The Ledger

Healthcare Realty Trust raised its 2026 same-store profit guidance to 5.00% to 5.25%, and the medical office building landlord is still selling hospital-linked buildings to fund buybacks. The real estate investment trust (REIT) reported October 29 that third-quarter same-store cash net operating income grew 5.1%, tenant retention was 88.0% and cash leasing spreads averaged 8.6% across 329 leases covering 1.5 million square feet, per its 8-K earnings release. Normalized funds from operations (FFO) were $0.42 per share, and 2026 normalized FFO guidance moved to $1.65 to $1.67 from $1.62 to $1.66. Same-store cash NOI growth guidance rose to 5.00% to 5.25% from 4.25% to 5.00%. The company sold $68 million of assets in the quarter, including a $36 million Atlanta building to an affiliated hospital, and is exiting Chicago. Its KKR joint venture bought $211 million of assets ($42 million at Healthcare Realty’s share), including two health-system-anchored buildings in Charleston, South Carolina for $56 million. It repurchased 4.2 million shares at an average $17.74 ($75 million) and on October 26 renewed a buyback of up to $500 million. Net debt to adjusted EBITDA stood at 5.5 times. Who it hits: health systems that lease outpatient space, and buyers pricing medical office buildings. So what: rent growth is solid, but the owner is recycling capital and shrinking markets rather than expanding. For scale, Ventas reported October 27 that its outpatient medical and research same-store cash NOI rose 2.5%, per its 8-K earnings release, while its senior housing operating segment grew about 16%; the two portfolios differ, so we do not rank them. Confidence: High, from company filings. The release gives no company-wide occupancy figure.

Alignment Healthcare cut its 2026 profit guidance as medical costs ran above plan, even as membership and revenue guidance rose. The Medicare Advantage insurer reported October 29 that third-quarter revenue rose 36.7% to $1,358.3 million, membership was about 301,200 (up 31.2%) and its medical benefits ratio was 89.5%, about 240 basis points higher, per its 8-K earnings release. It lost $8.1 million against net income of $3.7 million a year ago, and adjusted EBITDA (earnings before interest, taxes, depreciation and amortization) was $21.8 million, inside the $20 million to $30 million it guided in July. Full-year guidance now reads: membership of at least 305,000, revenue of at least $5,245 million, adjusted gross profit of at least $575 million and adjusted EBITDA of at least $100 million. The July second-quarter release had guided $630 million to $650 million and $145 million to $163 million for the last two, so by our arithmetic the EBITDA floor sits about $54 million below the prior midpoint. Chief executive John Kao said “medical trends ran higher than expected.” Who it hits: Medicare Advantage insurers growing fast on thin margins, and the providers contracted to them. So what: growth is being bought at a rising medical cost ratio, which is the question Cigna and Humana face next week. We do not cover its pending litigation over 2027 Star Ratings here. Confidence: High on figures; Med on the size of the cut, which is our calculation.

CareDx raised its 2026 revenue guidance by $30 million and its EBITDA guidance by about $24 million, as transplant testing volume grew 51%. The transplant diagnostics company reported October 29 that revenue rose 39% to $139.4 million, testing services revenue rose 65% to $119.2 million (about 58% excluding revenue from prior-period tests) and it ran about 75,900 tests, per its 8-K earnings release. Net income was $19.3 million against $1.7 million, adjusted EBITDA was $30.5 million, and cash rose to $250.5 million from $65.4 million at year-end. Guidance is now revenue of $520 million to $530 million (from $490 million to $500 million) and adjusted EBITDA of $90 million to $100 million (from $66 million to $78 million). The Naveris acquisition closed July 1 for $160 million cash plus up to $100 million of contingent payments. Who it hits: transplant centers and the payers that reimburse post-transplant monitoring. So what: a diagnostics vendor tied to transplant volume is accelerating the same week CMS finalized tougher organ procurement rules; the release does not link the two, and the reimbursement mix behind the growth is not stated. Confidence: High on figures; Low on reimbursement drivers.

Quorum Health is lining up a roughly $1.3 billion municipal bond sale to finish its conversion to a nonprofit. Per reporting by Modern Healthcare, Quorum’s bond sale is expected next month, after New Mexico regulators cleared the ownership change at Mimbres Valley Medical Center; we could not open the full article, so the company or state filing is the document to check. The Private Equity Stakeholder Project, an advocacy group, puts the sale to the new nonprofit, Healthside Partners, at $957 million and estimates the post-sale entity would carry about $1.26 billion of long-term debt, up from $968 million, and negative equity of $635 million, per its October 27 analysis (supplemental, advocacy lens). Quorum runs 11 hospitals in nine states, down from 24 when it filed for bankruptcy in 2020. Who it hits: municipal bond buyers and the rural communities served by the hospitals. So what: this is a test of whether investors will fund a nonprofit conversion of a hospital chain owned by a credit fund. We have not seen the offering document, so the amounts are unconfirmed. Confidence: Low to Med.

THE DEAL SHEET

No new transactions spotted in the last 24 hours.

Scan covered SEC filings, company releases and trade press for October 29 to 31. No new health system bankruptcy, rating action, or FTC or DOJ healthcare merger action dated in the window could be confirmed from a primary source. Earlier deals, listed for reference and not new: Quorum Health to Healthside Partners (reported $957 million, see above); HealthSpan Partners and Surgery Partners (about $5.7 billion, per the 8-K exhibit); Cencora and American Oncology Network ($2.4 billion enterprise value); Davion Healthcare and Healthcare Stat Homecare ($13.5 million). Frontier scan this run: ambient AI documentation and revenue cycle automation; only 2025 and early 2026 funding rounds surfaced, nothing in the window, so no story ran.