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From time to time, we like to take a break from reporting the headlines and tell you what our real estate attorneys, paralegals and consultants are working on across the country.

  • Senior Housing Projects – We can’t say enough about the high level of senior housing activity right now. The public Real Estate Investment Trusts (“REITs”) are buying everything in sight, or so it seems. We’re working with several regional senior housing developers and operators on the disposition of

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    Continue Reading Weekly Hospital Real Estate Briefing: What’s on Our Desk

    If you’ve been watching the real estate news over the past two years, you have probably noticed an increase in senior housing transactions. A number of the health care real estate investment trusts (“REITs”) and specialty REITs that have historically focused on nursing homes have pivoted to investing in senior housing communities that offer independent living, assisted living and memory care services. It seems like the major real estate investors can’t get enough of senior housing.

    We’ve seen it…
    Continue Reading Weekly Hospital Real Estate Briefing: 5 Reasons Why Hospital Systems Should Consider a Senior Housing Partnership

  • Hartford Hospital plans to construct a $950M, 14-story, 500,000-sf inpatient and surgical tower. Construction is expected to begin in 2027 and will include 216 private-room inpatient beds.
  • Health systems continue land banking for future development. Recent examples include Novant Health’s purchase of the 56-acre former TD Bank campus off I-85 in Greenville, SC, for $45M; Atrium Health’s acquisition of 10 acres near I-77 in Fort Mill, SC, for $5M; and Banner Health’s purchase of 18 acres in North Phoenix,

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    Continue Reading Weekly Hospital Real Estate Briefing: More Land Banking | Hartford Hospital Plans $950M Tower | CaroMont Invests $200M in Oncology Services

    For years, we’ve heard that outpatient services and home care are the future of health care in the U.S. To a certain extent, that’s true. We’ve seen tremendous growth in outpatient care across the country. Procedures that were once provided in inpatient settings are now provided in ambulatory surgery centers and physician offices. Payers, providers and patients are all pushing for care that can be provided at a lower cost, in a more convenient setting and in a manner…
    Continue Reading Weekly Hospital Real Estate Briefing: Understanding the Hub and Spoke Model

  • The Centurion Foundation has financially stabilized Roger Williams Medical Center and Our Lady of Fatima Hospital in Rhode Island and returned them to local nonprofit management through a bond-financed recapitalization exceeding $100M. The hospitals had been at risk of closure after their prior owner, Prospect Medical Holdings, filed for Chapter 11 bankruptcy in 2025.
  • U.S. Senators Jerry Moran and Michael Bennet introduced the Rural Hospital Revitalization Act, which would allow eligible rural hospitals to apply for five-year, interest-free loans

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    Continue Reading Weekly Hospital Real Estate Briefing: VA Approves $672M in New Hospital Projects | Rural Funding Bill Introduced | Centurion Closes RI Hospital Deal

    Preferred return and waterfall provisions are the backbone of economic alignment in the operating agreements that govern real estate joint ventures. These clauses dictate how distributions are made between investor members and sponsors or managers. Poor drafting can lead to confusion, misaligned incentives, disputes, and costly litigation, so understanding effective drafting techniques is crucial.
    Continue Reading Drafting Preferred Return and Other Waterfall Provisions in Real Estate
    Operating Agreements: Best Practices for Lawyers and Investors

    Health care organizations planning major capital projects, such as hospital expansions, surgical centers and outpatient facilities, often face familiar frustrations: delays, cost overruns, redesign cycles and coordination breakdowns. Traditional delivery models like design‑bid‑build or construction manager‑at‑risk can unintentionally reinforce silos. Integrated Project Delivery Agreements (“IPDA”) offer a collaborative alternative designed to align incentives, reduce waste and improve project performance.
    What Is an IPDA?
    An IPDA is a single, multi‑party contract that binds the owner, architect, contractor and key consultants…
    Continue Reading From Silos to Synergy: Integrated Project Delivery Agreements for Today’s Health Care Facilities

    We frequently get calls from hospital systems, health care providers and investors regarding negotiating on-campus ground leases. They are certainly unique. Here are 10 business points to consider when negotiating on-campus ground leases.

