Prepared for lenders, CDCs, and federal agencies to SBA SOP 50 10 8, USDA 7 CFR Part 5001, and conventional underwriting standards. Fiduciary duty runs to the lender and the agency, never the borrower. 4,000+ engagements since 1998 covering $41.2 billion in evaluated project value. So far in 2026: 41 engagements and $1.54 billion evaluated — 17 SBA, 11 USDA.
Medical office buildings are underwritten as leased real estate with a clinical tenancy overlay: physician and health-system demand within the patient draw area, the building's clinical specification — floor loads, HVAC, generator capacity, ADA clinical standards — and lease economics that run longer and stickier than commodity office when tenancy is genuinely medical. The study sizes provider demand from physician-supply data and health-system outpatient strategy, validates the rent thesis against medical comparables rather than office averages, and tests the rollover schedule against the anchor tenancy's credit and term.
Demand analysis from provider-per-capita gaps and system expansion patterns, rent and expense benchmarking against medical-specific comparables, tenant-improvement budgets at clinical buildout costs, and lease-up modeled against the submarket's documented medical absorption with anchor-tenant concentration stated plainly.
Every Wert-Berater financial model is fully linked with no hardcoded values, so any reviewer can stress any input. Deliverables comprise a complete narrative report and the linked Excel model, with ten-year pro forma, sensitivity analysis at ±5, 10, and 15 percent, interest-rate stress from +0.5 to +3.0 percent, and ratio analysis benchmarked against RMA and IBISWorld data.
SBA engagements are prepared to SOP 50 10 8, including its debt-service-coverage minimums of 1.15x operating and 1.00x global. USDA engagements follow RD Staff Instruction 5001 across the Business & Industry, Community Facilities, REAP, and Value-Added Producer Grant programs. Conventional engagements are built to the lender's stated coverage standard, typically 1.20x. Owner-occupied physician buildings fit SBA 504 directly; multi-tenant MOBs route conventional; hybrid owner-user structures with leased suites are modeled to each program's occupancy rules.
The firm's $38,900,000 medical-village engagement — nineteen clinical buildings on a hybrid lease-and-sale program — supplies the category's reference architecture. Independence is non-negotiable: determinations follow the evidence and are not revised under pressure, and studies are built to pass lender, agency, and third-party review without exception items.
A medical office building feasibility study covers more ground than a standard commercial real estate analysis because the asset functions as both real estate and clinical infrastructure. The narrative addresses site access for patients with mobility limitations, parking ratios calibrated to clinical visit frequency rather than office norms, floor-load capacity for imaging suites, dedicated HVAC zoning for procedure rooms, and emergency-generator sizing sufficient to sustain life-safety systems. Each of those physical attributes is tied directly to the tenant demand analysis, because a shell that cannot accommodate a radiology tenant cannot capture radiology rent.
The explicit statement of conditions identifies every assumption that, if wrong, would move a passing coverage ratio below the lender's threshold—so the credit officer knows exactly where the exposure sits.
Demand for medical office space is a derived quantity: it follows from the number of physicians and mid-level providers who need to see patients in a given area, the outpatient strategies of regional health systems, and the gap between current clinical supply and documented need. The analysis begins with provider counts drawn from state medical-board licensing registries, the National Plan & Provider Enumeration System, and county-level physician-supply reports published by state health departments. Those counts are normalized to a per-capita rate and compared against specialty-specific benchmarks to identify undersupply by discipline.
On the supply side, the study inventories existing medical office buildings using commercial property records, certificate-of-occupancy filings, and health-system real estate disclosures. Pipeline supply is identified through building-permit data, zoning-board agendas, and any publicly available health-system capital plans. Traffic and access analysis draws on state DOT counts and, where relevant, transit-authority ridership data for sites near transit nodes.
Payor mix data—available through state all-payer claims databases and CMS geographic variation reports—informs the revenue-per-visit assumptions that underlie each prospective tenant's ability to sustain market rent. Where a certificate-of-need process exists in the state, filed applications and approved certificates are reviewed as forward indicators of clinical capacity expansion. The result is a demand conclusion grounded in enumerable providers and documented system strategy, not extrapolated from regional population growth alone.
Four inputs account for the majority of variance in a MOB's projected debt-service-coverage ratio. Understanding how each is tested is more useful to a credit officer than reading a point-estimate pro forma that presents only the sponsor's preferred scenario.
Every assumption is a live input in the linked Excel model, so a reviewer can substitute any figure and observe the coverage impact immediately.
Medical office demand is frequently tied to a nearby hospital campus, and where a sponsor is evaluating the hospital itself rather than the surrounding office product, the applicable engagement is a hospital feasibility study.
