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Document and Entity Information - USD ($)	12 Months Ended
Document and Entity Information - USD ($)	Dec. 31, 2018	Feb. 22, 2019	Jun. 30, 2018
Document Information [Line Items]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2018
Document Fiscal Year Focus	2018
Document Fiscal Period Focus	FY
Trading Symbol	MPW
Entity Registrant Name	MEDICAL PROPERTIES TRUST INC
Entity Central Index Key	0001287865
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	Yes
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Filer Category	Large Accelerated Filer
Entity Shell Company	false
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		381,077,933
Entity Public Float			$ 5,087,316,078
MPT Operating Partnership, L.P. [Member]
Document Information [Line Items]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2018
Document Fiscal Year Focus	2018
Document Fiscal Period Focus	FY
Entity Registrant Name	MPT OPERATING PARTNERSHIP, L.P.
Entity Central Index Key	0001524607
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Entity Shell Company	false
Entity Small Business	false
Entity Emerging Growth Company	false

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Real estate assets
Land	$ 547,894	$ 639,626
Buildings and improvements	4,233,255	4,667,150
Construction in progress	84,172	47,695
Intangible lease assets	403,138	443,134
Real estate held for sale		146,615
Net investment in direct financing leases	684,053	698,727
Mortgage loans	1,213,322	1,778,316
Gross investment in real estate assets	7,165,834	8,421,263
Accumulated depreciation	(414,331)	(406,855)
Accumulated amortization	(50,653)	(48,857)
Net investment in real estate assets	6,700,850	7,965,551
Cash and cash equivalents	820,868	171,472
Interest and rent receivables	25,855	78,970
Straight-line rent receivables	220,848	185,592
Other loans	373,198	150,209
Other assets	702,024	468,494
Total Assets	8,843,643	9,020,288
Liabilities
Debt, net	4,037,389	4,898,667
Accounts payable and accrued expenses	204,325	211,188
Deferred revenue	13,467	18,178
Lease deposits and other obligations to tenants	27,524	57,050
Total Liabilities	4,282,705	5,185,083
Commitments and Contingencies
Equity / Capital
Preferred stock, $0.001 par value. Authorized 10,000 shares; no shares outstanding
Common stock, $0.001 par value. Authorized 500,000 shares; issued and outstanding — 370,637 shares at December 31, 2018 and 364,424 shares at December 31, 2017	371	364
Limited Partners:
Additional paid-in capital	4,442,948	4,333,027
Retained earnings (deficit)	162,768	(485,932)
Accumulated other comprehensive loss	(58,202)	(26,049)
Treasury shares, at cost	(777)	(777)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	4,547,108	3,820,633
Non-controlling interests	13,830	14,572
Total Equity / Capital	4,560,938	3,835,205
Total Liabilities and Equity / Capital	8,843,643	9,020,288
Common Units [Member]
Limited Partners:
Total Equity / Capital	371	364
MPT Operating Partnership, L.P. [Member]
Real estate assets
Land	547,894	639,626
Buildings and improvements	4,233,255	4,667,150
Construction in progress	84,172	47,695
Intangible lease assets	403,138	443,134
Real estate held for sale		146,615
Net investment in direct financing leases	684,053	698,727
Mortgage loans	1,213,322	1,778,316
Gross investment in real estate assets	7,165,834	8,421,263
Accumulated depreciation	(414,331)	(406,855)
Accumulated amortization	(50,653)	(48,857)
Net investment in real estate assets	6,700,850	7,965,551
Cash and cash equivalents	820,868	171,472
Interest and rent receivables	25,855	78,970
Straight-line rent receivables	220,848	185,592
Other loans	373,198	150,209
Other assets	702,024	468,494
Total Assets	8,843,643	9,020,288
Liabilities
Debt, net	4,037,389	4,898,667
Accounts payable and accrued expenses	108,574	121,465
Deferred revenue	13,467	18,178
Lease deposits and other obligations to tenants	27,524	57,050
Payable due to Medical Properties Trust, Inc.	95,361	89,333
Total Liabilities	4,282,315	5,184,693
Commitments and Contingencies
Limited Partners:
Accumulated other comprehensive loss	(58,202)	(26,049)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	4,547,498	3,821,023
Non-controlling interests	13,830	14,572
Total Equity / Capital	4,561,328	3,835,595
Total Liabilities and Equity / Capital	8,843,643	9,020,288
MPT Operating Partnership, L.P. [Member] \| Common Units [Member]
Limited Partners:
Limited Partners Capital	4,559,616	3,808,583
General Partner [Member] \| MPT Operating Partnership, L.P. [Member]
Limited Partners:
Total Equity / Capital	46,084	38,489
General partner — issued and outstanding — 3,706 units at December 31, 2018 and 3,644 units at December 31, 2017	$ 46,084	$ 38,489

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2018	Dec. 31, 2017
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares outstanding	0	0
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	500,000,000	500,000,000
Common stock, shares issued	370,637,000	364,424,000
Common stock, shares outstanding	370,637,000	364,424,000
MPT Operating Partnership, L.P. [Member] \| Common Units [Member]
Limited Partners, units issued	366,931,000	360,780,000
Limited Partners, units outstanding	366,931,000	360,780,000
General Partner [Member] \| MPT Operating Partnership, L.P. [Member]
General partner, units issued	3,706,000	3,644,000
General partner, units outstanding	3,706,000	3,644,000
LTIP Units [Member] \| MPT Operating Partnership, L.P. [Member]
LTIP Units, shares issued	232,000	292,000
LTIP Units, shares outstanding	232,000	292,000

Consolidated Statements of Net Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Revenues
Rent billed	$ 473,343	$ 435,782	$ 327,269
Straight-line rent	74,741	65,468	41,067
Income from direct financing leases	73,983	74,495	64,307
Interest and fee income	162,455	129,000	108,494
Total revenues	784,522	704,745	541,137
Expenses
Interest	223,274	176,954	159,597
Real estate depreciation and amortization	133,083	125,106	94,374
Property-related	9,237	5,811	2,712
General and administrative	80,086	58,599	48,911
Acquisition costs	917	29,645	46,273
Total expenses	446,597	396,115	351,867
Other income (expense)
Gain on sale of real estate and other, net	719,392	7,431	61,224
Impairment charges	(48,007)		(7,229)
Debt refinancing costs		(32,574)	(22,539)
Other	10,094	10,432	(1,619)
Total other income (expense)	681,479	(14,711)	29,837
Income before income tax	1,019,404	293,919	219,107
Income tax (expense) benefit	(927)	(2,681)	6,830
Net income	1,018,477	291,238	225,937
Net income attributable to non-controlling interests	(1,792)	(1,445)	(889)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 1,016,685	$ 289,793	$ 225,048
Earnings per share — basic
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 2.77	$ 0.82	$ 0.86
Weighted average shares outstanding — basic	365,364	349,902	260,414
Earnings per share — diluted
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 2.76	$ 0.82	$ 0.86
Weighted average shares outstanding — diluted	366,271	350,441	261,072
MPT Operating Partnership, L.P. [Member]
Revenues
Rent billed	$ 473,343	$ 435,782	$ 327,269
Straight-line rent	74,741	65,468	41,067
Income from direct financing leases	73,983	74,495	64,307
Interest and fee income	162,455	129,000	108,494
Total revenues	784,522	704,745	541,137
Expenses
Interest	223,274	176,954	159,597
Real estate depreciation and amortization	133,083	125,106	94,374
Property-related	9,237	5,811	2,712
General and administrative	80,086	58,599	48,911
Acquisition costs	917	29,645	46,273
Total expenses	446,597	396,115	351,867
Other income (expense)
Gain on sale of real estate and other, net	719,392	7,431	61,224
Impairment charges	(48,007)		(7,229)
Debt refinancing costs		(32,574)	(22,539)
Other	10,094	10,432	(1,619)
Total other income (expense)	681,479	(14,711)	29,837
Income before income tax	1,019,404	293,919	219,107
Income tax (expense) benefit	(927)	(2,681)	6,830
Net income	1,018,477	291,238	225,937
Net income attributable to non-controlling interests	(1,792)	(1,445)	(889)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 1,016,685	$ 289,793	$ 225,048
Earnings per share — basic
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 2.77	$ 0.82	$ 0.86
Weighted average shares outstanding — basic	365,364	349,902	260,414
Earnings per share — diluted
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 2.76	$ 0.82	$ 0.86
Weighted average shares outstanding — diluted	366,271	350,441	261,072

Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Net income	$ 1,018,477	$ 291,238	$ 225,937
Other comprehensive income (loss):
Unrealized (loss) gain on interest rate swap	(3,317)		2,904
Foreign currency translation (loss) gain	(28,836)	66,854	(22,923)
Total comprehensive income	986,324	358,092	205,918
Comprehensive income attributable to non-controlling interests	(1,792)	(1,445)	(889)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	984,532	356,647	205,029
MPT Operating Partnership, L.P. [Member]
Net income	1,018,477	291,238	225,937
Other comprehensive income (loss):
Unrealized (loss) gain on interest rate swap	(3,317)		2,904
Foreign currency translation (loss) gain	(28,836)	66,854	(22,923)
Total comprehensive income	986,324	358,092	205,918
Comprehensive income attributable to non-controlling interests	(1,792)	(1,445)	(889)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	$ 984,532	$ 356,647	$ 205,029

- Definition

The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest.

+ References

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+ Details

Consolidated Statements of Equity / Capital - USD ($) shares in Thousands, $ in Thousands	Total	MPT Operating Partnership, L.P. [Member]	MPT Operating Partnership, L.P. [Member] General Partner [Member]	Common Par Value [Member]	Common Par Value [Member] MPT Operating Partnership, L.P. [Member] Limited Partner [Member]	Additional Paid-in Capital [Member]	Retained Earnings (Deficit) [Member]	Accumulated Other Comprehensive Loss [Member]	Accumulated Other Comprehensive Loss [Member] MPT Operating Partnership, L.P. [Member]	Treasury Shares [Member]	Non-Controlling Interests [Member]	Non-Controlling Interests [Member] MPT Operating Partnership, L.P. [Member]	Long Term Incentive Plan [Member] MPT Operating Partnership, L.P. [Member] Limited Partner [Member]
Beginning balance at Dec. 31, 2015	$ 2,107,265	$ 2,107,655	$ 21,773	$ 237	$ 2,153,769	$ 2,593,827	$ (418,650)	$ (72,884)	$ (72,884)	$ (262)	$ 4,997	$ 4,997
Beginning balance (in shares) at Dec. 31, 2015			2,363	236,744	234,381								292
Net income	225,937	225,937	$ 2,251		$ 222,797		225,048				889	889
Unrealized (loss) gain on interest rate swap	2,904	2,904						2,904	2,904
Foreign currency translation (loss) gain	(22,923)	(22,923)						(22,923)	(22,923)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	7,942	7,942	$ 80	$ 1	$ 7,862	7,941
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			10	1,021	1,011
Distributions to non-controlling interests	(1,036)	(1,036)									(1,036)	(1,036)
Proceeds from offering (net of offering costs)	1,173,651	1,173,651	$ 11,737	$ 83	$ 1,161,914	1,173,568
Proceeds from offering (net of offering costs) (shares)			831	82,749	81,918
Dividends (Distributions) declared ($0.91 in 2016, 0.96 in 2017 and 1.00 in 2018 per common share/ unit)	(240,512)	(240,512)	$ (2,405)		$ (238,107)		(240,512)
Ending balance at Dec. 31, 2016	3,253,228	3,253,618	$ 33,436	$ 321	$ 3,308,235	3,775,336	(434,114)	(92,903)	(92,903)	(262)	4,850	4,850
Ending balance (in shares) at Dec. 31, 2016			3,204	320,514	317,310								292
Net income	291,238	291,238	$ 2,898		$ 286,895		289,793				1,445	1,445
Sale of non-controlling interests	10,000										10,000
Foreign currency translation (loss) gain	66,854	66,854						66,854	66,854
Stock (Unit) vesting and amortization of stock (unit)-based compensation	9,949	9,949	$ 99		$ 9,850	9,949
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			9	785	776
Treasury shares acquired (41,270 shares)	(515)									(515)
Treasury units acquired (41,270 units)		(515)	$ (6)		$ (509)
Distributions to non-controlling interests	(1,723)	(1,723)									(1,723)	(1,723)
Proceeds from offering (net of offering costs)	547,785	547,785	$ 5,478	$ 43	$ 542,307	547,742
Proceeds from offering (net of offering costs) (shares)			431	43,125	42,694
Dividends (Distributions) declared ($0.91 in 2016, 0.96 in 2017 and 1.00 in 2018 per common share/ unit)	(341,611)	(341,611)	$ (3,416)		$ (338,195)		(341,611)
Ending balance at Dec. 31, 2017	3,835,205	3,835,595	$ 38,489	$ 364	$ 3,808,583	4,333,027	(485,932)	(26,049)	(26,049)	(777)	14,572	14,572
Ending balance (in shares) at Dec. 31, 2017			3,644	364,424	360,780								292
Sale of non-controlling interests		10,000										10,000
Net income	1,018,477	1,018,477	$ 10,167		$ 1,006,518		1,016,685				1,792	1,792
Cumulative effect of change in accounting principles	1,938	1,938	19		1,919		1,938
Unrealized (loss) gain on interest rate swap	(3,317)	(3,317)						(3,317)	(3,317)
Foreign currency translation (loss) gain	(28,836)	(28,836)						(28,836)	(28,836)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	16,505	16,505	$ 165	$ 1	$ 16,340	16,504
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			6	599	593
Conversion of LTIP units to common units (shares)					60								(60)
Redemption of common units	(816)	(816)			$ (816)	(816)
Redemption of common units (shares)					(60)
Distributions to non-controlling interests	(2,534)	(2,534)									(2,534)	(2,534)
Proceeds from offering (net of offering costs)	94,239	94,239	$ 942	$ 6	$ 93,297	94,233
Proceeds from offering (net of offering costs) (shares)			56	5,614	5,558
Dividends (Distributions) declared ($0.91 in 2016, 0.96 in 2017 and 1.00 in 2018 per common share/ unit)	(369,923)	(369,923)	$ (3,698)		$ (366,225)		(369,923)
Ending balance at Dec. 31, 2018	$ 4,560,938	$ 4,561,328	$ 46,084	$ 371	$ 4,559,616	$ 4,442,948	$ 162,768	$ (58,202)	$ (58,202)	$ (777)	$ 13,830	$ 13,830
Ending balance (in shares) at Dec. 31, 2018			3,706	370,637	366,931								232

Consolidated Statements of Equity / Capital (Parenthetical) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Treasury shares acquired (shares)		41,270
Dividends (Distributions) declared per common share / unit	$ 1.00	$ 0.96	$ 0.91
MPT Operating Partnership, L.P. [Member]
Treasury shares acquired (shares)		41,270
Dividends (Distributions) declared per common share / unit	1.00	$ 0.96	0.91
MPT Operating Partnership, L.P. [Member] \| General Partner [Member]
Treasury shares acquired (shares)		41,270
Dividends (Distributions) declared per common share / unit	1.00	$ 0.96	0.91
Retained Earnings (Deficit) [Member]
Dividends (Distributions) declared per common share / unit	1.00	$ 0.96	0.91
Treasury Shares [Member]
Treasury shares acquired (shares)		41,270
Common Par Value [Member] \| MPT Operating Partnership, L.P. [Member] \| Limited Partner [Member]
Treasury shares acquired (shares)		41,270
Dividends (Distributions) declared per common share / unit	$ 1.00	$ 0.96	$ 0.91

