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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

  • The county approved a proposed purchase by University Health (San Antonio, TX) of the former Christus Santa Rosa Hospital campus for $71M. The 45-acre site also includes two MOBs, a parking structure and a solar farm. The buyer plans to spend $20M to renovate the hospital.
  • CMS Administrator Oz said applications for the agency’s $50B rural hospital fund will be available in early September as part of the recently passed One Big Beautiful Bill legislation. The fund is intended

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    Continue Reading Weekly Hospital Real Estate Briefing

  • UPMC and GoHealth have announced the opening of 81 urgent care centers, including 33 in the Pittsburgh area. The primary purpose of these centers is to enable patients to receive care for non-life-threatening conditions, but they can serve as an initial access point for those with more serious conditions.
  • Novant Health is planning to more than double the system’s ambulatory surgery center portfolio, targeting up to 50 ASCs within the next three to five years. The expansion is part

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    Continue Reading Weekly Hospital Real Estate Briefing

  • A recent article highlighted the resilience of health care mergers and acquisitions in 2025. While volumes are lower than in 2024, transaction volume is nearly double pre-pandemic levels. Behavioral health and home health/hospice remain the top targets for deals.
  • UCHealth University of Colorado Hospital and the CU Anschutz Medical Campus have developed a prototype alternative care facility at a hotel in Aurora, CO, to address hospital bed shortages during national emergencies. Funded by the Department of Defense, the project

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    Continue Reading Weekly Hospital Real Estate Briefing

    Most projects get completed and finally paid without having to resort to outside parties to resolve a dispute. Attorneys maximize the chance of success by teaching clients from our experiences – particularly clients who don’t have a lot of in-house knowledge about the most frequent causes of disputes.

    James M. Dash headshot
    James M. Dash, Houston 1985, is a founding equity member with Carlson Dash LLC in Milwaukee, where he concentrates his practice on the law of business in construction and design.

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    Continue Reading Avoid Project Disputes Before They Begin: The Lawyer’s Role in Guiding Client Expectations

  • New inflation data shows that the consumer price index (CPI) rose by 0.3% in June, bringing the annual inflation rate to 2.7%. Inflation has been slowly rising due to tariff concerns. Apparel and home furnishing prices have increased, while vehicle prices are down.
  • Florida passed legislation phasing out the state’s sales tax on commercial leasing transactions. The move has been widely viewed as a win for landlords and tenants doing business in Florida. The tax will be eliminated on

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    Continue Reading Weekly Hospital Real Estate Briefing: Inflation at 2.7% Year-to-Date | Florida Eliminates Sales Tax on Commercial Leases | JLL Releases Construction Report

    Real estate developers face a complex, evolving landscape for wetland permitting in Florida in light of the loss of the state’s permitting authority, combined with recent federal executive actions and changes to Section 404 of the Clean Water Act (the “CWA”). These state and federal developments create challenges for developers seeking to build hospitals, schools or housing in or near wetlands in Florida.
    Context and Legal Background
    Section 404 of the CWA regulates the discharge of dredged or fill…
    Continue Reading Developers Beware: How the Evolving Battle Over Wetland Permitting Is Impacting Florida Real Estate Projects