SBA lenders underwriting an owner-occupied physician building under the 504 or 7(a) programs require a feasibility study prepared to SOP 50 10 8, with debt-service-coverage demonstrated at 1.15x on an operating basis and 1.00x on a global basis. The occupancy rules matter: a physician practice that occupies the majority of a building it owns fits the owner-user framework, but a multi-tenant MOB where the sponsor leases space to unrelated providers is treated as investment real estate and routed accordingly. Hybrid structures—where the sponsoring practice occupies a portion and leases the remainder—require the model to allocate income and expense between the owner-user and investor components under each program's specific rules.
USDA Business & Industry and Community Facilities programs apply to MOBs in eligible rural geographies, and the study must follow RD Staff Instruction 5001. Community Facilities financing is particularly relevant for critical-access hospital outpatient facilities and federally qualified health center expansions, where the borrower's mission and service-area demographics are underwriting factors alongside coverage.
Conventional lenders typically require 1.20x coverage on a stabilized basis and will scrutinize the lease-up assumption, the anchor tenant's credit, and the rollover schedule. A lender whose portfolio already carries concentration in medical real estate may apply a more conservative vacancy stress. The study states the coverage ratio at each sensitivity increment so the credit officer can locate the break-even scenario without building a parallel model.
The fixed fee is quoted within one business day of an inquiry and does not change based on the study's conclusion. No portion of the fee is contingent on a favorable finding, and the determination is not revised because a sponsor or lender prefers a different outcome. That structure is the only one consistent with a fiduciary duty that runs to the lender and the reviewing agency.
Standard delivery is ten to fifteen business days from receipt of a complete data room. The data room for a MOB engagement typically includes the site control document or purchase agreement, any executed or letter-of-intent leases, the sponsor's construction budget and development schedule, existing survey and environmental reports, and the lender's term sheet or program-specific checklist. Rush delivery is available when the credit timeline requires it.
Upon completion, the bound narrative report and the fully linked Excel model are published to a secure client portal. The model remains live: when a lender's credit officer changes an occupancy assumption, a rent figure, or an interest rate, every downstream calculation—net operating income, debt-service coverage, sensitivity tables—recalculates without manual intervention. There are no hardcoded values. The portal access does not expire at delivery; it remains available through the lender's credit and closing process.
With 4,000+ engagements completed and $41.2 billion in evaluated project value since 1998, the firm's process is calibrated to pass lender, agency, and third-party review without exception items on the feasibility determination.
The fee is fixed, quoted within one business day, and does not vary based on the study's conclusion. Because clinical buildout complexity, anchor-tenant structure, and program requirements differ by engagement, the fee is stated after a brief intake conversation. No portion is contingent on a favorable finding, and the figure does not change once quoted.
Standard delivery is ten to fifteen business days from receipt of a complete data room. The most common source of delay is an incomplete data room—missing lease drafts, an unsigned purchase agreement, or the absence of a lender term sheet. Rush delivery is available. The fee and timeline are both confirmed before the engagement opens.
Three factors compound the difficulty: clinical tenancy demand must be derived from provider-supply data rather than general employment metrics; tenant-improvement costs at medical buildout are substantially higher than office norms, making rollover reserves a material underwriting variable; and anchor-tenant concentration risk is acute when a single health system or physician group represents the majority of scheduled rent.
Yes. SBA engagements are prepared to SOP 50 10 8 and must demonstrate 1.15x operating coverage and 1.00x global coverage. The occupancy classification—owner-user versus investment real estate—determines which SBA program applies and how income is allocated. Conventional studies are built to the lender's stated standard, typically 1.20x, with no program-specific occupancy rule.
A single study can address both programs when the engagement scope is structured to meet each agency's requirements. SBA engagements follow SOP 50 10 8; USDA engagements follow RD Staff Instruction 5001. Where the programs impose different coverage thresholds or occupancy tests, the model and narrative address each standard explicitly rather than defaulting to the more permissive one.
The core data room includes site control documentation, any executed leases or letters of intent, the construction budget and development schedule, existing survey and environmental reports, and the lender's term sheet or program checklist. The firm reviews the data room on receipt and identifies any gaps before the clock starts on the delivery window.
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Wert-Berater, Inc. is an independent provider of feasibility studies and other related services. The firm does not provide financing or equity investment advice, and does not arrange, broker, or place debt or equity capital of any kind.
All appraisal assignments are performed by Bruce E. Jones, MAI, ASA-GC, BCA, CMEA, a member of the Appraisal Institute since 2006, a staff member of Wert-Berater, Inc. and owner of Special Purpose Realty Valuation.