Consolidated Statements of Cash Flows $ in Thousands	12 Months Ended
Consolidated Statements of Cash Flows $ in Thousands	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)
Operating activities
Net income	$ 1,018,477	$ 291,238	$ 225,937
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	141,492	131,979	97,601
Amortization of deferred financing costs and debt discount	7,363	6,521	7,613
Direct financing lease interest accretion	(9,783)	(9,933)	(9,120)
Straight-line rent revenue	(90,811)	(70,808)	(41,567)
Share / (Unit)-based compensation expense	16,505	9,949	7,942
Gain from sale of real estate and other, net	(719,392)	(7,431)	(61,224)
Impairment charges	48,007		7,229
Straight-line rent and other write-off	18,002	5,340	3,063
Debt refinancing costs		32,574	22,539
Other adjustments	(3,768)	(1,204)	3,563
Changes in:
Interest and rent receivables	46,498	(21,116)	(13,247)
Other assets	(18,051)	(5,318)	(19,202)
Accounts payable and accrued expenses	(5,596)	2,494	41,583
Deferred revenue	145	(2,050)	(8,872)
Net cash provided by operating activities	449,088	362,235	263,838
Investing activities
Cash paid for acquisitions and other related investments	(1,430,995)	(2,246,788)	(1,682,409)
Net proceeds from sale of real estate	1,513,666	64,362	198,767
Principal received on loans receivable	885,917	8,480	906,757
Investment in loans receivable	(212,002)	(19,338)	(109,027)
Construction in progress and other	(53,967)	(73,812)	(171,209)
Investment in unsecured senior notes			(50,000)
Proceeds from sale of unsecured notes			50,000
Other investments, net	(138,441)	(94,970)	(69,423)
Net cash provided by (used for) investing activities	564,178	(2,362,066)	(926,544)
Financing activities
Proceeds from term debt	759,735	2,355,280	1,000,000
Payments of term debt		(1,038,221)	(575,299)
Payment of deferred financing costs		(32,794)	(15,468)
Revolving credit facilities, net	(811,718)	550,415	(810,000)
Distributions paid	(363,906)	(326,729)	(218,393)
Lease deposits and other obligations to tenants	(20,606)	27,525	14,557
Proceeds from sale of common shares, net of offering costs	94,239	547,785	1,173,651
Other financing activities	(3,614)	(12,984)	(16,485)
Net cash (used for) provided by financing activities	(345,870)	2,070,277	552,563
Increase (decrease) in cash, cash equivalents, and restricted cash for the year	667,396	70,446	(110,143)
Effect of exchange rate changes	(17,218)	16,920	(3,003)
Cash, cash equivalents and restricted cash at beginning of year	172,247	84,881	198,027
Cash, cash equivalents, and restricted cash at end of year	822,425	172,247	84,881
Interest paid, including capitalized interest of $1,480 in 2018, $840 in 2017, and $2,320 in 2016	221,779	149,798	138,770
Supplemental schedule of non-cash financing activities:
Dividends declared, not paid	95,419	89,403	74,521
Cash, cash equivalents and restricted cash are comprised of the following:
Cash and cash equivalents at beginning of period	171,472	83,240	195,541
Restricted cash, included in Other assets at beginning of period	$ 775	$ 1,641	$ 2,486
Restricted cash and cash equivalents, noncurrent, asset, statement of financial position [Extensible List]	us-gaap:OtherAssets	us-gaap:OtherAssets	us-gaap:OtherAssets
Cash, cash equivalents and restricted cash at beginning of year	$ 172,247	$ 84,881	$ 198,027
Cash and cash equivalents at end of period	820,868	171,472	83,240
Restricted cash, included in Other assets at end of period	1,557	775	1,641
Cash, cash equivalents, and restricted cash at end of year	822,425	172,247	84,881
MPT Operating Partnership, L.P. [Member]
Operating activities
Net income	1,018,477	291,238	225,937
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	141,492	131,979	97,601
Amortization of deferred financing costs and debt discount	7,363	6,521	7,613
Direct financing lease interest accretion	(9,783)	(9,933)	(9,120)
Straight-line rent revenue	(90,811)	(70,808)	(41,567)
Share / (Unit)-based compensation expense	16,505	9,949	7,942
Gain from sale of real estate and other, net	(719,392)	(7,431)	(61,224)
Impairment charges	48,007		7,229
Straight-line rent and other write-off	18,002	5,340	3,063
Debt refinancing costs		32,574	22,539
Other adjustments	(3,768)	(1,204)	3,563
Changes in:
Interest and rent receivables	46,498	(21,116)	(13,247)
Other assets	(18,051)	(5,318)	(19,202)
Accounts payable and accrued expenses	(5,596)	2,494	41,583
Deferred revenue	145	(2,050)	(8,872)
Net cash provided by operating activities	449,088	362,235	263,838
Investing activities
Cash paid for acquisitions and other related investments	(1,430,995)	(2,246,788)	(1,682,409)
Net proceeds from sale of real estate	1,513,666	64,362	198,767
Principal received on loans receivable	885,917	8,480	906,757
Investment in loans receivable	(212,002)	(19,338)	(109,027)
Construction in progress and other	(53,967)	(73,812)	(171,209)
Investment in unsecured senior notes			(50,000)
Proceeds from sale of unsecured notes			50,000
Other investments, net	(138,441)	(94,970)	(69,423)
Net cash provided by (used for) investing activities	564,178	(2,362,066)	(926,544)
Financing activities
Proceeds from term debt	759,735	2,355,280	1,000,000
Payments of term debt		(1,038,221)	(575,299)
Payment of deferred financing costs		(32,794)	(15,468)
Revolving credit facilities, net	(811,718)	550,415	(810,000)
Distributions paid	(363,906)	(326,729)	(218,393)
Lease deposits and other obligations to tenants	(20,606)	27,525	14,557
Proceeds from sale of common shares, net of offering costs	94,239	547,785	1,173,651
Other financing activities	(3,614)	(12,984)	(16,485)
Net cash (used for) provided by financing activities	(345,870)	2,070,277	552,563
Increase (decrease) in cash, cash equivalents, and restricted cash for the year	667,396	70,446	(110,143)
Effect of exchange rate changes	(17,218)	16,920	(3,003)
Cash, cash equivalents and restricted cash at beginning of year	172,247	84,881	198,027
Cash, cash equivalents, and restricted cash at end of year	822,425	172,247	84,881
Interest paid, including capitalized interest of $1,480 in 2018, $840 in 2017, and $2,320 in 2016	221,779	149,798	138,770
Supplemental schedule of non-cash financing activities:
Dividends declared, not paid	95,419	89,403	74,521
Cash, cash equivalents and restricted cash are comprised of the following:
Cash and cash equivalents at beginning of period	171,472	83,240	195,541
Restricted cash, included in Other assets at beginning of period	$ 775	$ 1,641	$ 2,486
Restricted cash and cash equivalents, noncurrent, asset, statement of financial position [Extensible List]	us-gaap:OtherAssets	us-gaap:OtherAssets	us-gaap:OtherAssets
Cash, cash equivalents and restricted cash at beginning of year	$ 172,247	$ 84,881	$ 198,027
Cash and cash equivalents at end of period	820,868	171,472	83,240
Restricted cash, included in Other assets at end of period	1,557	775	1,641
Cash, cash equivalents, and restricted cash at end of year	$ 822,425	$ 172,247	$ 84,881

Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Interest paid, capitalized	$ 1,480	$ 840	$ 2,320
MPT Operating Partnership, L.P. [Member]
Interest paid, capitalized	$ 1,480	$ 840	$ 2,320

Organization

12 Months Ended

Dec. 31, 2018

Accounting Policies [Abstract]

Organization

1. Organization

Medical Properties Trust, Inc., a Maryland corporation, was formed on August 27, 2003, under the General Corporation Law of Maryland for the purpose of engaging in the business of investing in, owning, and leasing healthcare real estate. Our operating partnership subsidiary, MPT Operating Partnership, L.P., through which we conduct all of our operations, was formed in September 2003. Through another wholly-owned subsidiary, Medical Properties Trust, LLC, we are the sole general partner of the Operating Partnership. At present, we directly own substantially all of the limited partnership interests in the Operating Partnership and have elected to report our required disclosures and that of the Operating Partnership on a combined basis, except where material differences exist.

We have operated as a real estate investment trust (“REIT”) since April 6, 2004, and accordingly, elected REIT status upon the filing in September 2005 of the calendar year 2004 federal income tax return. Accordingly, we will generally not be subject to United States (“U.S.”) federal income tax, provided that we continue to qualify as a REIT and our distributions to our stockholders equal or exceed our taxable income.

Our primary business strategy is to acquire and develop real estate and improvements, primarily for long-term lease to providers of healthcare services such as operators of general acute care hospitals, inpatient physical rehabilitation hospitals, long-term acute care hospitals, surgery centers, centers for treatment of specific conditions such as cardiac, pulmonary, cancer, and neurological hospitals, and other healthcare-oriented facilities. We also make mortgage and other loans to operators of similar facilities. In addition, we may obtain profits or equity interests in our tenants, from time to time, in order to enhance our overall return. We manage our business as a single business segment. All of our properties are located in the U.S. and Europe.

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2018

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2. Summary of Significant Accounting Policies

Use of Estimates: The preparation of financial statements in conformity with accounting principles generally accepted in the U.S. requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.

Principles of Consolidation: Property holding entities and other subsidiaries of which we own 100% of the equity or have a controlling financial interest evidenced by ownership of a majority voting interest are consolidated. All inter-company balances and transactions are eliminated. For entities in which we own less than 100% of the equity interest, we consolidate the property if we have the direct or indirect ability to control the entities’ activities based upon the terms of the respective entities’ ownership agreements. For these entities, we record a non-controlling interest representing equity held by non-controlling interests.

We continually evaluate all of our transactions and investments to determine if they represent variable interests in a variable interest entity (“VIE”). If we determine that we have a variable interest in a VIE, we then evaluate if we are the primary beneficiary of the VIE. The evaluation is a qualitative assessment as to whether we have the ability to direct the activities of a VIE that most significantly impact the entity’s economic performance. We consolidate each VIE in which we, by virtue of or transactions with our investments in the entity, are considered to be the primary beneficiary.

At December 31, 2018, we had loans and/or equity investments in certain VIEs, which are also tenants of our facilities. We have determined that we are not the primary beneficiary of these VIEs. The carrying value and classification of the related assets and maximum exposure to loss as a result of our involvement with these VIEs are presented below at December 31, 2018 (in thousands):

VIE

Type

Maximum Loss

Exposure(1)

Asset Type

Classification

Carrying

Amount(2)

Equity investments

17,187

Other assets

—

(1)	Our maximum loss exposure related to our equity investment in VIEs represent the current carrying values of such investment plus any other related assets (such as rent receivables) less any liabilities.

(2)	Carrying amount reflects the net book value of our equity interest only in the VIE.

For the VIE types above, we do not consolidate the VIE because we do not have the ability to control the activities (such as the day-to-day healthcare operations of our borrowers or investees) that most significantly impact the VIE’s economic performance. As of December 31, 2018, we were not required to provide financial support through a liquidity arrangement or otherwise to our unconsolidated VIEs, including circumstances in which it could be exposed to further losses (e.g., cash short falls).

Typically, our loans are collateralized by assets of the borrower (some assets of which are on the premises of facilities owned by us) and further supported by limited guarantees made by certain principals of the borrower.

Investments in Unconsolidated Entities: Investments in entities in which we have the ability to significantly influence (but not control) are accounted for by the equity method, such as our joint venture with Primotop as discuss in Note 3. Under the equity method of accounting, our share of the investee’s earnings or losses are included in the other income line of our consolidated statements of net income. Except for our joint venture with Primotop, we have elected to record our share of such investee’s earnings or losses on a 90-day lag basis. The initial carrying value of investments in unconsolidated entities is based on the amount paid to purchase the interest in the investee entity. Subsequently, our investments are increased/decreased by our share in the investees’ earnings/losses and decreased by cash distributions from our investees. To the extent that our cost basis is different from the basis reflected at the investee entity level, the basis difference is generally amortized over the lives of the related assets and liabilities, and such amortization is included in our share of equity in earnings of the investee.

We evaluate our equity method investments for impairment based upon a comparison of the fair value of the equity method investment to its carrying value, when impairment indicators exist. If we determine a decline in the fair value of an investment in an unconsolidated investee entity below its carrying value is other-than-temporary, and impairment is recorded.

Investments in entities in which we do not control nor do we have the ability to significantly influence and for which there is no readily determinable fair value (such as our investments in Steward Health Care System LLC (“Steward”) and Median Kliniken S.á.r.l. (“MEDIAN”)) are accounted for at cost, less any impairment, plus or minus changes resulting from observable price changes in orderly transactions involving the investee.

Cash and Cash Equivalents: Certificates of deposit, short-term investments with original maturities of three months or less and money-market mutual funds are considered cash equivalents. The majority of our cash and cash equivalents are held at major commercial banks, which at times may exceed the Federal Deposit Insurance Corporation limit. We have not experienced any losses to date on our invested cash. Cash and cash equivalents which have been restricted as to its use are recorded in other assets.

Revenue Recognition: We receive income from operating leases based on the fixed, minimum required rents (base rents) per the lease agreements. Rent revenue from base rents is recorded on the straight-line method over the terms of the related lease agreements for new leases and the remaining terms of existing leases for those acquired as part of a property acquisition. The straight-line method records the periodic average amount of base rent earned over the term of a lease, taking into account contractual rent increases over the lease term. The straight-line method typically has the effect of recording more rent revenue from a lease than a tenant is required to pay early in the term of the lease. During the later parts of a lease term, this effect reverses with less rent revenue recorded than a tenant is required to pay. Rent revenue, as recorded on the straight-line method, in the consolidated statements of net income is presented as two amounts: rent billed and straight-line revenue. Rent billed revenue is the amount of base rent actually billed to our tenants each period as required by the lease. Straight-line rent revenue is the difference between rent revenue earned based on the straight-line method and the amount recorded as rent billed revenue. We record the difference between base rent revenues earned and amounts due per the respective lease agreements, as applicable, as an increase or decrease to straight-line rent receivable.

We also receive additional rent (contingent rent) under some leases based on increases in the consumer price index (“CPI”) or when CPI exceeds the annual minimum percentage increase as stipulated in the lease. Contingent rents are recorded as rent billed revenue in the period earned. Rental payments received prior to their recognition as income are classified as deferred revenue.

We use direct financial lease (“DFL”) accounting to record rent on certain leases deemed to be financing leases, per accounting rules, rather than operating leases. For leases accounted for as DFLs, the future minimum lease payments are recorded as a receivable. The difference between the future minimum lease payments and the estimated residual values less the cost of the properties is recorded as unearned income. Unearned income is deferred and amortized to income over the lease terms to provide a constant yield when collectability of the lease payments is reasonably assured. Investments in DFLs are presented net of unearned income.

We begin recording base rent income from our development projects when the lessee takes physical possession of the facility, which may be different from the stated start date of the lease. Also, during construction of our development projects, we may be entitled to accrue rent based on the cost paid during the construction period (construction period rent). We accrue construction period rent as a receivable with a corresponding offset to deferred revenue during the construction period. When the lessee takes physical possession of the facility, we begin recognizing the deferred construction period revenue on the straight-line method over the term of the lease.

We receive interest income from our tenants/borrowers on mortgage loans, working capital loans, and other long-term loans. Interest income from these loans is recognized as earned based upon the principal outstanding and terms of the loans.

Commitment fees received from lessees for development and leasing services are initially recorded as deferred revenue and recognized as income over the initial term of a lease to produce a constant effective yield on the lease (interest method). Commitment and origination fees from lending services are also recorded as deferred revenue initially and recognized as income over the life of the loan using the interest method.

Tenant payments for certain taxes, insurance, and other operating expenses related to our facilities (most of which are paid directly by our tenants to the government or appropriate third party vendor) are recorded net of the respective expense as generally our leases are “triple-net” leases, with terms requiring such expenses to be paid by our tenants. Failure on the part of our tenants to pay such expense or to pay late would result in a violation of the lease agreement, which could lead to an event of default, if not cured.

In regards to property disposals, starting January 1, 2018, we account for such transactions pursuant to ASU No. 2014-09, “Revenue from Contracts with Customers,” (“ASU 2014-09”). Under this guidance, we recognize a sale of real estate when control has been transferred to the buyer and collection of the sales price is probable. Prior to 2018, we could not recognize a sale if we had continuing involvement in the real estate. Upon adoption of the new accounting guidance, we recorded a $2 million adjustment to retained earnings to fully recognize a gain on real estate sold in prior years that was required to be deferred under old accounting guidance.

