It just might be “the pause that refreshes.” Or it could be the beginning of a painful contraction in the hospital market. In the first five months of 2018, 34 deals—representing definitive agreements and closures—have been announced. That’s the same number reported in the first five months of 2017.

The difference lies behind the number of deals, of course. In the first five months of 2017, several large hospital systems merged or were acquired. Among the deals were Mississippi Baptist Health System (four hospitals) and Baptist Memorial Health (17 hospitals); IASIS Healthcare (17 hospitals) and Steward Health Care (18 hospitals); and Steward Health’s acquisition of eight hospitals from Community Health Systems (NYSE: CYH) in Florida, Ohio and Pennsylvania. A total of 14,459 beds changed hands in those five months, about 40% of the year’s combined total of 35,719.

In the first five months of 2018, deals targeting large health systems were scarce. The largest deal to reach the definitive agreement stage was the merger of Presence Health, one of the largest Catholic health systems in Illinois (eight hospitals), with Ascension, the largest not-for-profit Catholic health system in the United States. Prior to that announcement, Presence sold two hospitals in Urbana and Danville to OSF Healthcare System (nine hospitals) in Peoria for a reported $185 milion. Also, HealthQuest Systems (four hospitals) in the Hudson Valley Region agreed to merge with Western Connecticut Health (three hospitals) in Danbury.

Just a note: HCA Healthcare (NYSE: HCA), the largest for-profit system in the United States with 179 hospitals, announced it had signed a letter of intent to acquire the Asheville, North Carolina-based not-for-profit Mission Health (six hospitals) in March 2018. Negotiations are ongoing and have not reached the definitive agreement stage, the point where due diligence and regulatory approvals must be satisfied. Because this transaction involves the acquisition of a large not-for-profit system by a larger for-profit system, regulatory scrutiny will be sharp.

A total of 8,304 beds have changed hands between January and May 2018. Indeed, the targets are smaller, including seven critical access hospitals. (Just one critical access hospital was acquired in the same period in 2017.) Those specially designated facilities are limited to 25 beds, and must be located at least 35 miles from larger facilities.

Last year saw a significant number of sales by some for-profits that were paring under-performing facilities or leaving non-core markets in order to pay down debt or just boost revenue. Community Health Systems announced six transactions in the first five months of 2017, selling a total of 20 hospitals. Its spinoff, Quorum Health (NYSE: QHC), announced three deals, selling four hospitals, while Tenet Healthcare (NYSE: THC) sold three hospitals in a single transaction.

Those companies continued divesting in 2018, but the torrid pace has slowed considerably. Through May, Community Health has announced four deals for seven hospitals; Tenet has made two deals for two hospitals; and Quorum has sold one hospital. HCA, which isn’t experiencing the same financial pressures, sold one of its hospitals, as well as acquiring one, Memorial Health (612 beds) in Savannah, Georgia.

We’ll be exploring the issues behind these trends in an upcoming webinar, “Hospital M&A Market at Mid-Year: Surviving, or Not, Healthcare Reform.” Join us on June 21 to hear our panel of experts discuss where this sector is headed in 2018 and beyond.