Medical Facility Feasibility Study

From $4,900, fixed fee, quoted before the engagement starts. 9 to 16 business days, rush from 5 business days. Prepared to SBA SOP 50 10 8.1 and USDA 7 CFR Part 5001, with a contractual acceptance commitment written into the engagement letter. First response within 12 business hours.

MMCG Invest prepares independent, third-party feasibility studies for medical facility projects nationwide. The studies are written for the credit file: the lender, the CDC, the USDA state office or the bond underwriter receives a service-area definition, a demand model built on use rates and payer mix, a verified competitor census, a project cost estimate, a financing structure and a multi-year pro forma with debt service coverage and stress cases. Engagements are led by Michal Mohelsky, J.D., FMVA, Practicing Affiliate of the Appraisal Institute, and prepared under USPAP discipline from the firm's San Francisco office.

Medical facilities do not share one underwriting logic. A critical access hospital is underwritten on cost-based Medicare reimbursement and a tax base; an urgent care center on visits per day and a 12 to 18 month ramp; a surgery center on the sponsoring surgeons' case logs; a residential treatment facility on Medicaid policy. MMCG keeps a dedicated page for each of the four facility types that lenders finance most often, and handles the remaining types under this page.

Hospitals. Critical access hospital replacements, rural hospital expansions, Rural Emergency Hospital conversions, physician-owned specialty hospitals and the rural health clinics and FQHCs financed alongside them. The page covers USDA Community Facilities direct and guaranteed loans, the 7 CFR 5001.304 feasibility tiers and where the CPA examination opinion sits. Hospital Feasibility Study

Urgent care centers. De novo and franchise centers under SBA 7(a), rural centers under USDA Business and Industry, and freestanding emergency departments. The page carries the visit, revenue and break-even benchmarks lenders expect to see. Urgent Care Feasibility Study

Ambulatory surgery centers. Physician-owned and joint-venture centers under SBA 504, SBA 7(a) and conventional financing, with the CY2026 covered procedures expansion, certificate of need status and the special-purpose equity rules. Ambulatory Surgery Center Feasibility Study

Behavioral health and addiction treatment facilities. Residential and outpatient substance use disorder programs, psychiatric facilities and opioid treatment programs under USDA Business and Industry, USDA Community Facilities and SBA 7(a), with Medicaid payer-mix stress testing. Behavioral Health Facility Feasibility Study

Dialysis clinics, outpatient rehabilitation, imaging centers and dental practices are covered below. Medical office buildings are handled on the office feasibility page, and assisted living, memory care and skilled nursing on the assisted living feasibility study page.

The first question in any medical feasibility engagement is not the facility type but who owns it. Nonprofit and government-owned borrowers are ineligible for SBA business loans under 13 CFR 120.110, so hospital districts, county hospitals and nonprofit systems finance through USDA Community Facilities, tax-exempt bonds or HUD Section 242. For-profit operators in rural markets of 50,000 residents or fewer can use USDA Business and Industry guarantees of up to $25 million, and for-profit operators anywhere can use SBA 7(a) up to $5 million or SBA 504 with a $5 million debenture, with combined 7(a) and 504 capacity of $10 million since July 2026. In practice, SBA fits urgent care, surgery centers, dialysis, outpatient rehabilitation and smaller behavioral health projects, and total project costs above roughly $12 million to $15 million migrate to conventional, HUD or USDA capital.

The program then sets the study. USDA Community Facilities guaranteed loans require a financial feasibility report on every loan, a feasibility study by an independent qualified consultant on loans over $1 million to a new entity or a new activity, and a financial feasibility study with an examination opinion on loans that do not meet the conditions of 7 CFR 5001.304(a). USDA Business and Industry requires an independent feasibility study on guaranteed loans over $1 million to a new business. SBA has no categorical feasibility mandate, but startups, new construction and special-purpose property place a medical project in the highest-scrutiny underwriting bucket, and lenders order a study because repayment rests on projections.

USDA draws one line in regulation. Under 7 CFR 5001.304(b), a financial feasibility study with an examination opinion must be prepared in accordance with the attestation standards of the American Institute of Certified Public Accountants, so only a licensed CPA firm can issue it. Every other document in the feasibility package can be prepared by an independent qualified consultant acceptable to the Agency: the Appendix A feasibility study with its economic, market, technical, financial and management components, the financial feasibility analysis under 5001.304(a), the Guide 5 Financial Feasibility Report for direct loans, and the market, volume and payer-mix model that an examination-level study rests on.

