to the healthcare real estate, I think we’re a direct function of the healthcare industry per se. Is that everyone is just incredibly busy, even before COVID-19 came to us and I think, again, that’s a function of intense competition, real competition, the first to market, to get their flag into a market subset, to make sure they’re aligned with the doctors, that the physicians want to grow. They need to have a place to perform their procedures, to get their diagnostic tests taken care of. So they’re also trying to take care of the doctors because they’re trying to grow as well and then I also think it’s a function of macroeconomic, I guess, demographics, if you will, of just the aging population and the necessary volumes that are happening and I’ll tell you, this is anecdotally although I could probably present some empirical evidence to you, as you know, we’re really transitioning from the acute care hospital environment to the ambulatory environment.

Greg Ghee: Most of our clients have already cross over the 50/50 threshold where they are mostly … I shouldn’t say most. They’re probably either 50/50 or 49 inpatient and 51 outpatient as far as their revenues and so that has also really quickened the pace as it relates to that and their facilities or building new facilities but the pace of play, is that how you see it, Andrew, with your clients?

Andrew Dick: Absolutely. I think it’s interesting the way you described it as pace of play. The transactions just seem to be moving faster and faster, more compressed timeframes. We worked on a [inaudible 00:35:46] back transaction on the West Coast last month, helped a client close on four outpatient facilities and the timeline was I think three and a half weeks and there was a lot to do and I’ll tell you, Greg, it can be really exciting but also very stressful as well. So, pace of play is a good way to describe it as things just keep moving faster and the industry’s evolving and you really have to be on your game when you jump into some of these opportunities. So I think you’re right.

Andrew Dick: Greg, you mentioned COVID. Because we’re recording this really in the midst of COVID, a number of states have opened. Some still have stay-at-home orders. Some have opened and are now slowly rolling back their reopening plans. How has COVID impacted your work and what you’re seeing in the industry?

Greg Ghee: Yeah, it’s a very different time, Andrew, as a person and as a professional. A few things come to mind right off the bat. Fundamentally, I think it’s brought a lot of well-deserved attention to the profession of property management and I’ll say this not only about our people and it’s more than just the people in our property management service line because our construction management people and a lot of people in our advisory service line are supporting others, so it’s really about our company but I want to speak specifically to the people that are on the front line in our property management and I’ll also broaden that comment because we work with a lot of different companies out there and we also have clients that are real estate investment trusts and they have property managers internal in their organization and other property management firms, so I want to extend my compliment and my respect to everyone in the property management arena, not just RTG.

Greg Ghee: But it’s been very inspiring to see how integrated and essential our property management team, our people have been and continue to be to our hospital clients and other building owners during this time. I mean they are literally on the front line and so you think about an MOB that’s on a hospital campus, could be connected to the hospital campus or it’s off-campus but those doctors and those patients, it’s critical and we’ve been considered, as you know, an essential service and so every day that they’re open, we’re open. We’re there to make sure they’re open. We’re there to help with the traffic. We’re there to help police the security. We’re there to help make sure that the housekeeping and the additional sanitary conditions and cleaning and all of that is in place. We’re there to answer the phone in the middle of the night when things are not going well.

Greg Ghee: So, again, it’s not only the RTG team but everyone in this business. COVID, I think, is also really focused on the importance of technology. We’re doing this podcast today, you and I talked earlier about how many team meetings we have and Zoom meetings. Technology, communication protocols and really broad-based communication, how do we communicate directly with a risk manager or an infection control expert at the hospital or at our REIT client, how do we communicate with them directly and then how do we communicate out to the public and how do we communicate out to the other tenants in our building and you all may, as a law firm, also see it and I keep up with your great advice coming out on COVID-19 and the impact on real estate. We follow you guys and appreciate you sending out that thought leadership as well.

Greg Ghee: And so I think it’s not only drawing attention to what we do in the real estate/property management business, but I think it’s also drawing attention to skills and I said technology a moment ago but the people skills and Andrew, you touched on it a minute ago when you mentioned the timeframe. There’s no way to measure, although I think when we get past COVID-19 and we all look back, what percentage increase of our daily stress quotient that we’ve all put up with and some days, I am certain, I’m a believer that it has been beyond the 100%, many days maybe but it’s really been something to watch and we try to be supportive of everyone in our company and I know you guys are doing the same thing there with your company but the other thing there is I think that will also enhance our people skill training and we use a term, our emotional intelligence, how you’re taking care of yourself before you can help take care of other people and making sure that you’re thinking about that as you think about what you do from the time you wake up to the time you finish at the end.

Greg Ghee: And then the last thing that I’ll mention, Andrew, I know it’s evolving but I think it will impact the design of buildings in the future, whether that’s in materials and there’s people smarter than me that’ll be doing this but we work with a lot of great healthcare architectural firms across the country and I’m sure they’re looking at that but they’re also looking at how you enter and leave buildings. We talk about smart buildings all the time. We’ve talked about telemedicine. So I’m certain that it’s going to have a big impact on really facilitated design moving forward.

Andrew Dick: Yeah, those are all really good points and I was writing some notes down as you were talking. I think COVID’s going to have a significant impact on the push for healthcare systems to expand their outpatient network or their ambulatory network. I think you mentioned that earlier, Greg. That was really already happening but I think it’s going to accelerate the pace of more outpatient development, off-campus development. Just a couple days ago, one of the major healthcare REITs published an independent survey of consumers where they asked consumers where would you prefer to have healthcare and outpatient facilities was where most of the consumers indicated they’d prefer to be treated, primarily because there’s some fear associated with going to hospitals today as we live through COVID, but I think you’re right, it’s going to change facility design. I think it’s going to change or accelerate, I should say, how some health systems implement their ambulatory strategy. So all really good points.

Andrew Dick: Greg, as we wrap up here, I’ve got a couple more questions for you. Where do you see the opportunities for the industry, for healthcare real estate professionals, give us a couple of thoughts there.

Greg Ghee: Well, I’m extremely bullish on the healthcare real estate industry. You could probably have guessed that but I love it as much today as I loved it 32 years ago and through divine intervention, I was able to go to work for Fort Sanders and as a young person or whatever age person, if they’re transitioning into the healthcare real estate, I think there are opportunities across the continuum. I mentioned our service lines and our service lines tend to follow where the work is if you will but the one thing I would mention as they think about managing their professional career is to really develop an understanding of the patient experience.

Greg Ghee: While you and I are talking about ambulatory or acute care and then telemedicine, some virtual medicine, whatever term we want to use, that’s still a patient experience and so if you want to understand the destination or what you’re trying to accomplish, really seek to understand what the user is doing and we’re all, at a certain time in our life, users of healthcare. It’s important to pay attention when you go to your doctor’s appointment and how you go through that process but I would say to really figure out a way to understand the patient experience and look at the different facilities, if you will, my oldest daughter who lives in Washington D.C., she’s been in Knoxville for the last two and half months because of this pandemic but she’s based in D.C. working with one of the big public accounting firms, she accesses her provider through a smartphone and then does FaceTime and I just get a kick out of that. I think that’s just a mindblower.

Greg Ghee: We don’t do much of that here in East Tennessee but I can see it coming quicker and again, pace of play, I think change will be even more rapid than it has been but no need to call and schedule that. She just does it online and it picks up the phone and there you have it. So the reason I segued from the patient experience, the individual has to …

Greg Ghee: You need to think about what it is for them, what it’s like in the parking facility, where do they drop off their family member or themselves, how do they come in, how do they access the building but then also, what’s the impact of technology going to be on that end user and then as most things in life, you triangulate, so it’s end user, technology, destination to the facility and so I would just say as far as the opportunities in the industry, jump in anywhere you see it as far as construction all the way into management. I’m a big believer in first being an advisor, first be a consultant so you really have a broad based opportunity to do a lot of different things. So, I’m a big believer in the advisory side of the business but always keep in mind who you’re serving, the patient.

Andrew Dick: That’s good advice. Greg, we talked a little bit earlier on about what advice you’d give to someone who wants to get into the healthcare real estate industry. You talked about being flexible. What other advice would you have for someone who’s interested in starting a career in the healthcare real estate industry?

Greg Ghee: It’d be great if you had a mentor or someone that … professional real that you can ask about what it’s like to be in the healthcare real estate arena in our business. If not, there are different professional organizations where you can develop a network. I’m a member of CCIM. I’m also part of [inaudible 00:47:46] and lastly, Counselors of Real Estate and we have networks with people who can talk about different areas in real estate. You could also volunteer at local … I do a lot with our local United Way but you could also volunteer at one of the hospitals or something just to get a little bit of experience so to speak or a little bit of time with them but last thing I do, I read quite a bit, Andrew, and I’ll mention just a few of these off the top of my head.

Greg Ghee: One of the thought leaders in our business is the Advisory Board, that’s a subscription but you may be able to find some of their stuff online but the Advisory Board. Modern Healthcare is something out there that people could get and look at. Healthcare Design, but I would say kind of if a person is thinking about getting into, try to come into it through their real estate professional network one way or the other, through a professional relationship.

Andrew Dick: That’s good advice. Greg, really appreciate you taking the time to chat with me today. I’ve enjoyed it. I too have enjoyed our friendship and getting to know you over the years. Where can our audience learn more about you and RTG?

Greg Ghee: Yeah, thank you, Andrew. Thanks again for the opportunity and good seeing you and be safe and pass that along to your other colleagues that I know and talk with up there. I’ve talked with you most of the time but in answer to your question, over the last couple of years, we’ve really made significant investments in our website and there’s a lot of information on our website. Our marketing manager’s name is Angie Surface and she does a great job of keeping up with our resources there. My email address is on the website, gd@realtytrustgroup.com. If you don’t see any information on our website, you can either hit Angie on a link or hit me on a link and we’ll get back to you.

Greg Ghee: And really do appreciate the opportunity to talk to you, Andrew, today.

Andrew Dick: Great. Likewise, Greg. Thanks to our audience for listening to the podcast on your Apple or Android device. Please subscribe to the podcast and leave feedback for us if you have ideas for future podcasts. We’d love to hear from you and like to hear those ideas. We also publish a newsletter called The Healthcare Real Estate Advisor. To be added to the list, please email me at adick@hallrender.com.

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An Interview with Shawn Janus, Colliers National Director of Healthcare

An Interview with Shawn Janus, Colliers National Director of Healthcare

An interview with Shawn Janus at the Colliers Indianapolis office. In this interview, Andrew Dick interviews Shawn Janus, the newly appointed National Director of Healthcare. Colliers is an international real estate firm that provides real estate brokerage, property management, transaction management and strategic advisory services.

Podcast Participants

Andrew Dick

Attorney with Hall Render.

Shawn Janus

National Director of Healthcare for Colliers.

-Transcript Coming Soon-

Andrew Dick:  Hello and welcome to the Health Care Real Estate Advisor podcast. I’m Andrew Dick, an attorney with Hall Render the largest health care-focused law firm in the country. Today, I am in Indianapolis at the Colliers office and I am going to interview Shawn Janus, who is the newly appointed national director of health care at Colliers. Shawn is an industry veteran and we thought it would be interesting to sit down with Shawn to hear his story and his vision for the Colliers health care platform. We’ll also talk about the state of health care real estate and where Shawn sees opportunities in the future. Shawn, thanks for joining me.

