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We hope everyone enjoyed some time off over the holidays. As we reflect on 2025 and head into the new year, we spent some time mapping out our hospital real estate predictions for 2026. We believe it will be a mixed bag for hospitals and health systems around the country. Most hospital systems will face financial headwinds, which will result in cost-cutting measures. Those headwinds also create opportunities for strategic growth for those with strong balance sheets or in…
Continue Reading Weekly Hospital Real Estate Briefing: Our 2026 Predictions

  • Revista published a pair of interesting blog posts: (1) the amount of general hospital space under construction in Q3 of 2025 has continued a multi-year climb that started in 2022; and (2) noting that the least expensive MOB rents (bottom 10th percentile) have grown at just 1.3%/yr since 2018, while moderately priced properties (50th percentile base rent) have grown at 1.7%/yr and the most expensive properties (90th percentile base rents) have grown 2.7%/yr over the same period.
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    Continue Reading Weekly HRE Briefing, Dec. 24, 2025

  • Fitch Ratings’ 2026 outlook for the nonprofit hospital sector was “neutral,” and forecasts median operating margins between 1-2%, while noting largely healthy volume trends and strong balance sheets. It expects a roughly equal number of ratings downgrades and upgrades among its portfolio, and noted that the industry is still investing in patient tower and brick-and-mortar facilities.
  • Come join our growing real estate team! Hall Render is seeking a 2-5 year attorney to join our Indianapolis office, which serves health

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    Continue Reading Weekly Hospital Real Estate Briefing, Dec. 12, 2025

    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

  • According to a recent EY report commissioned by the AHA, nonprofit hospitals provide over $149B in annual community benefits, as compared with $13.2B in forgone federal income tax revenue. Even when factoring in state and local exemptions ($54B per year), community benefits were three times higher than total forgone taxes. The largest share of benefits is patient financial assistance and unreimbursed costs from government payors, valued at $65B.
  • Leaders at a recent Becker’s panel noted that cardiology is becoming

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    Continue Reading Weekly Hospital Real Estate Briefing, Nov. 26, 2025

  • 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

  • The longest government shutdown in American history ended Nov. 12. As part of the resolution to fund the government, Medicare telehealth and acute hospital care at home programs were extended through Jan. 30. The fate of ACA enhanced premium tax credits will be debated by Congress in December.
  • PwC, ULI, and Revista released an article predicting an overall strong outlook for the medical office sector in 2026. The article pointed to tailwinds such as continued strong outpatient demand, tight

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    Continue Reading Weekly Hospital Real Estate Briefing

    On October 9 and 10, our Firm hosted The Real Deal Summit in Scottsdale, Arizona. It was a conference focused on growth and strategy trends in the hospital and health system industry. We had a great turnout of hospital and health care executives, in-house counsel and leaders from across the country. Here are our top 10 takeaways from the conference.

  • When to Enter New Markets – Growth for the sake of growth doesn’t always make sense. The better strategy

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    Continue Reading Weekly Hospital Real Estate Briefing: Our Top 10 Takeaways from The Real Deal: Health Care Strategy, Growth & Transactions Summit in Scottsdale, AZ

  • 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

  • JLL published the results of its 2025 Patient Consumer Survey. Key takeaways: 1) access and affordability are persistent challenges for U.S. health care; 2) location and convenience of a health care facility are key to choosing a provider; and 3) the quality of a particular health care facility is a top factor when choosing a provider.
  • Wellstar Health received the necessary approvals to build a $1.1B hospital in Acworth, GA. The 230-bed hospital will be eight stories, 675,000 sf

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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

  • While institutional investor groups are a major acquirer of medical office buildings (MOBs), the past 18 months have seen a surge in “reverse monetizations” where hospitals and health systems are buying (or buying back) such buildings. Hospitals purchased $2.8B worth of MOBs in 2024 and $761M in 1H 2025, accounting for about 23 percent of all MOB purchases.
  • Hospitals are responding to upcoming reimbursement cuts by selling off ancillary businesses and non-core real estate, while pursuing joint ventures in

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    Continue Reading Weekly Hospital Real Estate Briefing: Rise in Hospital Reverse Monetizations of MOBs | Corewell/Quest Sign JV Agreement | Hospital Margins Continue to Decline

    FinCEN (the Financial Crimes Enforcement Network) is a subdivision of the U. S. Department of the Treasury and is tasked with combating money laundering and other financial crimes.

    Recently, FinCEN made headlines related to their proposed rule that would have instituted stringent beneficial ownership reporting requirements for many U.S. companies and their attorneys, accountants, and advisors. However, following strenuous objections to the proposed rule, FinCEN ultimately exempted U.S. companies from the reporting requirements.

    FinCEN is now back with a

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    Continue Reading FinCEN’s New Real Estate Reporting Rule: More Traps for the Unwary

  • According to CBRE, medical outpatient building (MOB) transaction volume increased 32% in Q2 with $2.2 billion in investments. Phoenix was the top market in terms of investment volume, followed by Los Angeles and Washington, D.C. The average MOB cap rate was 7.4%. The average sale price per square foot was $277, which is 40% more than the sale price per square foot for traditional office buildings.
  • BayCare Health (FL) is moving forward with plans to transform a 36-acre

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    Continue Reading Weekly Hospital Real Estate Briefing: MOB Rents Hit Record High | BayCare Begins Work on Academic Research Corridor | MUSC Innovation District Gets Initial Planning Approval