Q22018 Healthcare Practice Groupmarketing.joneslanglasalle.com/SouthWest/SanDiego/...Healthcare...

HealthcarePractice Group Medical Office Report

San Diego County

Q22018

Jones Lang LaSalle Brokerage, Inc.© RE License #01856260

sdmedicalrealestate.com

The retailization of healthcare is shifting the real estate dynamic in San Diego and keeping the medical office market robust. New walk-in clinics and urgent care facilities are opening at a higher frequency as primary care providers and health systems seek out new methods of offering more convenient access to care. There has also been increased activity by healthcare providers to move more outpatient services into medical office and retail locations in neighborhood communities. Despite this steady growth in demand, there remains a lack of new medical office projects in the construction pipeline.

By the end of the second quarter, occupancy among San Diego County medical buildings had increased, posting 181,841 square feet of positive net absorption over the past 12 months. One-half of medical lease transactions were for space consisting of 4,000 square feet or larger – a trend that has gradually become more apparent over the past several years, due in part to health systems acquiring and growing private practices. Over the past 12 months, the county’s aggregate net absorption equates to 1.5% of its total inventory of medical space.

The county’s vacancy rate is healthy and stable at 6.9 percent, almost exactly half of its 2009 peak of

13.7 percent. Essentially every submarket in the county is now in single-digit vacancy. High-quality property and space remains in particularly high demand, as evidenced by the ninth straight year of declining vacancy and positive net absorption among Class A MOBs. Only three of the nine San Diego medical office submarkets recorded negative net absorption in the second quarter. La Jolla/UTC drove most of the medical office demand with a total of 156,050 square feet of positive absorption, primarily due to the recently delivered 150,000-square-foot Koman Family Outpatient Pavilion located on UCSD’s La Jolla campus.

The weighted average asking rental rate for medical office space continues to hold steady, with a current year-over-year increase of 0.9 percent for the county overall. While Class A and B rates continued to climb to $4.17 and $3.74, respectively, a drop in Class C asking rates offsets the overall average. The North County Coastal submarket once again posted the highest average asking rental rate at $4.58 per square foot per month, full service gross. In a distant second was La Jolla/UTC/Sorrento at $4.04 per square foot per month – keeping in mind that most UTC buildings charge for staff and patient parking, which brings occupancy costs in that market closer to those of North County Coastal.

Market conditions

The San Diego medical office market remains strong.

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JLL Healthcare Practice Group

The county has seen nine straight years of positive net absorption, and one would be hard-pressed to identify an argument that would suggest the trend is not going to continue. We can expect to see the large healthcare providers jockeying for position by growing their outpatient footprints in medical buildings and retail centers in the community. Adding to the competition will be the growth of regional and national healthcare providers who specialize in a single area of healthcare services such as urgent care, outpatient surgery, dialysis, dermatology and cosmetic surgery, among others. Many of these organizations, who vary widely in size, are proving to be active players in the market since

they are generally more nimble and specialized than traditional health systems – one of the many reasons strategic partnerships and M&As will continue.

As online retailers temper the demand for bricks and mortar, retail rents should become more affordable, and not only will retail landlords be more open to having medical tenants in their centers but they will seek them out. As this new “supply” surfaces, it may be that the retail sector’s newfound interest in healthcare providers is what keeps the balance of MOB supply and demand in balance.

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6.9%Countywide direct vacancy

181,84112-month net absorption (s.f.)

131,044 s.f. (Q2 2018)

0.9%12-month rent growth

$3.53 FS Average Asking

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Net absorption vs. Direct vacancy

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Class A and B direct asking rents*

Forecast

having leased that building and planning to take occupancy in the fall of this year, the vacancy will soon drop to sub-5% and more accurately reflect the tight market that it is. The I-15 corridor remains an area of San Diego where people want to live and work, which will continue to fuel demand for medical office space in the area.

