INDIANAPOLIS-For many smaller, independent healthcare real estate development firms, the temptation has often been too great to resist. When larger entities with plenty of capital come calling, either for an acquisition or to form a partnership, they accept.

One regional healthcare real estate firm that has no plans to do so, however, is Indianapolis-based Cornerstone Cos. Inc. The company, long a regional player, has been quite busy so far in 2013, when it could open as many as six buildings.

“We've been approached,” says J. Taggart Birge, the company's executive vice president of development, “but we plan on maintaining our independence.”

In a recent interview with Healthcare Real Estate Insights, Birge talked about the company's role as a developer, owner and manager of medical office buildings since 1985, when Robert N. “Bob” Whitacre, the president, started the firm. Birge also discussed the healthcare development sector as a whole.

Here's the first part of the interview:

HREI: Cornerstone typically starts up to three new projects per year, but it looks like you could open six buildings in 2013. Why is that?

Birge: It does seem like there is a lot of activity out there and we have made a strong effort to market ourselves for these projects. It looks like there is a lot happening because even though demand has been building, the rules of the road were not clear. But now that the Patient Protection and Affordable Care Act looks like it is here to stay, that road is clear… Everyone might not agree with it, but it's easier for (the hospitals and health systems) to plan right now.

HREI: And what will the result be?

Birge: Well, one result will be that the need for outpatient buildings with a primary-care focus is going to accelerate given the amount of newly insured population that the hospital systems are going to have to deal with. And they're not going to want to care for those new patients in more expensive acute-care settings.

HREI: Quite a number of smaller and regional healthcare development companies such as yours have been acquired by or merged with larger firms, or have entered partnerships with larger companies or institutional capital. What about your firm?

Birge: We've been approached to sell our platform and we have no interest in that. We want to maintain our own unique culture. And the way hospital credit can be financed, we can be just as competitive with the REITs with certain debt-like instruments, so it's not like there's a competitive cost of capital difference. We've partnered with physicians in the past, but every project we do we co-invest in. We haven't used institutional money; it's all private equity, ours and third-party partners in the building.

John B. Mugford is the Editor of Healthcare Real Estate Insights™, the nation's first and only publication totally dedicated to covering news and trends in healthcare real estate development, financing and investment. For more information, please visit www.HREInsights.com.