Shawn Janus:  Thank you. Andrew. Good to be here.

Andrew Dick: Shawn, before we talk about your current role at Colliers, let’s talk about your background. Tell us where you’re from, where you went to college, and what you aspired to be at a younger age.

Shawn Janus:  What I aspired to be. That’s interesting. So actually I grew up, I’m Chicago bred, born and raised in the Chicago area. I actually grew up in the far southwestern, excuse me, far south suburbs of Chicago, a town called Chicago Heights, very blue-collar. The Ford Stamping Plant was down there through all rail cars. So it was again, very, very blue-collar area that I grew up in, but I loved it down there and it sets the foundation of who I became today. So that’s where I’m originally from.

Andrew Dick: And after you went to college, Shawn, what was your first job? What did you end up doing?

Shawn Janus:  Well, essentially, actually college was a complicated journey for me to some extent. So I played football in college. I think, Andrew, we talked about this a little bit when we last saw each other, but so I was recruited to play college football and I was overwhelmed by the process my parents didn’t go to college. They didn’t really have a perspective. My high school football coach was a first time football coach. Actually, it was a great experience and it was a long way of getting to where I work. Your question is more specifically, but I actually signed my national letter of intent to play at Iowa State. Got enthralled with the big eight and Earle Bruce went on to coach at Ohio State, was the head coach there. Actually broke my letter of intent, never matriculated there and the reason being I continued to be recruited by the Ivy leagues at the time.

Shawn Janus:  So I actually matriculated to Yale for my freshman year. But just found that I didn’t really fit into the Yale culture if you will. Again, being blue collar, some of the values that I had grown up with a little bit different than what was on the East coast. So I ended up transferring to University of Illinois. Absolutely loved it, played football there and I always had an interest in accounting, like the fact that there were answers, specific answers. When you’re young in your career made some sense. So I became an accounting major. I got my CPA coming out of school and that led to my work experience. I actually interviewed for jobs coming out of school and took a job with, which was then, this is my age, Peat Marwick and Mitchell and now KPMG and just so happened that I got thrown on the JMB audit account.

Shawn Janus:  JMB for those who don’t know is one, was one of the largest syndicators in the world at that point in time. So I spent nine months of the year, nine and a half months of the year on the JMB audit, really got to understand real estate and really had an affinity for it. I really enjoyed the business and liked what it did. Interestingly, in the summer months when we weren’t on the JMB account, I happened to get thrown into health care. So it came full circle later in my career. I didn’t actually focus on health care at that point, but started with the DuPage hospital, way back when it said DuPage hospital. So that’s how I got into the business if you will.

Andrew Dick: So fast forward, Shawn, at one point you worked with Todd Lillibridge when he was starting his business and building up his MOB portfolio. Talk a little bit about that.

Shawn Janus:  Yeah, so interestingly, so I was actually in investment banking. At the- around that time with Continental Bank in Chicago and like a lot of big, big investment banks, commercial banks, we have training sessions, et cetera. We’re in this big auditorium theater and the gal giving the presentation announces herself as Lynn Lillibridge. So I went up to her afterward and said, “Wait, any relationship to Todd? Well, I had gone to school with Todd little bridge, we were fraternity brothers.” Turns out that was her husband and she goes, “Oh my God, how do you know Todd?” So Todd actually put me onto his advisory board, you know, during his formative years. This was when he was still a little virgin company I believe. And he was really doing property management consulting. He actually tried to bring me onboard a couple of times. But my background had been really on the deal side of the business, capital markets acquisition and development.

Shawn Janus:  So when, we would get together two, three times a year, they usually come to Chicago, just meet for coffee or breakfast, stayed in touch. And then when he made the strategic decision to hire Lehman brothers when they were still around to begin the roadshow to raise the capital, the first to bring that capital solution to health care institutions. So he again approached me and said, “Hey, you say you love the business, you love real estate, you love health care. I need someone now on the deal side, we don’t have that capability in house.” So I was one of the initial five senior executives who formed and ran the first Lillibridge REIT if you will. So initially I was in charge of acquisition and development and the consulting practice. After a couple of years, we brought someone in who are specifically focused on the consulting side. So that I could focus on acquisition and development because that’s really where the meat of the organization was going.

Andrew Dick: So that had to be a pretty dynamic time to be in health care real estate. Todd’s a pretty dynamic guy, built a very successful business. It sounds like you were along for the ride and were you there when Lillibridge spun out and sold some of its assets to Ventas?

Shawn Janus:  So actually, so I was there through the iteration of the first two REITs, the first REIT, which was Lillibridge Health Trust, actually ends up being sold to CalSTRS. We were- Lillibridge was owned at that point in time by Prudential AEW and JP Morgan Chase along with managements. Those are the four entities we owned. The REIT itself, that was sold to CalSTRS. They wanted to buy the entire entity for tax reasons and other things and then Prudential wanted to stay in the business as did obviously the management folks.

Shawn Janus:  We bought back the management company and the development platform and then we raised capital through Prudential and formed a venture at the property level with Heitman for some of their funds. Yeah, so I was there really through the- and then we formed the second REIT, which was Health Care Lillibridge or a Lillibridge Health Care Real Estate Trust was the name of the second one. So I was there through the first two iterations and then actually got recruited away to join JLL right at the time or right before actually the Ventas transaction. So I was right there at the cusp of when that change occurred.

Andrew Dick: Okay, very interesting. So talk about that transition to JLL, big national firm. What were you doing for JLL?

Shawn Janus:  So JLL had made the … I’ve known that folks going back to those South Partner’s days, which is the predecessor entity to JLL. Jones Lang Wootton and they merged and they had several iterations, but I’d known the LaSalle partners guys having been in commercial real estate in Chicago for ages. Earl Webb, one of the gentlemen there actually is now, he ran capital markets in the Americas for JLL at the time. He is now the CEO of the Americas for Avison Young actually, no one leaves the industry we just move the pieces around a little bit, but I had known Earl for awhile.

Shawn Janus:  We got to talk, I think it was a barbecue if I’m not mistaken. And he had mentioned, they’re looking at, expanding their businesses and they either do it with bringing new products and services to existing clientele or they go into a new industry and they had focused on health care as a industry that which is becoming much more institutionalized, which they’d go- there was a lot of synergy to do that. Their research group internally had come up with some waive papers that made sense for that. So he would bounce things off me then with the, over the course of time in terms of how they should approach the business, what was driving the industry and they ended up getting that approved and to start a health care platform effectively.

Shawn Janus:  They actually hired a guy who came out of a different background. Initially, it didn’t work out and after a short period of time, Earl approached me and said, “Hey, would you be interested? You helped write this business plan if you will anyway,” so that’s when I joined JLL. So I really went there to basically put the entire strategy, the organization together and then to drive a growth platform for JLL across the service industry for health care real estate.

Andrew Dick: Okay. And after JLL you’ve also worked for some other prominent health care real estate firms, specific medical buildings, and then I think is it more recently Catus?

Shawn Janus:  Correct.

Andrew Dick: So talk a little bit about those opportunities and then we’ll jump into what’s going on here at Colliers.

Shawn Janus:  Yeah, so interesting. So my- Pacific Medical buildings, which is based out of San Diego, probably the preeminent health care real estate development company in California and the Western region of the country at that time and still today when we were at Lillibridge and going back, that’s my first interaction with them. One of the things that- I made the decision that we needed to rather than just grow organically on the development side of the business, we were doing, we did when I was there in excess of $1 billion of acquisition transactions through the course of several REITs. But the development side was growing rap- more and more rapidly as it went forward and so growing it organically, it was just tough to keep up with the demand in the industry. So we made the strategic decision to buy a developer, actually hired John Winer, another icon in the industry.

Shawn Janus:  John was with the NY at the time. One of the partners there, they identified, I think it was like 98 distinct entities, development entities across the country and either John, Todd or myself talked to every one of those. My first choice was to buy Pacific Medical buildings. We had approached them. They were maybe smart enough not to move forward with us at the time. We got to know those guys well. Entering the California is always, always tough. There’s a lot of different regulations there as well, but culturally, everything just fit with them. That didn’t work out. We ended up end of the day buying Mediplex Medical Building Corporation, MMBC out of Plano, Texas, outside of Dallas. But long story short, when I was with JLL, one of the things I saw an opportunity was to really bring some solutions into the ambulatory environment, which really was on the development side as well.

Shawn Janus:  So approached Mark Toothacre who is the, still the CEO out at Pacific Medical Buildings. We’ve known each other and stayed in touch all those years and just so happened, timing being everything. They were at a point where they were strategically looking at diversifying geographically and they were struggling with, well we don’t want to take on a bunch of overhead to start offices in other areas of the country. So ended up, we put together a venture of JLL and PMB whereby they had the expertise, the 40-year track record, the pretty pictures, the capital, all those things. JLL had an army of folks I had set up health care offices in most of the major and mid-major cities around the country. So JLL became the intake valve, if you will, from a business development perspective. And then also the execution arm.

Shawn Janus:  So we would get our service fees. We were a service organization, they would get more products, putting it to work and then building their portfolio. So we would do that, we would do the zoning and we would do the project management, we would do the leasing, so all those local type activities. Then they would bring the capital, the oversight and everything else. So that’s how I ended up getting involved with PMB and then eventually ended up joining PMB directly and effectively with the same function. So based in Chicago and was really taking their footprint, trying to expand it from the Rockies to East coast, if you will.

Andrew Dick: Very interesting. So your last stop was at Caddis. Tell us briefly about what you were doing there.

Shawn Janus:  Caddis, is very similar actually. I know Jud Jacobs, who is one of- the development partner at Caddis, he’s an old Trammell Crow guy. I actually worked at Trammell Crow in my commercial days and not that I knew Jud back then, but we’d known each other in the industry for quite some time. Similarly, they were actually looking to expand their platform geographically. They were growing in a much bigger way. They haven’t been around for 40 years. And so it’s a newer firm relative to the industry if you will, was an intriguing opportunity really to do the same thing.

Shawn Janus:  So effectively I was responsible for expanding their platform in the midwest in business development perspective and then for executive leadership for any and all projects in the midwest and that was- there are  acquisitions, there was development, they were involved in the senior housing arena through their hardest platform had not been as involved in the senior side of the business. But it was a great learning curve for me to actually bring that into my quiver in another area, if you will.

Andrew Dick: And how did the opportunity with Colliers present itself?

Shawn Janus:  Yeah, that’s interesting. So as we all do, as we get later in our career, obviously business development and relationships are always important. But particularly, once you’ve been in your career for quite some time. One of the things that I make a point of doing is reaching out to people in the industry and trying to stay in touch with them. A guy by the name of Ted McKenna in Chicago. I’d known Ted for, I don’t know how long, known Ted forever. So we would periodically try to get together just to catch up on what was going on. Just so happened we had arranged to have coffee up in the Northern suburbs of Chicago. We were sitting down and it just so happened that that week it was announced that Mary Beth Kuzmanovich, who was my predecessor here at Colliers, I’ve known Mary Beth for 12 years.

