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Healthcare Realty Trust Inc Q1 FY2025 Earnings Call

Healthcare Realty Trust Inc (HR)

Earnings Call FY2025 Q1 Call date: 2025-05-01 Concluded

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Operator

Thank you for standing by. My name is Frilla and I will be your conference operator today. At this time, I would like to welcome everyone to the Healthcare Realty First Quarter 2025 earnings conference call. All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question and answer session. If you would like to ask a question during this time, simply press the star followed by the number 1 on your telephone keypad. If you would like to withdraw your question, please press the star one again. Thank you. I would now like to turn the conference over to Ron Hubbard, Vice President of Investor Relations. He may begin.

Ron Hubbard Head of Investor Relations

Thank you for joining us today for Healthcare Realty's First Quarter 2025 Earnings Conference Call. A reminder that except for the historical information contained within, the matter discussed in this call may contain forward-looking statements that involve estimates, assumptions, risks, and uncertainties. These forward-looking statements represent the company's judgment as of the date of this call. The company disclaims any obligation to update this forward-looking material. A discussion of risks and risk factors are included in our press release and detailed in our filings with the SEC. Certain non-GAAP financial measures will be discussed on this call. A reconciliation of these measures to the most comparable GAAP financial measures may be found in the company's earnings press release for the quarter ended March 31, 2025. The company's earnings press release, earnings supplemental information, and Form 10 to you are available on the company's website. I'd now like to turn the call over to our outgoing president

and CEO, Connie Moore. Thanks, Ron, and welcome to Healthcare Realty's first quarter earnings call. Turning to our recent leadership announcement, I am pleased to welcome Peter Scott as Healthcare Realty's new president and CEO. Many of you are familiar with Pete, having come from CFO capacity at one of our peers in the outpatient medical real estate industry, Health Peak Properties. It's been an honor to serve as interim CEO for the past five months, and I look forward to continuing to serve on the board. The board is confident Pete is very well prepared to lead

our company going forward. Pete? Thanks, Connie. I am grateful to you and the board for selecting me to lead the company, and I am truly excited to be at Healthcare Realty. Also on the call for me today is Rob Hall, our COO, Austin Helfrichs, our CFO, and available for the Q&A portion of the call is Ryan Crowley, our CIO. I would like to start by commenting on what attracted me to Healthcare Realty. First, Healthcare Realty is the only pure play outpatient medical read. Our focus is 100% on a single asset class, and our vision is simple. To be the first choice for equity investors when they are seeking exposure to outpatient medical and to be the landlord choice for health systems. Second, the underlying operating fundamentals in outpatient medical are as strong as they have ever been. New supply remains muted and demand is steadily increasing. These incredibly strong tailwinds show no signs of abating. Third, the portfolio is very high quality, with a heavy focus on high-growth markets, including Dallas, Seattle, Nashville, Houston, and Denver, to name a few. In addition, the current tenant roster is with market-leading health systems, including HCA, Common Spirit, Baylor, Ascension, and Advocate. While the portfolio still needs some refining, which I will elaborate on in a bit, the core portfolio should continue to deliver strong returns throughout market cycles. Fourth, the team and culture. Since arriving here in early April, I have been incredibly impressed with the infectious positive attitude across the organization. There's a lot of pride at Healthcare Realty and a palpable desire to reestablish credibility with stakeholders. Additionally, the core values of respect, camaraderie, entrepreneurship, and excellence align well with my personal beliefs. One of my near-term focuses will be to augment the core values with a winning mentality. Fifth, my background lines up well with the skill sets needed to turn around the organization expeditiously. I love a good challenge and have been through similar circumstances, both as an executive and prior to that as an investment banker. Shifting gears, I want to lay out my initial areas of focus for the strategic path forward. Number one is leasing. At the end of the first quarter, our same-store occupancy was 89.3%. I believe stabilized occupancy should be in the low 90% area, so we have 200 to 300 basis points of upside that is out there for us to capture. I would expect to see sequential occupancy growth through 2025 as we make progress on the leasing front. Number two is portfolio optimization. We are in the process of reviewing the portfolio to maximize NOI growth potential going forward. The path to achieve this is through exiting markets where we have limited scale and or markets where we have a limited path to achieve scale. More work still needs to be done, but we are well underway. Our focus is to sell assets rather than contribute them to our joint ventures. Number three is the balance sheet. While outpatient medical can support higher leverage due to the stability of the asset class, we need to extend the tenor of our debt and reduce overall indebtedness. There are significant benefits to a solid balance sheet, including the opportunity to take advantage of accretive capital allocation opportunities when they arise. In addition, we will be assessing our reported leverage metrics to ensure better alignment with peers. Number four is efficiency across the organization. This includes efficiency at both the corporate level through lower GNA and at the property level through reduced operating expenses. NOI margins have been in the low 60% area, and we should be able to improve upon this. Number five is instilling more financial discipline within the organization. This will be a combination of improving our technology and systems alongside making further investments into our platform. This is by no means an exhaustive list, but rather my initial areas of focus. We will provide more detail around the strategic plan on our next quarterly earnings call. The end game is to create a more stable platform, an improved earnings growth profile, an increased multiple, and thus a better stock price. Let me touch on the dividend. As you saw, we maintained the dividend this quarter at $0.31 per share. We are discussing the dividend at the board level, given the elevated payout ratio. That said, no decision will be made until we have clarity on our earnings profile going forward. inclusive of the impact from efficiency gains, leasing upside, as well as deleveraging. In summary, the dividend will be an output of the strategic plan and not an input. With that, let me turn the call over to Rob to talk about leasing in the first quarter.

