Everyone likes to talk about cap rates. That’s usually the first number thrown around in a deal conversation. But in medical real estate, the real risk often hides somewhere else. Take a recent deal we reviewed—new construction, great tenant, long lease, 6.15 cap. Looked clean on the surface. But the tenant’s business model was razor-thin, with regional exposure to outdated Medicaid reimbursement schedules. The lease might be strong on paper, but the operator wasn’t. That’s the kind of thing you miss without real market intelligence. Knowing the market rent isn’t enough. You need to understand tenant risk, reimbursement trends, sale-leaseback history, and the health of the service line. You need to ask who else looked at the deal and walked away. This is where most deals live or die—and it’s the difference between transactional underwriting and true diligence. Market intelligence gives you the full picture before you commit. 📅 Want to run a deal by someone who knows what cracks to look for? Book a quick call 📰 Get no-fluff intel each month: Sign up here

Every market has its hot deals. And every market has the ones that look good—until someone does the math. We’ve been reviewing several transactions this month where broker materials projected strong returns, but the fundamentals told another story. In one case, the pro forma assumed rent increases well above market averages… with no justification. In another, a value-add play ignored deferred maintenance costs entirely. That doesn’t mean the brokers are wrong—it means they’re focused on a different part of the process. Their job is to bring energy and interest to a deal. Ours is to bring clarity. Market intelligence isn’t just a lender checkbox. It’s a grounding force in a market that runs hot. It tests assumptions, benchmarks risk, and tells you whether the asset holds up under pressure—because when things get tight, wishful underwriting won’t save you. Whether you’re buying, building, or refinancing, having a market intelligence partner who’s seen the cycle before can make all the difference. 📅 Want a second set of eyes on a deal? Book a quick call 📰 Get intel like this monthly: Join the newsletter

Ask five people what a good medical real estate deal looks like, and you’ll get five numbers. But price is rarely the full story—and if you’re not looking beneath the surface, you’re missing the parts that actually matter. We’re seeing more investors bid aggressively on on-campus MOBs or surgical centers with zero attention to how that income was built. Is the tenant paying market rent or subsidized by a health system? Is the lease arms-length or tied to a physician group’s practice sale? What happens if that anchor vacates? None of that shows up in the closing price. But it all shows up in the valuation. Good evaluations go beyond cap rate compression and lease term. They ask: Is this income stable? Replaceable? Scalable?  Because that’s what lenders, partners, and long-term investors really want to know. So while everyone’s chasing deals, we’re chasing clarity. And when you’re ready to get a real read on value—not just a number on paper—that’s when we should talk. 📅 Book a 15-minute call 📰 Subscribe to the newsletter

A few key moments this week are worth noting—they won’t make headlines but will shape the medical CRE market in the months ahead. First, Charlotte Healthcare Summit (July 17) —though technically last week, its ripple effects roll right into this one. The regional forum brought together hospital systems, developers, MOB investors, and lenders for a deep dive into outpatient demand and lifecycle capital strategy   . Expect continued conversations around absorption rates, lease structures, and site selection—particularly in secondary markets. Also, keep an eye on Cushman & Wakefield’s Q2 senior living investor survey , due later this week. Its May results showed over 89% nationwide occupancy and cap rate compression expectations—but Q2 data might highlight whether that momentum is holding or cooling  . On the federal level, the BOMA Medical Real Estate Conference recap  dropped last month in Denver, but the materials and insights are still circulating—and will drive deal strategy this week. Look for follow-up webcasts or proprietary content on CRE tooling for outpatient expansion, legal frameworks, and adaptive reuse strategies  . Here’s what you should be watching: Any mention of lease-term shifts or reimbursement changes  for outpatient and senior housing assets—especially from attendees or sponsors. Data releases on tax credit logistics  or municipal support for new healthcare infrastructure—these can shift underwriting overnight. Uptake of AI and automation by operators , particularly in senior living communities—a trend we’ve flagged, and one that’s gaining traction in public sector and legal definitions. If you’re modeling occupancy, underwriting debt, or advising on outpatient projects, this week presents an opportunity to recalibrate… quietly but meaningfully. 📅 Want to talk through capital strategy, drawings for Q3 pipeline, or fresh POV on senior housing absorption? 👉 Book a 15-minute chat 📰 Interested in a clean, monthly briefing with no fluff? 👉 Subscribe here