La Jolla / UTC / Sorrento: Two large medical office projects – University Pacific Centre and The Campus on Villa La Jolla – traded in the first half of 2018, an indicator of long-term confidence in the UTC submarket. Upon completion of UCSD’s new 150,000-square-foot medical building on campus – fully leased upon delivery – this area saw slightly more net absorption in the second quarter alone (144,000 SF) than it now has in total vacancy (143,000 SF). UTC continues to see healthy demand from various sized medical groups. In response, most UTC MOB owners have again pushed rents, which are now up to an average asking rate of $4.04 per square foot, full service gross.

Kearny Mesa / Mission Valley: Kearny Mesa is home to the flagship hospital campus of the county’s largest health system, Sharp HealthCare, as well as the only children’s hospital in the region, Rady Children’s Hospital. This submarket’s payer mix may not be as good on paper as that of some of the other submarkets in San Diego, but with such a

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Submarket updates and trendsOceanside / Vista: After obtaining approval from the Oceanside Planning Commission in June, Scripps will be breaking ground on their 85,000-square-foot medical office building on Jefferson Street. The future of the 50,000 square feet they lease on Cedar Road in Vista is unknown. Meanwhile rumors circulate about Tri-City Medical Center being closer to resolving the legal mess that has been dragging on for years with their 60,000-square-foot campus MOB, but when that will actually occur remains uncertain. The dynamics of these three properties will have a significant impact on market conditions in this area.

Escondido/San Marcos: All hospital services have now vacated Palomar’s former hospital in downtown Escondido. Vacancy is still hovering at 10%. Leasing activity in this area remains quiet, except for Phase I of the on-campus Palomar Health Outpatient Center (76,400 SF) in Escondido that will be delivered 100 percent preleased by the end of 2018.

North County Coastal: The subregion that spans Carmel Valley up to Carlsbad continues to boast low vacancy (5.9%) and high rents ($4.58 full service average). Only Tri-City’s medical building on El Camino Real has more than 10,000 square feet of vacancy, and there is a scarcity of fully improved medical office space on the market. North County Coastal remains an area where seemingly “everyone wants to be”. Given the unmatched demographics it has, medical practices tend to opt for first-class facilities that North County patients are generally attracted to. The combination of steady demand and very little new development has always kept the submarket stable, even during the Great Recession, and today it is pushing rents to new heights. Even Class C product is tight, benefiting from the trickle-down effect.

I-15 corridor: The vacancy rate in the I-15 corridor deceptively sits at 10%, as it has for the past year, due to the vacancy of the Sharp-Rees Stealy’s former 57,000-square-foot building on Via Tazon. With UCSD

Vacancy rates - by submarket

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Direct asking rental rates - by submarket strong base of hospitals and high-quality healthcare services, and with most of the county’s major freeways converging in and around the submarket, the outlook for this area’s healthcare real estate remains very promising. Its current market indicators back that up, including its vacancy (5.7%) and

average rental rate ($3.90 FSG). Sharp and Rady’s continue to grow their service platforms organically within the submarket, as do many private practice physician groups.

Uptown / Hillcrest: This healthcare-heavy area remains one of the tightest submarkets in San Diego, with a vacancy of 5.9%. The majority of activity in Hillcrest is coming from users under 5,000 square feet, with an occasional larger requirement floating around. If we look purely at leasing activity it may seem like the area is sluggish, but with very little high-quality space available, more tenants settle for renewing than perhaps they otherwise would.

This is also an area where younger physicians are gradually advancing their ownership in practices, and with time these younger doctors will look to upgrade their facilities, which should lead to increased activity.