Rob Hull COO

Thanks, Pete. Demand for outpatient medical space remains robust. During the quarter, we commenced nearly 1.5 million square feet of new and renewal leases. Our signed not-occupied pipeline, or SNOW, remains solid at more than 630,000 square feet, representing almost 165 basis points of occupancy in the coming quarters. We've signed 370,000 square feet of new leases. Historically, we have executed about 20% of our annual volume in the first quarter of the year. Our new lease volume this quarter is in line with this historical trend and sets us on pace to meet or exceed our annual new lease targets. Our lease pipeline remains solid with increasing interest from our health system partners. About half of this pipeline is in the letter of intent or lease documentation phase. It's worth noting that in the past five quarters, health system leasing as a percentage of our new signed lease activity has nearly doubled. Systems continue to experience improving revenue and margin trends, which will drive further growth and space needs. And in spite of increased noise around tariffs and potential policy shifts, we have not seen any signs of a slowdown in their expansion plans. In connection with this growing health system demand, a recent industry research piece assigned our on-campus portfolio with the highest average score at an A+. This research signals that we have a more resilient outpatient portfolio than our peers, which is notable in a more uncertain macroeconomic and policy environment. Turning to our same-store portfolio, tenant retention improved more than 300 basis points over last quarter to almost 85%. This generated a slight uptick in occupancy to 89.3%. know. Looking ahead, we expect occupancy to build throughout the year, with most of our gains expected in the second half. Our outlook for 2025 remains 75 to 125 basis points of absorption by year-end. In closing, with a strong leasing pipeline, growing demand from our health system partners, and a resilient tenant base, our portfolio is poised for accelerating NOI growth throughout the remainder of the year. I will now turn it over to Austin

to discuss financial results. Thanks, Rob. Normalized FFO per share was 39 cents for the quarter. This is in line with our expectations and a great start to the year. The first quarter is our seasonally weakest quarter of the year with almost a penny of seasonal expenses that we do not expect to reoccur in the second quarter. Same-store cash NOI growth was 2.3%. As discussed on our fourth quarter call, growth was primarily impacted by higher operating expenses related to weather volatility and a difficult year-over-year comparison. This cadence was anticipated in our 2025 guidance, and we expect a material acceleration in same-store cash NOI growth for the remainder of the year. On disposition activity, we sold four buildings for $28 million in the first quarter. This was great execution by our team, as these buildings required significant capital or asset repositioning in their markets. Subsequent to the quarter end, we also received full payoff of an outstanding loan, resulting in $38 million of additional proceeds. previously been accruing interest at a 6% rate, well below current market. Early in the quarter, we did pay down $35 million of term loans maturing in 2026. As indicated in our guidance, we expect increased disposition activity in the second quarter as our sale efforts build. Net debt to adjusted EBITDA was unchanged from 2024 year-end at 6.4 times, inclusive of the previously mentioned sales and loan payoff. We expect this to decrease to the guidance range of six to six-and-a-quarter times through the year as we execute on our disposition plan. We ended the quarter with $1.4 billion of capacity on our revolving line of credit, And yesterday, we accessed this available liquidity to pay off $250 million of maturing notes. This $250 million maturity is our only maturity in 2025, and we expect to use sale proceeds to reduce the revolver balance as the year progresses. In sum, our first quarter financial performance was in line with our expectations. While we are not providing quarterly guidance, I do want to note that we expect acceleration in same-store NOI growth and an uptick in FFO and FAD per share in the second quarter. For the full year, we are reaffirming our normalized FFO per share guidance of $1.56 to $1.60, as well as our other components of guidance. Operator, we're now ready to move to the Q&A portion of the call.