Shawn Janus:  Going back to when she was at Carolina’s Health Care that she had left the Colliers organization and had joined the Lillibridge organization in the small world category, which I’d get into that story. But anyway, we were just talking and catching up. I had mentioned an- what was going on with Mary Beth, and we were talking about the strikes they’ve made over the last four years. And then all of a sudden he stopped and looked at me and said, “Well I know you like your job and what you’re doing, but well you’d be perfect for this, any interest in potentially, thinking about joining the Colliers team?”

Shawn Janus:  So I said, “Well, love to hear more about it. It was right before BOMA. So he actually set up a meeting at BOMA with the internal executives who were running their search process. So that was in the April timeframe. And then over the course of, I guess I started there in September. So over the course of time I’ve got more and more intrigue in the opportunities and with Colliers it was about potential of the health care platform and really the value add that I could bring to the organization and made the decision to join the Colliers team.

Andrew Dick: And so what attracted you to the Colliers platform? When I think of Colliers, I think of an international brokers firm. They have a great health care group I’ve worked with personally over the years and always had good experiences. So what really drew you into the Colliers opportunity?

Shawn Janus:  A couple different things. One, obviously I had, I had built an organization very similar to JLL in terms of starting from scratch, if you will, and kind of building a health care capability. I mean they had some, even at JLL had some capabilities, but really moved that forward in a big way. That has always intrigued me. I really, I love real estate and enjoy the health care component of that. One of other things is I do enjoy the entrepreneurial nature of growing an organization. This was the, Colliers was a bit different in that Mary Beth had been here four plus years, so she had some had done some of the foundational elements in terms of putting their arms around the true health care platform. So those things really intrigued me. But I would tell you the thing that of put it over the top is just the culture of the organization.

Shawn Janus:  That’s very, very important to me has been since I mean going back to my soliloquy about choosing colleges and finding the right fit, if you will. So that’s always been important to me. So as I got to know the folks at the Colliers team across the country and their leadership, their vision, where they were going and just the comfort level in terms of how I could be a part of that team. So it was those things, it was the potential of the platform where they were and where we could take it, the entrepreneurial nature and just that culture.

Andrew Dick: So as the newly appointed national director, what are some of your goals and objectives?

Shawn Janus:  So it’s interesting. At Colliers, it’s set up a little bit differently than we had it at JLL. But, so my role is to really support, give vision, a strategy and drive the growth of the platform. Colliers is regionally based organization. So the health care folks in the organization are based through their regional presidents, if you will. So I look at my job and kind of, I put it in the four buckets, if you will. One of those, as we talked about, is always business development. Having been in the industry for 20 years specifically in health care, I’m talking about, have relationships across the country. So I can not only introduce Colliers into those relationships, ideally at least make those introductions, but can also be involved in pitches to help all those various teams as they try to win business.

Shawn Janus:  The second would be just in recruiting. I think that’s the second bucket. So helping the regions bring in the right type of individuals. Number one, help recruit them, understanding the nuances of the health care environment. They understand the Colliers platform obviously better than I do at this point in time, but identifying those types of candidates as having been in the industry for so long. The third would be just the tools that they use. So arming all those, all the brokers and the property managers and the consultants all across the country on the health care side, do they have the right tools? How can we organizationally support them to be successful, if you will. And then the last would be, and probably one of the most important is branding. In any organization obviously you need to be branded in terms of recognition and how you’re perceived in the industry.

Shawn Janus:  I would give kudos to Mary Beth Kuzmanovich because when I- I didn’t really know much about Colliers Heathcare in the business at a time I’d call it 15 years and I’d never really come across Colliers Health Care at any big way. But when they did make that decision to try to have a leader come forward with that Mary Beth’s leadership, she really did put them on the map a little bit and we began that entire process. But that’s a living, breathing organization- organism, if you will. So that whole branding concept would be my coming forth year.

Andrew Dick: So Shawn, when I think of working with a firm like Colliers, there’s often a couple of different service lines that I think about. There’s the brokerage, there’s the property management, sometimes there’s transaction management and then sometimes there’s investment sales. Are you going to be focusing on all of those within the health care platform or is there one that’s going to take priority over the other?

Shawn Janus:  So the easy answer to that Andrew, is actually we would focus on, we’ll focus on all of those and building all of those out. I think we- my vision is to be the best in classed health care, real estate service provider in the country. Obviously there’s great competition with some of the other larger firms we compete with every day. We’re friendly competitors with them, but I think we have the, the underpinnings and the foundation to be able to do that. Having said that, I mean Colliers is that entrepreneurial nature is, has been historically a broker led organization and much to your point. So I think we will first work through the brokerage side of the business on how can we better grow that piece of the business. But then also the other pieces you mentioned, the strategic consulting.

Shawn Janus:  I think that’s a big piece of what this industry needs and from a real estate perspective we can obviously bring that in a big way. You mentioned property management. I think project management is another area, project program management. So I think being able to bring that solution, like a lot of the big firms, you have the brokerage side of the house and you also have the corporate solutions side of the house. So also just marrying how those two work together. I’ve had experience with that. Obviously JLL had the same two type of platforms. So really looking to bring all those services to the industry.

Andrew Dick: So looking forward, where do you see the health care industry going? We hear a lot about the retailization of health care and the push for ambulatory care. I mean that’s been going on for years. But where do you think the industry is going?

Shawn Janus:  Yeah. I wish that crystal ball was clear. I would tell you. So essentially I always tell people that one of the things that’s intriguing about this industry is that it is constantly changing. And a big piece of that obviously is the fact that it’s so reliant on what the government is doing, through reimbursements, Medicare, Medicaid, all of those payees, if you will, into the health care system drive that. And that changes when we have elections and we’re obviously in that cycle right now. So irrespective of where you are on the political spectrum, it’s going to bring change at some point in time. And when you have that type of change, it creates challenges in the industry. But whenever you have challenges, there’s an opportunity to provide solutions. So I think that really allows an organization who can be nimble, who is strategic in their thinking, truly help their clients look at those things.

Shawn Janus:  You mentioned a couple of things and I think those are, those are probably first and foremost cost and convenience right now are probably two of the larger issues which have been driving health care decisions. The health care revenue model for hospitals and health systems has been under immense pressure. There’s been shifts in the payer mix as we talked about a little bit. Going from the private to the public. We’ve seen that, that affects reimbursements in a big way for hospitals. The case mix shift, that there’s a shift that’s going on there as well, which has implications.

Shawn Janus:  And then to your last point that you mentioned in terms of the convenience and the retailization, that shift of site of care, we’ve gone from this 20 years ago, this inpatient model to a much more diversified outpatient centric and ambulatory centers and whether that be larger MOBs, whether that be urgent care clinics, whether that be freestanding EDs, micro hospitals the buzz word in the industry, which should, depending on which states you’re in there’s quite a bit driving that as well. So, but I think those are two things that are really at this point in time right now we have the election coming up and then you have this issue relative to costs which everyone is dealing with and then the convenience factor which is really being driven by the consumer.

Andrew Dick: Shawn, in the past there was always the discussion about on-campus versus off campus medical office buildings. At one point investors really focused on the on campus assets. A couple of years ago there was a number of investors shifted their focus to looking at the off campus assets and then there’s always a discussion about cap rates spreads between on campus and off campus. What do you think- what’s your opinion, on campus, off campus assets? Where do you see investors going? Talk about some trends. I get that question all the time. I see a lot of activity on both fronts. I still see on campus buildings being constructed, we still are working on a lot of off-campus projects.

Shawn Janus:  Yeah, it’s, it’s interesting. So that … distinguishing between the on campus and the off campus has, as as you mentioned, has been, I would say a point of contention, but the differentiator if you will in terms of distinguishing how investors look at the market. When I first got into the business, it was as you said, just it was really wanted to be on campus. Then it was wanting it near campus and then that wasn’t quite off campus yet. But, it was across the street it would- but it was still around the major hospital. That has changed drastically. I don’t think the drivers of why investors are looking at that- not asset class, but that locational difference why they’re looking at that as a better investment opportunity is the fact that previously in the off campus location was the doc in the box.

Shawn Janus:  It had- it was a true medical office building, 40,000 square foot, two floors, 20,000 square foot floor plates and it really was the doctor’s office, if you will. We still refer to them as medical office building. It’s probably a misnomer. It’s just a general term that’s used now. They really are ambulatory care centers, so the driving factor for investors has been that higher and higher acuity delivery of care is now happening in those locations. It’s ambulatory surgery centers, it’s imaging centers. Now we’re moving into a whole wellness component which is, which is new to our industry, fairly new to our industry as well. So I think some of those factors are really what has driven investors to look at it and say, “What are we really underwriting?” Yeah, it’s real estate, but really underwriting the hospital, the provider, physician group, whatever it might be and what’s the driver for their business? It’s really the procedural side of things and where those occur in the fact that those higher acuities are now at a different location, it just made it easier for them to underwrite that.

Andrew Dick: Where do you see the most opportunities today in the health care real estate industry? I often get that question. I’m curious about, you’ve been in the business for many years. Where are the opportunities and I think you could say opportunities for Colliers or you could say opportunities for really anyone developing health care, real estate assets.

Shawn Janus:  It’s interesting, I answer that question similarly to the question when you asked why did I come to Colliers? The reason I did come here is because I do think there’s so many opportunities in the industry currently. And I think part of that is what I talked about. There’s so much change happening, it’s happening faster, just given technology and what’s going on in the industry and consumers are much more involved in their health care.

Shawn Janus:  So I think given all of that, hospitals and health systems and physician groups, through merger and acquisition activities, everything else that’s occurring, they become overwhelmed to some extent and pretty easily. And one of the things that I think the opportunity is, is to really bring them that trusted advisor. Some people think that’s an overused term, but I actually do believe that. I think if you can bring a specific expertise, again, we’re real estate experts in health care, but for us to be good at what we do, we will need to understand health care, what’s driving their industry, what’s keeping them up at night.

Shawn Janus:  And we always say that real estate will never be on the top issue for hospital or health system executives, but it never used to even be on the top 10 now what’s on the top 10 and it keeps going up and up and up into maybe number five on the list you make. It’ll probably never get higher than that. To use- just got to use an example because something else more relative to the health care. But I think the recognition of the importance of health care and how help app- excuse me, points of real estate and how real estate can from a tactical perspective, help them achieve what they’re trying to do from a mission critical and strategic perspective. So I think those opportunities to really have a seat at the table and really be that trusted advisor and offer that full breadth of services that they might need.

Andrew Dick: Shawn, during your tenure in the industry, what’s the biggest change that you’ve experienced working with health care providers?

Shawn Janus:  That’s a difficult question only because if so many things you could pick and choose from if I guess, just to pick one of those, and we talked about what happened, about elections and the affordable care act. I’m getting my tenure now, so that was a big transformational change in our industry. Even going back to the institutionalization of the class, when I first got into it, it really wasn’t an institutional asset class. It was the angel investors who would look at it and now it’s an accepted, their reach and their billions of dollars in REITs out there, et cetera. The shift to the ambulatory sector and what’s going on there. If I had to say one in that, most people wouldn’t think that would be the main one. But maybe it’s just because the recency of it is really this, this current shift in the delivery of care.

