The bread-and-butter medical office building (MOB) deal continues to entail the sale of a single building for a price of less $20 million, often quite a bit less. Such deals, of course, do not typically satisfy the appetites of the sector’s largest investors, including private equity funds, the larger publicly traded REITs, and institutions, as well as foreign capital. Such investors prefer deals that provide immediate scale instead of having to accumulate a portfolio by making smaller, one-building acquisitions.

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.

These new reports detail transaction activity for 3 types of investors – Real Estate Investment Trusts (REITs), Hospitals and Health Systems and Private Investors. Each of the 3 reports provides detail on volume trends, pricing, share data, as well as data for the most active investors and metro areas.

Here are the top 5 markets. The most active market during this time has been LA/Orange County which has seen $2.9B worth of MOB transaction volumes. LA/Orange also has the lowest cap rate/yield at 5.7%.

Revista has posted its 2017 Year End Transactions Reports for subscribers to its data service. By most accounts, 2017 was a record year for the sector in terms of transaction volume. Overall $21.8B worth of hospital and medical office real estate traded hands in 2017.

Continuing focus on high medical office sales activity might lead one to wonder where all this activity is occurring. In 2017, more than 25% of sales volume was represented in only 5 metro areas. Who's leading the pack?

Transaction volumes have been steadily rising for the past few years. Revista began tracking property transactions in 2014 and volumes in that year were $8.9B for MOBs

2017 will have broken many records in terms of sales transaction activity in healthcare real estate, but it won’t in terms of new construction. Revista data is showing 3 consecutive years with a decrease in starts which is now also affecting total deliveries. Only 16.3M square feet was delivered in 2017, 15% less than the previous year's total of 19.3M.

The table below shows the median price per square foot (PPSF) for medical office buildings (MOBs) that have a surgery center and do not have a surgery center and the resulting premium.

The medical real estate sector is seeing increasing levels of transaction activity, particularly across hospital real estate and medical office buildings