Operator

Thank you. We will now begin the question and answer session. If you have dialed in and would like to ask a question, please press the star 1 on your telephone keypad to raise your hand and join the queue. If you would like to withdraw your question, you may press star 1 again. And once again, please press the star 1 to join the queue. Your first question comes from the line of Preach Anderson with Redbush. Please go ahead.

Rich Anderson Analyst — Redbush

Hey, thanks. Good morning and welcome, Pete. So, you know, when you laid out your areas of focus, you know, some are going to take longer than others. I wonder, you know, where do you put out there in one, two, three-year time frame to sort of.

Yeah, hey, Rich, it's Pete. Great to chat with you. I don't know that I would necessarily say that everything is in the perfect order of priority, But if I talk about timing for a second, you know, my main objective is really to get the portfolio optimization as well as deleveraging done in the very near term so that when we look at 2026 and our numbers next year that, you know, everything could be incorporated in that guidance year. So we're obviously looking to accelerate that as much as we can. And with regards to leasing, I mean, that's just, you know, an important fundamental of any read. And obviously getting from high 80% occupancy into the low 90s, that's not going to happen in one year, but that will probably happen over, you know, multiple years. So I'd say that's probably two to three years to get to, you know, the stabilized occupancy levels. And if we could do something on an accelerated basis there, that'd be fantastic. But the optimization and deleveraging, I'd like to have a clear path on that in the very year term. and try and get as much of that done as quickly as possible.

Rich Anderson Analyst — Redbush

Second question is, you said sell, not JV, when you're exiting or selling out of markets. How do you feel about the JV model generally? I mean, is that something that you see as something to unwind over time to simplify the platform, or are you comfortable with the current setup as is?

I like having JVs as part of your toolkit. So we like the JVs that we have. We've got great relationships with our partners, and we'd like to grow those over time, but probably through acquisitions as opposed to us contributing more assets into those ventures. And we probably need to have a better cost of capital before we can do anything in scale to grow those JVs. But I do like the JV model. I feel like we've got good partners there. But when we talk about optimizing the portfolio, it's more about selling 100% of the assets because they're in markets where they're either orphaned assets or we just don't have scale at the moment. So I wouldn't look at those as target assets to contribute into joint ventures right now.

Rich Anderson Analyst — Redbush

Fair enough. I'll let someone else ask the dividend questions. Thanks very much. Thanks, Rich.

Operator

And your next question comes from the line of Juan Sanabria with BMO Capital Markets. Please go ahead.

Juan Sanabria Analyst — BMO Capital Markets

Hi, Pete. Welcome and congratulations. First question, just a simple one, I guess guidance. Is this a kind of Pete stamp approved at this point? I know you've only been there, I think, about two weeks, or is that something that may be refined as you incorporate some of your strategic plans as you outlined in your prepared remarks?

Yeah, I mean, obviously we reaffirmed guidance. on this call, Juan. And I'd say the first couple of weeks I was here, I spent a lot of time with the team going through the 2025 forecast. And we're off to a good start to the year, which allowed us to reaffirm guidance. So I'm comfortable with the numbers we have out there. And our forecast for this year did include $400 million to $500 million of sales. To the extent that we end up selling more assets, it will really be back-end weighted with regards to closing. So I don't see a huge impact there. Again, it will have an impact on 26, and we're not putting out 26 guidance on this call. But I would also say when I mentioned efficiencies, those will work their way into earnings, I think, a lot quicker than any asset sale dilution and dilution from deleveraging. And like I said, I'm trying to offset as much of that dilution, if not all of it from efficiencies as well, we're very mindful of our earnings stream and looking towards earnings growth if we can achieve it next year over this year. Again, too soon to say that that can be the case right now. But I do think the efficiencies will work their way into our 25