MMCG prepares those documents. On examination-tier hospital loans, MMCG builds the service-area, demand, volume and payer-mix assumptions that the CPA firm tests and attests to, and the two reports are issued as a coordinated package. On analysis-tier loans, direct loans and every Business and Industry loan, the MMCG study is the feasibility record.

Thirty-five states and the District of Columbia run certificate of need programs, and the 2023 to 2026 trend is targeted rather than wholesale repeal: ambulatory surgery centers and freestanding emergency departments are being released first and acute hospitals last. Where a state requires a certificate, USDA applications must include it under 7 CFR 5001.303(c)(12), and lenders will not close without it. Every MMCG medical study documents the certificate of need status of the facility type in the project's state, the capital thresholds that trigger review and the timeline the approval adds to the project schedule.

Three federal changes shape medical feasibility this year. The 2025 budget reconciliation law introduces Medicaid work requirements for expansion adults from January 1, 2027, moves expansion adults to six-month redeterminations, shortens retroactive coverage, freezes provider taxes and caps state-directed payments; the Congressional Budget Office estimates 10 million more uninsured by 2034. The $50 billion Rural Health Transformation Program distributes money through states over five years, caps capital spending at 20% of an award and does not allow new construction, so it supplements USDA debt rather than replacing it. The CY2026 OPPS and ASC final rule adds several hundred procedures to the ASC covered list and begins eliminating the inpatient-only list by 2029, moving surgical volume toward freestanding centers. MMCG's studies model each of these at the service-area level rather than citing them as national context.

The United States had 7,605 dialysis facilities and 137,195 stations in 2024, averaging 18 stations per facility, and the two largest operators run 74% of them. Facility counts fell 1.4% in 2024 as both operators closed or combined clinics to remove unused capacity, home dialysis reached 18% of fee-for-service treatments, and new ESRD cases now grow about 0.5% a year. The real estate is typically a 6,000 to 12,000 square foot build-to-suit on three-quarters of an acre to an acre and a half, held under a 10 to 15 year triple-net lease with a corporate guaranty. A dialysis feasibility study is therefore a developer's and lender's instrument: it tests station-level census and home dialysis penetration in the service area, nephrologist referral patterns and the renewal risk on the operator's lease, rather than the operator's credit.

Outpatient physical therapy, diagnostic imaging and dental practices are financed mainly through SBA 7(a) and 504 as owner-occupied practice real estate. A feasibility study is ordered when the project is a startup, a new building or an expansion into a second location, and when the lender needs independent support for projected volume. MMCG prepares these studies on the same demand, competitor and pro forma framework, scaled to the project.

MMCG publishes full model feasibility studies on real listed properties so lenders and sponsors can see the method before they commission it. The medical series covers a replacement critical access hospital under USDA Community Facilities, a closed rural hospital evaluated for reopening as a critical access hospital and as a Rural Emergency Hospital, a franchise urgent care startup under SBA 7(a), a rural urgent care center billing as a rural health clinic under USDA Business and Industry, a two-operating-room orthopedic surgery center under SBA 504, and a 32-bed licensed residential treatment facility under USDA Business and Industry. USDA Community Facilities Feasibility Study Case Study: A $55 Million Replacement Critical Access Hospital in Milan, Missouri, Feasible With the Sales Tax Pledge · Hospital Feasibility Study Case Study: Reopening the Former Van Zandt County Hospital in Grand Saline, Texas, Not Feasible as Proposed · SBA 7(a) Feasibility Study Case Study: A Franchise Urgent Care Center at Travis Ranch in Forney, Texas, Feasible Conditioned on the Ramp Reserve · USDA B&I Feasibility Study Case Study: A 32-Bed Residential Substance Use Disorder Facility in Adena, Ohio, Conditionally Feasible · SBA 504 Feasibility Study Case Study: A Two-OR Orthopedic and Pain Ambulatory Surgery Center in Leland, North Carolina, Feasible Conditioned on Surgeon Commitments · Model Case Study: Rural Urgent Care Acquisition, Duncan, Oklahoma, USDA B&I · Model Case Study: USDA Community Facilities Rural Health Clinic

Send the project location, the facility type, the loan program and a brief description of the sponsor and the program. A senior analyst responds within 12 business hours with a fixed-fee proposal and a delivery date.