Revenue Radio: Healthcare Real Estate Part 1

Episode 9 January 05, 2023 00:31:19
Revenue Radio: Healthcare Real Estate Part 1
Kassouf Podcast Network
Revenue Radio: Healthcare Real Estate Part 1

Jan 05 2023 | 00:31:19

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Hosted By

Tara Arrington

Show Notes

Kassouf Healthcare Solutions's Revenue Radio gives practice managers the tools you need to run a successful and profitable medical practice. Your host, Kassouf Healthcare Solutions Executive Director Jeff Dance, discusses the opportunities and challenges related to the business side of medicine. 

Today's episode features Commercial Real Estate Agent Richard Tidwell who specializes in healthcare real estate. Whether it's a start-up, relocation, or lease negotion, Tidwell offers providers and practice managers with niche expertise to make the best decision. 

Founded in 1981, Kassouf Healthcare Solutions was created to handle the business side of medicine, allowing doctors to focus on their patients. The Kassouf Healthcare Solutions team is comprised of operations management and revenue cycle specialists. We enhance the business of medicine by providing value to our clients with an action-oriented and caring customer-centered focus. Learn more here. 

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Episode Transcript

Speaker 1 00:00:02 Hello, and welcome to the Kassouf Revenue Radio podcast, where we bring information to you, the healthcare practice manager, the physician and business owner to enhance your business of medicine. We're powered by Kassouf and Kassouf Healthcare Solutions. Hi, I'm uh, Jeff Dance. I'm the, uh, executive director of Kassouf Healthcare Solutions. I'm also your host today for our Revenue Radio podcast. I have the unique opportunity at times in our business to, uh, build strong networks of resources and subject matter experts that assist our clients and our managed services organization with various operational, uh, matters. All of these are designed to bring value and again, enhance your, uh, your business in your healthcare practice. Today, we are diving into the world of healthcare real estate, and, uh, how that impacts your practice, your business, some of the choices that you will need to, uh, consider, uh, for your strategic planning now and, and going forward. Speaker 1 00:01:09 Um, we also got Russ Dorsey with me today, who's, uh, manning the booth and the, the board. And Russ, thanks as always for making it a smooth, uh, podcast for us. Oh, glad to be here on such a beautiful day, too. Yeah, it's raining outside, but, um, um, and we're warm inside, but hey, we've got today, uh, Richard Tidwell with us today. Richard and I have a long standing relationship. Uh, Richard is a commercial real estate agent here in Alabama, uh, based in Birmingham. And, uh, Richard specializes in healthcare. That's all you do, if I, uh, know that correctly. That's correct. So, um, I want, uh, to bring Richard in for a couple segments as we talk about this whole real estate, uh, idea as it relates to healthcare practices. Um, some of the things that, uh, business owners, business managers in a, in a physician's practice need to think about, uh, as, uh, as they, you know, go through their, whether they own the building, where they rent it, where they're thinking about moving, relocating, what's the renewal process. We're gonna get into all of those little right, uh, finer points, uh, as it relates to, uh, to these, these real estate questions. So, tell us a little bit about your background, Richard, what you do, what's kind of a core competency that you bring to the table, especially in this idea of healthcare, commercial real estate? Speaker 2 00:02:39 Sure. Your, uh, thanks Jeff. I, I appreciate you having me here and, uh, really love working with Kassouf and your clients. Um, yeah. So the commercial real estate, uh, world is, is very vast. Um, but what we, uh, and I specifically have found that if you can, um, really get a niche in a particular market, um, and what I've chosen to do is, is to work in the healthcare side of that niche when it comes to commercial real estate. So, um, doing that allows you to be, um, uh, pretty much the professional, uh, in, in working with these types of practices, which is why we work so much together. Um, so one of the core competencies, competencies of what we do, or what I do is that, um, you know, I work specifically with healthcare practices, um, whether it's a startup, uh, whether it's a relocation, uh, if I'm negotiating a lease, uh, that's current or a new lease, um, a ground up construction build, uh, if somebody wants to add locations, if you've got a practice that you want to sell and there's a real estate component, um, I'm dealing with the acquisition of the real estate. Speaker 2 00:03:43 Um, but more specifically, I do that on a buyer tenant side. Um, so that allows me to really focus in on one side of the