Juan Sanabria Analyst — BMO Capital Markets

earnings a lot faster than any dilution will. And as we think about the dividend in 26, noting that it sounds like dispositions may be a bit heavier than what's in the 25 guys, I guess, how should we think about those relative dispositions? Are they going to be deleted? I'm not sure where you think you can sell assets where cap rates are, but is the earnings base going to shrink before it grows, or how are you guys kind of at least penciling that currently?

Yeah. You know, we've gotten a lot of questions on dividend coverage, and I know there's been some things said in the past on that, but, you know, I won't say anything different that we're certainly trending towards covering our dividend towards the second half of this year, and that's what's in our forecast right now. But like I said, I'm less focused on that and more focused on 2026 and what our coverage is in 2026. So as I said on the dividend, it's going to be an output and not an input to the strategic plan, and we just need more work to be able to

Operator

definitively answer that question. Yep. Your next question comes from the line of Seth Berge with CDPs.

Seth Bergey Analyst — Citigroup

You know, how are you thinking about, you know, potential future acquisitions? Are you still going to be mostly on-campus focused, or could we see additional appetite for off-campus?

Yeah, I think our focus on acquisitions is going to be more on the core cluster markets, whether it be on-campus or affiliated or perhaps, you know, off-campus. And there's some pretty good disclosure information on, you know, our core cluster markets. I am a big believer in scale and the opportunity to generate outside NOI growth in our cluster markets. So I'd say we're less focused on the exact, you know, split on-campus, off-campus, and more market-based, you know, focused at the moment. And, you know, it probably makes sense for Ryan Crowley to give you guys just a quick update on what we're seeing in the transaction market, since that's pretty important for us as we're looking to dispose of some assets. And I think it's, you know, holding up quite well despite the volatility that we're experiencing. Ryan?

Certainly, Pete. Thanks, Seth. I would start by saying the favorable market conditions that we saw build throughout 2024 really did continue into 2025. And namely, I'm talking about a relative abundance of equity dry powder out there, as well as, you know, lenders that are eager to lend, and most importantly, a relatively low supply of MOBs for sale in the marketplace today. So with that backdrop, you know, it really is an environment that is supportive of the team's disposition efforts for the rest of the year.

Seth Bergey Analyst — Citigroup

Okay, thanks. And then I guess my second question is, you know, kind of, you know, Are you seeing any impact of potential, you know, federal health care budget cuts or policy changes and any impacts to your tenants or tenant decision making there?

Yeah, I mean, it's a good question on, you know, policy risks. And it's obviously come up a lot ever since the changeover in the administration. I think it's still too soon to say definitively where this is, you know, headed. And I do think you could make the argument that with certain things like site neutrality or perhaps, you know, cuts to Medicaid, which have very little impact on the portfolio we own. But over time, perhaps there could be an indirect benefit to the assets that we own tends to be a lower cost setting for services to get provided. But, again, I want to be very careful, you know, saying what our beliefs are because it's really not well known at this point in time. And we do certainly have some third-party lobbyists we're working with to make sure that we're, you know, completely aware of what's happening in D.C.

Seth Bergey Analyst — Citigroup

Great. Thanks.

Operator

And your next question comes from the line of Jan Pilichowski with Los Fargo. Please go ahead.

John Joseph Pawlowski Analyst — Wells Fargo

Thank you. And Pete, congrats again. So I'd like to start one for you, Pete. Our last conversation on OM, we're generally in a different seat, but same idea was that you saw room to kind of push the frontier on mark-to-markets from maybe that historical 2% to 3% to maybe 5% to 10%. I know in your opening remarks we talked about kind of growing occupancy here at a steady rate. Do you still think that there's room to do that here at HR, or does the focus be a little bit more programmatic, drive occupancy, and then maybe address that, you know, opportunity later?

