Carmel, Indiana, located in the northern suburbs of Indianapolis, has become a hot target of healthcare providers and associated real estate developers over the past few years. Revista is tracking several in progress and planned medical real estate developments sponsored by difference providers and developers.

Healthcare Real Estate Insights and Revista have partnered to create the healthcare real estate industry's most comprehensive survey of outpatient medical construction activity.

In past metro highlights we’ve talked about growth markets with lots of construction activity, interesting markets with innovative health systems, metros with the highest sales volume, but what about the tightest markets? The ones with the highest rent growth, the most expensive pricing and the lowest vacancy? Flipping through our Metro Rankings report, San Francisco clearly fits the bill.

Over the past year or so there have been many headlines speaking to how hot the medical real estate sector is. You see them pop up in your email or news feed: "Sales volume is at all time highs"..... "New investors are entering the sector right and left"...."Medical Real Estate Hitting Post Recession Peak". At times like this, many investors are getting priced out of the 'cream' offerings that trade and the heavy weight health system construction projects. So it would stand to reason that those interested parties would look elsewhere....and they are.

What do large, institutional MOB investors look for when seeking purchases? For the most part, they prefer larger portfolios in order to add instant scale. They prefer properties occupied by strong, perhaps credit-rated, health systems. And, they want high quality real estate: well-maintained, perhaps newer buildings in good locations.

As REITs pull back on acquisitions and focus more on refining their portfolios, private equity groups have more than taken up the slack. Total healthcare real estate transaction volume may have cooled ever so slightly - but not much - and so far this year, private investor buyers are making up 76% of that total.

This unassuming market is number 2 in terms of outpatient building deliveries and 4th for total deal volume. Even rent growth has been consistently surpassing the national average.

In general, health systems are choosing to build hospitals with lower bed counts. Technology, demand and reimbursement changes are all pressures that shift the focus to patient experience, advancing technology, and wellness and preventative medicine. This translates into more outpatient services, private rooms and fewer beds.

One of the largest projects in the Revista database is about to open on June 24th after more than a decade of careful planning and execution.

Houston is the number one metro in terms of square feet of hospital space under construction. As of the end of 2017, Houston had roughly 4.2 million square feet of hospital space under way – about a million square feet ahead of the runner up, New York.