Acquired Real Estate Purchase Price Allocation: Since January 1, 2018 with adoption of ASU No. 2017-01, “Clarifying the Definition of a Business” (“ASU 2017-01”), all of our property acquisitions have been accounted for as asset acquisitions. Prior to 2018, properties acquired for leasing purposes were accounted for using business combination accounting rules. The primary impact to us from this change in accounting is the capitalization of third party transaction costs that are directly related to the acquisition as these costs were expensed under business combination accounting rules. Under either accounting method, we allocate the purchase price of acquired properties to tangible and identified intangible assets acquired based on their fair values. In making estimates of fair values for purposes of allocating purchase prices of acquired real estate, we may utilize a number of sources, from time to time, including available real estate broker data, independent appraisals that may be obtained in connection with the acquisition or financing of the respective property, internal data from previous acquisitions or developments, and other market data. We also consider information obtained about each property as a result of our pre-acquisition due diligence, marketing, and leasing activities in estimating the fair value of the tangible and intangible assets acquired.

We measure the aggregate value of lease intangible assets acquired based on the difference between (i) the property valued with new or in-place leases adjusted to market rental rates and (ii) the property valued as if vacant. Management’s estimates of value are made using methods similar to those used by independent appraisers (e.g., discounted cash flow analysis). Factors considered by management in our analysis include an estimate of carrying costs during hypothetical expected lease-up periods, considering current market conditions, and costs to execute similar leases. We also consider information obtained about each targeted facility as a result of our pre-acquisition due diligence, marketing, and leasing activities in estimating the fair value of the intangible assets acquired. In estimating carrying costs, management includes real estate taxes, insurance and other operating expenses and estimates of lost rentals at market rates during the expected lease-up periods, which we expect to be about six months depending on specific local market conditions. Management also estimates costs to execute similar leases including leasing commissions, legal costs, and other related expenses to the extent that such costs are not already incurred in connection with a new lease origination as part of the transaction.

We record above-market and below-market in-place lease values, if any, for our facilities, which are based on the present value of the difference between (i) the contractual amounts to be paid pursuant to the in-place leases and (ii) management’s estimate of fair market lease rates for the corresponding in-place leases, measured over a period equal to the remaining non-cancelable term of the lease. We amortize any resulting capitalized above-market lease values as a reduction of rental income over the lease term. We amortize any resulting capitalized below-market lease values as an increase to rental income over the lease term.

Other intangible assets acquired may include customer relationship intangible values which are based on management’s evaluation of the specific characteristics of each prospective tenant’s lease and our overall relationship with that tenant. Characteristics to be considered by management in allocating these values include the nature and extent of our existing business relationships with the tenant, growth prospects for developing new business with the tenant, the tenant’s credit quality and expectations of lease renewals, including those existing under the terms of the lease agreement, among other factors.

We amortize the value of these intangible assets to expense over the term of the respective leases. If a lease is terminated early, the unamortized portion of the lease intangibles are charged to expense.

Real Estate and Depreciation: Real estate, consisting of land, buildings and improvements, are maintained at cost. Although typically paid by our tenants, any expenditure for ordinary maintenance and repairs that we pay are expensed to operations as incurred. Significant renovations and improvements which improve and/or extend the useful life of the asset are capitalized and depreciated over their estimated useful lives. We record impairment losses on long-lived assets used in operations when events and circumstances indicate that the assets might be impaired and the undiscounted cash flows estimated to be generated by those assets, including an estimated liquidation amount, during the expected holding periods are less than the carrying amounts of those assets. Impairment losses are measured as the difference between carrying value and fair value of the assets. For assets held for sale, we cease recording depreciation expense and adjust the assets’ value to the lower of its carrying value or fair value, less cost of disposal. Fair value is based on estimated cash flows discounted at a risk-adjusted rate of interest. We classify real estate assets as held for sale when we have commenced an active program to sell the assets, and in the opinion of management, it is probable the asset will be sold within the next 12 months.

Construction in progress includes the cost of land, the cost of construction of buildings, improvements and fixed equipment, and costs for design and engineering. Other costs, such as interest, legal, property taxes and corporate project supervision, which can be directly associated with the project during construction, are also included in construction in progress. We commence capitalization of costs associated with a development project when the development of the future asset is probable and activities necessary to get the underlying property ready for its intended use have been initiated. We stop the capitalization of costs when the property is substantially complete and ready for its intended use.

Depreciation is calculated on the straight-line method over the estimated useful lives of the related real estate and other assets. Our weighted average useful lives at December 31, 2018 are as follows:

Buildings and improvements		39.2 years
Tenant lease intangibles		26.0 years
Leasehold improvements		16.4 years
Furniture, equipment and other		9.8 years

Losses from Rent Receivables: For all leases, we continuously monitor the performance of our existing tenants including, but not limited to: admission levels and surgery/procedure volumes by type; current operating margins; ratio of our tenants’ operating margins both to facility rent and to facility rent plus other fixed costs; trends in cash collections; trends in revenue and patient mix; and the effect of evolving healthcare regulations on tenants’ profitability and liquidity.

Losses from Operating Lease Receivables: We utilize the information above along with the tenant’s payment and default history in evaluating (on a property-by-property basis) whether or not a provision for losses on outstanding rent receivables is needed. A provision for losses on rent receivables (including straight-line rent receivables) is ultimately recorded when it becomes probable that the receivable will not be collected in full. The provision is an amount which reduces the receivable to its estimated net realizable value based on a determination of the eventual amounts to be collected either from the debtor or from existing collateral, if any.

Losses on DFL Receivables: Allowances are established for DFLs based upon an estimate of probable losses on a property-by-property basis. DFLs are impaired when it is deemed probable that we will be unable to collect all amounts due in accordance with the contractual terms of the lease. Like operating lease receivables, the need for an allowance is based upon our assessment of the lessee’s overall financial condition; economic resources and payment record; the prospects for support from any financially responsible guarantors; and, if appropriate, the realizable value of any collateral. These estimates consider all available evidence including the expected future cash flows discounted at the DFL’s effective interest rate, fair value of collateral, and other relevant factors, as appropriate. DFLs are placed on non-accrual status when we determine that the collectability of contractual amounts is not reasonably assured. If on non-accrual status, we generally account for the DFLs on a cash basis, in which income is recognized only upon receipt of cash.

Loans: Loans consist of mortgage loans, working capital loans and other long-term loans. Mortgage loans are collateralized by interests in real property. Working capital and other long-term loans are generally collateralized by interests in receivables and corporate and individual guarantees. We record loans at cost. We evaluate the collectability of both interest and principal on a loan-by-loan basis (using the same process as we do for assessing the collectability of rents) to determine whether they are impaired. A loan is considered impaired when, based on current information and events, it is probable that we will be unable to collect all amounts due according to the existing contractual terms. When a loan is considered to be impaired, the amount of the allowance is calculated by comparing the recorded investment to either the value determined by discounting the expected future cash flows using the loan’s effective interest rate or to the fair value of the collateral, if the loan is collateral dependent. If a loan is deemed to be impaired, we generally place the loan on non-accrual status and record interest income only upon receipt of cash.

Earnings Per Share/Units: Basic earnings per common share/unit is computed by dividing net income applicable to common shares/units by the weighted number of shares/units of common stock/units outstanding during the period. Diluted earnings per common share/units is calculated by including the effect of dilutive securities.

Our unvested restricted stock/unit awards contain non-forfeitable rights to dividends, and accordingly, these awards are deemed to be participating securities. These participating securities are included in the earnings allocation in computing both basic and diluted earnings per common share/unit.

Income Taxes: We conduct our business as a REIT under Sections 856 through 860 of the Internal Revenue Code of 1986, as amended (“the Code”). To qualify as a REIT, we must meet certain organizational and operational requirements, including a requirement to distribute to stockholders at least 90% of our REIT’s ordinary taxable income. As a REIT, we generally pay little U.S. federal and state income tax because of the dividends paid deduction that we are allowed to take. If we fail to qualify as a REIT in any taxable year, we will then be subject to U.S. federal income taxes on our taxable income at regular corporate rates and will not be permitted to qualify for treatment as a REIT for federal income tax purposes for four years following the year during which qualification is lost, unless the Internal Revenue Service grants us relief under certain statutory provisions. Such an event could materially adversely affect our net income and net cash available for distribution to stockholders. However, we intend to operate in such a manner so that we will remain qualified as a REIT for U.S. federal income tax purposes.

Our financial statements include the operations of a taxable REIT subsidiary (“TRS”), MPT Development Services, Inc. (“MDS”), and with many other entities, which are single member LLCs that are disregarded for tax purposes and are reflected in the tax returns of MDS. MDS is not entitled to a dividends paid deduction and is subject to U.S. federal, state, and local income taxes. MDS is authorized to provide property development, leasing, and management services for third-party owned properties, and we will make non-mortgage loans to and/or investments in our lessees through this entity.

With the property acquisitions and investments in Europe, we are subject to income taxes internationally. However, we do not expect to incur any additional income taxes in the U.S. as such income from our international properties flows through our REIT income tax returns. For our TRS and international subsidiaries, we determine deferred tax assets and liabilities based on the differences between the financial reporting and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. Any increase or decrease in our deferred tax assets/liabilities that results from a change in circumstances and that causes us to change our judgment about expected future tax consequences of events, is reflected in our tax provision when such changes occur. Deferred income taxes also reflect the impact of operating loss carryforwards. A valuation allowance is provided if we believe it is more likely than not that all or some portion of our deferred tax assets will not be realized. Any increase or decrease in the valuation allowance that results from a change in circumstances, and that causes us to change our judgment about our ability to realize the related deferred tax asset, is reflected in our tax provision when such changes occur.

The calculation of our income taxes involves dealing with uncertainties in the application of complex tax laws and regulations in a multitude of jurisdictions across our global operations. An income tax benefit from an uncertain tax position may be recognized when it is more likely than not that the position will be sustained upon examination, including resolutions of any related appeals or litigation processes, on the basis of technical merits. However, if a more likely than not position cannot be reached, we record a liability as an off-set to the tax benefit and adjust the liabilities when our judgment changes as a result of the evaluation of new information not previously available. Because of the complexity of some of these uncertainties, the ultimate resolution may result in a payment that is materially different from our current estimate of the uncertain tax position liabilities. These differences will be reflected as increases or decreases to income tax expense in the period in which new information is available.

Stock-Based Compensation: We adopted the 2013 Equity Incentive Plan (the “Equity Incentive Plan”) during the second quarter of 2013. Awards of restricted stock, stock options and other equity-based awards with service conditions are amortized to compensation expense over the vesting periods (typically three years), using the straight-line method. Awards that contain market conditions are amortized to compensation expense over the derived vesting periods, which correspond to the periods over which we estimate the awards will be earned, which generally range from three to five years, using the straight-line method. Awards with performance conditions are amortized using the straight-line method over the service period in which the performance conditions are measured, adjusted for the probability of achieving the performance conditions. Forfeitures of stock-based awards are recognized as they occur.

Deferred Costs: Costs incurred that directly relate to the offerings of stock are deferred and netted against proceeds received from the offering. Leasing commissions and other leasing costs directly attributable to tenant leases are capitalized as deferred leasing costs and amortized on the straight-line method over the terms of the related lease agreements. Costs identifiable with loans made to borrowers are capitalized and recognized as a reduction in interest income over the life of the loan.

Deferred Financing Costs: We generally capitalize financing costs incurred in connection with new financings and refinancings of debt. These costs are amortized over the lives of the related debt as an addition to interest expense. For debt with defined principal re-payment terms, the deferred costs are amortized to produce a constant effective yield on the debt (interest method) and are included within Debt, net on our consolidated balance sheets. For debt without defined principal repayment terms, such as our revolving credit facility, the deferred costs are amortized on the straight-line method over the term of the debt and are included as a component of Other assets on our consolidated balance sheets.

Foreign Currency Translation and Transactions: Certain of our international subsidiaries’ functional currencies are the local currencies of their respective countries. We translate the results of operations of our foreign subsidiaries into U.S. dollars using average rates of exchange in effect during the period, and we translate balance sheet accounts using exchange rates in effect at the end of the period. We record resulting currency translation adjustments in accumulated other comprehensive income (loss), a component of stockholders’ equity on our consolidated balance sheets.

Certain of our U.S. subsidiaries will enter into short-term and long-term transactions denominated in a foreign currency from time to time. Gains or losses resulting from these foreign currency transactions are translated into U.S. dollars at the rates of exchange prevailing at the dates of the transactions. The effects of transaction gains or losses on our short-term transactions are included in other income in the consolidated statements of income, while the translation effects on our long-term investments are recorded in accumulated other comprehensive income (loss) on our consolidated balance sheets.

Derivative Financial Investments and Hedging Activities: During our normal course of business, we may use certain types of derivative instruments for the purpose of managing interest rate and/or foreign currency risk. We record our derivative and hedging instruments at fair value on the balance sheet. Changes in the estimated fair value of derivative instruments that are not designated as hedges or that do not meet the criteria for hedge accounting are recognized in earnings. For derivatives designated as cash flow hedges, the change in the estimated fair value of the effective portion of the derivative is recognized in accumulated other comprehensive income (loss) on our consolidated balance sheets, whereas the change in the estimated fair value of the ineffective portion is recognized in earnings. For derivatives designated as fair value hedges, the change in the estimated fair value of the effective portion of the derivatives offsets the change in the estimated fair value of the hedged item, whereas the change in the estimated fair value of the ineffective portion is recognized in earnings.

To qualify for hedge accounting, we formally document all relationships between hedging instruments and hedged items, as well as our risk management objective and strategy for undertaking the hedge prior to entering into a derivative transaction. This process includes specific identification of the hedging instrument and the hedge transaction, the nature of the risk being hedged and how the hedging instrument’s effectiveness in hedging the exposure to the hedged transaction’s variability in cash flows attributable to the hedged risk will be assessed. Both at the inception of the hedge and on an ongoing basis, we assess whether the derivatives that are used in hedging transactions are highly effective in offsetting changes in cash flows or fair values of hedged items. In addition, for cash flow hedges, we assess whether the underlying forecasted transaction will occur. We discontinue hedge accounting if a derivative is not determined to be highly effective as a hedge or that it is probable that the underlying forecasted transaction will not occur.

Fair Value Measurement: We measure and disclose the estimated fair value of financial assets and liabilities utilizing a hierarchy of valuation techniques based on whether the inputs to a fair value measurement are considered to be observable or unobservable in a marketplace. Observable inputs reflect market data obtained from independent sources, while unobservable inputs reflect our market assumptions. This hierarchy requires the use of observable market data when available. These inputs have created the following fair value hierarchy:

•

Level 1 — quoted prices for identical instruments in active markets;

•

Level 2 — quoted prices for similar instruments in active markets; quoted prices for identical or similar instruments in markets that are not active; and model-derived valuations in which significant inputs and significant value drivers are observable in active markets; and

•

Level 3 — fair value measurements derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable.

We measure fair value using a set of standardized procedures that are outlined herein for all assets and liabilities which are required to be measured at their estimated fair value on either a recurring or non-recurring basis. When available, we utilize quoted market prices from an independent third party source to determine fair value and classify such items in Level 1. In some instances where a market price is available, but the instrument is in an inactive or over-the-counter market, we apply the dealer (market maker) pricing estimate and classify the asset or liability in Level 2.

If quoted market prices or inputs are not available, fair value measurements are based upon valuation models that utilize current market or independently sourced market inputs, such as interest rates, option volatilities, credit spreads, market capitalization rates, etc. Items valued using such internally-generated valuation techniques are classified according to the lowest level input that is significant to the fair value measurement. As a result, the asset or liability could be classified in either Level 2 or 3 even though there may be some significant inputs that are readily observable. Internal fair value models and techniques used by us include discounted cash flow and Monte Carlo valuation models. We also consider our counterparty’s and own credit risk on derivatives and other liabilities measured at their estimated fair value.

Fair Value Option Election: For our equity interest in Ernest along with any related loans (all of which other than the mortgage loans were sold or paid off on October 4, 2018 - see Note 3 for more details), we have elected to account for these investments at fair value due to the size of the investments and because we believe this method is more reflective of current values. We have not made a similar election for other equity interests or loans that existed at December 31, 2018.

Reclassifications: Certain amounts in the consolidated financial statements for prior periods have been reclassified to conform to the current period presentation.

Recent Accounting Developments:

Leases

In February 2016, the FASB issued ASU 2016-02, “Leases”, which sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e. lessees and lessors). The new standard requires lessees to apply a dual approach, classifying leases as either financing or operating leases based on the principle of whether or not the lease is effectively a financed purchase by the lessee. This classification will determine whether lease expense is recognized based on an effective interest method or on a straight-line basis over the term of the lease. A lessee is also required to record a right-of-use asset and a lease liability for all leases with a term greater than 12 months regardless of their classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases today. The standard requires lessors to account for leases using an approach that is substantially equivalent to existing guidance for sales-type leases, direct financing leases and operating leases. In July 2018, the FASB issued ASU 2018-11, “Leases (Topic 842): Targeted Improvements” (“ASU 2018-11”), allowing companies to record a cumulative adjustment to retained earnings in the period of adoption rather than requiring the restatement of prior periods.

