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 data to calculate visits per 1,000 residents, chronic disease prevalence, and outmigration by service line at the ZIP+4 level. A practical threshold: in a 100,000-resident trade area, recapturing 5% of leakage at 2 visits per person annually yields roughly 10,000 visits; at $75 contribution per visit, that is $750,000 in yearly margin.

Assess competition and capacity. Inventory nearby providers, appointment wait times, clinic hours, and provider FTE density. Identify access gaps—submarkets where new-patient waits exceed 10–14 days or behavioral health waits exceed 21–30 days usually signal opportunity.

Score candidate sites on feasibility. Evaluate zoning and entitlements, ingress/egress, visibility, traffic counts (often target 25,000+ AADT on arterials), parking ratio (4.0–5.0 per 1,000 SF), utilities, digital backbone, and environmental risk. Strong co-tenancy (grocery, pharmacy) and transit access can lift volumes by improving convenience.

Model economics and capital. Compare own vs. lease scenarios, NPV, and EBITDA-to-rent coverage under ASC 842. Typical medical office hard costs run $350–$550 per SF (market dependent), with tenant improvements of $80–$140 per SF; market rents commonly range from $25–$45 per SF NNN. Target coverage above 2.0x and build options (expansion, contraction, termination) into leases to preserve flexibility. For help structuring these decisions, review our healthcare real estate services at real estate strategy and development.

Key considerations

Demand thresholds and program fit: Primary care-driven hubs typically support 8–16 universal exam rooms with 1.2–1.4 rooms per provider, targeting 18–22 visits per provider per day. Multi-specialty sites add imaging, infusion, or urgent care if modeled volumes exceed minimum viable throughput (for example, 3,000–5,000 annual imaging studies or 6–8 infusion chairs at 60–70% utilization).

Timeline and risk: From site screening to opening, plan for 20–36 months. Site selection (8–12 weeks), entitlements and design (6–12 months), and construction (12–20 months) vary by market and Certificate of Need requirements. Build contingencies for permitting delays, utility upgrades, and supply chain volatility.

Payor mix and value-based goals: Prioritize submarkets where commercial and Medicare Advantage mix supports sustainable rates, while using access to reduce avoidable ED use. Integrating behavioral health and care-at-home logistics can improve outcomes and lift shared savings in risk arrangements.

Flexibility and technology: Specify universal exam rooms, modular walls, standardized MEP risers, and 10–15% soft or shell space to pivot service lines without major renovation. Ensure power density, DAS/5G, and Wi‑Fi 6/7 capacity to support telehealth, remote monitoring, and device-rich specialties.

Governance and partnerships: Align referring physicians early, use trigger-based decision gates (panel size, access days, leakage reduction) to time investments, and consider programmatic developer partnerships to reduce schedule and transfer construction risk. Explore delivery and capital models on our Bremner Real Estate site or our services overview.

Actionable takeaway

Within 90 days, build a data-backed location plan: map 15–30 minute access gaps, quantify leakage by service line, score 3–5 viable parcels with a standardized feasibility matrix, and run own-versus-lease economics with options that match demand triggers. Secure LOIs on the top two sites and align governance to greenlight when access and volume thresholds are met—then track results with a quarterly dashboard tied to utilization, leakage, and EBITDA-to-rent coverage.

To discuss a location strategy tailored to your market, speak with our advisors or review our healthcare real estate services for evidence-based site selection and development support.

What trade area size works best for ambulatory care?

Most multi-specialty ambulatory hubs draw from a 15–30 minute drive-time, adjusted for traffic and transit patterns. Use service-specific radii—urgent care may be 10–15 minutes, while imaging and specialty clinics can justify 20–30 minutes—validated by your own referral and patient origin data.

How big should a typical ambulatory care facility be?

Primary care-led sites commonly range from 15,000 to 35,000 SF, while multi-specialty hubs often run 30,000 to 60,000 SF depending on imaging, infusion, urgent care, and procedure rooms. Size to modeled throughput and plan 10–15% soft or shell space to adapt as demand evolves.

Which data sources are most reliable for site selection?

Blend your EHR and referral data with third-party claims, census and migration data, SDOH indicators, and commercial real estate datasets. The goal is triangulation: demand (visits per 1,000), leakage, payer mix, and access gaps validated by on-the-ground physician input and competitive intelligence.

Should we own or lease our ambulatory site?

Own irreplaceable hubs where long-term control, complex infrastructure, or campus adjacency matters; lease satellites and early-stage markets to preserve flexibility. Compare risk-adjusted NPV, balance sheet impact under ASC 842, and option value—if the program could pivot within 7–10 years, a flexible lease with expansion and termination rights often wins.

How long will it take from site decision to opening?

Plan for 20–36 months depending on market complexity. Typical timelines include 8–12 weeks for site selection and LOIs, 6–12 months for entitlements and design, and 12–20 months for construction and commissioning, with longer paths in CON states or for projects with significant infrastructure upgrades.

Bremner Healthcare Real Estate partners with health systems to align real estate strategy with clinical performance and capital efficiency.