  • Premises – The land being leased can vary widely. We often see hospitals ground leasing only the footprint of the building. There are some instances, on larger campuses, where the hospital allows the developer to lease the land needed for the footprint of the building, plus

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    Continue Reading Weekly Hospital Real Estate Briefing: 10 Tips for Negotiating On-Campus Ground Leases

    Most construction contracts presume that unanticipated changes sometimes happen, and permit changes to the contract price in those circumstances. However, these terms typically require the party seeking the change (most often a contractor or subcontractor seeking additional money due to unanticipated issues) to establish a causal link between the change and the increased work needed, and thus price. When projects are beset by numerous overlapping issues (for example, adverse weather issues, a design change, and unforeseen jobsite conditions), it

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    Continue Reading Untangling Complex Construction Claims – Why the Total Cost Method Matters

    In 2025, we worked on a number of significant land transactions where hospitals acquired land for new hospital campus projects. From our perspective, it seemed like an increase in land transactions when compared to previous years. Here are 10 observations based on our work on these transactions:

  • Arms Race – Hospital systems were aggressive in tying up land in growing markets. In terms of data, markets with high population growth were the primary targets. In states like Indiana, North

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    Continue Reading Weekly Hospital Real Estate Briefing: Our Top 10 Hospital Campus Development Trends

  • Legislators in several states are considering certificate of need (CON) reform over the next year. According to a recent article, legislators in Alabama, North Carolina and Tennessee are considering a complete repeal of their CON laws.
  • Ascension Saint Thomas announced more than $537M in capital investments to improve medical facilities across Middle Tennessee. The investments include updates and expansions to existing hospitals as well as new construction of hospitals and freestanding EDs.
  • MOB investments surged to $2.7B in

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    Continue Reading Weekly Hospital Real Estate Briefing: Several States Consider CON Reform | Sanford Health Receives $300M Gift | Sutter Health Announces Flagship Hospital

    When negotiating any type of contract, it is important to give due attention to all terms, even topics that appear merely ministerial or administrative, as their interpretation may have serious implications in the performance of the contract. The Wisconsin Court of Appeals recently analyzed a right of first refusal agreement (“ROFR Agreement”) on the sale of a property after one party failed to comply with its notice provision. The decision underscores the importance of understanding and adhering to all…
    Continue Reading Importance of Complying With Contract Notice Provisions

  • Remedy Medical Properties and Kayne Anderson Real Estate announced the acquisition of a portfolio of outpatient medical assets from Welltower for $7.2B, totaling approximately 18M sf across 296 properties in 34 states. The transaction is the largest MOB deal to date and makes Kayne/Remedy the largest MOB owner in the country.
  • In its latest National Hospital Flash Report, Kaufman Hall data highlighted continued strain on hospital finances. According to the report, median monthly operating margins fell to just 0.1%,

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    Continue Reading Weekly Hospital Real Estate Briefing

  • According to a recent report, ASC volumes are expected to expand by 9% between 2023 and 2028, driven by site-neutral reimbursement, advancements in outpatient surgical techniques and cost savings to patients and payers. ASCs generated $45B in 2024 revenues, a figure projected to climb to $57B by 2030.
  • Medical City Health Care is expanding rapidly in Collin County, Texas, to keep up with the region’s growing population and health care needs. Projects include a $142M vertical expansion at

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    Continue Reading Weekly Hospital Real Estate Briefing: ASC Volumes Continue to Expand | 30% of Telemed Visits Paused During Shutdown | Intermountain Expands Outpatient Imaging Chain in WA

  • UnitedHealth Group Inc. has completed its $3.3B acquisition of Amedisys, a company that operates over 500 home health and hospice sites throughout the country.
  • During a recent U.S. House of Representatives subcommittee hearing, legislators criticized tax-exempt hospitals for failing to provide adequate charity care and community benefits in excess of the estimated $37.4B in tax benefits they received in 2021.
  • Community Hospital Corporation (TX) announced plans to build a $400M state-of-the-art acute care hospital within the Heritage Ranch Master

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    Continue Reading Weekly Hospital Real Estate Briefing – Sept. 29

    This week, we’re taking a break from our usual briefing format to spotlight 10 key trends currently influencing the hospital real estate market. From pediatric hospital expansions to adaptive reuse projects, these developments are shaping strategies nationwide. If there’s a trend you’re seeing that’s not on our list, we’d love to hear from you. And as always, if our team can support your organization’s real estate needs, don’t hesitate to reach out.

  • Children’s Hospitals – As we reported earlier

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    Continue Reading Weekly Hospital Real Estate Briefing: Top 10 Market Trends Shaping the Industry