This standard is effective for us on January 1, 2019. We do have leases in which we are the lessee, including ground leases, on which certain of our facilities reside, along with corporate office and equipment leases. Although we do not expect any change in the current operating lease classification of these leases, we will record a right-of-use asset and a lease liability on our balance sheet upon adoption of this standard, which we estimate to be between $80 million to $90 million with any difference recorded as a cumulative adjustment in equity. From a lessor perspective, we do not expect any change in the current classification and accounting of our existing leases. However, we do expect certain non-lease components (such as certain operating expenses that we pay and our tenants reimburse us for pursuant to our “triple-net” leases) to be recorded gross versus net of the respective expenses upon adoption of this standard in 2019 in accordance with ASU No. 2014-09, “Revenue from Contracts with Customers (Topic 606)”. For those operating expenses that our tenants pay directly to third parties pursuant to our leases, we will continue to present on a net basis.

Real Estate Activities

12 Months Ended

Dec. 31, 2018

Text Block [Abstract]

Real Estate Activities

3. Real Estate Activities

Acquisitions

For the years ended December 31, 2018, 2017, and 2016, we acquired the following assets:

	2018			2017			2016
	(in thousands)
Assets Acquired
Land	$	71,880		$	240,993		$	91,071
Building		686,739			985,219			655,324
Intangible lease assets — subject to amortization (weighted average useful life of 27.9 years in 2018, 27.7 years in 2017, and 28.5 years in 2016)		90,651			181,004			94,167
Net investments in direct financing leases		—			40,450			178,000
Mortgage loans		—			700,000			600,000
Other loans		336,458			—			—
Equity investments and other assets		245,267			100,000			70,166
Liabilities assumed		—			(878	)		(6,319	)
Total assets acquired	$	1,430,995		$	2,246,788		$	1,682,409
Loans repaid(1)		(764,447	)		—			(193,262	)
Total net assets acquired	$	666,548		$	2,246,788		$	1,489,147

(1)

The 2018 column includes $0.8 billion of loans advanced to Steward in 2016 and repaid in 2018 as part of sale leaseback conversion described below. The 2016 column includes $93.3 million of loans advanced to Capella⁽²⁾ in 2015 and repaid in 2016 as a part of the Capella transaction (2), along with $100.0 million of loans advanced to Prime Healthcare Services, Inc. (“Prime”) in 2015 and repaid in 2016 as part of the sale leaseback conversion of four properties in New Jersey.

(2)	In 2018, LifePoint Health, Inc. (“LifePoint”) merged with RCCH, who acquired Capella Healthcare, Inc. (“Capella”) in 2016. Any reference to either LifePoint, RCCH, or Capella represent the same entity.

2018 Activity

Joint Venture Transaction

On August 31, 2018, we completed a joint venture arrangement with Primotop Holdings S.à.r.l. (“Primotop”) pursuant to which we contributed 71 of our post-acute hospitals in Germany, with an aggregate fair value of €1.635 billion, for a 50% interest, while Primotop contributed cash for its 50% interest in the joint venture. As part of the transaction, we received an aggregate amount of approximately €1.14 billion, from the proceeds of the cash contributed by Primotop and the secured debt financing placed on the joint venture’s real estate (as more fully discussed in Note 4), and we recognized an approximate €500 million gain on sale. Our interest in the joint venture is made up of a 50% equity investment valued at approximately €210 million, which is being accounted for under the equity method of accounting, and a €290 million shareholder loan (with terms identical to Primotop’s shareholder loan).

Other Transactions

On August 31, 2018, we acquired an acute care facility in Pasco, Washington for $17.5 million. The property is leased to RCCH, pursuant to the existing long-term master lease entered into with RCCH in April 2016.

On August 28, 2018, we acquired three inpatient rehabilitation hospitals in Germany for €17.3 million (including real estate transfer taxes). These hospitals are part of a four-hospital portfolio that we agreed to purchase for an aggregate amount of €23 million (including real estate transfer taxes) in June 2018 – see Note 13 for an update on the final property in this portfolio. The properties are leased to MEDIAN, pursuant to a new 27-year master lease with annual escalators at the greater of 1% or 70% of the change in German CPI.

During 2018, we acquired the fee simple real estate of five general acute care hospitals, four of which are located in Massachusetts and one located in Texas, from Steward Health Care System LLC (“Steward”) in exchange for the reduction of $764.4 million of mortgage loans made to Steward in October 2016 and March 2018, along with additional cash consideration. These properties are being leased to Steward pursuant to the original master lease from October 2016 that had an initial 15-year term with three five-year extension options, plus CPI increases.

2017 Activity

Steward Transactions

On September 29, 2017, we acquired, from IASIS Healthcare LLC (“IASIS”), a portfolio of ten acute care hospitals and one behavioral health facility, along with ancillary land and buildings, that are located in Arizona, Utah, Texas, and Arkansas. The portfolio is now operated by Steward which separately completed its acquisition of the operations of IASIS on September 29, 2017. Our investment in the portfolio includes the acquisition of eight acute care hospitals and one behavioral health facility for approximately $700 million, the making of $700 million in mortgage loans on two acute care hospitals, and a $100 million minority equity contribution in Steward, for a combined investment of approximately $1.5 billion.

On May 1, 2017, we acquired eight hospitals previously affiliated with Community Health Systems, Inc. in Florida, Ohio, and Pennsylvania for an aggregate purchase price of $301.3 million.

See “2016 Activity — Acquisition of Steward Portfolio” below for details of the master lease and mortgage loan terms.

MEDIAN Transactions

On November 29, 2017, we acquired three rehabilitation hospitals in Germany for an aggregate purchase price of €80 million. The facilities are leased to affiliates of MEDIAN, pursuant to a new long-term master lease. The lease began on November 30, 2017, and the term is for 27 years (ending in November 2044). The lease provides for increases in rent at the greater of one percent or 70% of the change in German CPI.

During the third quarter of 2017, we acquired two rehabilitation hospitals in Germany for an aggregate purchase price of €39.2 million, in addition to 11 rehabilitation hospitals in Germany that we acquired in the second quarter of 2017 for an aggregate purchase price of €127 million. These 13 properties are leased to affiliates of MEDIAN, pursuant to a third master lease entered into in 2016. (See “2016 Activity” below for details of this master lease.) These acquisitions are the final properties of the portfolio of 20 properties in Germany that we agreed to acquire in July 2016 for €215.7 million, of which seven properties totaling €49.5 million closed in December 2016.

On June 22, 2017, we acquired an acute care hospital in Germany for a purchase price of €19.4 million, of which €18.6 million was paid upon closing with the remainder being paid over four years. This property is leased to affiliates of MEDIAN, pursuant to an existing master lease agreement that ends in December 2042 with annual escalators at the greater of one percent or 70% of the change in German CPI.

On January 30, 2017, we acquired an inpatient rehabilitation hospital in Germany for €8.4 million. This acquisition was the final property to close as part of the six hospital portfolio that we agreed to buy in September 2016 for an aggregate amount of €44.1 million. This property is leased to affiliates of MEDIAN pursuant to the original long-term master lease agreement reached with MEDIAN in 2015.

Other Transactions

On June 1, 2017, we acquired the real estate assets of Ohio Valley Medical Center, a 218-bed acute care hospital located in Wheeling, West Virginia, and the East Ohio Regional Hospital, a 139-bed acute care hospital in Martins Ferry, Ohio, from Ohio Valley Health Services, a not-for-profit entity in West Virginia, for an aggregate purchase price of approximately $40 million. We simultaneously leased the facilities to Alecto Healthcare Services LLC (“Alecto”), pursuant to a lease with a 15-year initial term with 2% annual minimum rent increases and three 5-year extension options. The facilities are cross-defaulted and cross-collateralized with our other hospitals currently operated by Alecto. With these acquisitions, we also obtained a 20% interest in the operator of these facilities.

On May 1, 2017, we acquired the real estate of St. Joseph Regional Medical Center, a 145-bed acute care hospital in Lewiston, Idaho for $87.5 million. This facility is leased to RCCH, pursuant to the existing long-term master lease entered into with RCCH in April 2016.

2016 Activity

Acquisition of Steward Portfolio

On October 3, 2016, we closed on a portfolio of nine acute care hospitals in Massachusetts operated by Steward. Our investment in the portfolio included the acquisition of five hospitals for $600 million, the making of $600 million in mortgage loans on four facilities, and a $50 million minority equity contribution in Steward, for a combined investment of $1.25 billion. The five facilities acquired are being leased to Steward under a master lease agreement that has a 15-year term (ending October 31, 2031) with three 5-year extension options, plus annual inflation-based escalators. The terms of the mortgage loan are substantially similar to the master lease.

Other Acquisitions

From October 27, 2016 to December 31, 2016, we acquired 12 rehabilitation hospitals in Germany for an aggregate purchase price to us of €85.2 million. Of these acquisitions, five properties (totaling €35.6 million) are leased to affiliates of MEDIAN, pursuant to a master lease agreement reached with MEDIAN in 2015. The remaining seven properties (totaling €49.5 million) are leased to affiliates of MEDIAN, pursuant to a third master lease that has terms similar to the original master lease in 2015 with a fixed 27-year lease term ending in August 2043.

On October 21, 2016, we acquired three general acute care hospitals and one free-standing emergency department and health center in New Jersey from Prime (as originally contemplated in the agreements) by reducing the $100 million mortgage loan made in September 2015 and advancing an additional $15 million. We are leasing these properties to Prime pursuant to a fifth master lease, which has a 15-year initial term (ending in May 2031) with three five-year extension options, plus consumer-price indexed increases.

On July 22, 2016, we acquired an acute care facility in Olympia, Washington in exchange for a $93.3 million loan and an additional $7 million in cash, as contemplated in the initial Capella acquisition transaction in 2015. The terms of the Olympia lease are substantially similar to those of the master lease with Capella post lease amendment. See the Capella Disposal Transaction under the subheading “Disposals” below for further details on the terms of these leases.

On June 22, 2016, we closed on the final property of the initial MEDIAN transaction that began in 2014 for a purchase price of €41.6 million.

On May 2, 2016, we acquired an acute care hospital in Newark, New Jersey for an aggregate purchase price of $63 million leased to Prime pursuant to the fifth master lease. Furthermore, we committed to advance an additional $30 million to Prime over a three-year period to be used solely for capital additions to the real estate; any such addition will be added to the base upon which the lessee will pay us rents. None of the additional $30 million has been funded to date.

Development Activities

2018 Activity

During the year ended December 31, 2018, we completed the construction on Ernest Flagstaff. This $25.5 million inpatient rehabilitation facility located in Flagstaff, Arizona opened on March 1, 2018 and is being leased to Ernest pursuant to a stand-alone lease, with terms similar to the original master lease.

2017 Activity

During 2017, we completed construction and began recording rental income on the following facilities:

•

Adeptus Health, Inc. (“Adeptus Health”) — We completed four acute care facilities for this tenant during 2017 totaling approximately $68 million in development costs.

•

IMED Group (“IMED”) — Our general acute facility located in Valencia, Spain opened on March 31, 2017, and is being leased to IMED pursuant to a 30-year lease that provides for quarterly fixed rent payments that started on October 1, 2017 with annual increases of 1% beginning April 1, 2020. Our ownership in this facility is effected through a joint venture between us and clients of AXA Real Estate, in which we own a 50% interest. Our share of the aggregate purchase and development cost of this facility is approximately €21 million.

In April 2017, we completed the acquisition of the long leasehold interest of a development site in Birmingham, England from the Circle Health Group (“Circle”) (the tenant of our existing site in Bath, England) for a purchase price of £2.7 million. Simultaneously with the acquisition, we entered into contracts with the property landlord and Circle committing us to construct an acute care hospital on the site and have subsequently added a rehabilitation facility to the development. Our total development costs for both facilities are anticipated to be approximately £50 million. Circle is contracted to enter into a lease of the hospital following completion of construction for an initial 15-year term with rent to be calculated based on our total development costs.

On December 19, 2017, we entered into an agreement to finance the development of and lease an acute care hospital in Idaho Falls, Idaho, for $113.5 million. This facility will be leased to Surgery Partners, Inc. (“Surgery Partners”) pursuant to a long-term lease upon completion.

2016 Activity

During 2016, we completed construction and began recording rental income on the following facilities:

•

Adeptus Health — We completed 19 acute care facilities for this tenant during 2016 totaling $136.6 million.

•

Ernest Toledo — This $18.4 million inpatient rehabilitation facility located in Toledo, Ohio opened on April 1, 2016 and is being leased to Ernest pursuant to the original 2012 master lease.

See table below for a status summary of our current development projects (in thousands):

Property	Commitment		Costs Incurred as of December 31, 2018		Estimated Rent Commencement Date
Circle Health (Birmingham, England)	$	43,288	$	28,881	2Q 2019
Circle Health Rehabilitation (Birmingham, England)		21,505		9,081	3Q 2019
Surgery Partners (Idaho Falls, Idaho)		113,468		46,210	1Q 2020
	$	178,261	$	84,172

Disposals

2018 Activity

On October 4, 2018, we finalized a recapitalization agreement in which we sold our investment in the operations of Ernest and were repaid for our outstanding acquisition loans, working capital loans, and any unpaid interest. Total proceeds received from this transaction approximated $176 million. We retained ownership of the real estate and secured mortgage loans of our Ernest properties.

On August 31, 2018, we completed the previously described joint venture arrangement with Primotop, in which we contributed the real estate of 71 of our post-acute hospitals in Germany, with a fair value of approximately €1.635 billion, resulting in a gain of approximately €500 million. See “2018 Activity” in this Note 3 for further details on this transaction.

On August 31, 2018, we sold a general acute care hospital located in Houston, Texas that was leased and operated by North Cypress for $148 million. The transaction resulted in a gain on sale of $102.4 million, which was partially offset by a net $2.5 million non-cash charge to revenue to write-off related straight-line rent receivables.

On June 4, 2018, we sold three long-term acute care hospitals located in California, Texas, and Oregon, that were leased and operated by Vibra Healthcare, LLC (“Vibra”), which included our equity investment in operations of the Texas facility. Total proceeds from the transaction were $53.3 million in cash, a mortgage loan in the amount of $18.3 million, and a $1.5 million working capital loan. The transaction resulted in a gain on real estate of $24.2 million, which was partially offset by a $5.1 million non-cash charge to revenue to write-off related straight-line rent receivables.

On March 1, 2018, we sold the real estate of St. Joseph Medical Center in Houston, Texas, for approximately $148 million to Steward. In return, we received a mortgage loan equal to the purchase price, with such loan secured by the underlying real estate. The mortgage loan had terms consistent with the other mortgage loans in the Steward portfolio. This transaction resulted in a gain of $1.5 million, offset by a $1.7 million non-cash charge to revenue to write-off related straight-line rent receivables on this property.

Summary of Operations for Disposed Assets in 2018

The properties sold during 2018 did not meet the definition of discontinued operations. However, the following represents the operating results (excluding the St. Joseph sale in March 2018) from these properties for the periods presented (in thousands):

	For the Year Ended December 31,
	2018			2017			2016
Revenues	$	88,838		$	132,039		$	109,544
Real estate depreciation and amortization		(15,849	)		(31,870	)		(26,410	)
Property-related expenses		(531	)		(404	)		(45	)
Other income (expense) (1)		709,717			(14,168	)		(23,937	)
Income from real estate dispositions, net	$	782,175		$	85,597		$	59,152

(1)

Includes approximately $720 million of gains on sale for the twelve months ended December 31, 2018.

2017 Activity

On March 31, 2017, we sold the EASTAR Health System real estate located in Muskogee, Oklahoma, which was leased to RCCH. Total proceeds from this transaction were approximately $64 million resulting in a gain of $7.4 million, partially offset by a $0.6 million non-cash charge to revenue to write-off related straight-line rent receivables on this property. The sale of Muskogee facility was not a strategic shift in our operations and therefore the results of the Muskogee operations were not reclassified to discontinued operations.

