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dizposition

Sell your hospital & surgery center

Surgery centers, specialty and rehab hospitals. Physician-owned, system-backed, or somewhere in between.

Hospital & Surgery Center at a glance

Typical deal size
$5M – $60M
Lease structure
Absolute NNN
Typical term
12–20 years
Escalations
2–3% annually
HCA HealthcareUnited Surgical Partners InternationalSCA HealthSurgery PartnersEncompass HealthSelect MedicalHealth systems and physician-owned groups

Overview

What hospitals & surgery centers are really worth

Our read

A surgery center or hospital is the most specialized building in medical real estate and one of the most valuable when it is working. Operating rooms, medical gas, sterile air handling, backup power, and the licensure and certifications behind them are expensive to build and slow to approve, which makes an operating facility genuinely hard to replace.

The credit is rarely as simple as the brand on the building. Surgery centers in particular are commonly joint ventures among physicians, a national surgical operator, and sometimes a health system, and the entity on the lease may not be the one owners have in mind.

The value ultimately sits with the people. Cases follow surgeons, and a small group of physicians often produces most of a facility's volume. A strong building with a departing surgeon base is a weaker asset than its lease suggests.

Valuation

How we underwrite it

The method

We underwrite who signed and who guarantees first, then rent coverage at the facility level. In a sector this capital-intensive, a center that cannot comfortably cover rent will renegotiate regardless of how many years remain.

The rent itself gets tested against fair market value. Where physicians have ownership on both sides, that is a regulatory requirement as much as an underwriting one, and we would rather resolve it in the structure than discover it in diligence.

Licensure, certification, and certificate of need are treated as part of the asset. They create scarcity, and we confirm whether they attach to the operator or the facility before relying on them.

Physical systems — medical gas, air handling, emergency power, and the building's occupancy classification — get priced on remaining life. In older leases some of these sit with the landlord, and they are costly enough to move the number.

What moves the number

  1. 01Who signed — a health system, a national surgical operator, or a physician-owned LLC — since the same building can carry three very different credits
  2. 02Rent coverage at the facility level, because procedure volume pays the rent and a struggling center renegotiates regardless of term
  3. 03The surgeon base behind the facility, since cases follow physicians and a few departures can change the economics
  4. 04Certificate of need and licensure where the state requires them, which create real scarcity and do not always transfer cleanly
  5. 05Physical infrastructure — operating room dimensions, medical gas, air handling, and backup power — that is costly to replicate and narrows the backfill pool
  6. 06Fair market value support for the rent where referring physicians have ownership interests in the real estate or the operator

Capital markets today

10-yr Treasury
5.24%
4.12% a year ago
SOFR
3.87%
4.2% a year ago
30-yr mortgage
7.28%
6.3% a year ago
CRE loan delinquency
1.53%
1.57% a year ago
CRE prices, YoY
6.58%
-2.7% a year ago

Sources: FRED DGS10, 2026-10-01 · FRED SOFR, 2026-10-01 · FRED MORTGAGE30US, 2026-10-01 · FRED DRCRELEXFACBS, 2026-04-01 · FRED COMREPUSQ159N, 2026-01-01

Diligence

What a buyer actually looks at in a hospital & surgery center

  1. Check 01

    Tenant entity, guarantor, and ownership of the operator

    Surgery centers are frequently joint ventures between physicians, a surgical operator, and sometimes a health system. Who actually guarantees the lease is the first question and is often not obvious.

  2. Check 02

    Fair market value analysis of the rent

    Where referring physicians own the real estate or the operator, federal anti-kickback and Stark rules require rent at fair market value. Above-market rent is a regulatory risk, not just a renewal risk.

  3. Check 03

    Licensure, Medicare certification, accreditation, and certificate of need

    These are what allow the facility to operate and be paid. In certificate-of-need states, the approval itself is a scarce asset, and its transferability matters.

  4. Check 04

    Case volume and facility-level financials where obtainable

    Rent coverage is the real measure of durability. Volume concentrated in a handful of surgeons is a key-person risk the lease does not reflect.

  5. Check 05

    Medical gas, air handling, and emergency power systems

    Operating rooms have strict air change, pressure, and power requirements. Systems near end of life are expensive and may be landlord obligations under older leases.

  6. Check 06

    Building code occupancy classification

    Hospitals and some surgery centers are built to stricter occupancy standards than ordinary medical office. That classification affects both what the building can be used for and what changing it would cost.

Backfill risk

What happens if the tenant leaves

The tenant-goes-dark scenario

Hospitals and surgery centers are the most specialized buildings in medical real estate, and backfill risk scales with that specialization. An ambulatory surgery center sits at the manageable end: a single-story building with operating rooms, recovery bays, and heavy mechanical systems that another surgical operator can use and a general medical user can, with significant work, convert. A hospital sits at the other end and is close to single-purpose.

The protection in an operating facility is how hard it is to replicate. Operating rooms, medical gas, air handling built for sterile environments, backup power, and in many states a certificate of need make relocation costly and slow. Operators renew in place far more often than they move, provided the facility is producing cases.

The risk is concentrated in the people rather than the building. Surgery volume follows surgeons, and a handful of physicians often account for most of a center's cases. When a physician group sells to a health system, retires, or moves its cases to another facility, the economics can change faster than the lease term would suggest.

Regulation runs through all of it. Where physicians own both the operator and the real estate, the rent has to hold up as fair market value, and a lease that was generous to the landlord can become a liability at renewal or in a sale.

Why this matters to you

Every buyer prices the tenant-goes-dark scenario, whether or not they say so out loud. It is the largest hidden input into the cap rate you get offered.

Understanding it before you go to market is the difference between negotiating and being negotiated with.