transaction and, and ultimately gives me a complete fiduciary with my client, um, your client, my client, uh, the healthcare practice, or the, you know, the healthcare professional, uh, to represent their best interests. So we, I found that, um, that's really a, not the only way to do it, and not necessarily better than any other, but it's the way that, that, um, we've really discovered works best for the healthcare, uh, industry when it comes to, uh, negotiating commercial real estate. Speaker 1 00:04:20 Why do you think, um, a lot of practices or practice managers, even the physicians themselves, um, tend to maybe shy away or don't know about using, or think about using a, a real estate agent? I, uh, don't want to kind of just use a generic term Sure. But, you know, someone like yourself that, uh, might know the market but isn't leveraged right. And, and activated in the decision making process. Speaker 2 00:04:50 Right. I think, um, a lot of it comes down to just what you said, not understanding, right? So, um, a lot of the times, you know, a practice manager has so much going on, uh, and they're trying to literally manage the entire practice. And so when you get to the real estate component, uh, which is typically either their first or second largest expense, um, uh, they just don't understand what's available to them, and they don't understand how important it is to have someone like myself that does nothing but negotiate for healthcare practices and, and knows the market completely. So I think a lot of it is just simply not knowing, uh, not being top of mind, uh, them not, uh, them thinking that there's a fee that's going to be charged, which again, because I'm, you know, uh, I represent buyers and tenants, we can talk about that more, but there's not a fee that I charge. Uh, and then I think sometimes it also comes down to a practice manager feels that there's a value add that they have maybe to their practice. Maybe they're getting paid and they think this is a way that I, you know, show my value to the practice, which there's a way that, you know, that I address that as well. So I think a lot of it just comes to not knowing what's available, uh, and thinking that they have to do it on their own own, because that's how it's been done by so many practices. Speaker 1 00:05:59 Right? So we all know healthcare is a very tight margin business. Mm-hmm. <affirmative>, um, you know, we're all aware of the contractual arrangement. You don't necessarily get what you charge. Right? And so we're all watching those, those margins and those numbers and a fee conscious practice or physician or business owner, manager, we're all watching those. Uh, that fear is, oh my gosh, here comes someone else with their handout. Right. And, uh, that's not typical with you. That's not how you, you operate. Correct. So, correct. Kind of tell us a little bit about that fiduciary that you mentioned and Sure. And the value that you do bring, uh, especially on a, from a, um, you know, time value of money perspective, and Right. How my best and highest use of my time as the practice manager. And I've got a Richard out there who's, who's helping me kind of go through some of those anecdotes, if you don't mind. Speaker 2 00:07:00 Right. So, uh, again, because I'm, I represent buyers and tenants, uh, in the healthcare practices when it comes to their leases or their purchases. Um, traditionally, just like in, if you thought about it from a residential perspective, you go and buy a house, uh, and you bring your agent with you to help you look at houses, um, there's an agent on the other side of the table. Typically when someone's selling a house, not always someone for sale owners, but most of the time there's an agent on the other side of the table. So, same way in my world, when I'm representing the buyers and the tenants, there's an agent on the other side of the table. Most landlords, most sellers have someone working on their behalf, an agent that has a fiduciary completely and solely to the seller or the landlord, which means that, and there's usually a misconception from people who don't do this from a living, is that, well, there's an agent involved, so we're being taken care of. Speaker 2 00:07:51 Well, you're not, cuz that agent has a fiduciary to the landlord to make the most money for them, to the seller to make the most money for them not to the buyer. Right? So, as the representation, I go to the table and represent my clients to make sure that they're getting a, a fair market or better than fair market deal negotiating terms that most people would never know they can even negotiate. And I'm doing that with no fee to my clients. Now, I've had to rebrand the way I say that because a lot of times if I say, you know, my services are free, it, it, it cheapens what I'm actually doing. So there is a, there is a fee cuz my, cause what I do is not free, but the great thing is for our clients, um, that they