2016 Activity

Capella Disposal Transaction

Effective April 30, 2016, our investment in the operator of Capella merged with RegionalCare Hospital Partners, Inc. (“RegionalCare”), an affiliate of certain funds managed by affiliates of Apollo Global Management, LLC (“Apollo”), to form RCCH. As part of the transaction, we received net proceeds of approximately $550 million including approximately $492 million for our equity investment and loans made as part of the original Capella acquisition that closed on August 31, 2015. In addition, we received $210 million in prepayment of two mortgage loans for hospitals in Russellville, Arkansas, and Lawton, Oklahoma that we made in connection with the original Capella transaction. We made a new $93.3 million loan for a hospital property in Olympia, Washington that was subsequently converted to real estate on July 22, 2016. Additionally, we and an Apollo affiliate invested $50 million each in unsecured senior notes issued by RegionalCare, which we sold to a large institution on June 20, 2016 at par. The proceeds from this transaction represented the recoverability of our investment in full, except for transaction costs incurred of $6.3 million.

We maintained our ownership of five hospitals in Hot Springs, Arkansas; Camden, South Carolina; Hartsville, South Carolina; Muskogee, Oklahoma; and McMinnville, Oregon. Pursuant to the transaction described above, the underlying leases, one of which is a master lease covering all but one property was amended to shorten the initial fixed lease term (to 13.5 years for the master lease and 11.5 years for the other stand-alone lease) , increase the security deposit, and eliminate the lessees’ purchase option provisions. Due to this lease amendment, we reclassified the lease of the properties under the master lease from a DFL to an operating lease. This reclassification resulted in a write-off of $2.6 million of unbilled DFL rent receivables in 2016.

Post Acute Transaction

On May 23, 2016, we sold five properties (three of which were in Texas and two in Louisiana) that were leased and operated by Post Acute Medical. As part of this transaction, our outstanding loans of $4 million were paid in full, and we recovered our investment in the operations. Total proceeds from this transaction were $71 million, resulting in a net gain of approximately $15 million.

Corinth Transaction

On June 17, 2016, we sold the Atrium Medical Center real estate located in Corinth, Texas, which was leased and operated by Corinth Investor Holdings. Total proceeds from the transaction were $28 million, resulting in a gain on the sale of real estate of approximately $8 million. This gain on real estate was offset by approximately $9 million of non-cash charges that included the write-off of our investment in the operations of the facility, straight-line rent receivables, and a lease intangible.

Encompass Health Transaction

On July 20, 2016, we sold three inpatient rehabilitation hospitals located in Texas and operated by Encompass Health for $111.5 million, resulting in a net gain of approximately $45 million.

Summary of Operations for Disposed Assets in 2016

The properties sold during 2016 did not meet the definition of discontinued operations. However, the following represents the operating results from these properties (excluding loans repaid in the Capella Disposal Transaction) for the periods presented (in thousands):

	For the Year Ended December 31, 2016
Revenues	$	8,350
Real estate depreciation and amortization		(2,870	)
Property-related expenses		(113	)
Other income(1)		60,283
Income from real estate dispositions, net	$	65,650

(1)

Includes approximately $60 million of net gains on sale for the year ended December 31, 2016.

Intangible Assets

At December 31, 2018 and 2017, our intangible lease assets were $403.1 million ($352.5 million, net of accumulated amortization) and $443 million ($394 million, net of accumulated amortization), respectively.

We recorded amortization expense related to intangible lease assets of $17.6 million, $15.8 million, and $13.4 million in 2018, 2017, and 2016, respectively, and expect to recognize amortization expense from existing lease intangible assets as follows (amounts in thousands):

For the Year Ended December 31:
2019	$	16,687
2020		16,507
2021		16,493
2022		16,479
2023		16,413

As of December 31, 2018, capitalized lease intangibles have a weighted average remaining life of 26.0 years.

Leasing Operations

At December 31, 2018, leases on two Alecto facilities, 15 Ernest facilities and ten Prime facilities are accounted for as DFLs.

The components of our net investment in DFLs consisted of the following (in thousands):

	As of December 31, 2018			As of December 31, 2017
Minimum lease payments receivable	$	2,091,504		$	2,294,081
Estimated residual values		424,719			448,339
Less unearned income		(1,832,170	)		(2,043,693	)
Net investment in direct financing leases	$	684,053		$	698,727

Minimum rental payments due to us over the remaining lease term under operating leases and DFLs at December 31, 2018, are as follows (amounts in thousands):

	Total Under Operating Leases		Total Under DFLs		Total
2019	$	433,542	$	64,971	$	498,513
2020		437,025		66,270		503,295
2021		445,598		67,595		513,193
2022		450,592		68,947		519,539
2023		457,732		70,326		528,058
Thereafter		9,612,430		1,544,035		11,156,465
	$	11,836,919	$	1,882,144	$	13,719,063

Adeptus Health – Transition Properties

2018 Activity

As noted in previous filings, effective October 2, 2017, we had 16 properties transitioning away from Adeptus Health in stages over a two year period as part of Adeptus Health’s confirmed plan of reorganization under Chapter 11 of the Bankruptcy Code. Through December 31, 2018, Adeptus Health vacated and stopped making rent payments on 14 properties. As a result of the shortening of our lease term on these properties, we accelerated the amortization of the straight-line rent receivables resulting in a reduction of straight-line rent revenue by $6.1 million in 2018. Of the other two properties, one will be transitioned away from Adeptus Health on October 1, 2019 and one has been re-leased by Adeptus Health.

In August and early October 2018, we re-leased three of the vacant facilities in the Houston market and five in the San Antonio market, respectively, to Steward at rates consistent with that of the previous Adeptus Health lease. At December 31, 2018, our investment in the remaining seven transition facilities (that have not been re-leased) approximates less than 0.5% of our total assets. Although we expect to re-tenant and/or sell the remaining seven facilities in the near future, we lowered the carrying value of the six remaining vacant facilities by $18 million to fair value during 2018, based on market data received during the year.

2017 Activity

On December 7, 2017, we announced that UCHealth Partners LLC (“UCHealth”), an affiliate of University of Colorado Hospital, had acquired all of Adeptus Health’s Colorado joint venture interests, assuming the existing master lease of 11 of our free standing emergency facilities. The 11 facilities that are now master leased to UCHealth affiliates had a gross investment of approximately $60 million. The master lease was amended to provide a new 15-year initial term effective January 1, 2018 with three five-year renewal options, while retaining annual escalation provisions of the increase in the CPI with a 2% minimum.

On April 4, 2017, we announced that our Louisiana freestanding emergency facilities then-operated by Adeptus Health (with a total budgeted investment of approximately $25 million) had been re-leased to Ochsner Clinic Foundation (“Ochsner”), a health care system in the New Orleans area. We incurred a non-cash charge of $0.5 million to write-off the straight-line rent receivables associated with the previous Adeptus Health lease on these properties. On October 18, 2017, Ochsner agreed to an amended and restated lease that provided for initial terms of 15 years with a 9.2% average minimum lease rate based on our total development and construction cost, as well as the addition of three five-year renewal options.

Gilbert and Florence Facilities

In the first quarter of 2018, we terminated the lease at our Gilbert and Florence, Arizona facilities due to the tenant not meeting its rent obligations pursuant to the lease. As a result of the lease terminating, we recorded a charge of $1.1 million to reserve against the straight-line rent receivables in February 2018. On April 25, 2018, this former tenant filed for involuntary bankruptcy. On December 14, 2018, the Florence facility was re-leased to Steward pursuant to our original master lease with them with a term to begin in the first quarter of 2019. At December 31, 2018, any outstanding receivables on Florence and Gilbert were completely reserved. Although no assurances can be made that we will not have any impairment charges in the future, we believe our investment in the Gilbert facility (less than 0.2% of total assets at December 31, 2018) is fully recoverable.

Alecto Healthcare facilities

At December 31, 2018, we own four acute care facilities that are leased to Alecto and have a mortgage loan on a fifth property. With the continued softening in the markets and the overall decline in the operating results of the facility tenant, we lowered the carrying value of the four owned properties by $30 million to fair value. At December 31, 2018, our total investment in these properties is less than 1 % of our total assets.

Loans

The following is a summary of our loans ($ amounts in thousands):

	As of December 31, 2018					As of December 31, 2017
	Balance		Weighted Average Interest Rate			Balance		Weighted Average Interest Rate
Mortgage loans	$	1,213,322		8.8	%	$	1,778,316		8.3	%
Acquisition loans		3,454		10.8	%		118,448		13.8	%
Working capital and other loans		369,744		5.4	%		31,760		7.6	%
	$	1,586,520				$	1,928,524

Our mortgage loans cover 10 of our properties with four operators. The decrease in mortgage loans relates to the use of Steward mortgage loans to fund the acquisition of the related fee simple real estate as more fully described in this note under sub-caption “Acquisitions”.

Upon the finalization of the Ernest recapitalization agreement on October 4, 2018, we sold our investment in the operations of Ernest, and all outstanding acquisition loans and unpaid interest with Ernest were repaid (which made up the majority of the acquisition loan balance in 2017). The remaining acquisition loan balance is our outstanding loan with Vibra, which will mature in 2020.

Other loans consist of loans to our tenants for acquisitions and working capital purposes and includes our shareholder loan made to the joint venture with Primotop on August 31, 2018 (as more fully described above in this Note 3) in the amount of €290 million.

Concentration of Credit Risks

We monitor concentration risk in several ways due to the nature of our real estate assets that are vital to the communities in which they are located and given our history of being able to replace inefficient operators of our facilities if needed, with more effective operators:

Facility concentration – At December 31, 2018, we had no investment of any single property greater than 4.2% of our total assets, which is consistent with December 31, 2017.

Operator concentration – For the year ended December 31, 2018, revenue from Steward, Prime, MEDIAN, and Ernest represented 39%, 16%, 13% and 8%, respectively. In comparison, these operators represented 27%, 18%, 14% and 10%, respectively, for the year ended December 31, 2017.

Geographic concentration – At December 31, 2018, investments in the U.S. and Europe represented approximately 80% and 20%, respectively, of our total assets, which is consistent with December 31, 2017.

Facility type concentration – For the year ended December 31, 2018, approximately 76% of our revenues are from our general acute care facilities, while rehabilitation and long-term acute care facilities make up 20% and 4%, respectively. In comparison, general acute care, rehabilitation, and long –term acute care facilities made up 69%, 25%, and 6%, respectively, for the year ended December 31, 2017.

Related Party Transactions

Lease and interest revenue earned from tenants in which we have or had an equity interest in during the year were $501.4 million, $422.4 million, and $282.9 million in 2018, 2017, and 2016, respectively.

Debt

12 Months Ended

Dec. 31, 2018

Debt Disclosure [Abstract]

Debt

4. Debt

The following is a summary of debt ($ amounts in thousands):

	As of December 31, 2018			As of December 31, 2017
Revolving credit facility(A)	$	28,059		$	840,810
Term loans		200,000			200,000
4.000% Senior Unsecured Notes due 2022(B)		573,350			600,250
5.500% Senior Unsecured Notes due 2024		300,000			300,000
6.375% Senior Unsecured Notes due 2024		500,000			500,000
3.325% Senior Unsecured Notes due 2025(B)		573,350			600,250
5.250% Senior Unsecured Notes due 2026		500,000			500,000
5.000% Senior Unsecured Notes due 2027		1,400,000			1,400,000
	$	4,074,759		$	4,941,310
Debt issue costs, net		(37,370	)		(42,643	)
	$	4,037,389		$	4,898,667

(A)	Includes £22 million and £8 million of GBP-denominated borrowings that reflect the exchange rate at December 31, 2018 and December 31, 2017, respectively.

(B)	These notes are Euro-denominated and reflect the exchange rate at December 31, 2018 and December 31, 2017, respectively.

As of December 31, 2018, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows ($ amounts in thousands):

2019	$	—
2020		—
2021		28,059
2022		773,350
2023		—
Thereafter		3,273,350
Total	$	4,074,759

Credit Facility

On February 1, 2017, we replaced our previous unsecured credit facility (which we had entered into in 2014 and amended in 2015) with a new revolving credit and term loan agreement (the “Credit Facility”). The new agreement included a $1.3 billion unsecured revolving loan facility (same amount as the previous revolving loan facility), a $200 million unsecured term loan facility ($50 million lower than the previous term loan facility), and a new €200 million unsecured term loan facility. The new unsecured revolving loan facility matures in February 2021 and can be extended for an additional 12 months at our option. The $200 million unsecured term loan facility matures on February 1, 2022, and the €200 million unsecured term loan facility had a maturity date of January 31, 2020; however, it was paid off on March 30, 2017 — see below. The term loan and/or revolving loan commitments may be increased in an aggregate amount not to exceed $500 million.

At our election, loans under the Credit Facility may be made as either ABR Loans or Eurodollar Loans. The applicable margin for term loans that are ABR Loans is adjustable on a sliding scale from 0.00% to 0.95% based on our current credit rating. The applicable margin for term loans that are Eurodollar Loans is adjustable on a sliding scale from 0.90% to 1.95% based on our current credit rating. The applicable margin for revolving loans that are ABR Loans is adjustable on a sliding scale from 0.00% to 0.65% based on our current credit rating. The applicable margin for revolving loans that are Eurodollar Loans is adjustable on a sliding scale from 0.875% to 1.65% based on our current credit rating. The commitment fee is adjustable on a sliding scale from 0.125% to 0.30% based on our current credit rating and is payable on the revolving loan facility.

At December 31, 2018 and 2017, we had $28.1 million and $840.8 million, respectively, outstanding on the revolving credit facility. At December 31, 2018, our availability under our revolving credit facility was $1.27 billion. The weighted average interest rate on this facility was 2.7% and 2.4% for 2018 and 2017, respectively.

At December 31, 2018 and 2017, the interest rate in effect on our term loan was 3.89% and 2.98%, respectively.

4.000% Senior Unsecured Notes due 2022

On August 19, 2015, we completed a €500 million senior unsecured notes offering (“4.000% Senior Unsecured Notes due 2022”). Interest on the notes is payable annually on August 19 of each year. The notes pay interest in cash at a rate of 4.000% per year. The notes mature on August 19, 2022. We may redeem some or all of the 4.000% Senior Unsecured Notes due 2022 at any time. If the notes are redeemed prior to 90 days before maturity, the redemption price will be 100% of their principal amount, plus a make-whole premium, plus accrued and unpaid interest to, but excluding, the applicable redemption date. Within the period beginning on or after 90 days before maturity, the notes may be redeemed, in whole or in part, at a redemption price equal to 100% of their principal amount, plus accrued and unpaid interest to, but excluding, the applicable redemption date. The 4.000% Senior Unsecured Notes due 2022 are fully and unconditionally guaranteed on an unsecured basis by us. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of the purchase.

5.500% Senior Unsecured Notes due 2024

On April 17, 2014, we completed a $300 million senior unsecured notes offering (“5.500% Senior Unsecured Notes due 2024”). Interest on the notes is payable semi-annually on May 1 and November 1 of each year. The notes pay interest in cash at a rate of 5.500% per year. The notes mature on May 1, 2024. We may redeem some or all of the notes at any time prior to May 1, 2019 at a “make-whole” redemption price. On or after May 1, 2019, we may redeem some or all of the notes at a premium that will decrease over time. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

6.375% Senior Unsecured Notes due 2024

On February 22, 2016, we completed a $500 million senior unsecured notes offering (“6.375% Senior Unsecured Notes due 2024”). Interest on the notes is payable on March 1 and September 1 of each year. Interest on the notes is paid in cash at a rate of 6.375% per year. The notes mature on March 1, 2024. We may redeem some or all of the notes at any time prior to March 1, 2019 at a “make whole” redemption price. On or after March 1, 2019, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to March 1, 2019, we may redeem up to 35% of the notes at a redemption price equal to 106.375% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

3.325% Senior Unsecured Notes due 2025

On March 24, 2017, we completed a €500 million senior unsecured notes offering (“3.325% Senior Unsecured Notes due 2025”). Interest on the notes is payable annually on March 24 of each year. The notes pay interest in cash at a rate of 3.325% per year. The notes mature on March 24, 2025. We may redeem some or all of the 3.325% Senior Unsecured Notes due 2025 at any time. If the notes are redeemed prior to 90 days before maturity, the redemption price will be equal to 100% of their principal amount, plus a make-whole premium, plus accrued and unpaid interest up to, but excluding, the applicable redemption date. Within the period beginning on or after 90 days before maturity, the notes may be redeemed, in whole or in part, at a redemption price equal to 100% of their principal amount, plus accrued and unpaid interest to, but excluding, the applicable redemption date. The 3.325% Senior Unsecured Notes due 2025 are fully and unconditionally guaranteed on a senior unsecured basis by us. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest up to, but excluding, the date of the purchase.