East County: After two years of rising occupancy in East County, this submarket experienced slightly

Total inventory (sf)

Q2 2018total net

absorption (sf)

12-month total net absorption (% of inventory)

Q2 2018 direct

vacancy (sf)

Q2 2018 direct

vacancy (%)

Q2 2017 direct

vacancy (%)

Q2 2018 average

asking rent * ($ psf)

Q2 2017 average

asking rent * ($psf)

Oceanside/Vista 1,029,997 671 0.9% 91,859 8.9% 9.8% $3.07 $2.94

Escondido/San Marcos

885,591 -11,439 1.8% 87,500 9.9% 10.1% $3.01 $2.91

North County Coastal 1,330,698 11,591 1.1% 78,198 5.9% 7.2% $4.58 $4.47

I-15 Corridor 983,466 2,467 0.6% 100,705 10.2% 10.7% $3.28 $3.48

La Jolla/UTC/Sor-rento

1,974,642 144,459 8.4% 143,123 7.2% 8.2% $4.04 $4.02

Kearny Mesa/ Mission Valley

1,452,459 -14,769 -1.6% 82,608 5.7% 4.1% $3.90 $3.69

Uptown/Hillcrest 943,709 8,222 0.3% 56,077 5.9% 6.4% $2.94 $3.01

East County 1,716,691 -10,488 -0.2% 89,098 5.2% 5.0% $2.99 $3.18

South County 1,446,067 1,505 0.1% 80,076 5.5% 5.7% $2.76 $2.79

Other 482,946 -1,175 1.2% 31,246 6.5% 4.8% $2.93 $2.37

Market Totals 12,246,266 131,044 1.5% 840,490 6.9% 7.1% $3.53 $3.50

* Asking rents weighted by available sf and grossed to FSG

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negative absorption in the first half of this year at a -0.2% (3,950 SF). Average asking rents also declined by 6%. The outlook for East County is relatively quiet, as there is no anticipated new MOB construction in the pipeline, and existing physician groups are generally staying put. That being said, Sharp’s continued steady growth in East County is the primary driver of vacancy hovering near 5% – currently the lowest of all submarkets in the region. Keep an eye on Sharp’s proposed 80,000-square-foot Santee medical office building as they will likely consolidate some of their services from the surrounding areas into their new building, which is being developed by PMB.

South County: In the second quarter, South County saw flat net absorption (0.1%) and experienced slight drops in both vacancy and average asking rent, which are currently 5.5% and $2.76, respectively. The region remained in a holding pattern regarding capital investment from the larger health systems, despite the area’s large population and increasing insurance coverage. The Millenia project in Otay Mesa is under construction with many pre-sold residential homes completed and occupied. As more residential, retail and office buildings are completed,

the area’s population and demand for medical services are expected to grow.

Investment sales spotlightAs remarkable as San Diego MOB investment activity was in 2017, MOB sales volume actually grew in the first half of 2018 to $186M, up 11% from the first half of 2017. San Diego continues to attract institutional, multi-market buyers, although there is also an uptick in the number of acquisitions being made by private investors and local health systems.

Nationally over the past 12 months, $19.1B in hospitals and MOBs were traded - down from the previous year. Although many trades had 5.0 percent or lower cap rates, average MOB cap rates increased to 6.4 percent from 6.1 percent a year ago. MOB price per square foot remained stable at $326. Private investor buyers made up 79% of all healthcare real estate sales with the top three metropolitan areas for sales volume being Atlanta, Houston and Chicago.


93.9%Average occupancy

5.7%Average cap rate

$186MTotal sales volume

San Diego County MOB Sales - last 6 months

Scripps Health announced a long-term plan for its five medical campuses to be renovated or replaced by 2030 to meet the state earthquake standards. With a proposed budget of nearly $3 billion, projects include the replacement of Scripps Mercy Hospital with a new stand-alone oncology building nearby in affiliation with MD Anderson Cancer Center, a new patient tower at Scripps Memorial Hospital in La Jolla, three smaller acute care structures at Scripps Memorial in Encinitas, and seismic retrofitting at the Green and Mercy Chula Vista hospitals. Other project news: the 80-acre undeveloped site in San Marcos with stalled plans for a future Scripps hospital campus has now received city approval to become a residential development.

Scripps Health received approval from the city of Oceanside to begin building an 85,000-square foot medical office building on a 4.8-acre site on Vista Way at the corner of Jefferson Avenue – a site that previously held various car dealerships. The location is about 1 mile west of Tri-City Medical Center and will offer urgent care, outpatient surgery, physician offices, imaging and lab services. The 3-story building is expected to open in 2020 and will serve approximately 12,750 patients a month.