Shawn Janus:  And it’s driven by some of the other things. Obviously we just, that I just mentioned. But it’s really that shift to that ambulatory environment where you went from, as we were talking about early, this on-campus inpatient centric environment to really being responsive to consumers and delivering care in ambulatory settings. And that’s driven obviously in a couple of different ways. The fact, that technology, from the wearables to, how people … you go into your doctor’s office if you’re like me or anyone else. Now if you’re going in that you feel like you’re the expert, you’re- you’ve Googled stuff and you’re going to tell your doctor what you have and so the pressure on physicians and them is much greater as well.

Shawn Janus:  But I think all of those things have really driven the need to provide, not a different care, but a different sensitivity relative to the consumer. And what that is, so that whole ambulatory piece, irrespective if you had to affordable care act and some of these seismic shifts, but I think that is a systemic change to our business. They’ll foundationally be there. The affordable care act will it stay? Will it be repealed? Will it be tweaked? Those things are going to be changed, but I think this particular shift as it relates to controlling costs, convenience of care, that’s going to be a foundational elements it’s going to continue.

Andrew Dick: Shawn, you have a built a great reputation in the industry. There are a lot of young folks getting into the business, whether on the brokerage side, the development side. What advice would you have for someone who’s starting out in the health care real estate business?

Shawn Janus:  Well, I’ll tell you, it’s a great business to be in. Not to be repetitive, but it’s very dynamic. There is constant change in these challenges, creating opportunities. So if you’re someone who wants to provide real value to your clients, to your constituency, it’s a great place to not only learn but to make a career out of … health care is not going away. Whether it’s technology or big data or some of the other things that are now transforming our industry, there’s always going to be something that that creates those opportunities, if you will. The other thing I would tell young people though, and I go back to when I was talking about my recruiting efforts a little bit and then even how I got into into this crazy business is I think it’s really important to pursue your passion.

Shawn Janus:  So if you have a passion for something, I absolutely love real estate. When I got exposed to it and back in my Peat Marwick days and got thrown happenstance into real estate and I really had a love for real estate. The one thing I always thought was missing, and here I’m a south side blue collar Catholic boy growing up wanting to give something back and it always felt like there’s, it sounds trite. I realized that in terms of something else I could bring to the industry.

Shawn Janus:  Then when I had gotten a little bit more involved in health care and start thinking back to that first job when I had some health care experience as well, it was a way to say, “Hey, it’s not just bricks and mortar but we’re bringing a solution that helps people.” So for me that was the passion. It’s marrying the real estate side of things I love to do with the health care side, which more altruistically is in my background. So that’s just me personally. But I think importantly if you can have a passion and health care real estate is a great venue and a foundational place to build a career that can really make something.

Andrew Dick: Shawn, I’ve really enjoyed our conversation and getting to know you over the past few days. Where can our audience learn more about you and the Colliers Health Care platform?

Shawn Janus:  You can obviously go to our website, but I would encourage anyone who would like to learn more just to reach out to me directly, and I’m very approachable and my email is Shawn.Janus@Colliers.com.  Feel free to reach out to me with questions, thoughts, et cetera, and we’d be happy to respond to those.

Andrew Dick: Thanks again, Shawn. Thanks to our audience for listening to the podcast on your Apple or Android device. Please subscribe to the podcast and leave feedback for us. We also publish a newsletter called the Health Care Real Estate Advisor to be added to the list. Please email me at adick@hallrender.com.

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Using Data Analytics for Site Selection with Bill Stinneford

Using Data Analytics for Site Selection with Bill Stinneford

An interview with Bill Stinneford from Buxton.  In this episode, Andrew Dick interviews Bill Stinneford, a Senior Vice President with Buxton. Buxton is a data analytics company based in Fort Worth, Texas.

Podcast Participants

Andrew Dick

Attorney with Hall Render.

Bill Stinneford

Senior Vice President with Buxton.

Andrew Dick:  Hello and welcome to the Healthcare Real Estate podcast. I’m Andrew Dick, an attorney with Hall Render, the largest healthcare-focused law firm in the country. Please remember the views expressed in this podcast are those of the participants only and do not constitute legal advice.

Today we’ll be talking about how hospitals and healthcare systems can use data analytics for site selection purposes. Buxton is a data company that helps a broad range of industry groups from retailers to healthcare providers make smart decisions when selecting the right location to do business. Today, we will be talking with Bill Stinneford, senior vice president with Buxton, about how healthcare providers can benefit from the use of customer data when developing an ambulatory network. Bill, thanks for joining me today.

Bill Stinneford: Thanks for having me.

Andrew Dick: Bill, before we talk about Buxton’s healthcare expertise, let’s talk about your background. You’re a Texas native with an interesting background in business and journalism. Tell us about your career experience before you joined Buxton.

Bill Stinneford: Yeah, well I studied business and English at college, and I got out of Texas A&M, and I was a financial analyst for a year, and I wasn’t really ready to grow up, and I’d always been a big sports fan and so I actually went back to graduate school to study journalism, and with the focus of really getting into sports, and ended up working with ESPN for about four years. So really, I got to be on the radio in Dallas Fort Worth and hosted pre- and post-game Mavericks shows. The Dallas Mavericks shows are still on the station, and were able to cover Super Bowls and spring training and training camps and just a fantastic education to study sports and study journalism, and did that for a long time. Hosted the afternoon show here in Dallas Fort Worth, and it was a blast, but you know, eventually, I didn’t want to … I guess I didn’t want to do that for the rest of my life, as fun as it was in the moment, and was ready to get back into quote-unquote “business.” So that led me to make a change.

Andrew Dick: So how did you make the transition from your broadcasting career to Buxton?

Bill Stinneford: Well, it was interesting. When I was going through graduate school, I was putting away through graduate school and so I had an internship at the ABC radio station here in town, and that internship was a great experience, but that was a free internship. I had to make a little money, obviously. Going to school, doing the free internship doing morning drives. So through friends, I had heard of this company called Buxton, which I didn’t know about at the time. I got an internship in the marketing department that paid me a little bit while I went to school, and I fell in love with this company. About that time that I was at ESPN, Moneyball had come out, by Michael Lewis and that became a sort of the rage and obviously they made a movie about it.

I remember reading that when it first came out, cover to cover, and I just loved that story. I think it’s important for data analytics today because I think that story gets bastardized at times about what it really was. I think sometimes people said, you know, that that was about the story about baseball and the Oakland As and being a very successful organization with one of the lowest payrolls in major league baseball, and doing it consistently over a long period of time. But with that story, what some people said was, “Oh, they just had a bunch of stats guys made decisions and you didn’t need scouts or baseball expertise.”

It was really, what the story was saying, was you do need expertise. You do need great scouts and gut, but you also need science and data as part of your decision-making process. When you can marry those two together, you can make much better decisions. Decisions that will produce the best return on investment for ballplayers. You’re investing millions of dollars into a ballplayer that you sign as a free agent or you draft, you want to go off more than just eyeballs.

So I loved that story, and in a way, that’s what Buxton was really doing for businesses, and what we do for businesses. It was really providing the science and the data to compliment the already strong decision-making processes of a company, to help them make better real estate decisions and better customer decisions. That always stuck with me, that fascinated me. That was fascinating to me while I was an intern for them, and then got into ESPN and did that, threw myself into that for four years. But again, I studied business in college and I was always wanting to kind of think about getting back into that world.

Buxton had always stayed in touch with me, and it came to the point in my career with broadcasting where you either need to kind of move markets, or really throw yourself into the next stage and I really didn’t want to move, and I didn’t want to do those types of things and I found a great home in Buxton. That was 14 years ago now, over 14 years ago. I have not looked back, and it’s been a tremendous professional decision, and to see how we’ve grown and advanced and helped companies with those investment decisions over time. So that’s kind of how I transitioned into Buxton.

Andrew Dick: So Bill, tell us a little bit about what you started off doing at Buxton and then what you’re doing today.

Bill Stinneford: Yeah, so I started out in our retail vertical, and Buxton is a consumer analytics company helping build predictive solutions that help people make great investment decisions, be there for new locations or relocations, market optimizations, targeted marketing, helping understand how their consumers behave beyond just demographics. So there’s a couple of different verticals that we have, but our historical vertical where we started was retail. So I started in our retail vertical in sort of a business development role, calling on majority retailers and restaurants throughout, when I first started, the southwestern portion of the United States, and helping in that. Quickly rose in our retail vertical, and then oversaw that and then also over the years took over our growing healthcare vertical and so now sort of oversee all client development, both making sure that our existing client relationships are strong and fruitful as well as helping coordinate our marketing message and our sales efforts to continue to bring new clients into Buxton.

Andrew Dick: That’s a great summary and Bill, how did Buxton get into the healthcare space? Because the audience listening to this podcast, they’re real estate investors, they’re hospital and healthcare executives looking to make smart decisions when they open up a new clinic location or a new hospital, and they’ll say, “Gosh, we’ve heard of Buxton, but primarily in the retail space.” But in reality, Buxton has done quite a bit of work in the healthcare space. Tell us about Buxton’s healthcare expertise and how Buxton moved from the retail vertical into the healthcare vertical.

Bill Stinneford: Yeah, so we still have a very strong retail vertical, but yeah. We’ve been around 25 years as a company, and we started in retail but yeah, over the years we’ve grown into a restaurant, we’ve grown into city government, private equity, and as you mentioned, healthcare. Basically, any type of business, if you have a customer or a patient or a consumer, and you want to find people that look just like that and grow your business with real estate or marketing or get more out of your existing investments, we can certainly help with that.

Our core verticals are those that I just mentioned but you know, we work with Marriott and we work with Fidelity Investments and insurance companies. So yeah, basically we can apply these types of approaches to all those different types of businesses, but specifically with healthcare, which is our fastest-growing vertical and pretty soon will end up being our largest overall vertical. It’s pretty close already. It is exciting to see, and it started probably 12, 13 years ago now. One of our retail clients actually sat on the board of Florida Hospital and they were looking to roll out their Centra Care line, their urgent care line. They were like, “Hey, this is kind of like retail, this type of healthcare business, and I think that you guys can help us with that.”

At the time, we said, “Well you know, we don’t know anything about healthcare, but we’ll try.” And it worked, and in fact, they’re still a client to this day. It’s been a really successful obviously rollout, Centra Care, over the years. They still use it for that. But we’ve branched into other different service lines for them and we realized, hey, there’s something here with where healthcare is going.

Then over the last sort of five, six years as there’s been a huge growth in ambulatory facilities or outpatient facilities, that’s really been the biggest boon to our healthcare business because the things that make an outpatient or an ambulatory location successful are somewhat different and in many cases very different than what makes an inpatient healthcare facility successful. In many cases, in an inpatient standpoint, it is still a bit of: if you build it, they will come. But in outpatient, there are so many choices and there’s so much competition that the difference between success or failure of an outpatient facility maybe a quarter of a mile apart from where you pick, right? So the things that make successful ambulatory location strategies work today are still a combination of some traditional healthcare metrics. You know, certain outpatient and inpatient utilization data, insurance data, competition provider data. Those types of things.