This week didn’t have a headline, but it had traction—you just needed to look closely. Chicago suburb deal blooms MedProperties Realty Advisors quietly closed on the 41,540 sq ft Millennium Medical Center in Chicago Ridge. Built by local physicians in 2018, it’s anchored by a US Oncology affiliate and leased long‑term. It’s not flashy, but it’s exactly the kind of physician‑aligned, built‑to‑use asset that continues to defy broader office trends  . Midwest outpatient taste Davis Healthcare picked up a 28,000 sq ft MOB in Maplewood, MN for $9.85 million—leased 86 % to M Health Fairview on a 10‑year lease. That’s $352/sf in a metro with steady demographics but less runway than coastal peers  . Senior living capital starts flowing Cambridge Realty Capital closed $19.3 million in HUD loans this week—primarily in Missouri and Texas—to refinance and shore up senior housing. It’s not investor fireworks, but it shows the sector’s resilience and confidence in long‑term financing  . Turnkey memory care hits bid deadline Hilco put a 120,000 sq ft assisted‑living/memory care asset in Cape Coral out for bids this week, fully leased and cash‑flow positive—current yield around $2 million on a 135‑bed community. It’s the kind of off‑market, income‑producing play investors chase quietly  . Why it matters These aren’t splashy headlines—but they’re signal-rich: Physician and operator‑aligned assets are still winning in suburban MOBs. Subtle but steady investor activity in senior housing shows lending and liquidity remain available. Off‑market senior assets with stable income are still moving—even in quiet weeks. 📅 Want to dive into similar assets or explore cap rate trends in MOBs and senior housing? 👉 Book a 15‑minute strategy call 📰 Want this on your inbox monthly—no fluff, just intel? 👉 Subscribe to the newsletter

For all the noise about private equity rollups and REIT portfolios, physician-owned medical buildings continue to quietly outperform. They may not make headlines, but they make money—and they often fly under the radar during institutional bidding frenzies. The key advantage? Alignment. When the operator owns the dirt, there’s typically less turnover, stronger reinvestment, and better community ties. And in smaller metro markets, physician groups that own their real estate often operate more efficiently than their corporate-backed counterparts. It’s also a defensive play. In times of rate uncertainty, long-term owner-users are less exposed to refi pressure or leaseback renegotiations. If anything, they’re buying more—especially when they can add an ASC or imaging suite next door. From a valuation standpoint, these deals demand a different lens. It’s not just about cap rates and lease comps. You have to look at physician stability, generational succession planning, and what happens if the group ever sells. A good appraisal doesn’t just reflect income—it reflects reality. Whether you’re an investor, broker, or developer, don’t write off these owner-user assets. They may be the most stable thing in your pipeline. 📅 Want a second set of eyes on a physician-owned asset? Book a 15-minute call 📰 Want insights like this in your inbox each month? Sign up for the newsletter

It’s not flashy. It’s not fast. But senior living is getting stronger every month—and July’s numbers are the latest proof. Brookdale just posted its June occupancy report, and it’s telling. Same-community occupancy now sits at 82.8%, with systemwide rates trending up for the 17th straight quarter. That’s not just recovery. That’s momentum. Investors are noticing. A new CBRE survey found most senior living buyers expect rent growth and cap rate compression over the next 12 months. And while big institutional money is still cautious, regional players are getting aggressive—especially in states with strong Medicaid waivers or growing 75+ populations. But the real shift is happening under the radar. Infill projects with flexible care licenses, mid-market communities with fewer amenities but better staffing ratios, and even cohousing pilots are all gaining traction. Cohousing in particular—long a staple in Denmark—is showing early promise here in the US. It’s less about flash, more about community, and it’s something we’ll be keeping an eye on. On the ground, we’re seeing deals move fastest when appraisals take a hard look at tenant credit, real capex, and market-rate labor assumptions. Because in senior living, value isn’t just the building—it’s the operator’s ability to keep it full, staffed, and compliant. If you’re modeling a new build, looking to value a stabilized asset, or need help pressure-testing assumptions, now’s the time to take a closer look. 📅 Want to talk it through? Book a quick call 📰 Want these updates in your inbox each month? Sign up here