A dozen new Scripps walk-in clinics called Scripps HealthExpress will open by the end of September. The clinics will be in existing Scripps Clinic and Scripps Coastal outpatient medical offices and will offer the same minor-tier healthcare services as those offered at retail clinics such as CVS, Target and Albertsons.

DestinationCare San Diego has received $150,000 in seed money to launch a medical tourism campaign to promote San Diego. The coalition is comprised of local civic, tourism and business leaders who have joined with San Diego’s four major hospitals to in an initiative to attract affluent patients and their families, who may not have considered traveling to San Diego or aware of its medical providers and life sciences research.

UC San Diego Health expanded its cancer services in Coachella Valley beginning in January. UCSD and Eisenhower Health signed a five-year affiliation agreement which will make available the multidisciplinary team from Moores Cancer Center to provide services to the southeastern California region. Eisenhower already offers state-of-the-art treatments at its Lucy Curci Cancer Center, The Schnitzer/Novack Breast Center, Bighorn Radiation Oncology Center, plus six oncology clinics and five infusion sites. As a member of the UC San Diego Health Network, patients of Eisenhower Health will have expanded access to care.

In March, UC San Diego Health opened the new 150,000-square-foot Koman Family Outpatient Pavilion, located on the La Jolla Campus. The facility was designed to treat patients in a single day with eight surgery suites, imaging, physical therapy, pain management, and infusion and apheresis services. The integrated treatments also include multi-specialty clinics for breast, urology, sports medicine and spine care. The estimated completion cost for the project is $140 million.

News and updates


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Kaiser Permanente saw its operating revenue increase by 12.5% in 2017. Operating revenue in 2017 was $72.7 billion, compared to $64.6 billion in 2016. The increase was largely due to its Kaiser Foundation Health Plan, which added 1M new members in the past year. Kaiser spent $3.3B on capital projects in 2017, up $500 million from 2016. Net-operating revenue also increased from $1.2B in 2016 to $1.6B in 2017. With the opening of its 39th hospital, the San Diego Medical Center, and 15 new medical office buildings plus 25 more scheduled to open in 2018, Kaiser now has over 682 hospitals and medical office buildings.

Sharp Grossmont Hospital in La Mesa opened a Care Clinic at 8851 Center Drive, across the street from the hospital, to shift non-emergencies outside its emergency department. The 6,500-square-foot clinic has 14 exam rooms and will also offer follow-up care after a true emergency.

The Excel Centre medical office building, located at 17140 Bernardo Center Drive in Rancho Bernardo sold for $37.1M in December 2017 to MBRE Healthcare. Anchored by Kaiser Permanente and part of the Park Terrace mixed-use development, the

83,213-squaere- foot building was renamed Park Terrace Health Center.

MOB Factors: On-campus vs. Off-campus

Medical office buildings located on hospital campuses comprise 14.2% of San Diego’s medical office supply. It is no surprise that these buildings maintain extremely low vacancy rates – 1.9 percent at the end of Q2 and 5.1 percentat at the last peak in 2012.

The buildings that are located adjacent to hospital campuses currently have the highest vacancy at a rate of 9.3 percent, correlating to their average asking rate of $3.38 per square foot, full service gross, lower than all other off-campus MOBs.

Excluding buildings adjacent to hospitals, off-campus buildings account for 65.3% of the San Diego MOB inventory. The vacancy rate for these off-campus buildings has rebounded significantly from 17.2 percent in 2009 to 7.2 percent currently, with rental rates closely following those of on-campus buildings.

