In our experience with numerous hospitals and health systems, we find that many face a common issue—, an ongoing challenge to balance the three key elements of strategy, facilities and finance within their organizations. As they work to expand their physician networks and delivery of health system services in order to protect or enhance market share, our clients rely on Realty Trust Group to provide them with unique and achievable solutions through our use of integrated Advisory, Operations and Capital Projects services.

Realty Trust Group works with health systems and physician groups to align existing real estate assets and future real estate investments with the strategic, operational and financial goals of the organization. The RTG service delivery commitment is based on extensive healthcare experience and a proven track record in delivering results for our clients, independently and objectively.

Optimization is a series of processes designed to reduce costs and create value in the operation of a health system’’s real estate portfolio. The optimization process begins with an inventory of the complete real estate portfolio, and an understanding of the vision and direction of the system, as well as the competitive environment in which it competes.

Determining if a potential healthcare real estate transaction fits the required standards of “Fair Market Value” (“FMV”) and “Commercial Reasonableness” can be a complex undertaking. Hospital administration, and their legal counsel, should rely upon an analysis from an independent and objective advisor to determine if the proposed transaction meets the regulatory safe harbor. The professionals at Realty Trust Group hold professional designations in the real estate industry with the highest standards of practice including: Counselor of Real Estate (CRE); Certified Commercial Investment Member (CCIM); and Certified Property Manager (CPM). We have provided objective and independent opinions on many healthcare real estate transactions.

Monetization is a process of re-deploying capital from a financial transaction involving real estate into other capital needs for a health system or physician group. There are several different transaction structures which can be utilized to free up the capital, including a sale, sale/leaseback, Credit Tenant Lease (CTL), mortgage financing, and others. The decision to monetize or not, and the appropriate structure to use, should be subjected to careful analysis and planning prior to initiating a transaction.

Selecting the right developer for a new MOB or similar facility can be challenging, even for the most sophisticated health system or physician group. There are dozens of qualified medical real estate developers around the country. Utilizing the proper tools, asking the right questions and generating comparable responses from multiple development firms will allow the provider to engage the appropriate developer.

RTG understands that project financing must be tailored to the needs of the owners, and not just left to a “best interest rate” mentality. We have experience in analyzing, selecting and closing the most appropriate financing strategy for your project.

RTG works with your legal advisors in forming a real estate partnership, or similar legal entity, for the ownership of one or more properties. RTG can assist a hospital or physician group with analyzing and selecting the best partnership framework to accomplish the business and operational goals of the partnership.

Finding and achieving cost-savings in real estate operations can and must be done by healthcare systems in this environment of healthcare reform. Medical office buildings and other ancillary facilities should be considered strategic assets and managed for operational advantage in the areas of operating costs, facility utilization, leasing strategies and market share.

On a regular basis, every healthcare organization should review the real estate properties, including vacant land, in their portfolio and determine whether there is a “higher and better use” of the asset. Raw land and vacant or under-utilized buildings may be valued and sold; thereby returning capital to the organization that can be used for other investments.

Realty Trust Group uses operational policies and objectives, as well as financial data to evaluate the organizational activities. It is a review of the efficiencies and economy of the operation, and provides the company with new perspectives and ideas on how to perform better. The review and audit also helps to determine if management’s goals and objectives are being met in the most efficient manner.

Our Property and Asset Management services are routinely customized to meet our client’s needs, but are consistently based on three (3) fundamental elements of effective property management: Asset Preservation, Tenant Satisfaction and Cost Containment. Additionally, our Asset Management approach involves a broader view of the strategic plan for one or more assets, market position, capital & financing strategies, and partnership management. RTG staff maintains the highest credentials: Certified Property Manager (CPM), and as a firm, carries the Accredited Management Organization (AMO) designation, one of only 537 firms nationwide with this well-respected designation.

When acquiring or disposing of a property or portfolio, completing the appropriate due diligence tasks helps to ensure proper risk management. There are physical, legal and financial aspects to due diligence which must be completed, and they are generally subject to a compressed time frame. Having the right advisors in place to assist with these processes can help to mitigate risk and allow for a successful closing.

Leasing medical office space to (or from) physicians should involve a trained professional that understands real estate negotiations; market information with respect to tenant improvements necessary for healthcare occupancy; market rental rates and other commercial terms for similar buildings; and an understanding of the legal and regulatory environment that influences hospital and physician leases.

Every two or three years, health systems should routinely subject their real estate operations to a comprehensive audit and review of their lease rates, operating costs and construction costs for their medical office buildings that are leased to referring physicians. The purpose of this review is to ensure compliance with applicable legal and regulatory requirements involving hospital and physician business transactions.

At RTG, we understand that capital is limited and that facility investments must be fully analyzed prior to construction and then managed closely during the project delivery process. We manage construction to completion with an “Owner’’s Representative” mind-set, and then integrate as part of the team from concept to close-out and occupancy.

A determination of whether a project will meet all financial and strategic objectives as identified by the client stakeholders. The feasibility analysis may also be used in assessing funding options and ROI calculations.

Your real estate is a precious asset that should contribute to your organization’’s strategic goals and serve as a catalyst for business growth and increased market share. RTG has worked with numerous health systems, hospitals, and physician groups, each distinct in their own way, and we often find a common theme among many of our clients- an ongoing challenge to balance three key elements of their business: Strategy, Facility & Finance.

An in-depth review of a facility’’s overall physical condition targeted at short and long-term maintenance and capital expenditure, the facility condition assessment is often utilized to determine future capital investment in property valuation processes or in physical plant annual budgeting. The results may also be used in “repair or replace” exercises regarding existing facilities.

Transition Planning is defined as “the operational and physical relocation of the existing hospital to a new physical plant.” Transition encompasses the relocation of hospital processes and services, staff, materials, and patients in a manner that is expeditious and minimizes interference with current daily operations.

Development of the projected total project or program budget and the tracking of expenses associated with a project ensure that project expenses align with committed values as stated in various contracts for professional services including construction and soft costs resulting from the clients activities.

Oversight and facilitation of the project delivery process focusing on budget control, schedule compliance, issue resolution and decision making.

Oversight of the construction phase of the project to ensure the client’’s interests are represented as the physical building is constructed.

RTG offers construction project consulting services to owners, contractors, and subcontractors. Scopes of services range from advising parties on how to deliver value on construction projects to providing construction risk management, helping the contracting parties avoid problems on construction projects and, when necessary, helping the parties put problematic projects back on track.