The Acuity Brief — Issue No. 03 | Q3 2026

Healthcare CRE Intelligence for owners and investors · Issue No. 03 · Q3 2026

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

The 2027 dialysis payment rule is final — base rate lands at $297.52

CMS finalized the CY2027 ESRD PPS on October 30. The base rate rises from $281.71 to $297.52 — below the $299.55 proposed — with phosphate binders folded permanently into the bundle at $12.85 rather than the proposed $15.96. CMS estimates total facility payments increase roughly 2.7%. Effective January 1, 2027.

Why it matters to owners

The final number came in lighter than proposed, and the binder add-on was trimmed by about $3 per treatment. The read from last issue holds: the major chains absorb it, thin-margin independents don't. 2027 renewal risk at marginal clinics is being set now — evaluate census and market position before the notice window opens.

Sources: CMS CY2027 ESRD PPS Final Rule; Federal Register (10/30/26); Missouri Hospital Association.

Site-neutral imaging is finalized — the off-campus HOPD premium keeps shrinking

The CY2027 OPPS/ASC final rule locks in physician-fee-schedule-equivalent rates for no-contrast imaging — X-ray, ultrasound, bone density, CT, MRI — at excepted off-campus hospital outpatient departments, exempting rural sole community hospitals. Year two of the inpatient-only phaseout removes another 637 procedures, with the final 801 slated for 2028.

Why it matters to owners

What was a proposal in July is now payment policy. Off-campus, hospital-badged buildings that depend on HOPD imaging premiums should be underwritten to post-premium revenue — while the same rule keeps pushing volume toward physician-office and ASC settings, a durable demand tailwind for well-located MOBs.

Sources: CMS CY2027 OPPS/ASC Final Rule; Becker's ASC Review; McDermott+.

619 procedures join the ASC list for 2027

CMS finalized 619 additions to the ASC covered-procedures list — the 618 proposed plus one commenter-recommended spine code — most of them higher-acuity cases leaving the inpatient-only list. Payment mix shifts with it: musculoskeletal and nervous-system procedures rise about 6% and cardiovascular about 5%, while eye and GI dip roughly 1%.

Why it matters to owners

Procedure migration is the engine behind ASC real estate demand, and it just got its largest fuel load yet. Higher-acuity ortho, spine, and cardio cases need ORs, recovery bays, and parking — strengthening ASC-occupied buildings and the sale-leaseback case for physician owners, especially in MSK-weighted centers.

Sources: CMS CY2027 OPPS/ASC Final Rule; Becker's ASC Review; ASCA.

Hospital M&A: 56 deals year-to-date — busiest year since the pandemic

Kaufman Hall counted 16 announced hospital and health-system transactions in Q3 — $8.2 billion in transacted revenue — bringing 2026 to 56 deals through September, already past 2025's full-year total of 46. Mega-mergers appeared for a third straight quarter, including Erlanger and Prisma Health, divestitures made up nearly a third of transactions, and roughly 43% of hospitals are operating at a loss.

Why it matters to owners

Consolidation reshuffles real estate, and the divestiture share means buildings are actually changing hands. 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 Q3 2026 M&A Report; Fierce Healthcare; Becker's Hospital Review.

Net-lease cap rates jump to 6.92% — the highest in over a decade

The Boulder Group's Q3 2026 report puts single-tenant net-lease cap rates at 6.92% — up 10 basis points, the largest quarterly increase since 2023 — with retail at 6.69%. Permanent financing costs now exceed most net-lease cap rates, bid-ask spreads widened, and the market is bifurcating hard along credit and lease-term lines.

Why it matters to owners

Negative leverage is the market now, so the buyers who clear are paying cash or trading 1031 equity — and they pay for credit, term, and escalations. Healthcare assets with lease term still price through the index; short-WALT product is widening fastest. The cheapest basis point you can buy is a renewal signed before you go to market.

Sources: The Boulder Group Q3 2026 Net Lease Research Report.

The Fed hiked, the 10-year touched 5.25% — then pulled back under 5%

September's rate increase and hot inflation drove the 10-year Treasury above 5.25% in early October — its highest since 2007 — before a November rally pulled it back toward 4.9%. The Fed held at 3.75%–4.00% on October 28 in a 10–2 vote, with both dissents favoring another hike, and markets still price a possible December move.

Why it matters to owners

Last issue said stop waiting for a rate rescue; Q3 delivered the opposite of one. Underwrite to today's debt, not a forecast, and price certainty of close over headline number. Equity-rich 1031 buyers remain the most reliable bid in healthcare net lease — they buy on story and certainty, not spread.

Sources: Federal Reserve FOMC statement (10/28/26); CNBC; Charles Schwab; Tradeweb.

DaVita Q3: volume up 1.2%, guidance tightened

DaVita posted $3.58 billion in revenue and $561 million in adjusted operating income, with treatment volume up 1.2% year over year and revenue per treatment up about 1.1%. Management narrowed full-year guidance, flagged a roughly 1% day-mix headwind for Q4, and laid out a path back to 2%-plus volume growth by 2029 on lower patient mortality. Shares sold off on the print.

Why it matters to owners

The tenant credit is stable; the growth is slow. For a landlord, the consolidated print matters less than your clinic's census — DaVita keeps absorbing patients where competitors close, so clinics on the receiving end of that migration are getting stronger while the system averages stay flat.

Sources: DaVita Q3 2026 earnings release and call (10/29/26).

Fresenius: U.S. treatments fall a third straight quarter as the footprint shrinks

U.S. same-market treatments fell 1.1% in Q3 — the third consecutive quarterly decline — and Fresenius trimmed its 2026 operating-income outlook to flat-to-down. After combining, closing, or selling more than 90 U.S. clinics in the first half, pruning slowed in Q3, with management crediting closures for part of its FME25+ savings and flagging a €300–350 million TDAPA reimbursement headwind for 2027. One bright spot: patient inflow began stabilizing.

Why it matters to owners

The two-chain divergence from last issue is now plainly in print. If Fresenius is your tenant, footprint optimization is an explicit, ongoing program — not a rumor. Station count, census trend, and your clinic's position against the nearest Fresenius and DaVita sites tell you which side of the keep list you're on. Find out before the renewal notice does.

Sources: Fresenius Medical Care Q3 2026 results and Form 6-K (11/3/26); earnings call transcript.

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