It’s become an accepted, almost expected, transaction. Privately held hospitals sell their real estate assets to a real estate investment trust (REIT) to get some fresh cash and to focus on operations rather than physical plants.

Between 2009 and 2012, REIT deals for U.S. hospitals were announced once or twice a year. The number rose to six per year in 2013, 2015 and 2016 (just three in 2014). After two years of two or three deals annually (2017 and 2018), the number has already reached seven in 2019, with several weeks of deal making left in the year.

The most recent deal was announced on November 5, as LifePoint Health agreed to sell the real estate assets of 10 unidentified hospitals in six states to Medical Properties Trust, Inc. (NYSE: MPW) for $700 million. That deal followed three transactions by Medical Properties Trust in July 2019, totalling more than $1.7 billion.

Through the first week in November, spending on U.S. hospital REIT deals has reached $2.5 billion, approaching the all-time record of $2.8 billion spent in 2015. That year, Ventas, Inc. (NYSE: VTR) paid $1.75 billion for 10 hospitals owned by Ardent Health Services, a portfolio company of Welsh, Carson, Anderson & Stowe. The hospitals comprised about 3.2 million square feet and 2,045 beds.