Four of the largest for-profit health systems in the country have entered into multiple transactions this year as part of strategic plans to strengthen their hospital portfolios, offload certain facilities or explore ways to expand their reach.
Many large systems are expanding into new geographic areas to diversify their portfolios, strengthen bargaining power and pursue further economies of scale. This trend is expected to continue as systems support investments to meet evolving community needs.
Here are 26 hospital transactions that HCA Healthcare, Community Health Systems, Tenet Healthcare and Universal Health Services have either entered into or completed this year:
HCA Healthcare (Nashville, Tenn.)
1. Medical City Healthcare in Dallas, a subsidiary of HCA, acquired Trinity Regional Hospital Sachse (Texas) from Sunland Medical Foundation Feb. 1. The hospital opened in 2021 and filed for Chapter 11 bankruptcy protection in 2023, when it also began its search for a buyer.
2. HCA sold West Hills Hospital and Medical Center, a 260-bed hospital, to Los Angeles-based in March.
3. In July, Catholic Medical Center, a 330-bed regional health system in Manchester, N.H., entered into an asset purchase agreement with a subsidiary of HCA and initiated the regulatory review process with the New Hampshire Attorney General's Office. CMC has an affiliated medical staff of more than 400 providers and more than 3,000 employees.
4. Santa Clara (Calif.) County's board voted unanimously in August to buy HCA's Regional Medical Center in San Jose, Calif. The proposed $175 million deal is expected to be completed in the first quarter of 2025, pending regulatory approvals and closing conditions. After closing, Regional Medical Center would integrate with the county-operated Santa Clara Valley Healthcare system.
5. HCA plans to sell Terre Haute (Ind.) Regional Hospital, a 178-bed facility, to Union Health, which is headquartered in Terre Haute. The deal is the first to test the state's certificate of public advantage law. The Federal Trade Commission submitted a Sept. 5 comment to the Indiana Department of Health urging it to reject an application, arguing that the hospitals are financially stable and could operate on their own without a merger. Union Health disagreed with the FTC's claim and said the transaction would help overcome "persistent health disparities" in the area.
Tenet Healthcare (Dallas)
6-10. Dallas-based Tenet Healthcare sold its 70% majority ownership interest in Birmingham, Ala.-based Brookwood Baptist Health to Orlando (Fla.) Health in October. The sale comprises five hospitals:
- Brookwood Baptist Medical Center (Birmingham, Ala.)
- Princeton Baptist Medical Center (Birmingham, Ala.)
- Walker Baptist Medical Center (Jasper, Ala.)
- Shelby Baptist Medical Center (Alabaster, Ala.)
- Citizens Baptist Medical Center (Talladega, Ala.)
11-13. Tenet sold three South Carolina hospitals to Winston-Salem, N.C.-based Novant Health for $2.4 billion, effective Feb. 1. The hospitals include East Cooper Medical Center in Mount Pleasant, Hilton Head Hospital and Coastal Carolina Hospital in Hardeeville.
14-17. In March, Tenet completed the $975 million sale of four Southern California hospitals to Orange, Calif.-based UCI Health. Fountain Valley Regional Hospital, Lakewood Regional Medical Center, Los Alamitos Medical Center and Placentia-Linda Hospital are now part of UCI Health, which has added 858 inpatient beds as a result of the transaction.
18-19. In March, Tenet also sold two hospitals — Sierra Vista Regional Medical Center in San Luis Obispo and Twin Cities Community Hospital in Templeton — to Roseville, Calif.-based Adventist Health for $550 million.
Community Health Systems (Franklin, Tenn.)
20-21. CHS sold Davis Regional Psychiatric Hospital and Davis Regional Medical Center in Statesville, N.C., to Iredell Health System in October. Earlier this year, Winston-Salem, N.C.-based Novant Health scrapped plans to acquire Davis Regional and Lake Norman Regional Medical Center from CHS in a deal worth $320 million. The decision came after an appellate court granted the FTC — which had been fighting to block the acquisition for more than a year — an emergency injunction blocking the deal.
22. In August, CHS sold Tennova Healthcare-Cleveland (Tenn.) to Vitruvian Health in Dalton, Ga. Vitruvian, which rebranded from Hamilton Health Care System as part of its regional expansion plans, acquired the 351-bed for $160 million.
23-25. CHS in July signed a definitive agreement to sell Commonwealth Health, a three-hospital system, to non profit organization WoodBridge Healthcare. The proposed $120 million deal would see CHS exit Pennsylvania. The hospitals include:
- Regional Hospital of Scranton (186 beds)
- Moses Taylor Hospital in Scranton (122 beds)
- Wilkes-Barre General Hospital (369 beds)
Universal Health Services (King of Prussia, Pa.)
26. UHS in September sold River Crest Hospital, an 80-bed behavioral health hospital, to Shannon Medical Center in San Angelo, Texas.