(Press-News.org) Embargoed for release: Thursday, Dec. 18, 2025, 5:30 AM ET
Key points:
Real estate investment trust (REIT)-acquired hospitals were associated with a greater risk of bankruptcy or closure than non-REIT-acquired hospitals. REIT-acquisition of hospitals was not associated with any significant changes in quality of care or outcome indicators.
The study is the first national examination of the consequences of REIT acquisitions of hospitals. According to the researchers, its findings suggest the need for greater regulatory oversight over these acquisitions.
Boston, MA—Real estate investment trust (REIT)-acquired U.S. hospitals were associated with a greater risk of bankruptcy or closure than non-REIT-acquired hospitals, according to a new study led by researchers at Harvard T.H. Chan School of Public Health. The findings also showed that REIT acquisition of hospitals had no significant impact on quality of care or clinical outcomes.
The study will be published Thursday, Dec.18, 2025, in the BMJ.
When a hospital sells its real estate to a REIT, the REIT then functions as a landlord with the hospital as a tenant. This practice has become increasingly common among private equity- and corporate-owned hospitals in the U.S. Proponents argue that the profits from a hospital’s sale of its real estate to a REIT can be used to improve clinical care. But concern has grown that for-profit hospital owners are using REITs as a strategy to strip assets from hospitals to generate returns to investors.
While prior studies have examined the consequences of private equity and corporate ownership of hospitals, none have evaluated the consequences specifically of REIT acquisition of hospitals. For this study, the researchers compared the clinical and financial outcomes of 87 hospitals that had been acquired by REITs from 2005-2019 with 337 non-REIT acquired hospitals. They assessed at a variety of data, including Medicare claims, financial performance, patients’ experiences at hospitals, hospital staffing levels, and clinical outcomes and quality, indicated by 30-day mortality and readmission rates for patients with heart attacks, congestive heart failure, and pneumonia.
The findings showed that REIT acquisition had no significant impacts on quality of clinical care or patient outcomes—but had a significant negative impact on a hospital’s finances. REIT-acquired hospitals had a 5.7-fold higher risk of closure or bankruptcy compared with non-REIT acquired hospitals.
“In REIT-acquired hospitals, there don’t seem to be any systematic reinvestments into clinical services, which is one of the arguments employed by private equity or corporate owners of hospitals as to why a REIT transaction may be beneficial,” said corresponding author Thomas Tsai, associate professor in the Department of Health Policy and Management, co-director of the Healthcare Quality and Outcomes Lab, and a surgeon at Brigham and Women’s Hospital. “What we see instead is that these hospitals are less likely to survive. As more and more financial resources are stripped away, it’s death by a thousand cuts.”
The researchers say the findings highlight the need for greater oversight over REIT acquisitions of hospital real estate.
“REIT acquisition of hospitals has the potential to help hospitals and the communities they serve, or to seriously damage them,” Tsai said. “The real-world evidence generated by our study can inform federal and state regulatory efforts to more closely monitor hospital ownership and transactions, to ensure that patients and communities are not being harmed.”
Article information
“Changes in hospital finance performance and quality of care after real estate investment trust acquisition; quasi-experimental difference-in-differences study,” Joseph Doc Bruch, Tarum Ramesh, Eric Boyang Yu, Jie Zheng, Jessica Phelan, E. John Orav, Thomas C. Tsai, The BMJ, December 18, 2025, doi: 10.1136/bmj-2025-086226
The study was supported by the Rx Foundation, the UM1TR004408 award through Harvard Catalyst 1, The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health), and financial contributions from Harvard University and its affiliated academic health care centers.
Visit the Harvard Chan School website for the latest news and events from our Studio.
###
Harvard T.H. Chan School of Public Health is a community of innovative scientists, practitioners, educators, and students dedicated to improving health and advancing equity so all people can thrive. We research the many factors influencing health and collaborate widely to translate those insights into policies, programs, and practices that prevent disease and promote well-being for people around the world. We also educate thousands of public health leaders a year through our degree programs, postdoctoral training, fellowships, and continuing education courses. Founded in 1913 as America’s first professional training program in public health, the School continues to have an extraordinary impact in fields ranging from infectious disease to environmental justice to health systems and beyond.
END
Hospitals acquired by real estate investment trusts associated with greater risk of bankruptcy, closure
2025-12-18
ELSE PRESS RELEASES FROM THIS DATE:
City of Hope scientists study rare disorder to uncover mechanism and hormone regulation underlying fatty liver disease and sweet aversion
2025-12-18
LOS ANGELES — Scientists at City of Hope®, one of the largest and most advanced cancer research and treatment organizations in the U.S. and a leading research center for diabetes and other life-threatening illnesses, have unraveled how citrin deficiency (CD), a rare genetic disorder that prevents the liver from converting food into energy efficiently, can trigger fat buildup in the liver — even in lean individuals.