5.250% Senior Unsecured Notes due 2026

On July 22, 2016, we completed a $500 million senior unsecured notes offering (“5.250% Senior Unsecured Notes due 2026”). Interest on the notes is payable on February 1 and August 1 of each year. Interest on the notes is to be paid in cash at a rate of 5.250% per year. The notes mature on August 1, 2026. We may redeem some or all of the notes at any time prior to August 1, 2021 at a “make whole” redemption price. On or after August 1, 2021, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to August 1, 2019, we may redeem up to 35% of the notes at a redemption price equal to 105.250% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

5.000% Senior Unsecured Notes due 2027

On September 7, 2017, we completed a $1.4 billion senior unsecured notes offering (“5.000% Senior Unsecured Notes due 2027”). Interest on the notes is payable on April 15 and October 15 of each year. The notes pay interest in cash at a rate of 5.000% per year. The notes mature on October 15, 2027. We may redeem some or all of the notes at any time prior to October 15, 2022 at a “make whole” redemption price. On or after October 15, 2022, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to October 15, 2020, we may redeem up to 40% of the notes at a redemption price equal to 105% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

With the completion of the 5.000% Senior Unsecured Notes due 2027 offering in 2017, we canceled a $1.0 billion term loan facility commitment from J.P. Morgan Chase Bank, N.A. that we received to assist in funding the September 2017 Steward Transaction.

Other Activity

2018

In preparation of the joint venture with Primotop described under “2018 Activity” in Note 3, we issued secured debt on August 3, 2018, resulting in gross proceeds of €655 million. Provisions of the secured debt included a term of seven years and a swapped fixed rate of approximately 2.3%. Subsequently, on August 31, 2018, the secured debt was contributed along with the related real estate of 71 properties to form the joint venture.

2017

In connection with our acquisition of the Northland LTACH Hospital on February 14, 2011, we assumed a $14.6 million mortgage. The Northland mortgage loan required monthly principal and interest payments based on a 30-year amortization period. The Northland mortgage loan had a fixed interest rate of 6.2%, a maturity date of January 1, 2018 and could be prepaid, without penalty within 120 days of the term of the loan. On September 29, 2017, we prepaid the principal amount of this mortgage loan at par in the amount of $12.9 million.

On February 17, 2012, we completed a $200 million offering of senior unsecured notes (“6.375% Senior Unsecured Notes due 2022”), and on August 20, 2013, we completed a $150 million tack on to the notes. These 6.375% Senior Unsecured Notes due 2022 accrued interest at a fixed rate of 6.375% per year and had a maturity date of February 15, 2022. The 2013 tack on offering, was issued at a premium (price of 102%), resulting in an effective rate of 5.998%. On October 7, 2017, we redeemed these notes and incurred an $11.2 million redemption premium.

On October 10, 2013, we completed a €200 million offering of senior unsecured notes (“5.750% Senior Unsecured Notes due 2020”). The 5.750% Senior Unsecured Notes due 2020 paid interest in cash at a rate of 5.750% per year. The notes had a maturity date of October 1, 2020. On March 4, 2017, we redeemed the €200 million aggregate principal amount of our 5.750% Senior Unsecured Notes due 2020 and incurred a redemption premium of approximately $9 million.

Debt Refinancing Costs

2017

With the replacement of our previous credit facility, the early redemption of the 5.750% Senior Unsecured Notes due 2020 and the 6.375% Senior Unsecured Notes due 2022, the payoff of our €200 million euro term loan, the cancellation of the $1.0 billion term loan facility commitment, and the payment of our $12.9 million mortgage loan, we incurred a charge of $32.6 million (including redemption premiums and accelerated amortization of deferred debt issuance cost and commitment fees) during the year ended December 31, 2017.

2016

On July 22, 2016, we used the net proceeds from the 5.250% Senior Unsecured Notes due 2026 offering to redeem $450 million of senior unsecured notes that had an original maturity date in 2021. This redemption resulted in a $22.5 million debt refinancing charge, consisting of a $15.5 million redemption premium and the write-off of deferred debt issuance costs.

Covenants

Our debt facilities impose certain restrictions on us, including restrictions on our ability to: incur debts; create or incur liens; provide guarantees in respect of obligations of any other entity; make redemptions and repurchases of our capital stock; prepay, redeem or repurchase debt; engage in mergers or consolidations; enter into affiliated transactions; dispose of real estate or other assets; and change our business. In addition, the credit agreements governing our Credit Facility limit the amount of dividends we can pay as a percentage of normalized adjusted funds from operations (“NAFFO”), as defined in the agreements, on a rolling four quarter basis. Through 2018, the dividend restriction was 95% of NAFFO. The indentures governing our senior unsecured notes also limit the amount of dividends we can pay based on the sum of 95% of NAFFO, proceeds of equity issuances and certain other net cash proceeds. Finally, our senior unsecured notes require us to maintain total unencumbered assets (as defined in the related indenture) of not less than 150% of our unsecured indebtedness.

In addition to these restrictions, the Credit Facility contains customary financial and operating covenants, including covenants relating to our total leverage ratio, fixed charge coverage ratio, secured leverage ratio, consolidated adjusted net worth, unsecured leverage ratio, and unsecured interest coverage ratio. This Credit Facility also contains customary events of default, including among others, nonpayment of principal or interest, material inaccuracy of representations and failure to comply with our covenants. If an event of default occurs and is continuing under the Credit Facility, the entire outstanding balance may become immediately due and payable. At December 31, 2018, we were in compliance with all such financial and operating covenants.

Income Taxes

12 Months Ended

Dec. 31, 2018

Income Tax Disclosure [Abstract]

Income Taxes

5. Income Taxes

Medical Properties Trust, Inc.

We have maintained and intend to maintain our election as a REIT under the Code. To qualify as a REIT, we must meet a number of organizational and operational requirements, including a requirement to distribute at least 90% of our taxable income to our stockholders. As a REIT, we generally will not be subject to U.S. federal income tax if we distribute 100% of our taxable income to our stockholders and satisfy certain other requirements; instead, income tax is paid directly by our stockholders on the dividends distributed to them. If our taxable income exceeds our dividends in a tax year, REIT tax rules allow us to designate dividends from the subsequent tax year in order to avoid current taxation on undistributed income. If we fail to qualify as a REIT in any taxable year, we will be subject to federal income taxes at regular corporate rates, including any applicable alternative minimum tax. Taxable income from non-REIT activities managed through our TRS is subject to applicable U.S. federal, state and local income taxes. Our international subsidiaries are also subject to income taxes in the jurisdictions in which they operate.

From our TRS and our foreign operations, income tax expense (benefit) were as follows (in thousands):

	For the Years Ended December 31,
	2018			2017			2016
Current income tax (benefit) expense:
Domestic	$	(125	)	$	(41	)	$	42
Foreign		3,294			3,062			1,856
		3,169			3,021			1,898
Deferred income tax (benefit) expense:
Domestic		(3,713	)		(233	)		147
Foreign		1,471			(107	)		(8,875	)
		(2,242	)		(340	)		(8,728	)
Income tax expense (benefit)	$	927		$	2,681		$	(6,830	)

A reconciliation of the income tax expense (benefit) at the statutory income tax rate and the effective tax rate for income before income taxes for the years ended December 31, 2018, 2017, and 2016 is as follows (in thousands):

	2018			2017			2016
Income before income tax	$	1,019,404		$	293,919		$	219,107
Income tax at the U.S. statutory federal rate (21% in 2018 and 35% in 2017 and 2016)		214,075			102,872			76,687
Increase (decrease) resulting from:
Foreign rate differential		(2,643	)		(2,326	)		1,434
State income taxes, net of federal benefit		379			—			66
U.S. earnings not subject to federal income tax		(208,472	)		(98,026	)		(84,927	)
Equity investments		(46	)		3,293			4,297
Change in valuation allowance		(2,668	)		(5,391	)		(6,104	)
Other items, net		302			2,259			1,717
Total income tax expense (benefit)	$	927		$	2,681		$	(6,830	)

The foreign provision (benefit) for income taxes is based on foreign profit before income taxes of $18.6 million in 2018 as compared with foreign losses before income taxes of $(0.1) million in 2017, and $(23.5) million in 2016.

The domestic provision (benefit) for income taxes is based on income before income taxes of $8.0 million in 2018 from our TRS as compared with income before income taxes of $13.9 million in 2017, and a loss before income taxes of $(1.4) million in 2016.

At December 31, 2018 and 2017, components of our deferred tax assets and liabilities were as follows (in thousands):

	2018			2017
Deferred tax assets:
Operating loss and interest deduction carry forwards	$	21,984		$	24,580
Other		277			504
Total deferred tax assets		22,261			25,084
Valuation allowance		(3,444	)		(11,101	)
Total net deferred tax assets	$	18,817		$	13,983
Deferred tax liabilities:
Property and equipment	$	(12,359	)	$	(4,336	)
Net unbilled revenue		(1,633	)		(6,113	)
Partnership investments		—			(2,099	)
Other		(300	)		(1,320	)
Total deferred tax liabilities		(14,292	)		(13,868	)
Net deferred tax asset (liability)	$	4,525		$	115

At December 31, 2018, our U.S. net operating losses (“NOLs”) consisted of $78.3 million of federal NOLs and $99.9 million of state NOLs available as offsets to future years’ taxable income. The NOLs primarily expire between 2022 and 2036. We have alternative minimum tax credits of $0.1 million as of December 31, 2018. To the extent these alternative minimum tax credits exceed regular tax liability in tax years 2019 through 2021, 50% of the excess credit are refundable. Any remaining alternative minimum tax credit will be refunded in 2022. At December 31, 2018, we had foreign NOLs of $8.6 million that may be carried forward indefinitely.

Valuation Allowance

The valuation allowance disclosed in the table above relates to foreign and domestic net operating loss carryforwards and other net deferred tax assets that may not be realized. As of each reporting date, we consider all new evidence that could impact the future realization of our deferred tax assets. In the evaluation of the need for a valuation allowance on our deferred income tax assets, we consider all available positive and negative evidence, including scheduled reversals of deferred income tax liabilities, carryback of future period losses to prior periods, projected future taxable income, tax planning strategies and recent financial performance.

During the fourth quarter of 2018, we released $4.4 million of valuation allowances previously recorded against our U.S. federal and state net deferred tax assets. We now expect these domestic deferred tax assets will be fully utilized to offset taxable income in future years. The decision to reverse the valuation allowance was due to improved operating income in our TRS resulting in a three-year cumulative income position at the end of 2018 and future year taxable income projected in our forecasts.

We also evaluated the need for a valuation allowance on our foreign deferred income tax assets. In doing so, we considered all available evidence to determine whether it is more likely than not that the foreign deferred income tax assets will be realized. Based on our review of all positive and negative evidence, we concluded that a partial valuation allowance should remain against certain foreign deferred income tax assets that are not expected to be realized through future sources of taxable income generated from scheduled reversals of deferred income tax liabilities and forecasted taxable income from operating activity.

We have no material uncertain tax position liabilities and related interest or penalties recorded at December 31, 2018.

REIT Status

We have met the annual REIT distribution requirements by payment of at least 90% of our taxable income in 2018, 2017, and 2016. Earnings and profits, which determine the taxability of such distributions, will differ from net income reported for financial reporting purposes due primarily to differences in cost basis, differences in the estimated useful lives used to compute depreciation, and differences between the allocation of our net income and loss for financial reporting purposes and for tax reporting purposes.

A schedule of per share distributions we paid and reported to our stockholders is set forth in the following:

	For the Years Ended December 31,
	2018		2017		2016
Common share distribution	$	0.990000	$	0.950000	$	0.900000
Ordinary income		0.438792		0.655535		0.619368
Capital gains(1)		0.551208		0.021022		0.102552
Unrecaptured Sec. 1250 gain		0.132280		0.004647		0.045432
Section 19A Dividends		0.438792		—		—
Return of capital		—		0.273443		0.178080

(1)	Capital gains include unrecaptured Sec. 1250 gains.

MPT Operating Partnership, L.P.

As a partnership, the allocated share of income of the Operating Partnership is included in the income tax returns of the general and limited partners. Accordingly, no accounting for income taxes is generally required for such income of the Operating Partnership. However, the Operating Partnership has formed a TRS on behalf of Medical Properties Trust, Inc., which is subject to U.S. federal, state and local income taxes at regular corporate rates, and its international subsidiaries are subject to income taxes in the jurisdictions in which they operate. See discussion above under Medical Properties Trust, Inc. for more details of income taxes associated with our TRS and international operations.

Earnings Per Share/Unit

12 Months Ended

Dec. 31, 2018

Earnings Per Share [Abstract]

Earnings Per Share/Unit

6. Earnings Per Share/Unit

Medical Properties Trust, Inc.

Our earnings per share were calculated based on the following (amounts in thousands):

	For the Years Ended December 31,
	2018			2017			2016
Numerator:
Net income	$	1,018,477		$	291,238		$	225,937
Non-controlling interests’ share in earnings		(1,792	)		(1,445	)		(889	)
Participating securities’ share in earnings		(3,685	)		(1,409	)		(559	)
Net income, less participating securities’ share in earnings	$	1,013,000		$	288,384		$	224,489
Denominator:
Basic weighted average common shares		365,364			349,902			260,414
Dilutive potential common shares		907			539			658
Diluted weighted average common shares		366,271			350,441			261,072

MPT Operating Partnership, L.P.

Our earnings per unit were calculated based on the following (amounts in thousands):

	For the Years Ended December 31,
	2018			2017			2016
Numerator:
Net income	$	1,018,477		$	291,238		$	225,937
Non-controlling interests’ share in earnings		(1,792	)		(1,445	)		(889	)
Participating securities’ share in earnings		(3,685	)		(1,409	)		(559	)
Net income, less participating securities’ share in earnings	$	1,013,000		$	288,384		$	224,489
Denominator:
Basic weighted average units		365,364			349,902			260,414
Dilutive potential units		907			539			658
Diluted weighted average units		366,271			350,441			261,072

Stock Awards

12 Months Ended

Dec. 31, 2018

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Stock Awards

7. Stock Awards

Stock Awards

Our Equity Incentive Plan authorizes the issuance of common stock options, restricted stock, restricted stock units, deferred stock units, stock appreciation rights, performance units and awards of interests in our Operating Partnership. Our Equity Incentive Plan is administered by the Compensation Committee of the Board of Directors. We have reserved 8,196,770 shares of common stock for awards under the Equity Incentive Plan and 976,073 shares remain available for future stock awards as of December 31, 2018. The Equity Incentive Plan contains a limit of 5,000,000 shares as the maximum number of shares of common stock that may be awarded to an individual in any fiscal year. Awards under the Equity Incentive Plan are subject to forfeiture due to termination of employment prior to vesting and/or from not achieving the respective performance/market conditions on performance-based awards. In the event of a change in control, outstanding and unvested options will immediately vest, unless otherwise provided in the participant’s award or employment agreement, and restricted stock, restricted stock units, deferred stock units and other stock-based awards will vest if so provided in the participant’s award agreement. The term of the awards is set by the Compensation Committee, though Incentive Stock Options may not have terms of more than ten years. Forfeited awards are returned to the Equity Incentive Plan and are then available to be re-issued as future awards. For each share of common stock issued by Medical Properties Trust, Inc. pursuant to its Equity Incentive Plan, the Operating Partnership issues a corresponding number of Operating Partnership units.

The following awards have been granted pursuant to our Equity Incentive Plan:

Restricted Equity Awards

These stock-based awards are in the form of service-based awards and performance awards based on either company-specific performance hurdles or certain market conditions.

Service-Based Awards

The service-based awards vest as the employee provides the required service (typically three years). Service based awards are valued at the average price per share of common stock on the date of grant. Dividends are generally paid on these awards prior to vesting. See table below for a summary of activity involving service-based awards.

