Weekend Twofer Medical CRE Recap and Week Ahead

Last week was all about policy turning into operational reality. The federal shutdown rolled on and telehealth flexibilities that expired on October first started to bite in day to day scheduling and cash flow. CMS put out fresh guidance midweek that narrowed its earlier payment pause, telling contractors to hold only the claims tied to expired authorities rather than everything across the board. That still means delays for many telehealth and FQHC claims, but it eases pressure on the rest of the revenue cycle. If your tenants relied on virtual volume to keep visit counts steady, this is now showing up in working capital and it needs to be reflected in near term rent coverage and TI timelines. 

Advocacy groups stayed loud. The American Telemedicine Association pressed Congress for a short term fix as the shutdown dragged into a second week and hospitals also lost the Acute Hospital Care at Home authority at the end of September. For real estate that matters because at home programs had been soaking up inpatient pressure. With those waivers gone, some of that demand shifts back into bricks and mortar which can lift throughput for outpatient nodes but also strain staff and space where capacity is already tight. 

Connecticut’s hospital chessboard kept moving and the implications reach beyond acute care. Hartford HealthCare came out of the auction with a winning bid around eighty six million dollars for Manchester Memorial and Rockville General. At the same time the state floated bonding to help UConn Health absorb Waterbury Hospital and officials discussed how to deal with legacy liabilities from the Prospect Medical bankruptcy. The lesson for lenders and buyers is simple. Regulatory history and landlord obligations follow the real estate and they color credit views on everything from specialty hospitals to nearby outpatient assets in the same markets. 

Public market tone stayed cautious rather than panicked. Healthcare REITs set investor calls for later in the month, and the shutdown’s economic drag was a constant headline over the weekend. None of this stops closings, but it does argue for thicker schedule buffers around permits, surveys, and any step that relies on a federal or state touchpoint. In a rate sensitive world, a few weeks of slippage can move pricing. 

Now for the week ahead. HLTH opens in Las Vegas this afternoon and runs through Wednesday. Expect a flood of operator and vendor noise about access, data plumbing, and site selection tech. Innovation talk does not pay rent on its own, but it tips the hand on where systems plan to deploy outpatient dollars over the next two quarters. Use those signals to validate which submarkets deserve your next LOI and which should move to the watchlist. 

Policy will keep steering behavior. If Congress advances even a narrow telehealth patch, some claims now on hold could clear and hybrid models regain footing. If not, expect more clinics to push volume back in person and to revisit staffing and room utilization to keep access steady. Either way, underwrite this property by property rather than with a blanket rule and stay close to your operators on throughput and payer mix through month end. 

On the transactional side, watch Connecticut for court and board milestones on the Prospect unwind and keep an eye on late month REIT commentary for hints on dispositions, leverage, and rent coverage. Quiet signals this week can turn into price movement next. 

If you want a quick sanity check on how these moving parts change value in your markets, I am happy to map it out with you.

📅 Book a call: https://calendly.com/contact-loveladyperspective/15min

📬 Get the weekly newsletter: https://www.loveladyperspective.com/contact