Hey, John. By the way, I know you're a Vandy grad, so hopefully you can give me some good recommendations on places to get a beer down here. I've been in the office a bunch the last couple weeks. But, you know, generally speaking, on operating fundamentals, you know, consistent with our prior, you know, conversations, I mean, I do think they're as strong as they've really ever been in outpatient medical. You know, you've got demand, far outstripping, supply escalators are routinely at 3% or better is what we're achieving now. You know, rental rates on in-place product is around $25 a foot, and that's up about 20% over the last four to five years. New construction rental rates are probably at $35 a foot. So there's still room for in-place to grow, I think. higher, not all the way to the new, you know, construction rental rates, but somewhere in between. So my view has not changed. I'd say, you know, at the moment, we are certainly focused on two things. One, achieving the best lease economics possible on every single deal, but we obviously want to continue to grow, you know, occupancy as well as, you know, margin. So I wouldn't say that we're looking to, you know, sign deals at lower rates than what we think we can achieve, but we're trying to balance the two. I do think when you get occupancy to more stabilized levels that you'll have an even greater opportunity to push rents. So that may be a reason why you're seeing perhaps lower cash leasing spreads today. But we look at every lease deal and all the economics, and we try and achieve the best rate of return possible.

John Joseph Pawlowski Analyst — Wells Fargo

Got it. And then maybe on your remark around the potential for dispositions to be increased sort of back half-weighted and into 26, you know, the guy right now has about $450 million with $300 million to cut back, so I guess the other $150 is the pay down your line. If you were to increase that number, is that use of funds strictly to pay down the line? is there any consideration where the stock is trading? Because, you know, that helps the dividend coverage versus I know the focus seems right now to be deleveraging, but you're balancing those. So I'm curious if you were to increase those proceeds, is there any consideration to the stock or is this purely deleveraging at this point? Yeah, sorry, you went in and out of it,

but I think your question is generally, you know, what are my views on stock buybacks? You know, look, I think if you have the balance sheet capacity, then buybacks can absolutely be a good use of capital and a good near-term, you know, tactic. And the team here did take advantage of that a little bit last year, actually more than a little bit, a lot. But ultimately, that's resulted in our leverage being at, you know, 6.4 times now, and we're on negative outlook by one of the rating agencies. So, I don't think buybacks are a great long-term strategy, but they certainly can, you know, help your stock price in the very near term. I'd say my immediate focus right now is on creating balance sheet capacity. So I would prioritize that before I would prioritize stock buybacks at the moment. But to the extent we can achieve, you know, what we're seeking to achieve and delever in the near term, then certainly if we had dry powder, we could take a look at, you know, buybacks at that point in time. But we don't have that opportunity today. So that

John Joseph Pawlowski Analyst — Wells Fargo

will take some time to get there. Got it. Well, thank you. Congrats again. And I'll have that list of ours over to you shortly. Perfect. Thanks, John.

Operator

And your next question comes from the line of Nick Ulico with Scotiabank. Please go ahead. Oh, hi. Thanks, everyone.

Nick Yulico Analyst — Scotiabank

So in terms of prospects, I didn't see an update versus what you said back in March. Any update you could provide there on recollection and expectations? Yeah. Hey, Nick,

Nick, I think it tells a good story on where we've started to trend with Prospect and also with Store, but I'll kick it to Austin.

Good morning, Nick. We disclosed in our 10-Q that we did receive full rent from Prospect for February and March, and we also received full rent in April. I would say it's still early in Prospect in the bankruptcy process, so not much more to update you on there. On the steward front, obviously, we talked about overachieving on our expectations in the fourth quarter regarding some of the backfill opportunities that we had in that portfolio. That's now in Rob's leasing pipeline. A lot of that just kicked off at the end of the year. So I don't expect we're going to provide a lot of updates on steward as we move through the year. I think it's in the pipeline. Neither prospect rent nor outside from steward is in our original guidance. So I think good things so far, but it's still early in the year.

Nick Yulico Analyst — Scotiabank

Okay, great. Thanks, Austin. And then, yeah, Pete, congrats on the new role. So it sounds like, you know, there's sort of a strategy plan being put in place. And, you know, at some point, I guess later this year, there's going to be an update on that, you know, to the market. and then sort of at the same time to the board to think about, you know, where the dividend, I guess, could be set in the future. Is there any, like, specific, you know, more time frame you're able to kind of share on that? Thanks.