Performance-Based Awards

In 2018, 2017, and 2016, the Compensation Committee granted performance-based awards to employees. Generally, dividends are not paid on performance awards until the award is earned. See below for details of such performance award grants:

2018 performance awards — The 2018 performance awards were granted in three parts:

Certain 2018 performance awards (target number) were granted based on the achievement of specific performance thresholds as set by our compensation committee. However, more or less shares than the target number of shares were allowed to be earned based on our performance. The pre-established performance thresholds for 2018 were as follows:

Approximately 40% of the target shares can be earned based on our return on equity (“ROE”), as defined by our compensation committee, over the period from January 1, 2018 through December 31, 2020, with the opportunity to earn one-third of the award in any one year. If our ROE was 12.5% or less for the performance period, 50% of these shares would be earned; if our ROE was at least equal to 13.0%, 100% of these shares would be earned; and, if our ROE was greater than or equal to 13.5%, 200% of these shares would be earned. The fair value of this award was based on the average price per share of common stock on the date of grant with the number of shares adjusted as needed based on the probability of such performance hurdles being met. Based on performance in 2018, one-third of the target shares was earned at 200%.

Approximately 40% of the target shares can be earned based on our earnings before interest expense, taxes, depreciation and amortization all in accordance with GAAP adjusted for other certain items (or “EBITDA”) as defined by our compensation committee, for the year ending December 31, 2020, with the opportunity to earn one-third of the award in any one year. If our EBITDA is at least equal to $720 million for either of the 2018 or 2019 years, or $775 million for 2020, 50% of these shares would be earned; if our EBITDA is at least equal to $740 million for either of the 2018 or 2019 years or $800 million for 2020, 100% of these shares would be earned; and, if our EBITDA is at least equal to $760 million for either of the 2018 or 2019 years or $825 million for 2020, 200% of these shares would be earned. The fair value of this award was based on the average price per share of common stock on the date of grant with the number of shares adjusted as needed based on the probability of such performance hurdles being met. Based on performance, one-third of the target shares was earned at 200%.

Approximately 20% of the target shares can be earned based on our completed acquisitions ("Acquisitions") as defined by our compensation committee, over the period from January 1, 2018 through December 31, 2020, with the opportunity to earn one-third of the award in any one year. If our Acquisitions were at least equal to $500 million for either of the 2018 or 2019 years or $1.5 billion for the cumulative three-year period; 50% of these shares would be earned; if our Acquisitions were at least equal to $750 million for either of the 2018 or 2019 years or $2.25 billion for the cumulative three-year period, 100% of these shares would be earned; and, if our Acquisitions were at least equal to $1.0 billion for either the 2018 or 2019 years or $3.0 billion for the cumulative three-year period, 200% of these shares would be earned. The fair value of this award was based on the average price per share of common stock on the date of grant with the number of shares adjusted as needed based on the probability of such performance hurdles being met. Based on performance, 73% of the target shares available in the first year of the measurement period was earned.

At the end of each of the performance periods, any earned shares during such period will vest on January 1 of the following calendar year.

Certain 2018 performance awards were subject to a modifier (which increases or decreases the actual shares earned in each performance period) based on how our total shareholder return compared to the SNL U.S. REIT Healthcare Index (“SNL Index”). If our total shareholder return is in the 75^th percentile of the SNL Index, the number of earned shares under this award is increased by 25%, if our total shareholder return is in the 55^th percentile of the SNL Index, the number of earned shares under this award had no change; and, if our total shareholder return is in the 35^th percentile of the SNL Index, the number of earned shares under this award is decreased by 25%. For 2018, our total shareholder return was in the 95^th percentile of the SNL index.

In 2018, 508,566 shares were earned but not vested, and 2,000 shares were forfeited. At December 31, 2018, we have 1,238,748 of 2018 performance awards remaining to be earned.

2017 performance awards — The 2017 performance awards were granted in three parts:

Certain 2017 performance awards (target number) were granted based on the achievement of specific performance thresholds as set by our compensation committee for the one-year performance period of 2017. However, more or less shares than the target number of shares were allowed to be earned based on our performance. The pre-established performance thresholds for 2017 were as follows:

Approximately 42% of the target shares were earned based on the achievement of a one-year total shareholder return as compared to the SNL Index over the period from January 1, 2017 through December 31, 2017. If the shareholder return was equal to the SNL Index minus 3% for the one-year period, 50% of these shares would be earned; while, if shareholder return was greater than or equal to the SNL Index plus 3%, 200% of these target shares would be earned. The fair value of this award was estimated on the grant date using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1%; expected volatility of 25%; expected dividend yield of 6.9%; and expected service period of three years.

Approximately 47% of the target shares were earned based on our return on equity (“ROE”), as defined by our compensation committee, over the period from January 1, 2017 through December 31, 2017. If our ROE was at least equal to 12.5% for the one-year period, 50% of these shares would be earned; and, if our ROE was greater than or equal to 13.5%, 200% of these shares would be earned. The fair value of this award was based on the average price per share of common stock on the date of grant with the number of shares adjusted as needed based on the probability of such performance hurdles being met. For this performance hurdle, 200% of the target shares was earned.

Approximately 11% of the target shares were earned based on general and administrative expenses (“G&A”) as a percentage of revenue, as defined by our compensation committee, over the period from January 1, 2017 through December 31, 2017. If our G&A as a percentage of revenue was no more than 10% for the one-year period, 50% of these shares would be earned; while, if our G&A as a percentage of revenue was 9% or less, 200% of these shares would be earned. The fair value of this award was based on the average price per share of common stock on the date of grant with the number of shares adjusted as needed based on the probability of such performance hurdles being met. For this performance hurdle, 200% of the target shares was earned.

At the end of the one-year performance period, all earned shares will vest in equal annual amounts on January 1, 2018, 2019, and 2020.

Certain other 2017 performance awards were based on the achievement of a multi-year cumulative total shareholder return as compared to pre-established returns set by our compensation committee. If the cumulative shareholder return from January 1, 2017 through December 31, 2019 is 27% or greater, then 30% of these shares will be earned (“2019 award”). If the cumulative shareholder return from January 1, 2017 through December 31, 2020 is 36% or greater, then 30% of these shares may be earned (“2020 award”). However, the maximum percentage cumulatively earned in connection with both the 2019 award and the 2020 award shall not exceed 30% of the total award. If the cumulative shareholder return from January 1, 2017 through December 31, 2021 is 45% or greater, then all remaining shares will be earned. At the end of each of the performance periods, any earned shares during such period will vest on January 1 of the following calendar year. The fair value of this award was estimated on the grant date using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.9%; expected volatility of 25%; expected dividend yield of 6.9%; and expected service period of 5 years.

The final portion of our 2017 performance awards will be earned if our total shareholder return outpaces that of the SNL Index over the cumulative period from January 1, 2017 to December 31, 2019. Our total shareholder return must be within 3% of the SNL Index to earn the minimum number of shares under this award; while, it must exceed the SNL Index by 3% to earn 100% of the award. If any shares are earned from this award, the shares will vest in equal annual amounts on January 1, 2020, 2021, and 2022. The fair value of this award was estimated on the grant date using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.5%; expected volatility of 25%; expected dividend yield of 6.9%; and expected service period of 3 years.

In 2018, 396,142 shares were earned but not vested, and 3,750 performance awards were forfeited. In 2017, 596,472 shares were earned but not vested, and 14,000 performance awards were forfeited. At December 31, 2018, we have 1,125,281 of 2017 performance awards remaining to be earned.

2016 performance awards — The 2016 performance awards were granted in two parts:

One-half of the 2016 performance awards were based on us achieving a cumulative total shareholder return from January 1, 2016 to December 31, 2018. The minimum total shareholder return needed to earn a portion of this award was 27.0% with 100% of the award earned if our total shareholder return reached 35.0%. Shares earned from this award vest in equal annual amounts on January 1, 2019, 2020, and 2021. The fair value of this award was estimated on the dates of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.0%; expected volatility of 24.4%; expected dividend yield of 7.0%; and expected service period of 5 years.

The remainder of the 2016 performance awards were to be earned if our total shareholder return outpaced that of the MSCI U.S. REIT Index (“MSCI Index”) over the cumulative period from January 1, 2016 to December 31, 2018. Our total shareholder return needed to be within 3% of the MSCI Index to earn the minimum number of shares under this award, while it had to exceed the MSCI Index by 3% to earn 100% of the award. Shares earned from this award vest in equal annual amounts on January 1, 2019, 2020, and 2021. The fair value of this award was estimated on the dates of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.0%; expected volatility of 24.4%; expected dividend yield of 7.0%; and expected service period of 5 years.

In 2018, 779,004 shares were earned but not vested, while no shares were forfeited. In 2017 and 2016, no shares were earned and vested, while 16,000 and 2,400 awards were forfeited in 2017 and 2016, respectively.

The following summarizes restricted equity award activity in 2018 and 2017 (which includes awards granted in 2018, 2017, 2016, and any applicable prior years), respectively:

For the Year Ended December 31, 2018:

	Vesting Based on Service					Vesting Based on Market/Performance Conditions
	Shares			Weighted Average Value at Award Date		Shares			Weighted Average Value at Award Date
Nonvested awards at beginning of the year		276,280		$	12.68		2,676,755		$	7.86
Awarded		958,480		$	14.31		1,750,834		$	11.61
Vested		(307,275	)	$	12.92		(288,404	)	$	11.25
Forfeited		(3,637	)	$	13.05		(5,750	)	$	9.35
Nonvested awards at end of year		923,848		$	14.29		4,133,435		$	9.21

For the Year Ended December 31, 2017:

	Vesting Based on Service					Vesting Based on Market/Performance Conditions
	Shares			Weighted Average Value at Award Date		Shares			Weighted Average Value at Award Date
Nonvested awards at beginning of the year		347,128		$	13.35		1,811,675		$	6.78
Awarded		249,841		$	12.40		1,741,003		$	8.21
Vested		(304,613	)	$	12.86		(491,071	)	$	6.84
Forfeited		(16,076	)	$	12.75		(384,852	)	$	5.65
Nonvested awards at end of year		276,280		$	12.68		2,676,755		$	7.86

The value of stock-based awards is charged to compensation expense over the service periods. For the years ended December 31, 2018, 2017, and 2016, we recorded $16.5 million, $9.9 million, and $7.9 million, respectively, of non-cash compensation expense. The remaining unrecognized cost from restricted equity awards at December 31, 2018, is $34.9 million, which will be recognized over a weighted average period of 2.1 years. Restricted equity awards that vested in 2018, 2017, and 2016, had a value of $8.4 million, $10.4 million, and $12.7 million, respectively.

Commitments and Contingencies

12 Months Ended

Dec. 31, 2018

Commitments And Contingencies Disclosure [Abstract]

Commitments and Contingencies

8. Commitments and Contingencies

Commitments

Operating leases, in which we are the lessee, primarily consist of ground leases on which certain of our facilities or other related property reside along with corporate office and equipment leases. The ground leases are long-term leases (almost all having terms of 30 years or more), some of which contain escalation provisions and one contains a purchase option. Properties subject to these ground leases are subleased to our tenants except for three Adeptus transition properties. Lease and rental expense (which is recorded on the straight-line method) for 2018, 2017, and 2016 was $9.4 million, $9.8 million, and $6.8 million, respectively, which was offset by sublease rental income of $4.3 million, $6.6 million, and $4.2 million, for 2018, 2017, and 2016, respectively.

Fixed minimum payments due over the remaining lease term under non-cancelable operating leases of more than one year and amounts to be received in the future from non-cancelable subleases over their remaining lease term at December 31, 2018 are as follows: (amounts in thousands)

	Fixed minimum payments		Amounts to be received from subleases			Net payments
2019	$	6,602	$	(3,284	)	$	3,318
2020		6,903		(3,458	)		3,445
2021		6,841		(3,551	)		3,290
2022		6,838		(3,632	)		3,206
2023		6,861		(3,636	)		3,225
Thereafter		198,932		(93,586	)		105,346	(1)
	$	232,977	$	(111,147	)	$	121,830

(1)

Reflects certain ground leases, in which we are the lessee, that have longer initial fixed terms than our existing sublease to our tenants. However, we would expect to either renew the related sublease, enter into a lease with a new tenant or early terminate the ground lease to reduce or avoid any significant impact from such ground leases.

Contingencies

We are a party to various legal proceedings incidental to our business. In the opinion of management, after consultation with legal counsel, the ultimate liability, if any, with respect to these proceedings is not presently expected to materially affect our financial position, results of operations or cash flows.

Common Stock/Partner's Capital

12 Months Ended

Dec. 31, 2018

Equity [Abstract]

Common Stock/Partner's Capital

9. Common Stock/Partner’s Capital

Medical Properties Trust, Inc.

2018 Activity

In the 2018 fourth quarter, we sold 5.6 million shares of common stock under our at-the-market equity offering program, resulting in net proceeds of approximately $95 million.

2017 Activity

On May 1, 2017, we completed an underwritten public offering of 43.1 million shares (including the exercise of the underwriters’ 30-day option to purchase an additional 5.6 million shares) of our common stock, resulting in net proceeds of approximately $548 million, after deducting offering expenses.

On November 13, 2017, we entered into a new at-the-market equity offering program, which gives us the ability to sell up to $750 million of stock with a commission rate up to 2.0%. During 2017, we did not sell any shares of our common stock under this program.

2016 Activity

On October 7, 2016, we sold 10.3 million shares of common stock in a private placement to an affiliate of Cerberus, the controlling member of Steward, and certain members of Steward management. We sold these shares at a price per share of $14.50, equal to the public offering price of our September 2016 equity offering, generating total proceeds of $150 million.

On September 30, 2016, we completed an underwritten public offering of 57.5 million shares (including the exercise of the underwriters’ 30-day option to purchase an additional 7.5 million shares) of our common stock, resulting in net proceeds of $799.5 million, after deducting estimated offering expenses.

During 2016, we sold approximately 15 million shares of our common stock under a previously existing at-the-market equity offering program (that ended in 2016), resulting in net proceeds of approximately $224 million, after deducting approximately $2.8 million of commissions.

MPT Operating Partnership, L.P.

At December 31, 2018 the Operating Partnership is made up of a general partner, Medical Properties Trust, LLC (“General Partner”) and limited partners, including the Company (which owns 100% of the General Partner) and two other partners. By virtue of its ownership of the General Partner, the Company has a 99.9% ownership interest in Operating Partnership via its ownership of all the common units. The remaining ownership interest is held by the two employees via their ownership of LTIP units. These LTIP units were issued pursuant to the 2007 Multi-Year Incentive Plan, which is now part of the Equity Incentive Plan discussed in Note 7 and once vested in accordance with their award agreement, may be converted to common units per the Second Amended and Restated Agreement of Limited Partnership of MPT Operating Partnership, L.P. (“Operating Partnership Agreement”).

In regards to distributions, the Operating Partnership shall distribute cash at such times and in such amounts as are determined by the General Partner in its sole and absolute discretion, to common unit holders who are common unit holders on the record date. However, per the Operating Partnership Agreement, the General Partner shall use its reasonable efforts to cause the Operating Partnership to distribute amounts sufficient to enable the Company to pay stockholder dividends that will allow the Company to (i) meet its distribution requirement for qualification as a REIT and (ii) avoid any U.S. federal income or excise tax liability imposed by the Code, other than to the extent the Company elects to retain and pay income tax on its net capital gain. In accordance with the Operating Partnership Agreement, LTIP units are treated as common units for distribution purposes.

The Operating Partnership’s net income will generally be allocated first to the General Partner to the extent of any cumulative losses and then to the limited partners in accordance with their respective percentage interests in the common units issued by the Operating Partnership. Any losses of the Operating Partnership will generally be allocated first to the limited partners until their capital account is zero and then to the General Partner. In accordance with the Operating Partnership Agreement, LTIP units are treated as common units for purposes of income and loss allocations. Limited partners have the right to require the Operating Partnership to redeem part or all of their common units. It is at the Operating Partnership’s discretion to redeem such common units for cash based on the fair market value of an equivalent number of shares of the Company’s common stock at the time of redemption or, alternatively, redeem the common units for shares of the Company’s common stock on a one-for-one basis, subject to adjustment in the event of stock splits, stock dividends, or similar events. LTIP units must wait two years from the issuance of the LTIP units to be redeemed, and then converted to common units. In 2018, approximately 60 thousand LTIP units were converted to common units and then redeemed for approximately $0.8 million of cash.

