How do you price a termination right tied to a suite losing its hospital outpatient designation

Price it as a shortened term, not as a fee you might collect. If the clause is exercisable at any point, your underwriting term on that suite is effectively 12 months plus notice, and the residual value of the building at exit reflects whatever a buyer thinks that risk is worth. A cap rate buyer paying 6.9% for 9 years of system-affiliated cardiology is not the same buyer as one pricing a suite that can hand back 11,200 sf on a year's notice.

Arbor is right that the trigger language is where the exposure sits. Add two more constraints. Make the right exercisable only in a defined window, say months 48 through 60, rather than any time. And make the fee cover unamortized costs, so leasing commissions plus whatever TI you funded, not a flat six months. If you put $70 psf into that suite, six months of rent doesn't come close.

What your lender will do with this matters more than the redline itself. Lenders sizing debt on a single-tenant-dominant medical building often set amortization and term against the lease term, and a termination right inside the loan term can move proceeds or trigger a cash sweep starting a year or two before the window opens. Get the clause in front of them before you go hard on deposit, because the deal can survive the clause and still fail on proceeds.

The other thing to check is whether the reimbursement designation is attached to the site at all. Site-neutral payment policy has been moving toward paying the same for a service regardless of where it's delivered, which is exactly the shift this clause is hedging. If the tenant expects that shift, the clause isn't hypothetical to them, and you should assume they'll use it. Any read on whether the designation actually attaches to your address needs healthcare counsel, not a broker's opinion.