Hey, Nick, I mean, we're not going to spend a lot of time on the road this next quarter, and this is something I've actually talked to some of our key stakeholders on. I mean, our focus is internally on the strategic plan and where we intend to take things going forward, and I think that's where we should be focusing the vast majority of our, you know, time. So the plan right now is to provide more detail on our next call with regards to that, and we'll certainly, you know, comment more on the dividend at that time. But, again, as I said, it's going to be an output, not an input to this. And, you know, at that time, hopefully we can provide some more clarity on the way we're seeing things shape up, not only for this year but how our, you know, dispositions are trending as well as where we see the trajectory heading into 26.

Operator

And your next question comes from the line of Austin Worsmith with K-Bank. All right.

Austin Worshak Analyst — KeyBanc

Good morning. Hey, Pete, welcome. Appreciate all the comments and your prepared remarks. Just wanted to hone in on one about the upside in the margin profile of the company and really, you know, how much, you know, upside you see as kind of that initial low-hanging fruit and, you know, what are the best opportunities you see to drive margin just given kind of your background and, you know, know, what you've recently gone through in your prior role and whether internalizing certain, you know, leasing is an opportunity, you know, across the platform, maybe where, you know, just curious what you see on that front.

Yeah, it's a good question, Austin. And obviously, you know, in my prior role, there was a lot of internalization that happened the last few years, I'd say, within this platform, a lot of that internalization was already in place. So I don't know that there's a ton of additional internalization, although we've certainly talked about some. We don't, you know, have internalized operations in every single, you know, market. So selectively, that is something we certainly will look at. You know, I think the other thing I would just mention, you know, Rob and I have spent a lot of time talking at length on just organizational structure and how to maximize, you know, margin within the local markets. And I think one of the key things is just empowering the local teams and pushing down some P&L responsibility much closer to the real estate. More of the structure here from that perspective has been kind of centralized, you know, historically. And we're looking to improve, as we said, profitability as well as, you know, the tenant experience. And I think the more you empower your local teams to have some control over that, we think the better off you'll be from an expense perspective, which will improve margin. And the other way to improve margin is sign more leases and take your revenues up. In fact, that's probably the easiest way to improve your margins there. But we're certainly looking at, you know, both ways. I don't know, Rob, if you have any other comments you want to make on that topic.

Rob Hull COO

Yeah, I would say for sure that occupancy is number one way to do it, but then continuing to push that responsibility down. But then not to lose sight of, you know, improvements in technology and being able to take advantage of technology, not just here in the home office, but also out in the field. So we will continue to evaluate those opportunities and implement them where we think it allows us to drive greater efficiency.

And then I'll just say one last thing in case you have a follow-up. I think at the G&A side, you know, our costs are generally, you know, in line with peers. But, you know, simply put, if you can find $3.5 million of savings, that's a penny a share in earnings. You know, the entire C-suite here is in Nashville, which is actually incredibly efficient. We do have a couple of extra offices in areas like Charleston, Scottsdale. So those are just a couple examples of areas. Perhaps we could, you know, strip those costs out of our G&A as well. And, you know, like I said, if you can find a penny a share of G&A, that's pretty significant.

Austin Worshak Analyst — KeyBanc

That's all very helpful. And maybe, Rob, just, you know, switching over to you, you know, you had some positive commentary around just what you're seeing in the leasing pipeline, despite maybe optically what looked like a little bit of a softer quarter to start the year. Can you just give us the average size of what that leasing pipeline looked like today versus, you know, where that stood in prior quarters? and then just given kind of the probability that you think you can, you know, deliver on that, maybe given what's a little bit of an uncertain environment overall? Thanks.

Rob Hull COO

No, I think the pipeline remains as strong as it's ever been. You know, I mentioned in my remarks that we're seeing an increasing amount of health system participation in that pipeline and executing leases with a growing number of health systems. So I'm very optimistic about the outlook for this year. You know, we continue to – this quarter we did $370,000 for a feed of new leasing. If you look historically at our new leasing trends, typically the first quarter is the softest. And so even at the lower amount versus the fourth quarter, we are on pace to meet or exceed our annual targets for new leasing. So I'm very optimistic about where we are today and the path that we have in front of us. So I think health systems and this morning the jobs report came out and, you know, health system and health care employment continues to be a strong point in the labor, on the labor front. So that's certainly good for our business and will continue to drive space needs inside of the MOB space.