But just as much, if not more, it is an understanding of the consumer and not just based on demographics, but how they live their lives, how they spend their money, how they behave as consumers. Their attitudes toward different things, and also retail metrics. Things like co-tenancy or area draw, visibility. Sometimes people don’t realize that a lot of times your most successful marketing vehicle in a healthcare situation or a retail situation is your facility itself. You know? And how visible are you, and are you located near things that people are driving by all the time on their way to work, on their way home, when they run errands on the weekends. That impression frequency can build up and allow people to understand you’re there. Certainly for things like urgent care that’s vital, but what we’re seeing is even in things like orthopedics and sports medicine, things that were predominantly referral-based, while there’s still a huge component of that more and more you’re seeing healthcare companies go straight to the consumer to advertise their specialty services and location strategy is extremely important in that being successful.

That was just as much to do with understanding consumers and retail metrics as it does healthcare metrics, so when you can combine all those and bring them together, which we’ve done, because now we know a lot about healthcare, it allows our clients to have … or just companies in general that employ these strategies, to have a significant leg up on the ever-growing competition.

Andrew Dick: So Bill, if a healthcare provider came to you and said, “We’re thinking of rolling out an ambulatory care network or outpatient clinic network,” depending on what you call it, what could Buxton provide to that healthcare provider in terms of finding the right location? What type of metrics would you look at, what type of services would you offer?

Bill Stinneford: Yeah, well what we would do, I mean every case is a little bit different. We would want to build a customized solution for each one of those specific clients and what they’re trying to achieve, but you would build a forecasting solution, that is a combination of understanding the ideal patient/consumer profile for that particular service, and also the payer mix that you would like to optimize: is it all-payer, is it, commercial payer? You know, what are you trying to go achieve? Then what are the competitive variables? What are the positive correlating factors that need to be there? Then the traditional utilization data and provider data, and understand what makes successful locations successful and what makes ones that don’t succeed in an outpatient environment for that particular service unsuccessful? And build that solution that then allows the client to be able to forecast any intersection across their service areas or the whole country if they wanted, you know?

They can use the models to say: find me all the locations that will do greater than X in performance and will cannibalize my existing locations by more than a specific percentage that they set. So you help understand how many locations you can support in a market, where those locations should be optimally, how to evaluate your existing portfolio for that if you offer that service line. Which ones are not doing well but they’re underperforming their potential, which ones are not doing well but frankly they’re doing as well as they could be doing and they’re in the wrong spots, or that trade area has changed over time so they need to be consolidated or relocated and then they can use the solution to do that.

So those are a lot of the output that we provide, and we actually provide that into a very easy to use but powerful mapping and analytics platform that they can access on their phones or their tablets or their laptops, wherever they have an internet connection and visualize all the things that we’re talking about: where is their competition, where are their patients coming from, where are their potential patients coming from? Where are those recommended points? If there’s availability that pops up that you want to investigate, you can click a button and get a forecast on that potential site in about two minutes. Store files, run just regular utilization reports, insurance reports, demographic, behavioral reports. All those different types of things at their fingertips, but most imply from a real estate strategy standpoint, understand where their home runs will be and how to avoid expensiveness as well.

Andrew Dick: So Bill, we talked about a new outpatient clinical strategy. What about a health system that has an existing network that wants to analyze how that existing network is performing? Is that something that Buxton could help with?

Bill Stinneford: Yeah, you know, absolutely. I think one of the things that when you build those forecasting solutions and you’re studying their data, what makes them… For instance, you do this a lot with primary care, where they have many, many locations within a market if you’re a system. It’s identifying what’s the DNA of your best locations in suburban markets in your service areas? What are the things that are always present in those trade areas that are sort of present in the okay locations trade areas, that are hardly ever-present in the poor performing trade areas? You know, what are those factors?

Then that model that is built can again forecast future performance like we just talked about. But you can also take it and score the existing locations and compare actual performance to forecast performance. This becomes very valuable for our health system clients because it helps break down what I sort of like to call is the log jam of opinion that can develop.

So for instance, if leadership of the system comes in to evaluate the primary care facilities and their performance and they look at the low performing locations, the question that the CEO asks, she may say, “Why do we have these low performing locations?” Typically, what you’ll have is people pointing fingers at each other in the boardroom, you know? The people that picked the sites will blame the operators and the physicians within the site. The physicians and the operators of the site will blame whoever picked the site. Then eventually, everybody will get around to blaming marketing. They can all agree on that; it’s marketing’s fault.

But you know, in reality, sometimes is it the location that was a miss. Should have never been selected. Or, just as frequently, it was a great location for 20 years for primary care but that trade area has changed over time significantly and that’s not necessarily the most optimal spot for those services today. But the analytics, in an unbiased way, is informing to say, you know what? No matter what you do, no matter how many physicians you put in, no matter how often you change out the front office, no matter how much money you dump in from a marketing standpoint or a huge remodel, you’re wasting dollars. The analytics are showing that for that particular service line if you want it to produce at a certain level, the trade area potential is no longer there. So let’s use the models to understand how to best consolidate that site and where should that be transferred to, or, where should you best locate that site?

But that’s very different than another location that you may have that’s doing the same actual volume, which is below par, but when we look at that with the model the forecasts are saying it should be doing 40% better because this site looks like 10 other sites you have in these types of markets that they have the same type of potential patients in the same volumes, they have the same level of competition, the same area draw factors, the same utilization and insurance metrics. All these things are the same as all these other locations that all do 40% better but this one’s not: why?

Sometimes that can be that it does need to be remodeled or it needs to be moved just a little bit down the street to a more visible area because that piece of the street is no longer where people are drawn. Or it could be that you need to add physicians. A lot of times we see that. The wait times in those facilities end up being longer and it’s tougher to get an appointment because you don’t have the proper staff, or the front office isn’t … You know, the front office help is not as nice as they need to be. Or maybe we do need to do more marketing. But you know that that trade area should be performing better than it is.

That opens up a lot of possibilities because now what you’re doing is not only finding the best places to invest in new locations to the degree that you’re opening up locations for primary care or urgent care or specialty, but you’re also improving the performance of the existing portfolio of investments by knowing which ones to not invest in any more, and then which ones have potential and you should invest in. The overall return on investment on all of your real estate becomes that much better. There’s just a lot of waste in healthcare today because people are making decisions based on opinion, and people that make decisions based on data for the actual healthcare of their business, sometimes they’re not making the best decisions based on data for where they invest dollars.

Andrew Dick: That was a great summary, and it seems to me, Bill, that there are a lot of different companies that claim to offer site selection. A number of our healthcare clients get pitched all the time, but Buxton seems to have maybe the more comprehensive platform for this service. What do you think makes Buxton unique when compared to its competitors?

Bill Stinneford: Well you know, it’s interesting. I think we take a very different approach than the traditional players, I guess, in healthcare, with regard to these types of decisions. I think that that comes from our consumer analytics and retail site selection background. There’s a lot of good companies, but I think one of the things that I tend to see that people are still relying on or offering as a way to select sites is more macro-level traditional healthcare data. So certainly outpatient and inpatient utilization data, but at a county level or a city level. The output may say you have a need for three additional orthopedic surgeons within this market. Okay, great. Where? That’s a big county. That’s a big geography. Again, as we talked about in an outpatient environment, the difference between a successful location or an expensive miss might be only a half a mile down the road, one spot versus another.

So if you’re talking about macro level, county-level data that shows demand for a particular service, great. Where are you going to service that? Because especially as you have so much more competition, both system competition as well as, you know, private companies that are focusing on a specialty or two, many of them, backed by private equity that can choose where they operate, choose the type of payer, the type of patient that they want to go after. They’re employing a lot of these quote-unquote “consumer research strategies” and if you make it much more convenient, if somebody is in need of a service and you make it much more convenient, if your primary care doctor is telling you to go 40 minutes across town but there’s a specialist that you drive by all the time and you’re seeing their billboards and their advertisements on TV and those types of things, well, can I just check them out? And so it’s really important to understand where to be at an intersection level, at a micro-level.

That’s where we grew up and where we still excel today with retail and restaurant, and weaving in a lot of that traditional healthcare data and weaving in over a decade now of really strong ambulatory site selection healthcare experience with our consumer analytic experience and our retail experience really allows us to produce a unique solution that again can help our healthcare clients have a tool that the people that they’re competing against might not have to help them be successful in a very evolving healthcare environment.

Andrew Dick: Bill, let’s switch gears at this point and talk about ICSC or the International Council of Shopping Centers. They host an annual event called Recon. This year was significant from my perspective because there was quite a bit of effort and showcasing health and wellness programs and how retailers can collaborate with healthcare providers. Why do you think there was such a strong push this year to talk about health and wellness at ICSC Recon?

Bill Stinneford: Well, there’s a number of different reasons and I’ll try to knock out a few of them. I mean, first off, I was really excited that ICSC did that because it is such a strong push from a “retail center” standpoint, quote-unquote, obviously, it’s no secret that there are certain retail concepts that are struggling. Some are going out of business. There are vacancies in a lot of these centers. Now, I don’t think that retail is dying. I think that retail is evolving just like healthcare is evolving, but one of the things that you’ll see thriving right now are things like fitness facilities, gyms, restaurants. Things that are focused on a healthy type of environment. Urgent care, different healthcare specialties. So from an ICSC, an International Council of Shopping Centers perspective, to focus on a sector that can help fill vacancies and help create great foot traffic and those types of things, obviously that’s a no brainer.

But I also think you’re seeing the demand on that side, but I think also you’re seeing the demand on the healthcare and the health and wellness side of understanding that healthcare cannot exist in the old traditional way. That it has to be out in the neighborhoods, and it’s not just … You know this is something that we talk about all the time with our clients, with the health system. People need to think about their health system as a brand, and some people within those systems may be thinking about that as a brand, but not enough.

I think sometimes health systems think that people in the market, just regular Joe America, understand the difference between health system A and health system B in a market, but for the most part, they really don’t. So how do you distinguish your brand and how do you make people want to stay with you in sort of a cradle to grave relationship? Not just, “Hey, come to us. We’ll treat you when you’re sick.” But, “Come to us. We’ll keep you from getting sick. We’ll keep you healthy.” That’s really I think the future of healthcare and no amount of healthcare legislation or type of healthcare legislation is going to help us as a country if we don’t start getting healthier and start making better decisions.

Part of that is education. Part of that is taking that education and those types of offerings and types of ways to stay healthy, both with food and with education and with fitness, into the communities. Into neighborhoods. And that’s a retail strategy, right? So the things that will help people be successful in healthcare, offering these types of services, not just health and wellness but healthcare, you’re going to have to be out in the neighborhoods, and to do that you’re going to have to understand a real estate strategy beyond the old, if you build it, they will come.

In our presentations, we talk about how healthcare is evolving. Clearly there are regulatory hurdles and uncertainty with regard to healthcare regulation and certainly, Buxton can’t help with any of that. But the other things that are making healthcare evolve are the evolving consumer, and how people make decisions and choices about the healthcare services that they provide. Their smartphones and where they go and look at things as they go shopping for other things, you know? That you have an evolving consumer and the type of expectation that they have, but also you have, as we talked about earlier, an extremely competitive environment. Extremely competitive.