Their landmark study, published in Nature Metabolism, also reveals how the liver turns on a hormone that reduces cravings for sweets and alcohol. The findings could lead to new therapies for a variety of health conditions, including fatty liver disease ...
Your genes may influence gut microbiome of others, rat study shows
2025-12-18
Your "roommate's" genes could be influencing the bacteria living in your gut, and vice versa, according to a study of rats published today in Nature Communications.
The research, carried out by studying more than four thousand animals, reveals that the composition of the rat gut microbiome is shaped not only by an individual’s own genes but also by the genes of the individuals they share a living space with.
The discovery reveals a new way genes and social life intertwine: through the exchange ...
‘Personality test’ shows how AI chatbots mimic human traits – and how they can be manipulated
2025-12-18
Researchers have developed the first scientifically validated ‘personality test’ framework for popular AI chatbots, and have shown that chatbots not only mimic human personality traits, but their ‘personality’ can be reliably tested and precisely shaped – raising implications for AI safety and ethics.
The research team, led by the University of Cambridge and Google DeepMind, developed a method to measure and influence the synthetic ‘personality’ of 18 different large ...
Global food systems driving twin crises of obesity and global heating
2025-12-18
Global food systems driving twin crises of obesity and global heating
A major review in Frontiers in Science highlights how tackling unsustainable food systems—reflected by our changing food environment—is urgent for both health and climate.
The paper reviews evidence that both obesity and environmental harms result from a profit-led food system that encourages high intake and poor health. The authors say that our food ...
Osaka Medical and Pharmaceutical University researchers capture real-time molecular movies of enzyme catalysis
2025-12-18
In a groundbreaking study, researchers have captured real-time "molecular movies" showing how an enzyme changes shape during catalysis. Using an advanced technique called mix-and-inject serial crystallography at Japan's SACLA X-ray free-electron laser facility, the team observed domain movements and structural changes in the enzyme, copper amine oxidase enzyme over millisecond timescales, revealing dynamics that are nearly impossible to observe by other methods.
Enzymes are nature's catalysts, that speed up biochemical reactions ...
Could your genes influence the gut microbiome of others?
2025-12-18
The gut microbiome — made up of trillions of microbes in the digestive tract — is vital for digestion and overall health. Diet and medication shape these microbial ecosystems, but the contribution of genetics has been more difficult to ascertain. Now, a new study of rats — a model organism for understanding the human gut — has found that the composition of the rat gut microbiome is shaped not only by a rat’s own genes but also by the genes of those it lives with.
The discovery reveals a novel way in which genes and social interactions intertwine: through the exchange of commensal ...
Clues to Alzheimer’s disease may be hiding in our ‘junk’ DNA
2025-12-18
When most of us think of DNA, we have a vague idea it’s made up of genes that give us our physical features, our behavioural quirks, and keep our cells and organs running.
But only a tiny percentage of our DNA – around 2% – contains our 20,000-odd genes. The remaining 98% – long known as the non-coding genome, or so-called ‘junk’ DNA – includes many of the switches that control when and how strongly genes are expressed.
Now researchers from UNSW Sydney have identified ...
Study reveals that the body uses different sensors to detect cold in the skin and in internal organs
2025-12-18
A research team led by Félix Viana, co-director of the Sensory Transduction and Nociception laboratory at the Institute for Neurosciences (IN), a joint research centre of the Spanish National Research Council (CSIC) and Miguel Hernández University of Elche (UMH), has demonstrated that the body uses different molecular mechanisms to detect cold in the skin and in internal organs. These findings represent a significant advance in understanding thermal homeostasis and certain pathologies associated ...
iPS cells from dish to freezer and back
2025-12-18
With a Kobe University-developed procedure, induced pluripotent stem cells can now be frozen directly in their dishes without losing their viability or undifferentiated state after thawing. This marks a significant step for research automation, personalized medicine and drug discovery research.
Induced pluripotent stem cells, also widely known as iPS cells, can be created from any tissue in the human body and possess the ability to transform into a wide range of tissues. As such, they are essential for regenerative medicine and drug discovery research. Kobe University biochemical ...
Deep neural networks enable accurate pricing of American options under stochastic volatility
2025-12-18
Background and Motivation
Accurately pricing American-style options, which allow early exercise at any time before expiry, remains a significant challenge in quantitative finance. This task becomes even more complex under realistic market conditions where asset volatility is not constant but fluctuates randomly, as described by stochastic volatility models like Heston's. Traditional numerical methods, often mesh-based, can be computationally intensive and struggle with high-dimensional problems. With the exponential growth of derivatives trading and the critical need for effective risk management, evidenced by billions of contracts ...