A lot of medical real estate looks stable on paper—but when you dig into the comps, the buildouts, and the tenancy, the numbers stop making sense. Valuations are getting thrown off by three things we’re seeing again and again in the field: First, deferred maintenance isn’t priced in . Investors are underwriting deals off surface-level rent rolls without accounting for aging HVAC, outdated fire systems, or upcoming code compliance work. That’s real money—and it’s not always visible in broker packages. We’re adjusting for it in every report. Second, non-credit tenants are being treated like institutional leases . A local behavioral health group with five locations and no audited financials is not equivalent to a national dialysis provider. But we keep seeing cap rates flatten across both. That’s a mistake. Long-term value depends on lease survivability and actual payment performance. Third, TI costs are being underestimated . Especially in second-generation space, the cost to bring a property up to clinical standard is higher than most people are modeling. That impacts market rent, yield, and ultimately value. If you’re using comps from generic MOB leases without adjusting for use type or licensing requirements, you’re off. This is why real medical real estate valuations matter. Not because they check a box—but because they keep your pro forma grounded in what’s actually happening in the market. 📅 Want to walk through a facility or stress test your assumptions? Book a 15-minute call 📰 Want monthly market insight on where values are moving? Sign up for the newsletter

If you’re trying to finance a healthcare real estate deal right now, you better come prepared. Lenders are asking sharper questions than they were even six months ago—and frankly, sharper than some buyers and equity partners. They’re not just looking at rent rolls and appraisals. They’re asking about payer mix. They want audited financials from the operator. They’re reviewing licensing risk, staff vacancies, referral patterns, and what happens if your revenue model shifts midstream. And if the asset is behavioral health, memory care, or specialty outpatient—they’re digging deeper. These are need-based sectors, yes. But they’re also operationally complex. One bad state inspection or a 10 percent census drop can flip the coverage ratio. Lenders want to see full-stack underwriting. That means more than just stabilized pro forma. It means showing you’ve thought through hiring timelines, TI funding, state-level regulations, and even downstream reimbursement exposure. They don’t want hope—they want a plan. And here’s the real kicker: the groups getting financed right now aren’t necessarily the ones with the cheapest deal. They’re the ones that can explain their deal. Cleanly. Credibly. With enough detail to prove they know what they’re walking into. 📅 Need to prep for a lender conversation or review your deck? Book a 15-minute call 📰 Want monthly market reads like this sent straight to you? Join the newsletter

The timeline you think you’re on probably isn’t real. Medical real estate deals are dragging. Entitlements are slower. Lenders are pickier. Attorneys are taking longer to paper leases. Buildout timelines are slipping by 30 to 60 days in markets that used to move fast. And a lot of groups are still acting like they can go from LOI to open in six months. Not happening. Right now, if you’re not planning for delay, you’re planning to blow your budget. That’s especially true in behavioral health and specialty outpatient. You’ve got licensing timelines, inspection windows, local planning meetings, and TI costs that shift week to week. This is where deals fall apart. Operators assume the landlord will deliver space by September, but the city doesn’t approve permits until October. Capital groups assume licensing will be fast, but the provider still needs to hire a program director and pass a fire inspection. Suddenly the rent clock starts, and the building is empty. You don’t solve this with more emails or asking everyone to hustle. You solve it by building real timelines, not wishful ones. Add time for approvals. Budget for delays. Map out what actually needs to happen to open the doors and bill revenue—and then add 15 percent. The deals that are closing right now are the ones that started early, planned realistically, and stayed ahead of the curve. 📅 Need to pressure test a timeline or talk through entitlement risk? Book a 15-minute call 📰 Want monthly updates that skip the fluff and get to what matters? Join the newsletter