Operator

And your next question comes from the line of Amatamayo Okusania with Deutsche Bank. Please go ahead.

Congratulations. Thanks, Ty. I'm sorry to miss your conference in April. That was my one week of unemployment.

Mytiamo Okusanya Analyst — Deutsche Bank

You're forgiven. That's perfectly fine. So I am curious, sir, if you've had an opportunity just to speak with a lot of the healthcare that are a tenant of yours, again, so it's clearly an overlap versus your prior job. But just kind of curious, what are healthcare systems at this point just thinking, just kind of given the way the macro backdrop is evolving, and how do you see that impacting your business one way or another?

Yeah, I mean, we haven't seen it to date. And, you know, the one thing about outpatient medical is it's a pretty resilient, you know, asset class, and demand is holding up quite well. You know, Ryan talked about the transaction market. I'd say that's holding up quite well despite, you know, the whipsawing of rates and overall volatility. And on the health system side and leasing, if anything, we're actually today seeing the amount of lease deals we're doing with health systems increasing and not decreasing. And that's been a trend that's been going on for the last couple of decades. And I don't see that trend changing going forward. I didn't talk about the importance of relationships. I mean, one of the overarching things that we're very focused on here is continuing to maintain our strong relationships with our counterparties and obviously trying to work with them on allowing them to grow within our portfolio for the demand that they see. But to date, we've seen a lot of demand from health systems, and there's nothing we're seeing right now that shows any signs of it abating. Rob, do you want to add anything to that?

Rob Hull COO

Yeah, I would just add to that, maybe a little more granular, that there are a number of campuses that we're on now where the systems are coming to us and increasing their – maybe we were talking about 10,000 feet and saying, hey, we need to double that because demand is so great. They're continuing to execute on their expansion plans by establishing new service lines and surgical suites and forming new partnerships with physicians on the ASC front. So, as Pete said, not seeing any slowdown and not, at this point, not seeing any signs of a slowdown in the near term.

Mytiamo Okusanya Analyst — Deutsche Bank

That's helpful. And then on the balance sheet front, again, everything you said makes sense, but I'm just kind of curious just tactically as you kind of start thinking about, again, the $1.2 billion of debt coming during 26, over half a billion dollars of swaps coming during 26. Like, are there things one can be doing now just kind of based on the forward curve, or do you kind of really have to kind of wait for things to play out a little bit better before you can actually start to make some kind of some real moves?

Yeah. Hey, Tayo, it's Pete here. You know, I think as we look at our overall liquidity measurement and back to the question on stock buybacks and why we're less focused on that, as you bring up a good point, Yes, we have liquidity today, but we also have, you know, well over a billion dollars of debt coming due, you know, not really this year. We paid off with our line of credit, the one bond that we had coming due this year, but it's really next year. So we're going to work with our bank group on our revolver and look at any options that we have. There are some extension options on those term loans as well, but I just don't think we have enough runway today in a downside scenario, and we're very, very focused on enhancing that in the very near term. So more to come on that. I think just generally speaking, I did want to spend a second on overall leverage because I've gotten varying feedback from different investors on what they think is the right leverage level for us. But I'll tell you the way I think about it, is, you know, look, 6.4 times net debt debits out, like, that's just too high. And you're never going to have a CEO tell you, I really want to be on negative outlook from one of the rating agencies. Like, that would be crazy if somebody said that, and I'm not going to say that. So I don't think we have to delever, though, all the way to five times net debt debits out. I think if we got closer to those levels, then we'd have some balance sheet capacity to redeploy those proceeds. So probably somewhere in between. I don't want to peg, you know, a specific number right now, but you can, you know, take the average and come up with where we're sort of targeting that to be. And if we de-levered a little bit more initially, that's more just because we don't think those assets make sense to be in our portfolio long-term, and we think they're going to be habitual underperformers and drag down NOI growth. So if we end up going a little further on the balance sheet initially, you should expect us to redeploy capital into the right markets over time. So I'd say that would be a temporal impact to our earnings. Hopeful. Thank you, and good luck.

Mytiamo Okusanya Analyst — Deutsche Bank

Thanks, Tyle.

Operator

And your next question comes from the line of Michael Mueller with J.P. Morgan. Please go ahead.

