What’s the total timeline from concept to opening for a medical office building? Most medical office buildings take about 20–30 months for ground-up development and 12–18 months for adaptive reuse, based on healthcare construction benchmarks from sources such as CBRE’s 2025 U.S. Healthcare Real Estate Outlook and schedule data from the Dodge Construction Network Outlook. Why it matters Accurate medical office building (MOB) timelines drive capital planning, physician alignment, and market-entry strategy for health systems. When schedules slip, the impact shows up in delayed ambulatory volumes, missed revenue targets, and higher carrying costs on capital projects. Advisory research on ambulatory care growth highlights that outpatient volumes are a key lever in system performance, making on-time openings critical for strategic execution and margin stability Advisory Board. A six-month delay on a 30,000 SF ambulatory clinic modeled for 40,000 annual visits at $75 contribution margin per visit can defer roughly $1.5 million in margin, not including staffing and reputational effects. How it works Pre-development (4–5 months). This phase includes strategic definition, clinical programming (about 4–8 weeks), site identification and letters of intent (8–12 weeks), [...]

How do you decide where to build your next ambulatory care facility? Use market demand analytics, access gaps, physician alignment, and site feasibility scoring to pinpoint submarkets where volumes, payer mix, and economics support an investable, flexible facility with measurable ROI. Why it matters Ambulatory care continues to outpace inpatient growth as payers and employers push care to lower-cost settings. Many health systems now see more than half of encounters in outpatient sites, and elective procedures continue to migrate from hospital-based departments to ambulatory venues. Choosing the wrong location can lock in 10–20 years of elevated occupancy costs and underutilized space. Conversely, targeting care deserts and high-leakage submarkets can recapture revenue, cut total cost of care, and strengthen physician networks—often adding hundreds of thousands to several million dollars in annual contribution margin. How it works Define the clinical scope and the trade area first. Determine whether the facility will be primary care-led, multi-specialty, procedural, or diagnostics-focused, then map 15- and 30-minute drive times and transit access to establish the service radius and patient catchment. Quantify demand and leakage. Use claims and EHR [...]

How can long-term real estate planning prepare health systems for shifts in population health needs? By pairing demand analytics with flexible facility design, capital stack planning, and adaptive leasing, health systems can realign sites, services, and costs as population health needs change—without straining balance sheets or clinical performance. Why it matters Demographics and disease burden are shifting fast: by 2030, roughly 73 million Americans will be 65+, and 6 in 10 adults live with a chronic condition (4 in 10 with two or more). Behavioral health demand is up double digits since 2020, while maternal health and primary care gaps are widening in many regions. Real estate cycles are long, and the wrong asset in the wrong place can lock in 10–20 years of elevated occupancy costs. Conversely, rightsizing and network optimization can free millions for clinical priorities. For example, a 500,000 SF ambulatory portfolio that trims operating and rent expense by $3/SF improves annual cash flow by $1.5 million—and compounds over the lease term. How it works Start with a 10–15 year roadmap anchored by 3-, 5-, and 10-year decision gates. [...]

Use a structured, data-driven framework that compares after-tax NPV, balance-sheet impact, and strategic flexibility; lease when preserving capital and speed-to-market produce higher risk-adjusted value, and own when long-term control, low cost of capital, and site durability outweigh the opportunity cost. Why it matters Ambulatory growth is essential, but capital is scarce. The own-versus-lease choice determines how much balance sheet capacity you preserve for clinical systems, digital infrastructure, and core hospital upgrades—and it shapes your bond rating trajectory. Ownership can lower long-run occupancy cost and maximize control; leasing can accelerate market entry, transfer residual risk, and keep cash free for higher-return clinical initiatives. Under ASC 842, leases appear on the balance sheet, but structure still influences leverage, liquidity, and rating agency views on risk. How it works Start with a six-part decision framework: define the use case and time horizon, quantify total cost of occupancy, run a financial comparison, score strategic factors, apply decision rules, and optimize the deal structure. Define the clinical program and market horizon. If a site’s value depends on durable referral patterns, protective CON barriers, or long-term ambulatory throughput [...]

Capital constraints, CON laws, and the shift to ambulatory care are reshaping value-based delivery. Leaders must hit the trinity of clinical outcomes, operational throughput, and financial performance while preserving ratings and liquidity. One question we’re hearing: How should our health system balance ambulatory expansion with acute-care investment to maximize capital efficiency and population health impact? As healthcare-exclusive strategists since 1989—validated by our acquisition by Duke Realty—we integrate operations, population health, and capital planning to turn strategy into execution. Bremner leads strategic portfolio optimization that repositions underutilized space, frees trapped capital, and improves access—linking ROIC to care models and system goals. What follows is a CFO-ready, fiduciary playbook you can take to the board. Health system leaders are confronting a trilemma: protect margins, expand access, and modernize facilities under value-based care and persistent capital constraints. The fastest ROI increasingly comes from repositioning underutilized space, right-sizing ambulatory networks, and embedding digital into the care model. As a healthcare-exclusive platform since 1989—validated by our acquisition by Duke Realty—and a partner to national health systems on $100M+ on and off-campus developments, Bremner translates strategy into measurable [...]