The headlines may be quiet, but this week is full of signals—especially for anyone watching distressed assets, regulatory shifts, or the fallout from underfunded health systems. Here’s what’s worth your time: First up, Connecticut’s hospital crisis just got a $30 million Band-Aid . Prospect Medical Holdings secured emergency financing to cover payroll at three hospitals: Waterbury, Manchester, and Rockville General. These facilities are in bankruptcy, and without the loan, paychecks weren’t getting cut. A second, contingent $55 million loan is on the table—tied directly to upcoming asset sales. This isn’t just a regional crisis. It’s a national case study in what happens when hospital operators collapse and private landlords get stuck holding the bag. These buildings are now part of the bankruptcy estate. Expect sale-leaseback fallout, distressed pricing, and some very interesting conversations around who’s really responsible for long-term healthcare infrastructure when REITs are involved. Then there’s the UK , where the NHS is weathering a five-day walkout by trainee doctors . This is part of a broader labor dispute that’s been simmering for months. The bigger issue? Hospitals are now paying consultants up to £4,000 per shift  to plug coverage gaps. In some cases, that’s more than a month’s salary for the junior doctors they’re replacing. This kind of financial pressure has real estate implications. Capital projects are being shelved. Facility upgrades are stalling. Long-term planning is taking a backseat to emergency staffing needs. If you’re working with hospital systems—or looking at UK-based healthcare real estate—watch this closely. Instability in operations always trickles down to how space is used, funded, and maintained. Finally, keep an eye on state-level REIT legislation here in the U.S.  Several states—Connecticut, Louisiana, Pennsylvania, Massachusetts, and New Mexico—are reviewing or advancing bills that could restrict or add oversight to sale-leaseback deals involving hospitals . These aren’t just theoretical. If passed, they’ll change how health systems can monetize their real estate—and what that means for valuation, investment strategy, and long-term lease structuring. This isn’t a week for flashy announcements. It’s a week to watch the ground shift. 📅 Want to talk through how this affects a deal you’re working on? Book a 15-minute strategy call 📰 Want this kind of insight regularly—no fluff, no filler? Sign up for the newsletter

Markets don’t slow down just because it’s summer. Here’s your dose of what went down in medical CRE last week: • North Carolina gets its first standalone children’s hospital UNC and Duke are teaming up on a 500‑bed pediatric hospital in Apex, NC—with outpatient services, behavioral beds, and associated research space. The 230‑acre Veridea campus broke ground but won’t open until 2027. Expect 8,000 jobs and a $2‑3 billion development cost backed by $320 million in state funding  . • Office-to-clinic in Danbury, CT A 50 percent vacant suburban office building will be converted to a physical therapy clinic. It’s the fourth such adaptive reuse in Danbury since 2013—showing how medical use is stepping in where offices failed  . • St. Louis behavioral health bet Marcus & Millichap sold a 63K sq ft former nursing facility on Broadway for $6.3 million. The buyer plans to turn it into a behavioral health center—a push into specialty care off campus  . • Surgical hospital deal in Houston IRA Capital picked up Houston Physicians’ Hospital and adjacent outpatient buildings (150K sq ft) fully leased to Memorial Hermann and USPI. It includes long-term strategic expansion rights  . • Pasadena SNF to mental health housing A former nursing facility sold for $5.1 million and will be repurposed into temporary housing with behavioral health support services—transitioning licensed healthcare real estate into community health solutions  . Why it matters These moves tell a clear story: ESG capability, specialty care both inpatient and outpatient, and office to med conversions are in full swing. Developers, lenders, and investors in medical CRE need to see this as more than piecemeal. It’s a sector-wide wave. What you should be thinking about Job-generating healthcare campuses  like Apex—plan for long timelines but massive impact. Office conversions  continuing to fill the MOB and behavioral care gaps in suburban markets. Purpose-built specialty facilities  with strong operator alignment—surgical, psych, behavioral. Closed facilities finding new life —smart repositioning for community health and housing. 📅 Want to talk through which sector is right for your strategy—hospital build, clinic conversion, specialty asset? Book a call: https://calendly.com/contact-loveladyperspective/15min 📰 Prefer the intel served weekly without the fluff? Sign up here: https://www.loveladyperspective.com/contact