don't pay it, right? Yeah. Speaker 2 00:08:29 It comes from the landlord who already has a pre-negotiated, uh, commission typically, uh, with their agent. And all I'm doing is coming in representing my client with that fiduciary completely to my client, not to the landlord or the seller. And I'm splitting the fee that's already going to be paid to the other agent, whether there's someone that comes to the table or not. So a lot of times the, the ploy by a, a savvy landlord or agent would be, well, hey, if you don't bring anybody to the table, we'll save you three or 4% by not having to pay an agent. Well, that's a complete lie. Um, because they're still going to pay their, their, their agent the same commission and their, their understanding that most, if not all people who come to the table who don't do this for a living are gonna give up a lot of concessions and a lot of negotiating points because they don't know what to negotiate. So, um, that's why even if I charged a fee, um, and, and, and Jeff, you're, you can attest to this, to, to the savings that a lot of the clients that we work with, if not most that I work with, what they end up saving, it would still be worth it to them. Right. Right. About the money that they save off the practice. But even better, I don't charge a fee to them. Speaker 1 00:09:33 Right. Right. The, the, that the fees are gonna be there regardless. Sure. Absolutely. And it's a matter of, and you're not, again, working with a time clock. That's right. Um, that's right. Type of thing that you're gonna, the, the client would see. That's correct. A bill each month, never Speaker 2 00:09:50 Sent one. Speaker 1 00:09:51 Yeah, exactly. Um, boy, all kinds of questions come to mind. And as we're thinking through this and, you know, the practice manager, all the pressures on the time and just pulling at you constantly, right? You're out there working for the client, right? You're working for that tenant, that one that is trying to get the, get the lease going and such, or renegotiated mm-hmm. <affirmative>, find this place, all of those, the time that that takes, uh, talk to us a little bit about some of the, just the research that you do Sure. For a client to find that right spot. Right, Speaker 2 00:10:33 Right. Yeah. Probably the easiest thing that I do is, is finding the space. Um, uh, does it take time? Sure. But, but over years in the market, years and years in the market, uh, I, I'm very familiar with that market as, as, as with in other markets. So that eliminates a lot of the time from all the back work that's been done over the years of negotiating multiple spaces for tenants. And they only, of course take one space. So I have all these other spaces or buildings or, or leases that have been negotiated, but they didn't take that particular one. So I have all of those in my resources and in my files so that I can say, Hey, based off of these needs, this would be a great fit. I know kind of what we can get, you know, from a negotiating standpoint on this. Speaker 2 00:11:12 So a lot of it is a back work, um, but it, and if a practice manager tried to take this on it, you know, you would basically be starting from scratch every time. Right. So, uh, you could spend 50, a hundred hours minimum, you know, doing the right things, you know, finding the right space, negotiating, uh, and then paying a lot of different, uh, parties to do some of the things that I would, you know, do again for, for no fee. Um, so that's a big, um, uh, basically, um, piece of the puzzle that I can take off a practice manager or a doctor who's trying to do it on their own and just take that off their plate. Because again, I've done so much back research in the market. Speaker 1 00:11:50 Yeah. And if I were sitting with my practice management colleagues, I'd say don't try to be, um, so ego driven that you want to come off looking like you're the one who saved the day, use your resources, use someone who knows the market. Sure. Um, and we're, we've worked on situations where it's one of those, I need such and such and this is what I'm thinking of. Oh, well I've already started talking to that. Right, right. Uh, yeah. You know, landlord type of situation and Right. Um, uh, again, I think from my perspective, um, it is refreshing to have someone on your side Yeah. That can go and find these things and help. It doesn't always work out. Right. And sometimes I I, I'm sure you've probably said there's nothing more I can do. Right. We can only get to this point. That's right. You gotta a really good rate. Speaker 1 00:12:47 I mean, tho we're not, we're not forcing things. Um, so good. So really just helping out with the time being a resource. Um, one of the things that I always say is, you know, I don't want a salesperson, I want a resource. I want somebody that can provide me information, help me and get through an advocate, facilitator and such like that. What are, when, when, uh, there's, there's