医疗办公楼投资完全指南：物业类型、租约与尽职调查

On-campus MOB 20,000 SF：health system tenant，rent $32–$40/sf，NOI $640K–$800K，cap 5.5%–6% → value $10.7M–$14.5M。Off-campus multi-tenant：rent $22–$28/sf，cap 6.5%–7.5%。

ASC (Ambulatory Surgery Center)：build $400–$600/sf，rent $45–$65/sf，lease 15–20 yr，cap 6%–7%。CON state 限制供给 → approved ASC 有 moat but CON risk at development。

Health system tenant 12 yr remaining on 25,000 SF at $35/sf = $875K/yr rent。TI sunk cost $80/sf = $2M — tenant unlikely to relocate。But hospital merger/acquisition may consolidate space → non-renewal risk 5–10 yr out。

Modified gross common for MOB（HVAC/plumbing maintenance complex）。NNN with medical tenant — verify CAM excludes specialized system maintenance。Single-tenant MOB cap 5.5%–6.5% vs multi-tenant 6.5%–7.5%。

Medical TI breakdown：exam rooms $80–$120/sf，imaging suite $150–$250/sf，ASC OR $400–$600/sf。Landlord TI allowance $60/sf on 10,000 SF = $600K capital at signing。

Build-to-suit：pre-lease 15–20 yr with credit tenant before construction。Dev cost $350–$500/sf，yield-on-cost target 7%–8.5%。Specialized: radiation shielding, medical gas, negative pressure rooms add $20–$50/sf。

Telehealth reduces exam room demand 10%–20% for primary care but surgery, imaging, infusion, rehab require physical space — specialty MOB demand stable。Cap range 5.5%–7.5%；on-campus compressed to 5%–6% in top markets。

Health system self-development reduces external MOB opportunities but off-campus ambulatory strategy creates new demand in suburban markets。ASC growth 5%–8%/yr — outpatient migration from hospital continues。

CON state ASC application：6–18 mo review，approval not guaranteed — sunk cost $100K–$500K。Non-CON states — faster development but more competition。

Financing：Credit tenant MOB — CMBS/life co 65%–75% LTV，DSCR ≥1.25。SBA 504 — physician owner-occupy only，10% down。MOB favored by lenders due to tenant stickiness and long leases。

Sell after tenant renewal with 10+ yr WALT → buyer pays 5.5%–6% cap。Same building with 2 yr remaining → cap 7%–8%，value difference 20%–30% on same NOI。

Healthcare REIT buyers (Physicians Realty, HTA-type) active for on-campus MOB。1031 into/out of MOB standard like-kind exchange。Broker opinion: list 12–18 mo before major lease expiration if no renewal in sight。