Who sells to us

Situations we see most often

  • Physician owners of an ASC selling the real estate while keeping the operating company
  • Physician group whose practice was acquired and who want liquidity on the building
  • Health system monetizing owned facilities through sale-leaseback
  • Developer selling after a build-to-suit commenced rent
  • Owner of a facility where the operator changed and the lease is up for renegotiation

Buy box

What we buy

  1. 01Ambulatory surgery centers, specialty and rehabilitation hospitals, $5M to $60M
  2. 02Physician-owned real estate sale-leasebacks
  3. 03Health system and joint venture tenants
  4. 04Short remaining term and operator transitions

Process

How selling to Dizposition works

The full process
  1. Day 0

    01

    Send us the property

    Address, asset type, and the lease if there is one. That is enough for us to start.

  2. 02

    We underwrite it

    Our underwriting runs the income against current market pricing and the cost of capital. No lowball anchor.

  3. 10 minutes

    03

    You get a firm offer

    In 10 minutes, with the math shown. You will know exactly how we got there.

  4. As fast as 30 days

    04

    Close on your timeline

    As fast as 30 days, or as slow as you need. We are the principal, so the date is yours.

FAQ

Selling a hospital & surgery center

We are physicians who own the surgery center and the building. Can we sell just the real estate?

Yes, and it is one of the most common transactions in the sector. You keep the operating company and its economics, sign a long-term lease, and take the capital out of the building. The rent needs to be supportable as fair market value, which also protects you.

Our rent is above market. Does that make the building worth more?

On paper, yes. In practice, if referring physicians have an ownership interest on either side, above-market rent is a regulatory exposure and buyers will discount it or require it be reset. We would rather address it directly than price around it.

Our state has certificate of need. Does that help the value?

Generally yes, because it limits new competition. What we need to understand is whether the approval belongs to the operator or attaches to the facility, and what happens to it if the operator changes.

A health system bought our physician group. What happens to the lease?

It depends on who signed it and what the system decides about its network. Sometimes the credit improves materially; sometimes the system moves cases to its own facility at expiration. We look at both the lease and the system's existing footprint nearby.

How long does it take to sell a commercial property to Dizposition?

You get a firm written offer within 10 minutes of sending us the property. If you accept, you can close in as little as 30 days — most of that is title work and your own timeline. There is no listing period, no marketing, and no waiting on a buyer's financing contingency.

Can I sell my property as-is?

Yes. We are the buyer, so there is no lender requiring repairs and no inspection contingency to renegotiate against you. Deferred maintenance, a failing roof, an aging tank system — we price it into the offer rather than asking you to fix it first.

Can I sell with a tenant in place?

Yes, and in most cases a tenant makes the property more valuable to us, not less. We will ask for the lease, a rent roll, and any estoppel certificates. You do not need to deliver the property vacant.

What if my lease is short-term or about to expire?

Short remaining term is one of the main reasons owners come to us. A conventional buyer needs lease term to get financing, which is why short-dated assets sit on the market. We underwrite the real estate and the backfill prospects rather than the remaining term alone.

What if the property is vacant?

We buy vacant assets. Pricing shifts from an income approach to what the building and land are worth to the next user, which is a different calculation — but it is one we do routinely rather than one that disqualifies the property.

Do I need a broker to sell to you?

No. We buy directly, and there is no commission because there is nothing to market. If you already have a broker, we will pay them. Selling without one saves the commission, but you should understand you are also giving up price discovery — a broker's job is to find out whether someone will pay more than we will.

What documents do I need to get an offer?

The address and the lease are enough to start. To finalize, we will want the rent roll, the last two years of operating statements, the title commitment, any existing survey, and any environmental reports you already have. You do not need an appraisal or a broker package.

How do you determine your offer?

We underwrite in-place income against what the space would re-lease for, adjust for capital needs and any environmental tail, and apply a cap rate supported by comparable transactions. We show you the inputs. If you disagree with an assumption, we would rather argue about the assumption than about the number.

What are typical seller closing costs?

Title and escrow fees, any transfer or recording tax owed in your state, prorated property taxes, and payoff of any existing debt. Because we are the buyer, there is no commission and no marketing cost. Transfer tax varies significantly by state and is often the largest single line.

Will I owe capital gains tax when I sell?

Usually yes, on the gain above your adjusted basis, and depreciation recapture is taxed separately from appreciation. State treatment varies. This is a question for your CPA before you sign, not after — the structure of the sale can change the answer.

Can I do a 1031 exchange?

Yes. A 1031 exchange lets you defer federal capital gains by reinvesting in like-kind property, subject to a 45-day identification window and a 180-day closing window from the date you sell. You must have a qualified intermediary in place before closing — it cannot be arranged afterward. Most states conform to federal treatment, but a few do not.

Can I sell if I am behind on payments or facing foreclosure?

Yes, and speed is the reason to move early rather than late. We can close on a defined date, which is what a lender or a receiver generally needs to see. Send us the payoff figure and any notices you have received.

Can I sell a property I inherited or that is in probate?

Yes. Probate sales take longer because the court timeline governs, not ours, and multiple heirs need to agree on the price before anything can close. We are used to working around both. Inherited property also generally receives a stepped-up basis, which can change the tax math substantially.

What if there is environmental contamination?

Send it anyway. Environmental history is one of the most common reasons a conventional sale falls apart, and it is one of the reasons owners call us. We price the remediation and the residual liability into the offer rather than walking away at the Phase II.

Is there any cost or obligation to get an offer?

None. There is no fee, no listing agreement, and no obligation to accept. If our number does not work for you, you keep the underwriting we showed you and we part ways.

Markets

Top markets we buy hospitals & surgery centers in

10-minute offer

Ready to sell your hospital & surgery center?

Send us the property and the lease. You'll have a firm offer, with the math shown, in 10 minutes.