some paperwork that's involved mm-hmm. <affirmative> in a process to get someone like you started, uh, in, in representing a relationship like that. Right. Uh, that's kind of the legal side of things. Right. What are some other things that you like to do with your clients to just get the process started? Right. Speaker 2 00:13:32 Great question. So, uh, what I, what I like to do with every client is I, I like to, uh, sit down with them, um mm-hmm. <affirmative> and just talk to 'em about their vision for the practice. Um, you know, it's not, in my opinion to really understand some of these transactions and what needs to happen with a practice, especially if they're wanting a new location or to grow. Um, or even if they're in a, in a place they've been for 10 or 15 years, it's go, well, what is your vision for the practice? Like, what is your 5, 10, 15 year vision for your practice? And so those types of questions when they're answering 'em, which most people don't ask 'em other than, you know, folks like you who are really invested in their practice outside of that, most, most people don't ask 'em those questions. And that really gets them to kind of open up and, and really dream a little bit. Speaker 2 00:14:16 You know, I want 'em to dream it, it sounds cheesy, but I mean, it, it's, this is their livelihood, this is their practice, it's what they've gone to school for, you know, for so long to do. And so there needs to be some vision, uh, for that practice. And so I want 'em to, to, to answer those questions, which then helps me to go, you know, to be able to assess, you know, where they need to go, what area that would be a, a great place for them to go. The terms, um, you know, the link, what, just in, in general, what they want to do with their practice. So I like, that's one of the most important things to me to really start the process. And I do that before there's any paperwork signed, right? Mm-hmm. <affirmative>, because I wanted them to know, this is not about just finding a space, uh, this is about what, what is best for their practice, what's gonna put them in a position where they wanna be 5, 10, 15 years from now. Um, and there's a lot of different factors that go into that. Speaker 1 00:15:07 So when you think about that and you, you have the client really start putting down on paper a wishlist. Mm-hmm. <affirmative>, what do you want? Right? How do you, well, I want flat parking, I want free parking, I want this type of entrance, I want, I mean, all those little things. Um, I wanna be in a retail space. I don't, you know, where, um, where do, where do you want to be as it relates to the, the market, um, side of, of the, of the business? Um, you know, again, a lot of what I see you helping with is really understanding the difference between what somebody could do on their own and what you can do for them and with them. Right. And, um, what kind of, again, is there market research that you can bring and say you might want to pay attention to this side of town versus this, and Sure. How does that conversation typically work? Speaker 2 00:16:11 Right, right. So, you know, depending on the client, um, if they want a real in-depth market, uh, search, uh, you know, from a demographic and a, and a and a, a printout of where they should put their practice, absolutely. Have access to those, um, types of things. And I think those are valuable. Mm-hmm. <affirmative>, um, I think the most valuable thing is, uh, you know, obviously having someone who knows the market very well, um, because deeper than some of the demographics, I think when you get in very specific, you know, especially like if you get into the dental, uh, practice and, and some that, uh, there's a, you know, ratio per, you know, number of, uh, the population per what a dentist should go in. Cuz if you notice, Dennis will go in, you know, five in, in a six square blocks based off of the population. Speaker 2 00:16:55 So I think those are very important things and heat mapping and traffic and all those sort of things that, that I will look into personally. And if, if a client wants a print out of that, I can absolutely do it. Um, but I think, you know, more invaluable is just the, the years of understanding what is moving, you know, what, what, what is flowing in and out, what is, what is the projection, what are we hearing behind the scenes about a development coming in this area and how this is going to tra transition here and what, you know, those, those are the things I think that, um, they're not necessarily things you can track on a, on a, on a heat map or a demographic printout, but again, those things are very inva or very valuable and we can, you know, I can provide those for a client as well. Right. But just understanding the market is the most important thing. And again, if they don't, if you don't do it for a living as practice managers and doctors don't do, they're not going to, they may catch