There is so much money being spent in healthcare, and any time you have that much money being spent and some of the traditional players by taking a traditional healthcare approach are investing those dollars inefficiently and leave themselves open to competitors, you’re going to have a bunch of people jump into that market. Any time there’s a bunch of money to be had and there’s a perceived inefficiency in the market, you’re going to have a lot of players jumping into that space and so you’ve got that. Private equity is in it in a huge way. You’ve got, obviously, you’re looking at the growth of CVS and Walgreens and Walmart and you know, just what is going on with all of that. You’ve got a lot of different players in the space and what are they doing? They’re understanding consumers. They’re understanding a retail strategy. They’re going into neighborhoods and being more convenient and more visible to provide these offerings.

If you’re sitting out there on the free land that the church gave you behind an industrial park that no one can see, you can’t see in from the highway and those types of things, you’re going to get slaughtered. So that’s part of why it’s important to not only have these conversations like you and I are having but why ICSC and retail are getting involved as well.

You know, sorry to keep blabbing here but the last piece on this is in our presentations we talk about Blockbuster. Blockbuster, I think there’s one Blockbuster still in business in Bend, Oregon. Right? But if you and I were having this conversation 13, 14 years ago and I told you Blockbuster would be completely out of business in 2019, you’d have told me I was crazy. But that happened. It wasn’t that Blockbuster didn’t have a lot of really smart people and did a lot of really smart things, but A, they didn’t pay enough attention, or enough people didn’t pay enough attention or pay enough respect to how the consumer was evolving and how they wanted to make choices, and they also didn’t pay attention or give enough respect to the new competitors in the market. “They can’t do what we do,” and that type of thing.

They’re completely out of business. That’s mind-blowing when you think about how big they were and how many smart people that they had, and they did a lot of things right. But it doesn’t take that many bad decisions, or that much not paying attention or giving enough respect to your competitors to let it bite you in the rear, so to speak.

So think about today. You’ve got CVS, right? What is CVS, there are 9000 CVS locations, most of them in the United States. There are 1100 plus MinuteClinic locations. They’re starting to offer other types of services. Obviously Aetna, with the affiliation there. You know, I mean there’s all kinds of innovation that can come from that, and they’re in every neighborhood in the United States. They can be the ones. They’re not there yet, but they could absolutely be the ones that have the ongoing conversation with the people in their trade areas and develop cradle to grave type relationships with those types of people across a variety of different healthcare services and wellness.

That is pretty interesting but should be pretty scary to a lot of traditional players in the space. But what is CVS but a retailer who understands consumers? All of these things are sort of blending together into this world, and so I was glad to see ICSC jump on that. So sorry if I’m talking too long about that, but that’s just near and dear to my heart and I’ve just seen that evolution over the last few years.

Andrew Dick: No, I appreciate the conversation, Bill, and in fact, the one reason I wanted you to talk about ICSC is that I know that Buxton has had a presence within the organization for some time, and that’s really where some of Buxton’s roots started, in the retail space. I also enjoyed our conversation offline about CVS and Walgreens and what those organizations are doing, because they have a powerful footprint. They have a network that’s hard to compete with, and I know they’ve partnered with some of the local healthcare providers to staff their clinics, but you’re right in that CVS and Walgreens are looking to expand healthcare operations and local healthcare providers should be watching what they’re doing, and be concerned in some cases because of the network that they have.

Bill Stinneford: Yeah, you know, and … Yeah, sorry, Andrew. I was just going to say real quick on that, but there are strategies to take if you are those systems to make sure that you don’t get swallowed up by that. You know, but it is taking a neighborhood by neighborhood approach and not a one size fits all approach to your marketing or to the services that you offer. It’s really catering your offerings in each of the neighborhoods that you serve to the population of that neighborhood and their needs and their desires and the services that they may need, and how to educate that population to have better outcomes over time, and think, you know, there’s no one size fits all approach to that.

The way that you achieve those localized, local store marketing if you will, neighborhood customization of your offerings, is to use data and analytics and understand people as consumers, not just demographics in those neighborhoods and understand their behaviors and their attitudes and how often do they exercise or not exercise, how are they eating, poorly or well? How are they aging? What are the different types of things? You could have two houses that demographically are the same, but how they live their lives, how active one is versus another, you know, one could be 65 and hikes three times a week and eats well and is always very active, and the other living right across the street that’s 65 that has the same net worth is a couch potato. You know, one guy needs an orthopedic surgeon, the other guy needs a cardiologist.

If I’m just looking at them demographically, I’m not going to be able to tell the difference, so implementing consumer-level data, understanding people’s attitudes and behaviors in combination with other things, can help people forecast what will be needed and how to change outcomes not on a market level basis, but on a location by location or a trade area by trade area basis. Not every CVS trade area is the same, but they’re using data and analytics to optimize their offerings and their messaging in those local communities to be as successful as possible, and that is possible for healthcare companies outside of those big guys, but you’ve got to implement some of the things we’ve been talking about today.

Andrew Dick: Great point, and I enjoyed that part of our discussion. Bill, switching gears, I know that Buxton recently developed a strategic relationship with CoStar, which is a huge player in the real estate space. What does that strategic relationship look like, and how will it benefit your clients?

Bill Stinneford: Yeah, we’re really excited about the relationship. It is a game-changer in real estate investment. For those that don’t know, CoStar is a very large data and research and analytics company in their own right, and publicly traded and they have amazing information on real estate. What’s available in the markets for sale, for lease, of what type of real estate, what are the asking rents, what’s the asks price for land, what are things being leased for around it, what’s the tenant mix, who are the tenants in particular facilities? It’s just, I’m not even doing it justice, the vast amounts of wonderful data market comps. The vast amount of data and research that goes into their offering. So for the first time, what we’re able to do is combine our two offerings in one platform for the benefit of our clients.

If you think about some of the things we talked about earlier, the output of a healthcare system comes to us and says, “Hey, we want to really grow primary care, urgent care, orthopedics and cardiology in an outpatient setting.” We would build those forecasting models based on combining their data with our data and methodologies and then forecast: here’s how many locations you’re going to have for each of those service lines in the market and here’s where they layout. The best analytical intersections for you. You now have that inventory of top potential locations that meet all the criteria that your successful locations already have for those services. Well now with CoStar, the one thing we weren’t able to provide was: okay, that’s great. These are the best analytical intersections for me. Is there anything available that meets my ideal location both in terms of size and quality but also economics.

Now, they can actually turn on the Buxton recommended potential traders. You can turn on then CoStar and say, “Okay. What’s available that meets my economic criteria, my size criteria, my use criteria, that fall within those recommended trade areas?” So actually see all of that in one platform, see who to contact there or who to put your people in contact with to get these very precious sites in the most ideal trade areas as quickly as possible without having to wait on brokers or other things that may take a while, or only see some of the sites that may be available. This gives you access to all of the sites with all of the information that you have to get to sites … Again, we’re talking about a very competitive market. To get to those sites in the best-recommended trade areas analytically faster than your competition, it is really a game-changer in our world.

Andrew Dick: So Bill, when we were talking offline it sounds like your clients could also use this, the CoStar feature as well, to the extent that they were looking at a leasing arrangement with a referral source and the Stark law or the anti-kickback law may apply. You could quickly pull comps from that area and make an educated decision based on what is fair market value in that area. Is that right?

Bill Stinneford: That’s exactly right. I mean, CoStar does a tremendous job pulling that data in every market across the United States at regular intervals so that it’s clearly available on the platform. So you have to utilize data to prove that you are asking fair market value for real estate. You can easily pull that report in a few seconds and so it’s just tremendously valuable, yes, for Stark law compliance and anti-kickback.

Andrew Dick: Right. Bill, as we wrap up, I want to ask you just a couple of questions. Over the next five years, how do you think the Buxton business model will change?

Bill Stinneford: It’s interesting. Over 25 years, our business model, what we do has not really changed, which is combining our clients’ data with our data and methodologies and technologies to produce answers, right? We love data. We’ll always love data. We spend millions of dollars a year on data to help answer a lot of these questions, but data in and of itself is worthless. There’s a lot of people that are data-rich and insight poor, to use the cliché. But what we really bring to the table and have always brought to the table is the ability to find the patterns in the chaos. To know what to do with all of that data combined, and experience to create answers. These are the things that you need to be successful and here are all the places that you do not that have it. Here are all the places that you are that don’t have it anymore. Right? Whatever that ends up being.

Now, where we’ve changed and evolved and grown is how our clients interact with those answers. So we talked about our technology platform that enables our clients to push buttons easily and get the answers that they need to make these decisions, so I think you’ll continue to see our technology evolve. You’re seeing all kinds of things with artificial intelligence and machine learning. Those are buzzwords out there, and we certainly implement those things into our solutions, but you always have to question with that, when you hear those sexy buzzwords, you still need a lot of sample set. A lot of data points, to be able to come up with valuable insights in that. But we’re experimenting with that. Data visualization, mobile data to be able to follow people’s traffic patterns and shopping behaviors. There are all kinds of interesting technologies and new data sources that we’ll continue to investigate and implement and develop ourselves to continue to make our answers better and the way in which our clients interact with them better.

But, you know, the fundamental question of what Buxton does, helping people understand who their consumers are and where’s everybody else that looks just like them that aren’t utilizing them right now, and where are the best places to invest their dollars for real estate, that’s always going to be who we are. In healthcare, that will only continue to grow. I think you’re continuing to see the advancement and the acceptance of these types of strategies and the need to understand people, patients as consumers. The need to think about things not purely as retail but more like retail than they have in the past. So I think you’ll continue to see us invest heavily in our healthcare vertical, in data technology and people to continue to produce the best solutions for our clients to help them navigate a very competitive and evolving time.

Andrew Dick: Great. Bill, where can our audience learn more about you and Buxton’s healthcare practice?

Bill Stinneford: Yeah, you know, the best place, we have a lot of great content, is to go to our website. That’s just buxtonco.com. You can contact me directly as well. It’s Bill Stinneford and my email is bstinneford@buxtonco.com. Or you go to our leadership page and you’ll see our leadership and our email addresses on the website as well, but there’s a healthcare section on there. Lots of great content and videos, and for people at any stage to learn more about the things that we’re talking about today and why they’re so important.

Andrew Dick: Bill, thanks for joining the podcast. I really enjoyed our discussion. Thanks to our audience for listening as well, on your Apple or Android device. Please subscribe to the podcast and leave feedback for us. If you have any ideas for future topics or guests, please reach out to me. My email address is adick@hallrender.com. We also publish a newsletter called the Healthcare Real Estate Advisor. To be added to the list, please reach out to me at the same email address. Thank you!

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Creating HealCo, A Technology Platform to Manage Medical Office Timesharing with Kirat Kharode

Creating HealCo, a Technology Platform to Manage Medical Office Timesharing with Kirat Kharode

An interview with Kirat Kharode that was recorded in Scottsdale, Arizona at the Health Care Real Estate Legal Summit sponsored by Hall Render. In this interview, Andrew Dick interviews Kirat Kharode, Founder and CEO of Healtor. Healtor is a technology platform that is designed to create a marketplace for health care providers to better utilize timeshare space and to manage timeshare arrangements in a compliant manner.

Podcast Participants

Andrew Dick

Attorney with Hall Render.

Kirat Kharode

Founder and CEO of Healtor.