Michael W. Mueller Analyst — J.P. Morgan

Hi. I guess, first, how do you think about balancing the disposition-driven portfolio optimization and deleveraging with earnings impact over the next few years?

Yeah. I think it's pretty simple, Mike. I mean, obviously, we're going to be very mindful of what we're selling and the cap rates that we can get. And we don't have to be a, you know, price taker in this market. And I think the market's holding up pretty well. But the other side of that, you know, question is, okay, there's a negative impact from deleveraging, right? That's just a fact of where our interest rates are and where we're going to sell assets at. But if you can offset that and think about the outsides, I mean, we've got pretty good year-over-year lease escalators that are, you know, built in place at close to 3%. I've talked about efficiencies, you know, more to come on that. But I will tell you, we are going to turn over every rock here to find as many efficiencies as we possibly can. And then, obviously, we've got the leasing upside as well. So we're looking at it from all angles. I know when you say asset sales, the first thought that comes out to the street is dilution. But our first thought is, how do we offset that dilution? And that's an important work stream we're working on.

Michael W. Mueller Analyst — J.P. Morgan

Got it. And then I know you said you'll review the dividend. But as you sit there today, are there any benefits that you can point to from not cutting the dividend as it relates to, you know, operations and growth prospects?

You know, look, do I wish the dividend coverage was lower? Of course, I wish it was lower, but it's not. And like I said, we've talked to a variety of different investors. And, you know, I think there's an opportunity for us to grow earnings irrespective of what we do with the dividend. I think retaining some earnings could have a, you know, nominal benefit to, you know, earnings growth going forward. But, again, we've got more work to do. No decisions have been made. And, you know, we'll provide more thoughts on that topic next quarter. Okay.

Operator

And your next question comes from the line of Michael Gorman with BTIG. Please go ahead.

Michael Gorman Analyst — BTIG

Yeah, thanks. Good morning. Going back to the discussion on the NOI margins, I'm wondering if you could kind of break out the potential for the dispositions to help drive margin higher as well. Do you see kind of a material differentiation between some of your larger markets and some of your core markets in terms of the NOI margin you can drive there versus maybe some of the smaller markets that you would be looking to exit?

Yeah, I'll have Ryan jump in and answer this.

Yeah, Michael, you're thinking about it the absolute correct way. It's the way we looked at it. As we came up with our list of potential disposition properties, we took an asset-by-asset bottom-up approach. An NOI margin and historical rent growth, those are all things we looked at and analyzed. As Pete referenced earlier, we also looked at where do we have to scale and where can we get those operational efficiencies out of the platform into the property level. So the team has been hard at work. We've been really deliberate about building the list of potential properties to sell, And we've also been meticulous about preparing those assets for sale. And what the team has done over the last couple of months is provide the company with maximum optionality as we look to potentially throttle dispositions throughout the year. So I think the potential is there to see NOI margins improve as its pace of dispositions continues throughout the coming quarters.

Michael Gorman Analyst — BTIG

Okay, great. That's helpful. And then, Pete, maybe just approaching the dividend from a different angle here, Given your prior role, can you just spend a minute talking about, as you think about the strategic plan and the opportunities for HR, how you think about the role of retained cash flow in the capital stack and in the future of leasing CapEx and potential either redevelopment or development opportunities and just kind of how you view retained cash flow in an MOV portfolio? Thanks.

Yeah, look, I think there's really good redevelopment opportunities within outpatient medical where you get a solid return from reinvesting, you know, capital into high-quality real estate that, you know, may be older, but you can get a much higher rental rate to the extent that you can refurbish that asset or, you know, the suite for the individual health system or doctor. So, I mean, the first area you put retained earnings is into redevelopment capital, and I think that'd be priority, you know, number one. You know, priority number two would probably be, you know, along the lines of reinvesting it into, you know, development or something of that like. But, you know, I'd really focus more on the redevelopment capital because I think you get a much higher rate of return on that, and it's assets you already own, and you're just bringing them up to a higher standard. Great. Thank you for the time.

Operator

And that concludes our question and answer session. I would like to turn it back to Peach Club for closing remarks.

Great. Well, first of all, thanks, everyone, for joining, and I look forward to seeing all of you at NARES next month.

Operator

Thank you. And this concludes today's conference call. You may now disconnect.