a word or whisper here and there, but not really know the full scope of what's happening in a, a market. Speaker 1 00:17:49 So that segues into kind of the, the basics of what, what has to happen, right? And, uh, we've got our list. We kind of know where we want to be, we understand what the per square footage, um, lease rate's gonna be and all of those kind of, again, just the things that we know mm-hmm. <affirmative>. Well then we run into these terms such as triple net, full service, net, net, net mm-hmm. <affirmative>, whatever. Can you give us a little bit of a quick and easy way to remember those things as we're dealing with leases? Speaker 2 00:18:28 Sure. You know, the, the, the fun stuff, the interesting stuff that everybody really wants to know, right? Speaker 1 00:18:33 I just like the full service cuz it's Speaker 2 00:18:35 Right. Everything, it sounds great too, right? Full service. I mean, who doesn't want Speaker 1 00:18:39 Full service? Right? Speaker 2 00:18:39 Exactly. If I go to a resort, I want full service. That's right. Um, yeah. So, so some of the basics, you know, triple nets versus full service is, uh, full service leases. Uh, you see modified gross leases, you see all these different terminologies that are used within a lease. Um, and, you know, if it's important to understand for the, the client as we explain it, that's great. And so, uh, the basics be between a triple net and a full service lease. And we don't have to go into all the modified and everything else really. It's just the typically comes down to the landlord or REIT in what they've historically done. Right? So if you've got an old school landlord, uh, who, who loves a particular type of lease, most of the time we see them kind of leaning towards full service, right? Because they know it's an easy number for them to put out there, an easy number to market because typically it includes everything, right? Speaker 2 00:19:28 Well, it doesn't include everything, which is why someone like me knows the right questions to ask. So if they say a full service lease, let's just throw a number out there and they're advertising, you know, lease space at $20 a square foot fsg, right? Full service gross. Um, that would typically incorporate what we would see on the triple net side, which are the taxes, insurance, maintenance cost. Right? Right. So they're factored into that number. We don't know what their base operating number is. It could be $5 a foot that they own the building that they're operating at, or it could be $15, right? Mm-hmm. <affirmative>. So we don't know that number per se, but we know that the full service includes the taxes, insurance, and typically maintenance costs. But there's usually a cam on top of that, not always. And then, and a lot of times, Speaker 1 00:20:12 So we said Cam, we gotta make sure we, everybody knows Speaker 2 00:20:15 It's common area maintenance costs. So that's, if you're in an office building, there's the shared space, there's the bathrooms, there's the parking lot, there's the landscaping, the electricity, those costs are passed on to the tenants and it's based your amount that you pays based off of how much square footage that you lease, right? Mm-hmm. <affirmative>. And it's broken down on a percentage. So with a full service gross lease, those numbers are typically included. The only things that they will typically not include that we would ask those questions are again, what does it not include? So janitorial is usually not included. Sometimes it is, is uh, you know, your, your electricity, your, your gas, your water, those are things that are not always included, you know, in that particular space in a full service lease mm-hmm. <affirmative>. And we would ask those questions. Cause sometimes they'll tell you how it includes everything but internet cuz you just don't know every, every landlord and agent and does something different. Speaker 2 00:21:05 Okay. Now on the other side of that, we have triple net leases. So typically let's use the same number. They say it's a triple net lease at $20 a square foot. Well, I then ask the question, where are your triple nets, which are your taxes, insurance, and, and maintenance cost, right? Mm-hmm. <affirmative>. And so they could be anywhere from $2 a square foot and I've seen 'em as high in Birmingham sometimes at $13 a square foot. Right. Based off of the type of building, the amount of vacancy that's in the building and you know, the cost and how they've been negotiated because those costs are a landlord or the, or the management company's obligation to negotiate, uh, how much their landscaping's gonna cost, uh, how much, you know, repaving this or, or fixing that's gonna cost. And that's a pass through expense to the tenant. It's not a, uh, uh, it's not a, a profit for the, for the landlord. Speaker 2 00:21:57 It's a pass through expense. So the next question would be Right Jeff, which one's better <laugh>? Yeah. Well, there's not really a better, it's, it's, um, there are pros and cons to each. So with the triple net lease, if you've got a, um, you know, a landlord who's negotiating the cost, right? Um, you will see sometimes that if they're overestimating the cost at the end of the year or the end of the quarter, however, they, um, bill you would, you could potentially see a reimbursement, right? An overage that you paid, that you would get back. Whereas with a full service lease, you don't always see that because we don't know what the operating number is and they sometimes overestimate or underestimate and they eat the cost the landlord does if they don't estimate enough, right? If it's a full service lease. And then what they do is the next year they ream, amateurize or restructure, um, you know, those services or those cost for the next lease year, which is something we negotiate as well, which is the, the correct base rent year for a full service Speaker 1 00:22:59 Lease mm-hmm. <affirmative>. And that's where you typically see that invoice that comes in after the fact. Right. Um, one of my clients, we've got that operation expense, um, uh, situation statement. Yeah. Yeah. Mm-hmm. <affirmative>, and I'm at the kind of near the end of that quarter, I'm constantly checking in how we doing, you know, do I need to start watching the, the air and the lights, right? H V A C, all of that a little bit closer. Uh, fortunately we've got some good folks in that practice that, that are, um, frugal and, and uh, and pay attention to those things and not just crank the air up all the way <laugh>, you know, over the weekend and right. The middle of summer, um, where it's freezing when you walk in on Monday morning mm-hmm. <affirmative>. But, um, that's, that's just a partnership with everybody understanding that we just gotta pay attention to all those expenses. Mm-hmm. <affirmative>, um, and, you know, to ask you which one you favor over the other, Speaker 2 00:24:05 I I say a full service lease always, it's always there's pros and cons. Right? Speaker 1 00:24:10 Right, right, right. Uh, but even in the other where you've got, where you're sort of paying the the yard person or, or landscaping and such, you don't necessarily have a say so in cuz you're not gonna have four or five landscapers out there. Correct. So that's, it's staying in good communication with the property manager and the landlord and Right. Speaker 2 00:24:36 Um, yeah. One one's a little bit more open ended, you know, and, and maybe a little bit more transparent from a triple net, whereas a full service, you just know it's, it's taken care of and, and, um, it's a little bit less, uh, obvious of, of where the expenses are. Right. Speaker 1 00:24:53 For sure. Just real quick, how, how much, uh, in involvement do you have with the, uh, property management group or the landlord if it, if he or she or that entity is doing all that and the tenant kind of even after the, the, um, transaction takes place and the leases in place and such? Speaker 2 00:25:18 Sure. Um, not, you know, it does not a lot. Um, we, we hope that those things are negotiated correctly up front, so mm-hmm. <affirmative>. So, you know, if there's a question that a, that a client has that says, Hey, listen, this was said or negotiated, but, uh, this is what's happening, then I'm going to, to delve into, all right, well what did the lease say? What did we negotiate? Right? And then I can follow up at that point and say, look, you know, Mr. Landor, this is negotiating the lease you need. You've gotta hold by the terms of the lease. And these things are not lining up with what, what was negotiated for sure mm-hmm. <affirmative>. So that's, that's really the extent of it. And then, you know, just making sure that everything's negotiated up upfront is the most important part of, you know, before signing that contract. Right. It's gotta be, right. Yeah. You've gotta consult, you know, your team Kaun, we need to make sure an attorney's reviewed the lease that everything, you know, looks right and is, is what we negotiated in the terms of the letter of intent. Yep. Speaker 1 00:26:08 Good. Well we've got a, a few more minutes, uh, on this session and our second, uh, time around. I want to, uh, to kind of get into some of those war stories and some other strategic kind of things that, that one might, uh, consider. But, uh, as, as we wrap up, uh, today, a few more just, uh, basics if you will, what are some of the real landmines you, you look for would caution someone that's looking at a lease, not that we need to, um, you know, just get the lease and, hey, I'll listen to this podcast. So I'm, now I'm an expert cuz you've, you've spent a lot of time at this, but we all work together, right? You, you see things that I didn't see vice versa. Um, what are, what are some of those landmines that you really try to pick up first and foremost, uh, when you, when you get a term sheet