PESP finds nearly 1 in 10 private hospitals are now PE-owned

The Private Equity Stakeholder Project updated its hospital tracker with new data showing 447 U.S. private equity-owned hospitals and growing use of REIT-owned real estate and nonprofit joint ventures. The findings add fresh scrutiny to ownership structures that can shift profits away from care and toward complex financial arrangements.

Why it matters: - Nearly one in 10 private hospitals in the U.S. is now owned by a private equity firm. - The new tracker shows private equity hospital ownership is increasingly tied to REITs and joint ventures, structures that can make financial control less visible than a direct acquisition. - PESP says those arrangements can affect patients, workers, and local communities because they shape who controls the hospital and the land beneath it. - Private equity-owned hospitals continued to lag national quality benchmarks in available CMS ratings, with lower average star scores and fewer top-rated facilities.

What happened: - The Private Equity Stakeholder Project released the 2026 update to its Private Equity Hospital Tracker. - The tracker identifies 447 private equity-owned hospitals nationwide. - Those hospitals account for 9.5% of all private hospitals in the United States and 26.8% of proprietary for-profit hospitals. - For the first time, the tracker includes hospitals with REIT-owned real estate and hospitals run through joint ventures with nonprofit health systems.

The details: - At least 136 of the 447 private equity-owned hospitals, or 30.4%, have real estate owned by REITs. - That share is higher than the REIT ownership rate for all for-profit hospitals, which is 11.9%, and all privately owned hospitals, which is 4.7%. - PESP identified 223 hospitals nationwide with REIT-owned real estate, and private equity-backed companies operate 61% of them. - Medical Properties Trust remains the largest REIT owner in the tracker, with the real estate underlying 105 hospitals. - Steward Health Care and Prospect Medical Holdings both used sale-leaseback deals with REITs before financial distress and bankruptcy. - More than one-fifth of private equity-owned hospitals, or 21.4%, now operate through joint ventures with nonprofit health systems. - Apollo Global Management’s hospital platform, through Lifepoint Health and ScionHealth, operates 68 hospitals through nonprofit joint ventures and 71 hospitals with REIT-owned real estate. - Apollo Global Management remains the largest private equity hospital owner, with 200 hospitals through Lifepoint Health and ScionHealth. - Texas has the most private equity-owned hospitals, with 90. - New Mexico has the highest concentration, with 42.1% of its private hospitals under private equity ownership. - Among hospitals with available CMS quality ratings, private equity-backed hospitals averaged 2.5 stars. - The tracker found a higher share of 1- and 2-star hospitals and a lower share of 5-star hospitals than the national average. - The tracker is available at the Private Equity Hospital Tracker.

Between the lines: - The data suggests private equity’s role in hospitals is expanding beyond simple ownership stakes into layered real estate and partnership structures. - Those structures can create additional revenue extraction points, while also making oversight harder for regulators and communities to follow. - The Steward and Prospect examples show why REIT sale-leasebacks have become a focus for policymakers after hospital distress and bankruptcies.

What's next: - PESP is signaling that oversight may need to adapt as hospital ownership becomes more complex. - The tracker is likely to remain a reference point for policymakers, regulators, and advocates watching private equity’s footprint in healthcare. - Future updates may show whether REIT ownership and nonprofit joint ventures continue to spread across the sector.

The bottom line: - Private equity now has a deeper and more complicated hold on U.S. hospitals, and the financial structures behind that control are drawing more scrutiny.