The Acuity Brief — Issue No. 02 | July 2026

Healthcare CRE Intelligence for owners and investors · Issue No. 02 · July 2026

What changed in healthcare — and what it means for your property. Eight items, a five-minute read.

CMS proposes the 2027 dialysis payment rule — base rate rises to $299.55

The CY2027 ESRD PPS proposed rule would lift the base rate from $281.71 to $299.55, but most of that jump is the $15.96 phosphate-binder add-on folding permanently into the bundle. Net of adjustments, CMS projects total payments to dialysis facilities rising just 1.1%, on a 1.6% market-basket update trimmed by productivity cuts. Comments are due August 24.

Why it matters to owners

This is the annual credit check on your dialysis tenant’s revenue line. A roughly 1% net update keeps the major chains stable but squeezes thin-margin independents — driving consolidation, clinic closures, and renewal risk at marginal facilities. Owners should evaluate census and market position before the renewal notice arrives.

Sources: CMS CY2027 ESRD PPS Proposed Rule; Federal Register (6/26/26); Forvis Mazars.

The 2027 outpatient rule doubles down on site-neutral — imaging is next

CMS’s CY2027 OPPS/ASC proposed rule raises outpatient rates a net 2.4%, but expands site-neutral payment to no-contrast imaging at excepted off-campus hospital outpatient departments — roughly $260 million in first-year Medicare cuts — and reworks 340B. Hospitals are objecting; comments close August 31.

Why it matters to owners

Every expansion of site-neutral pay pushes more volume into physician-office and ASC settings — a demand tailwind for well-located MOBs and single-tenant medical assets. Off-campus, hospital-affiliated buildings that depend on HOPD premiums deserve a fresh underwrite before another rule cycle.

Sources: CMS CY2027 OPPS/ASC Proposed Rule; AHA News; Holland & Knight; Fierce Healthcare.

Hospital M&A stays hot: 18 deals and $7.7B in Q2

Kaufman Hall counted 18 announced hospital and health-system transactions in Q2 2026 — $7.7 billion in transacted revenue and three mega-mergers — up from $1.4 billion in the same quarter last year. Two-thirds involved independent systems proactively seeking partners; only three involved a financially distressed seller.

Why it matters to owners

Consolidation reshuffles real estate. New parents rationalize footprints, re-badge facilities, and revisit lease guarantees. Your lease may be assigned to stronger credit — or your building may land on the consolidation list. Both outcomes move value.

Sources: Kaufman Hall Q2 2026 M&A Report; Healthcare Dive; Fierce Healthcare.

Net-lease cap rates hold near 6.8% as supply jumps 12.5%

The Boulder Group’s Q2 2026 report puts single-tenant net-lease cap rates at 6.82%, with retail at 6.60%. On-market supply increased 12.5% to roughly 5,800 properties, yet investment-grade tenants with long lease terms represent less than 10% of that inventory.

Why it matters to owners

Commodity net lease is piling up; credit-tenant medical with term remains scarce. Well-leased dialysis and healthcare assets still trade at a premium, while short lease term is drawing a widening discount. Renewal strategy should come before sale strategy.

Sources: The Boulder Group Q2 2026 Net Lease Research Report; Connect CRE.

The 10-year sits near 4.5% — stop waiting for a rate rescue

The 10-year Treasury finished mid-July around 4.5%, while the Federal Reserve remained divided and inflation dampened expectations for cuts. Commercial real estate debt prices off the long end, and the long end is not cooperating.

Why it matters to owners

Value moves are coming from tenant credit, lease term, census, and buyer scarcity — not macro relief. Equity-rich 1031 buyers remain the most reliable bid in healthcare net lease, and they buy on story and certainty.

Sources: Advisor Perspectives Treasury Snapshot (7/17/26); Federal Reserve H.15; Bisnow.

DaVita volume benefits from Fresenius clinic closures

DaVita’s Q1 results beat on treatment volume, revenue per treatment, and cost per treatment. Management cited patient transfers from competitor clinic closures as part of the volume upside, while Fresenius continues pruning its U.S. footprint.

Why it matters to owners

The key question is which side of consolidation your building is on. Clinics absorbing displaced patients become stronger; clinics on the pruning list face non-renewal risk. Station count, census trend, service lines, and proximity to competing facilities help reveal which one you own.

Sources: DaVita Q1 2026 earnings call; Investing.com; StockStory.

41% of rural hospitals are losing money

Chartis’s 2026 rural snapshot counts 41% of rural hospitals operating at a loss and 417 vulnerable to closure. Medicaid cuts are beginning to bite, while only a limited share of the Rural Health Transformation Program can pay providers for actual patient care.

Why it matters to owners

When a rural hospital closes, the referral ecosystem around it reorganizes. Owners of dialysis, imaging, and specialty-clinic real estate should underwrite the local hospital’s financial health alongside their own tenant’s. Surviving regional hubs may absorb displaced outpatient volume.

Sources: Chartis 2026 Rural Health State of the State; KFF; Daily Yonder; Georgetown CCF.

CMS proposes adding roughly 618 procedures to the ASC list

The CY2027 proposed rule would make approximately 618 additional surgical and surgery-like procedures payable in ambulatory surgery centers, alongside a 2.4% ASC rate update. It is one of the largest proposed expansions of the ASC covered-procedures list.

Why it matters to owners

Procedure migration is the engine behind ASC real estate demand. Every procedure moving off the hospital campus needs a physical home, strengthening demand for ASC-occupied buildings and sale-leaseback opportunities for physician owners.

Sources: CMS CY2027 OPPS/ASC Proposed Rule; HFMA; Ankura; ASCA.

Acuity’s view

Acuity Private Capital specializes nationally in dialysis and healthcare net-lease real estate. We help owners understand tenant credit, facility operations, census, lease-renewal probability, and how buyers will price the asset in today’s market.

Bryan Webb · President, Acuity Private Capital · D. 415.500.3013 · C. 415.515.6878 · bryan@apccre.com · CA BRE 02298407 · www.APCCRE.com