or, or the actual lease? Speaker 2 00:27:06 Right? Um, so going back to, to having a, um, experienced real estate attorney is a big deal, right? Mm-hmm. <affirmative>, um, consulting your team that you're working with and then making sure that you have a real estate attorney that actually, you know, a lot of times what we'll hear is clients say, well have an attorney, will they, they're a divorce attorney. Right? Or they're a, you know, they've, they've done a real estate deal before. Right? So the first thing we wanna do is make sure that they understand real estate, they understand their practice, and that they understand really what their place is. And that is to make sure that the legal parts of the contract are, uh, no more advantageous than the landlord than they should be. Because every contract, every lease is written in favor of the landlord. Mm-hmm. <affirmative>, it's not written in favor of the tenant. Speaker 2 00:27:48 Right? Right. Uh, so we wanna make sure that there's nothing out of the ordinary first and that the terms of the letter of intent that we've negotiated line up with the contract, uh, and some of those things within, you know, the contract that we're gonna make sure that could be landmines are, first of all, I wanna make sure that they, if there's a buildout included, in other words, if they're going into a new space, uh, or their space needs to be rehabbed, that there's enough time within that lease that gives them buildout time. So that in other words, they're not going in, if they need four months of buildout, they're not in the space and paying rent the first month. Right. Right. They need to be at least four months out, if not longer, so that that way they're not paying when they're not making revenue and there's no revenue coming in. Speaker 2 00:28:28 So we wanna make sure that's negotiated. We wanna make sure that there's free rent even over and above the build out time to give them some cushion, especially if it's a new practice, starting a new practice that they have some time to settle in and start, you know, seeing patients and the, the time it takes to move into a space or rehab the space. Uh, and then going back to the cam stop making sure that there's a, there's a, um, what we would say was a cam expense stop, or there's, in other words, the, the landlord can't have an unlimited ability to continue to raise, uh, you know, what their expenses are. And so there's a, there's an expense stop basically that's negotiated in the lease. Uh, outside of that, there's a lot of variables that we negotiate, but from a landmine that usually gets overlooked, and then a base year, if it's a full service gross that we're making sure that the base year is based off of the year they're either moving in or the following year. So that way that there's a good, um, average that they're seeing when they're coming in to, to paying their lease. Um, those are some of the landmines that are kind of outside the box that we see that would mm-hmm. <affirmative> wanna be paid attention to. And they're almost always overlooked. Speaker 1 00:29:32 And getting those building policies and procedures, knowing what you're getting into Right. Where you can't, what you can and can't do. Speaker 2 00:29:40 Exclusivity. Yeah. In the, in the, in the property is a lot of times it's overlooked and we make sure that that's always in the initial negotiation that they can have an exclusivity. And if they can't have a 100% exclusivity as we know Yep. Then it can be defined enough that makes sense for the practice, that they don't have a competing practice coming in next to them. And you know, that, that, that their practice is set up for Speaker 1 00:30:01 Success. Right. And that's the, I'll tell you as we, as we wrap, that's kind of that, you know, um, just that little point of, wow, I never thought about that. Mm-hmm. <affirmative> Well, that's why you have experts and advisors to, to help with those things. Right. Well, Richard, thank you for being with us. Uh, in this segment we're gonna bring you back for a, another segment where we talk a little bit more about those anecdotes, a little more conversational and appreciate all of the, the basics and the, and the, you know, just the things that we need to be thinking about from a, a technical standpoint as it relates to our, our real estate and the healthcare space. Um, uh, it is, it's, it's an ever moving target, right. And that's why we, we appreciate, uh, experts like yourself, uh, being a part of this. Speaker 2 00:30:51 Thank you, Jeff. I'm glad I could be Speaker 1 00:30:53 Here. Yeah. Russ, thanks again for Man the board. My name's Jeff Dance. I'm the host of your Kasu revenue radio, where we bring you ideas and information on how you can enhance the practice of medicine and, uh, always maximizing your revenue within your practice. Thank you. And we'll see you again soon.

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