Andrew Dick:  Hello and welcome to the Health Care Real Estate Advisor Podcast. I’m Andrew Dick. I’m an attorney with Hall Render, the largest healthcare focused law firm in the country. Today, we are broadcasting from the Health Care Real Estate Legal Summit in Scottsdale, Arizona. My guest today is Kirat Kharode, the founder and CEO of Healtor. We’re going to talk about his career and how he ended up founding a tech startup company. Kirat, Thanks for joining me.

Kirat Kharode:  Thanks so much for having me, Andrew.

Andrew Dick: Before we jump into your business, talk a little bit about your background. You have a unique story to tell, and tell us a little bit about.

Kirat Kharode: Sure. I started my career in hospital administration. I went to a grad school at Johns Hopkins School of Public Health. Started my career at the VA hospital in Pittsburgh. I had the opportunity to work with the transplant program there and separate the transplant program to be the first independent in-house liver and kidney transplant program based out of a VA hospital in the country, and that was my administrative residency. Kind of opened my eyes to compliance world regulatory issues and fostered my interest in going to law school.

Kirat Kharode: But coming out of grad school I didn’t really have a whole lot of funds, didn’t want to pay for law school. I was fortunate enough to find an opportunity where a health system, the University of Pennsylvania, paid for me to go to law school at night across town in Philadelphia while I was working at Penn.

Kirat Kharode: After that, I continued in hospital administration, did law school while I was working. Completed law school. Learned a lot about compliance. Regulatory health law was my particular focus, and it helped me understand a lot of the nuances as I was going through different business development and operations roles, to understand the complexities and also have intelligent conversations with the general counsel in the facility so that we could have some healthy discussions about what was appropriate and what wasn’t appropriate in the risk spectrum.

Kirat Kharode: I stayed in hospital administration for almost 20 years, working in all kinds of different organizations, both nonprofit, for profit publicly traded, for profit privately owned. It just opened me up to a gamut of sort of issues, both from a strategic perspective as well as an operation perspective that really kind of set the stage for the creation of Healtor.

Andrew Dick: You have this health care administration background. You have a law degree. At what point did you say, “Gosh, I want to start a technology company.” I mean, that’s a pretty big transition.

Kirat Kharode: Sure, sure. Well, you know, I think the theme throughout my career, regardless of the setting that I was in, was really focused on making convenient ambulatory care settings for patients. With the physician shortage that exists nationally, to me, it’s very important to foster that medical office ecosystem because I think the medical offices are really the unheralded hero to me in the whole health system. Everything that you do from the most complex of procedures to the very basic. The birth of a child doesn’t happen in a medical office, but certainly the first conversations do.

Kirat Kharode: The NRC actually just put out research that 80% of decisions that patients make are based on convenience of the provider location. To me, medical office locations was always extremely critical.

Kirat Kharode: As a hospital administrator, I feel today too, that there almost should be term limits on how long you stay in hospital administration before you’re forced to do something that really changes the world because, as an administrator you see all kinds of issues that you know that, hey, if somebody had a solution like this, this would solve a problem. I think that too often hospital executives stay in positions. They move from one facility to the other. They come up with these realizations, and it just kind of goes out the window.

Kirat Kharode: I really wanted to focus on this because I see it as an important issue, especially as we move to more of a value-based world. As more services are done outside of the hospital facility, I think it’s critical to have a technology where it makes it easier for doctors and hospitals to access and create timeshare spaces and places where patients want them to be.

Andrew Dick: Let’s stop there. Hospital administration, you find a pain point with how hospitals are managing, owning the real estate. When did the light bulb go on and you say, “Here’s a problem. I need to find a solution.” Talk a little bit about that. What was that moment like and talk about the pain point that you’re trying to solve for.

Kirat Kharode: Sure. To boil it down to just one or two might be a little difficult. I think there’s a whole … There’s a whole subset of problems that kind of compound the issue of medical office timesharing.

Kirat Kharode: First is just basically that right now, like 50 years ago, if a physician wanted to look for a medical office space in a new community, and they didn’t want to spend an inordinate amount for capital cost and leasing out the facility for 10 years, there’s really a few options that exist besides calling around to every building in town to try to find space.

Kirat Kharode: On the front end, there’s that problem that exists. On the back end is the bigger issue of whether hospitals are … When they enter arrangements with physicians if they remain compliant with stark and anti-kickback statutes.

Kirat Kharode: And both of those issues kind of came up in various points of my career a number of times as both we were trying to place physicians out into communities that we didn’t have a presence, hub and spoke type of strategy as well as issues where we have timeshares with physicians and we’re trying to manage it as best we can. But there’s just a whole host of compounding issues that take place and make it a little bit complicated to manage that process for both the administrators as well as the physicians, which leads to lapses in payments, and potentially down the road could lead to [inaudible 00:06:55].

Kirat Kharode: So, I can’t pinpoint a moment in time necessarily that I came to the realization. I think it was over the course of a few years that I realized that this was really something that needed to be addressed and was extremely important.

Andrew Dick: So, getting those specialist out in the community, trying to document those arrangements, trying to ensure that they’re fair market value, and you’re really focused on the timeshare space, is that correct?

Kirat Kharode: That’s correct. Yep.

Andrew Dick: And so, for our listeners, a timeshare space being a physician can go use some clinical space for a half a day, a day, a couple of days throughout the month, but there’s no longterm commitment. It’s just buying blocks of time. Is that what-

Kirat Kharode: That’s right. I mean if it’s a hospital leasing to the physician, there’s the commercial it has to be set in at dance in terms of the rate, and it has to be a year long in terms of the lease, depending on who the owners are and the relationships, those factors change a little bit have a different … They can lease it at different amounts of time than hospitals can when they have a referral arrangement with the physician.

Kirat Kharode: So, it’s certainly a very small amount of time, or it could be two, three days, but right now there’s no technology platform. If you wanted to buy a building, you could find that online. You could buy a medical office building. You could lease a 10,000 square foot space that’s completely shell and build it out yourself. You could find those opportunities. But if you wanted to look for a second generation space per se, one day a week or two days a week, that’s going to be really hard unless you’re picking up the phone and calling around at this point.

Andrew Dick: So, timeshare space is the area you’re working in, and you recognized really maybe two pain points. One is there’s not a way to connect landlord and tenant who wants to enter into these type of timeshare arrangements, at least not efficiently. And then there’s that compliance issue. Stark, kickback, if it’s two providers who want to enter into these arrangements. There’s often not a lot of money exchanging hands, but the risk is a quite great if they get it wrong.

Kirat Kharode: That’s correct.

Andrew Dick: Right? And you witnessed that as a hospital administrator, healthcare professional.

Kirat Kharode: That’s correct.

Andrew Dick: So, talk about Healtor and how does it solve for those problems?

Kirat Kharode: So, we essentially solve for six different issues, and those are pain points that we’ve learned through, not just my own experience, but countless conversations with hospital executives, medical office owners, physicians, and as we’ve developed the product, and we’re still very early stage, but as we’ve developed the product, we now have 70 customers around the country. We have three health systems in the pipeline as well for our compliance product. So, we’ve had the opportunity to talk with many executives, and I think it’s extremely important as we grow that we keep that alignment and discussions with the customer very close to what we’re trying to build.

Kirat Kharode: Those six pain points that we’ve encountered are a lack of accountability on who owns the timeshare. So, in a health system, there’s multiple different angles by which a timeshare becomes active. For example, business development may bring the doctor in. They court the doctor for a couple of years, then they hand off the arrangement to maybe a practice administrator who has a space that’s there for employee doctors. The actual leasing goes to the accounts receivable department and finance who’s tracking payments.

Kirat Kharode: There’s all these different hands kind of involved in that process, and when there’s a breakdown, there’s really few people that are accountable in terms of who’s actually responsible for that. So, that’s the first one.

Kirat Kharode: That triggers things like payment lapses, which is the second issue that we’ve heard quite a bit. So, physician either forgets to pay or now they’ve been there for a year, and Dr. Jones has decided that it’s time that he stopped paying because he’s doing a lot for the hospital, and as an administrator I’ve heard that quite a bit as well.

Kirat Kharode: The third is the lack of communication that exists between tenants and the physicians who are valuable parts of this ecosystem, and hospitals often look at medical offices as being an incubator to build a broader relationship with the doctor within the inpatient facility. And yet the lack of communication about the space issues that exist themselves, if something’s broken or not fixed, that could also ruin strategically the relationship with the doctor.

Kirat Kharode: The fourth one that we’ve heard quite a bit is a space creep. So, physician has space, and they decide they’re paying for two exam rooms. They decide that, yeah, take a third because nobody’s there. That’s obviously not okay either. We’ve also encountered a lot of organizational history gap that exists when there’s mergers and acquisitions and people who have an Excel spreadsheet somewhere are no longer a part of the organization, and now many hospitals are combining it to one and centralizing their real estate function and have no way to sort of track what’s going on in these new facilities that they’ve acquired.

Kirat Kharode: And then finally, it’s really the core issue of the front end piece, which is underutilized medical spaces not being optimized by the hospital. And often, employed medical groups that are affiliated with hospitals either through a captive PC or another arrangement often have specialists that they have out in the communities and they’re willing to take a loss on those employed specialists, but a big part of that overhead is where their offices are located. And when a physician is out during surgery or they’re rounding at the hospital, in days when those offices are not used, those lack of optimization creates overhead challenges for the medical group.

Andrew Dick: So, I’m hearing … You hit on a number of points that I’m very familiar with. One, the compliance issue but also the timeshare arrangements historically haven’t gotten the attention they deserve. The whole health system administrators will say, “Yeah, a couple of hundred dollars a month even if we don’t collect or we mess this up. It’s not a big deal.” When, in reality, is a very big deal.

Andrew Dick: And then, you’ve also talked about efficiency of timeshare spaces. So historically if a hospital has some timeshare space, you’re right, maybe they rent out a couple blocks of time throughout the month, and the rest it’s just sitting idle, right? Not generating any revenue, not helping further the health system’s mission, and that’s what you’re hitting on, right?

Kirat Kharode: Absolutely.

Andrew Dick: You’re hoping to make that space more efficient. And how do you do that?

Kirat Kharode: Right. So we have three basic products within our technology that we’re building right now. Healtor market is the front end piece of it and relates to onboarding. Healtor recon is our compliance engine. And the third piece is Healtor MD, and that’s more of our management function. Each of those plays a different role.

Kirat Kharode: The front end marketplace is like an Airbnb for medical offices if you will. And, as we’re building this … We’ve started … I wanted to point out we’ve started … As a non technology person, I’ve now surrounded myself with a lot of resources of really experienced technical people. But my goal from the beginning was really to be very basic and prove out the concept and really figure out our product market fit in terms of what we’re doing so that we’re not spending a whole lot of money and resources to build the technology that’s fancy and really doesn’t serve anybody’s purpose.

Kirat Kharode: So, what we’ve done is really create a basic front end splash website right now to prove out the concept around Healtor market. Right now we have 70 customers. We’ve already started generating revenue, which is really exciting. The Healtor … The recon piece of it, which is a compliance engine is where we’re working with health systems to figure out ways to take their best practices from across the country, and the health systems that we’re working with all have these pain points and so they’re really willing to work together in terms of building a product and improving our product from what I believe is the ideal to really what the customer believes is crucial in terms of making the compliance product effective.

