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  • According to a recent report, cardiology outpatient strategy is shifting towards ambulatory surgery centers (“ASCs”) and away from hybrid office-based lab/ASC models to streamline staffing, space and back-office functions. Many health systems are prioritizing cardio ASC developments that are physically connected to, or in close proximity with, hospitals to support clinical integration and quality oversight.
  • Nearly one in ten private U.S. hospitals are now private equity-owned, totaling 447 facilities. Of the total PE-owned hospitals, REITs own about one-third while 

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    Continue Reading Weekly Hospital Real Estate Briefing: Nearly 1 in 10 US Hospitals Now PE-Owned | Pearl Innovation District Generates $224M in Economic Impact | AdventHealth Continues Land Banking

    On July 6, 2026, the Supreme Court of Wisconsin held in a narrow 4-3 decision that the ‘ensuing loss’ exception to the “Construction Defect” exclusion (or “Faulty Workmanship” exclusion) contained in the policyholder-defendants’ homeowner’s insurance policy reinstated coverage for damages caused by rainwater entering the policyholder’s dwelling as a result of construction defects, regardless of whether such defects existed from the time of original construction. Cincinnati Ins. Co. v. Ropicky, 2026 WI 25. While the Court recognized and purported…
    Continue Reading Wisconsin Supreme Court Holds That the Ensuing Loss Exception Reinstates Coverage for Rainwater Damage Caused by Construction Defects

    New house building at the construction site.
    New house under construction, front view from garage door entry with clouds blue sky. Framing of home exterior structure with a pile of lumber and siding plank leftover. Real estate business industry.

    In the world of real estate, what lies beneath the surface can be just as important as what stands above it.

    Buyers frequently focus their commercial real estate due diligence on topics including structural integrity, environmental factors, title and survey, zoning, and financing. However, there is one critical issue that is frequently overlooked: the condition of underground sewer and drain systems.

    Sewer and drain systems are essential infrastructure for any building, whether that be industrial, retail, office, or multifamily…
    Continue Reading Real Estate Due Diligence: Sewer Inspection Risks and Buyer Protections

  • The Veterans Health Administration and HCA occupy the largest amount of REIT- and investor-owned outpatient space, according to a recent Revista post; however, most health systems overwhelmingly favor owner-occupied outpatient space. On the development side, third-party development accounts for about 30% of health system MOB projects, with the remainder being self-developed.
  • High-quality, well-located medical office space is increasingly difficult for health care tenants to secure, with competition intensifying in many markets as demand shifts toward suburban markets. The supply

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    Continue Reading Weekly Hospital Real Estate Briefing: $300M Novant Campus | Baystate/Mercy Announce Transaction | Growing Sale-Leaseback Restrictions

    Workers at the construction site
    Architects and investors meeting at the construction site, on top of the residential building under construction.

    Wisconsin’s recently enacted 2025 Act 173, commonly referred to as the “Truth in Planning” law, introduces important changes to the relationship between comprehensive planning and zoning for municipalities. Act 173 represents a meaningful shift in Wisconsin land use law and reflects broader policy objectives related to housing availability and affordability. By requiring municipalities to plan for residential development in a more detailed and transparent manner, the legislature intended the updated statutes to reduce uncertainty and facilitate the construction of…
    Continue Reading Truth in Planning Law Changes Planning and Zoning for Municipalities

    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