Last Qtr 12-MonthChange Forecast

On, Off, Adjacent to Campus | San Diego Medical Office Overview | Q2 2018

On, Off, Adjacent to Campus direct asking rents*

*Asking rents weighted by available sf and grossed to FSG

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Vacancy rates- By property location

1.9%

7.2%

9.3%

0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%9.0%

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2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

On Campus Off Campus Adjacent to Campus

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On, Off, Adjacent to campus direct vacancy

Direct asking rental rates by property location

Last Qtr 12-MonthChange Forecast

On, Off, Adjacent to Campus | San Diego Medical Office Overview | Q2 2018

On, Off, Adjacent to Campus direct asking rents*

*Asking rents weighted by available sf and grossed to FSG

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Vacancy rates- By property location

1.9%

7.2%

9.3%

0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%9.0%

10.0%

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On Campus Off Campus Adjacent to Campus

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Tenant Use Dialysis Center Cosmetic Surgery Dermatology Ophthalmology

Address 963 Lane AveChula Vista

10672 Wexford StScripps Ranch

11943 El Camino RealCarmel Valley

4060 4th AveHillcrest

Class A A A B

SF 9,500 1,999 5,559 4,628

Term 120 60 125 63

Start Rate $2.50 NNN $3.35 NNN $4.00 NNN $2.55 NNN

Execution Date 06/06/2018 06/04/2018 03/20/2018 03/19/2018

Increase 3% 3% 3% 3%

Free Rent 0 months 0 months 5 months 3 months

TIA/SF $50.00 $20.00 $65.00 $50.00

Type New lease Renewal New Lease New Lease

Recently completed lease transactions

Project Address Buyer/Seller SF Price/Sale Date Cap Rate Leased at TOS

Price per SF

8910-8950 Villa La Jolla(5 buildings)La Jolla

B: The Resmark CompaniesS: Goldstein Planning Investments

198,453 $97,100,00005/17/2018

4.2% 83% $498

769 Medical Center CtChula Vista

B: Sharp HealthCareS: Makena Medical Buildings

45,000 $27,500,000 N/A 100% $611

3444 Kearny Villa RdSan Diego

B: MBRE HealthcareS: Genesis Helathcare Partners

38,665 $20,000,000 6.0% 90% $517

285 N El Camino Real (4 buildings)Encinitas

B: Medicus Property GroupS: North El Camino Real, LLC

43,488 $13,500,000 4.8% 72%(estimated)

$310

Recently completed sale transactions


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JLL Healthcare Practice Group Healthcare Real Estate Advisory | San Diego

The JLL Healthcare Practice Group is San Diego’s leading team in healthcare real estate. With more than 45 years of combined industry experience, we specialize exclusively in local medical office properties and clients.

Expertise. Integrity.Our clients benefit from access to our unique market intel and expertise, giving them a distinct advantage in the marketplace. Our team delivers comprehensive solutions and seamless transactions to grow your practice, system or investment. Our services include:

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Hospitals

Health systems

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Medical office buildings

Surgery centers

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JLL Expertise

Kelly Moriarty Associate 858.410.6359 [email protected] RE Lic. #01963162

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About JLL

JLL (NYSE: JLL) is a leading professional services firm that specializes in real estate and investment management. Our vision is to reimagine the world of real estate, creating rewarding opportunities and amazing spaces where people can achieve their ambitions. In doing so, we will build a better tomorrow for our clients, our people and our communities. JLL is a Fortune 500 company with nearly 300 corporate offices, operations in over 80 countries and a global workforce of 86,000 as of June 30, 2018. JLL is the brand name, and a registered trademark, of Jones Lang LaSalle Incorporated. For further information, visit jll.com



Although information has been obtained from sources deemed reliable, neither Owner nor JLL makes any guarantees, warranties or representations, express or implied, as to the completeness or accuracy as to the information contained herein. Any projections, opinions, assumptions or estimates used are for example only. There may be differences between projected and actual results, and those differences may be material. The Property may be withdrawn without notice. Neither Owner nor JLL accepts any liability for any loss or damage suffered by any party resulting from reliance on this information. If the recipient of this information has signed a confidentiality agreement regarding this matter, this information is subject to the terms of that agreement. ©2018. Jones Lang LaSalle IP, Inc. All rights reserved.

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