Kirat Kharode: And the third piece of it, Healtor MD, is going to be further down in our technical development but really deals with how are we going to manage that space creep issue effectively and use technologies appropriately, whether it be machine learning, whether it be some sort of distributed ledger, a combination of those including IOT, things that we can use to basically take our technology and make it easier to manage the utilization of these spaces and do it in a compliant manner. So, those are the three basic areas that we’re, we’re working on.

Andrew Dick: So the marketplace idea is pretty interesting. So Airbnb gets a lot of attention, but this product will allow a physician, for example, to potentially find unused or available timeshare space. Is that the right way to look at it?

Kirat Kharode: Absolutely. So, available timeshare spaces and areas where they’re looking. We also give the control … I mean a lot of the control in that process is obviously with the physician that has a space, the landlord, so to speak. So, the physician landlord really has to make the decision about who they want to welcome into the space.

Kirat Kharode: And so, in these conversations that we’re having, and it depends on area. There’s some specialties that really aren’t welcome from a competitive perspective or from a perception perspective, and we honor those requests as we’re developing our protocol to make those arrangements.

Kirat Kharode: So, it’s not completely … It’s not exactly like Airbnb in that there are certain restrictions of who’s coming into the space that we allow, but we are creating that mechanisms to be able to bring physicians into communities and into spaces and blocks of times in these timesharing increments that they’re looking to come into.

Andrew Dick: What would that look like? You log … You get online, and you’d log into Healtor, and depending on what market you’re in, at some point, I know you’re company is relatively new, but as you grow out in certain areas around the country, someone could either list I guess or find available timeshare space. Is that right?

Kirat Kharode: Yeah. Ultimately that’s what’s going to happen. I suspect that this summer we’re going to be doing some private launches in particular regions of the country that we’ve already realized are pretty hot areas from the 70 customers that have signed up so far. And those are areas where we’re really going to fine tune the product itself and make sure that it’s delivering and the quality’s high before we kind of roll it out to five or six markets and so forth and so on.

Kirat Kharode: So, we’re really excited about some of the partnerships that we’re creating, some of the things that we’ll be announcing very soon about alignments we’ve made with really prominent members of the real estate community. Really a who’s who of BOMA [inaudible 00:18:25] if you will in terms of who’s helping us and is already on our board.

Kirat Kharode: And so we are envisioning a scenario where it’s an alignment both with brokers, with physician liaisons and hospital executives as well as the general marketing to the community of physicians at large that are looking for spaces and have spaces.

Andrew Dick: So let’s talk about the second component, the recon component, compliance. It’s a big deal in the timeshare world. What will the Healtor platform offer a healthcare provider in terms of compliance?

Kirat Kharode: Well, it’s really the management and the ability to account for, on a monthly basis, the transactions that are happening and any changes that might create a trigger. For example, if a physician stops paying in the middle of their lease, that sort of compliance alert and that chain of command at a very basic level will be a function that we’ll have a through the Healtor recon platform, but the compliance engine is being built to track those payments on a monthly basis.

Kirat Kharode: We’re also looking forward to building APIs with different data sources around the fair market value specifically so that if there are changes, so that these quote-unquote … Some of these in a discussion I was having the other day, there’s a physician who had a space, had a lease that was an evergreen for 20 year, and now they’re paying significantly and have for many years been paying significantly under fair market value. With Healtor recon that won’t be possible because we’d have caught that at the beginning. And I think that’s an important piece to highlight because in my experience and the experiences that I’ve heard from hospital executives, it’s one thing if you approach a physician who hasn’t paid a month in and say, “Hey doc, you’ve forgotten to pay. Something must’ve gone wrong with the setup.”

Kirat Kharode: It’s a very different conversation 18 months later when the person hasn’t been paid, and now they’ve incurred thousands of dollars in fees and penalties that they now owe the hospital, and they’ve also been bringing a ton of admissions, and they’re now the rock star of the hospital. And so, that immediate communication component is going to be a big part of recon as well.

Andrew Dick: Yeah. Because those noncompliant arrangements can really create tough conversations between providers and jeopardize those relationships.

Kirat Kharode: Right. And it’s also who … Going back to the point earlier about accountability. If there’s a clerk in finance who realizes that there’s been a non-payment, they might try to escalate it through the channels that they have, but they get buried with work. They’re trying to reach out to a business development person who, really what they’ve been spending two years trying to recruit those physicians. Do they really want to be shaking that person down now for a lack of payment along with kind of just the culture that often is created. As you pointed out earlier about, is $200 is really a big deal here and there? If you really think about the downstream revenue, which even though many hospitals don’t want to talk about really, that’s really what it’s all about is the downstream revenue that these physicians are bringing to the hospital, which is millions of dollars in some cases, and are they really going to irritate the physician about $200 here or there? It’s something that’s difficult to have when you don’t address it right away and proactively.

Andrew Dick: So, the way I envision this platform working almost like a … Not only do you have this Airbnb type component where you can shop for space or list space, you’ve got this compliance component that helps you manage the space. So, almost like a property management type platform. Is that a way to think about it?

Kirat Kharode: Yeah. In some ways it’s a bit of a property management platform, but really it addresses this particular pain point around timeshares and these arrangements that exist. So, we’re not trying to do everything to everyone. We’re really trying to address this … Property management, as you know Andrew, is such a wide span, a spectrum of things that get covered. And what we’re really trying to do is provide a specific value set around this pain point that everybody seems to have. And everybody seems to hate medical office timeshares, but the phrase that keeps coming up to me is necessary evil. Medical office timeshares are something that every hospital needs. Ever hospital wants to have, but it’s just a pain to manage. And that’s really the specific property management issue that we’re trying to tackle.

Andrew Dick: So, the third benefit, which sounds like will be developed maybe a little bit later on, this Healtor MD, that will help you manage the space. Give us a little bit more information about what that might do when you build that out.

Kirat Kharode: Yeah. I think that with Healtor MD, there certainly is going to be an integration beyond just the online technology but into more of a hardware integration. So for example, the monitoring of the spaces itself, and for the folks that really are … The health systems that really are on the Uber end of being compliant. these are the folks that we’re talking to about, what can we do about space to (a), from the get-go, create a 3D visual of the space, of what it looks like, what it looks like today, what’s in there, having a potentially [inaudible 00:23:54] some of the equipment that’s in there, looking at the activation and the doors as a key component of who’s entering the space, when they entered, how long they were there and tracking that utilization.

Kirat Kharode: And it also ultimately, if things go according to plan, will also be an automatic indicator that would prompt us to alert the medical office owner that they have under utilized space. If they have blocks and weeks and weeks ago by without a room or two rooms or a part of the space or all the space not being utilized on a particular day of the week. And so then it basically will fuel the Healtor market and get us more activity on that end too.

Kirat Kharode: So, Healtor MD is really going to be one of the things that we will build out over time once we really have the first two components built out. But I’m really excited about it. I think there’s a lot of the application that will come, and depending on the needs of our customers, we’ll adapt and we’ll speed up the development timeline to address those needs sooner rather than later if we have to.

Andrew Dick: Well this is fascinating. I think there is definitely a need for a product like this. Talk about you founded the company not so long ago have made quite a bit of progress in a short amount of time. Talk about that from the point when you founded the company. How long ago was that?

Kirat Kharode: Yeah, so we started the company in January of this year, so not too long ago. I’ve obviously been thinking about it a lot longer than that, but we became a C-Corp in January and started at that point, but since that time, we have, even though we’re a small team, a set of developers, there’s a few people that are helping me out. We have annual goals, and we have a quarterly goals that we track weekly in terms of the progress. And in the first six months, one of the things I really wanted to do is make relationships with the industry. There’s a lot of stuff, even having done this for almost 20 years, there’s a lot of things that I don’t know, and I’m learning things every day. And so really getting closer to the customers, whether they be the physicians, the hospital executives, the property management companies, the brokers, and really understanding what these pain points were from a macro perspective so that I’m that making assumptions about what the product should be or should ultimately look like.

Kirat Kharode:  And so, I’ve really been thrilled. I’ve met a ton of people. I’ve had hundreds of conversations about medical office timeshares. I joke around. I’m like the Bubba Gump shrimp guy for medical office timeshares because I’m always going around talking about medical office timeshares. But it’s really been fascinating, and everyone has a different perspective, and everyone … The common sentiment is that these are pain to deal with, but if we have a solution that comes in and can fix this, it’d be extremely valuable to a lot of people.

Kirat Kharode: And one of the very interesting things … I was so focused on the United States, and last week I was contacted by one person in Canada and one person from Australia. And so, as we are looking at our addressable market, it’s a lot larger than I initially expected this would be.

Kirat Kharode: So, I think there’s a lot of applications that we are probably not even thinking about when we look at the global market just yet. But we have to walk before we can run, and that’s exactly what we’re doing right now.

Kirat Kharode: So, the first six months have been really busy and active, and we value the key KPIs around revenue as being our North star in terms of how we’re developing the company and what metrics we’re looking at to grow. And so, we wanted to get to having revenue, ideally even before the technology was completely rolled out, which I’m thrilled that we’ve done. The traction from having customers join as quickly as they’ve been joining and the health system’s interests and just the tremendous amount of interest and activity as will be reflected in our announcement of our advisory board very soon, which really reflects a whole a spectrum of thought leaders in the healthcare real estate world.

Andrew Dick: So as we wrap up here, talk a little bit about your vision over the next five years and what does Healtor look like five years from now?

Kirat Kharode: Yeah, I think five years from now, five to seven years from now, there’s going to be … Ideally it’ll be …. In the medical office world, It’ll be a household name, if you will. Everyone will know that this is the gold standard to turn to as it relates to medical office marketplace and compliance.

Kirat Kharode: Marketplaces aren’t easy to develop. There’s just so many different factors in there, and there’s a lot of things that could trip up our success, but I think if we stay grounded and we really stay close to what the customers need and really keep fine tuning the product market fit, then I think that we’ll get to a place, in five years, where it’s very possible that we are, not only in medical office a household name for medical offices in the United States, but around the world.

Andrew Dick: How can our listeners find you and Healtor if they’re interested in the product?

Kirat Kharode: Sure. I think the easiest way is probably just email me. My email is Kirat, kirat@healtor.net. Please feel free to email me and share your thoughts, or any questions I can answer, I’m happy to do that.

Andrew Dick: And so if providers want to try the product out or be involved developing the product, they can just reach out to you.

Kirat Kharode: Absolutely, yep. Right now we have a very basic splash website right now where we’re lead-generating through a contact form, and I’m having discussions even through our chat rooms sometimes where I’ll take the helm and be answering chat questions from folks who interact through our website, and the questions range in spectrum from compliance issues to what they’re actually looking for in terms of space.

Kirat Kharode: And so, if they want to reach out to me they can certainly reach out through our website, healtor.net. We have a contact form on there. Again, it’s a very basic site, but it’s up and running, and my email would be the best way.

Andrew Dick: Terrific.

Andrew Dick: Kirat, thanks so much for being on the podcast. I want to thank our audience for listening as well. On your Apple or Android device, please subscribe to the podcast and leave feedback for us. We also publish a newsletter called the Healthcare Real Estate Advisor. To be added to the list, please email me, Andrew Dick at adick@hallrender.com.

 

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