For each share of common stock issued by Medical Properties Trust, Inc., the Operating Partnership issues a corresponding number of operating partnership units.

Fair Value of Financial Instruments

12 Months Ended

Dec. 31, 2018

Fair Value Disclosures [Abstract]

Fair Value of Financial Instruments

10. Fair Value of Financial Instruments

We have various assets and liabilities that are considered financial instruments. We estimate that the carrying value of cash and cash equivalents, and accounts payable and accrued expenses approximate their fair values. We estimate the fair value of our interest and rent receivables using Level 2 inputs such as discounting the estimated future cash flows using the current rates at which similar receivables would be made to others with similar credit ratings and for the same remaining maturities. The fair value of our mortgage and working capital loans are estimated by using Level 2 inputs such as discounting the estimated future cash flows using the current rates which similar loans would be made to borrowers with similar credit ratings and for the same remaining maturities. We determine the fair value of our senior unsecured notes, using Level 2 inputs such as quotes from securities dealers and market makers. We estimate the fair value of our revolving credit facility and term loans using Level 2 inputs based on the present value of future payments, discounted at a rate which we consider appropriate for such debt.

Fair value estimates are made at a specific point in time, are subjective in nature, and involve uncertainties and matters of significant judgment. Settlement of such fair value amounts may not be possible and may not be a prudent management decision. The following table summarizes fair value estimates for our financial instruments (in thousands):

	December 31, 2018						December 31, 2017
Asset (Liability)	Book Value			Fair Value			Book Value			Fair Value
Interest and rent receivables	$	25,855		$	24,942		$	78,970		$	78,028
Loans(1)		1,471,520			1,490,758			1,698,471			1,722,101
Debt, net		(4,037,389	)		(3,947,795	)		(4,898,667	)		(5,073,707	)

(1)	Excludes loans to Ernest that are recorded at fair value – see below for further details.

Items Measured at Fair Value on a Recurring Basis

Our equity interest in Ernest and related loans, which we sold or were repaid in full (other than our mortgage loans) on October 4, 2018, were measured at fair value on a recurring basis as we elected to account for these investments using the fair value option method. We elected to account for these investments at fair value due to the size of the investments and because we believe this method is more reflective of current values. We have not made a similar election for other equity interests or loans existing at December 31, 2018 or December 31, 2017.

At December 31, 2018 and 2017, the amounts recorded under the fair value option method were as follows (in thousands):

	As of December 31, 2018				As of December 31, 2017				Asset Type
Asset (Liability)	Fair Value		Original Cost		Fair Value		Original Cost		Classification
Mortgage loans	$	115,000	$	115,000	$	115,000	$	115,000	Mortgage loans
Equity investment and other loans		—		—		114,554		118,354	Other loans/other assets
	$	115,000	$	115,000	$	229,554	$	233,354

Our mortgage and other loans (for 2017 only) with Ernest are recorded at fair value based on Level 2 inputs by discounting the estimated cash flows using the market rates which similar loans would be made to borrowers with similar credit ratings and the same remaining maturities. Our equity investment in Ernest was recorded at fair value based on Level 3 inputs, by using a discounted cash flow model, which requires significant estimates of our investee such as projected revenue and expenses and appropriate consideration of the underlying risk profile of the forecasted assumptions associated with the investee. We classified the equity investment as Level 3, as we used certain unobservable inputs to the valuation methodology that were significant to the fair value measurement, and the valuation required management judgment due to the absence of quoted market prices. For these cash flow models, our observable inputs included use of a capitalization rate, discount rate (which is based on a weighted average cost of capital), and market interest rates, and our unobservable input included an adjustment for a marketability discount (“DLOM”) on our equity investment of 40% at December 31, 2018.

In arriving at the DLOM, we started with a DLOM range based on the results of studies supporting valuation discounts for other transactions or structures without a public market. To select the appropriate DLOM within the range, we then considered many qualitative factors including the percent of control, the nature of the underlying investee’s business along with our rights as an investor pursuant to the operating agreement, the size of investment, expected holding period, number of shareholders, access to capital marketplace, etc.

Because the fair value of Ernest investments noted above was below our original cost, we recognized an unrealized loss during 2018 (before selling our investment) and 2017. We did not recognize any unrealized gains/losses on the Ernest investments in 2016.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Other Assets

12 Months Ended

Dec. 31, 2018

Deferred Costs Capitalized Prepaid And Other Assets Disclosure [Abstract]

Other Assets

11. Other Assets

The following is a summary of our other assets (in thousands):

	At December 31,
	2018		2017
Debt issue costs, net(1)	$	4,793	$	7,093
Equity investments		520,058		288,398
Other corporate assets		115,416		117,827
Prepaids and other assets		61,757		55,176
Total other assets	$	702,024	$	468,494

(1)

Relates to revolving credit facility

Equity investments have increased over the prior year primarily due to our €210 million joint venture arrangement with Primotop — see Note 3 for further details. Other corporate assets include leasehold improvements associated with our corporate offices, furniture and fixtures, equipment, software, deposits, etc. Included in prepaids and other assets is prepaid insurance, prepaid taxes, goodwill (2017 only), deferred income tax assets (net of valuation allowances, if any), and lease inducements made to tenants, among other items.

Summarized Financial Information for Significant Investees

The following table presents financial information as of and for the year ended December 31, 2018 for the joint venture arrangement with Primotop in which we made an equity method investment in and advances to on August 31, 2018 (in thousands):

	2018
Revenue	$	42,526
Net income	$	6,009

Assets	$	2,018,496
Liabilities	$	1,553,191

Quarterly Financial Data (unaudited)

12 Months Ended

Dec. 31, 2018

Quarterly Financial Information Disclosure [Abstract]

Quarterly Financial Data (unaudited)

12. Quarterly Financial Data (unaudited)

Medical Properties Trust, Inc.

The following is a summary of the unaudited quarterly financial information for the years ended December 31, 2018 and 2017: (amounts in thousands, except for per share data)

	For the Three Month Periods in 2018 Ended
	March 31		June 30		September 30		December 31
Revenues	$	205,046	$	201,902	$	196,996	$	180,578
Net income		91,043		112,017		736,476		78,941
Net income attributable to MPT common stockholders		90,601		111,567		736,034		78,483
Net income attributable to MPT common stockholders per share — basic	$	0.25	$	0.30	$	2.01	$	0.21
Weighted average shares outstanding — basic		364,882		364,897		365,024		366,655
Net income attributable to MPT common stockholders per share — diluted	$	0.25	$	0.30	$	2.00	$	0.21
Weighted average shares outstanding — diluted		365,343		365,541		366,467		367,732

	For the Three Month Periods in 2017 Ended
	March 31		June 30		September 30		December 31
Revenues	$	156,397	$	166,807	$	176,580	$	204,961
Net income		68,185		73,796		76,881		72,376
Net income attributable to MPT common stockholders		67,970		73,415		76,464		71,944
Net income attributable to MPT common stockholders per share — basic	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average shares outstanding — basic		321,057		349,856		364,315		364,382
Net income attributable to MPT common stockholders per share —diluted	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average shares outstanding — diluted		321,423		350,319		365,046		364,977

MPT Operating Partnership, L.P.

The following is a summary of the unaudited quarterly financial information for the years ended December 31, 2018 and 2017: (amounts in thousands, except for per unit data)

	For the Three Month Periods in 2018 Ended
	March 31		June 30		September 30		December 31
Revenues	$	205,046	$	201,902	$	196,996	$	180,578
Net income		91,043		112,017		736,476		78,941
Net income attributable to MPT Operating Partnership partners		90,601		111,567		736,034		78,483
Net income attributable to MPT Operating Partnership partners per unit — basic	$	0.25	$	0.30	$	2.01	$	0.21
Weighted average units outstanding — basic		364,882		364,897		365,024		366,655
Net income attributable to MPT Operating Partnership partners per unit — diluted	$	0.25	$	0.30	$	2.00	$	0.21
Weighted average units outstanding — diluted		365,343		365,541		366,467		367,732

	For the Three Month Periods in 2017 Ended
	March 31		June 30		September 30		December 31
Revenues	$	156,397	$	166,807	$	176,580	$	204,961
Net income		68,185		73,796		76,881		72,376
Net income attributable to MPT Operating Partnership partners		67,970		73,415		76,464		71,944
Net income attributable to MPT Operating Partnership partners per unit — basic	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average units outstanding — basic		321,057		349,856		364,315		364,382
Net income attributable to MPT Operating Partnership partners per unit — diluted	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average units outstanding — diluted		321,423		350,319		365,046		364,977

Subsequent Events

12 Months Ended

Dec. 31, 2018

Subsequent Events [Abstract]

Subsequent Events

13. Subsequent Events

On January 31, 2019, we entered into definitive agreements to acquire a portfolio of eleven Australian hospitals currently operated by Healthscope Ltd. (“Healthscope”) for an aggregate purchase price of approximately $859 million. Upon closing, these facilities will be leased to Healthscope pursuant to master lease agreements that have an average initial term of 20 years with annual fixed escalations and multiple extension options. In a related transaction, Brookfield Business Partners L.P. together with its institutional partners (“Brookfield”) has agreed to acquire up to 100% of Healthscope’s outstanding shares. Closing of our acquisition, which is expected to be completed in the second quarter of 2019, is subject to Healthscope shareholder approval, customary real estate and regulatory approvals, the successful completion of the Brookfield transactions, and other closing conditions.

As discussed in Note 3, in June 2018, we agreed to purchase a four-hospital portfolio from MEDIAN for an aggregate amount of €23 million (including real estate transfer taxes) for which we closed on three of the properties in 2018. The properties are leased to affiliates of MEDIAN. On February 6, 2019, we closed on the last of the four inpatient rehabilitation hospitals in Germany for €5.8 million (including real estate transfer taxes).

Schedule II: Valuation and Qualifying Accounts

12 Months Ended

Dec. 31, 2018

Valuation And Qualifying Accounts [Abstract]

Schedule II: Valuation and Qualifying Accounts

Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.

Schedule II: Valuation and Qualifying Accounts

December 31, 2018

			Additions			Deductions
Year Ended December 31,	Balance at Beginning of Year(1)		Charged Against Operations(1)			Net Recoveries/ Write-offs(1)				Balance at End of Year(1)
	(In thousands)
2018	$	16,397	$	57,285	(2)	$	(7,551	)	(3)	$	66,131
2017	$	18,852	$	2,525	(4)	$	(4,980	)	(5)	$	16,397
2016	$	27,384	$	2,722	(6)	$	(11,254	)	(7)	$	18,852

(1)	Includes allowance for doubtful accounts, straight-line rent reserves, allowance for loan losses, tax valuation allowances and other reserves.

(2)	Represents $48 million increase to real estate impairment reserve and $9.3 million increases in accounts receivable reserves during 2018.

(3)	Includes $7.7 million decrease in valuation allowance (which includes the $4.4 million release of domestic valuation allowances in the 2018 fourth quarter) that was originally recorded to reserve against our net deferred tax assets.

(4)	Represents increases in accounts receivable reserves during 2017.

(5)	Includes $4.9 million decrease in valuation allowance that was originally recorded to reserve against our net deferred tax assets.

(6)	Includes $1.9 million of rent reserves related to our Twelve Oaks facility and $0.8 million of rent reserves related to our Corinth facility.

(7)

Includes write-offs of $3.3 million related to payment of rent, late fees, and loans for our Twelve Oaks facility; $0.8 million of write-offs for rent and interest reserves related to the sale of the Corinth facility; $0.1 million of write-offs related to the McLeod Healthcare loan; and $6.1 million decrease in valuation allowances (which includes the $4 million release of foreign valuation allowances in the 2016 fourth quarter) that was originally recorded to reserve against our net deferred tax assets.

SCHEDULE III - REAL ESTATE INVESTMENTS AND ACCUMULATED DEPRECIATION

12 Months Ended

Dec. 31, 2018

Real Estate And Accumulated Depreciation Disclosure [Abstract]

SCHEDULE III - REAL ESTATE INVESTMENTS AND ACCUMULATED DEPRECIATION

SCHEDULE III — REAL ESTATE INVESTMENTS AND ACCUMULATED DEPRECIATION

December 31, 2018

		Initial Costs				Additions Subsequent to Acquisition				Cost at December 31, 2018(1)						Accumulated						Life on which depreciation in latest income statements is
Location	Type of Property	Land		Buildings		Improve- ments		Carrying Costs		Land		Buildings		Total		Depreciation		Encum- brances		Date of Construction	Date Acquired	computed (Years)
	(Dollar amounts in thousands)
Bath, UK	Acute care general hospital	$	1,512	$	31,334	$	—	$	—	$	1,512	$	31,334	$	32,846	$	3,526	$	—	2008, 2009	July 1, 2014		40
Braunfels, Germany	Acute care general hospital		2,202		14,073		57		—		2,259		14,073		16,332		1,245		—	1977	June 30, 2015		40
Heidelberg, Germany	Rehabilitation hospital		6,404		37,006		75		—		6,479		37,006		43,485		2,325		—	1885, 1991	June 22, 2016		40
Cologne, Germany	Acute care general hospital		4,494		15,545		104		—		4,598		15,545		20,143		593		—	2011	June 23, 2017		40
Bad Salzuflen, Germany	Rehabilitation hospital		9,972		27,611		939		—		10,911		27,611		38,522		816		—	1974, 2016	November 30, 2017		40
Bad Salzuflen, Germany	Rehabilitation hospital		7,062		24,283		353		—		7,415		24,283		31,698		683		—	1989, 2016	November 30, 2017		40
Bad Oeynhausen, Germany	Rehabilitation hospital		1,042		2,859		127		—		1,169		2,859		4,028		87		—	1973, 2010	November 30, 2017		40
Dormagen, Germany	Rehabilitation hospital		1,843		5,848		140		—		1,983		5,848		7,831		52		—	1993, 2006	August 28, 2018		40
Grefath, Germany	Rehabilitation hospital		1,145		3,127		102		—		1,247		3,127		4,374		28		—	1886, 1983	August 28, 2018		40
Remscheid, Germany	Rehabilitation hospital		1,029		2,614		60		—		1,089		2,614		3,703		23		—	1951, 1983	August 28, 2018		40
Houston, TX	Acute care general hospital		3,501		34,530		8,477		16,589		3,274		59,823		63,097		12,943		—	1960	August 10, 2007		40
Allen, TX	Freestanding ER		1,550		866		—		—		1,550		866		2,416		441		—	2014	July 14, 2014		40
San Diego, CA	Acute care general hospital		12,663		52,431		—		—		12,663		52,431		65,094		10,377		—	1973	February 9, 2011		40
Alvin, TX	Freestanding ER		105		4,087		—		—		105		4,087		4,192		462		—	2014	March 19, 2014		40
Houston, TX	Freestanding ER		950		3,996		—		—		950		3,996		4,946		225		—	2016	September 26, 2016		40
Aurora, CO	Freestanding ER		—		4,812		—		—		—		4,812		4,812		391		—	2015	September 17, 2015		40
Ft. Worth, TX	Freestanding ER		—		4,392		—		—		—		4,392		4,392		412		—	2015	March 27, 2015		40
Ayer, MA	Acute care general hospital		9,048		77,913		1,603		—		9,048		79,516		88,564		911		—	1970-2013	June 27, 2018		47
Bayonne, NJ	Acute care general hospital		2,003		51,495		—		—		2,003		51,495		53,498		20,383		—	1918	February 4, 2011		20
Bennettsville, SC	Acute care general hospital		794		15,772		—		—		794		15,772		16,566		4,157		—	1984	April 1, 2008		42
Blue Springs, MO	Acute care general hospital		4,347		23,494		—		—		4,347		23,494		27,841		2,417		—	1980	February 13, 2015		40
Boise, ID	Long term acute care hospital		1,558		11,027		—		—		1,558		11,027		12,585		173		—	2008	February 29, 2012		50
Bossier City, LA	Long term acute care hospital		900		17,818		628		—		900		18,446		19,346		4,786		—	1982	April 1, 2008		40
Brighton, MA	Acute care general hospital		18,540		146,490		11,176		—		18,540		157,666		176,206		8,304		—	1917-2009	October 3, 2016		41
Brockton, MA	Acute care general hospital		18,328		67,248		4,296		—		18,328		71,544		89,872		4,798		—	1965-2010	October 3, 2016		41
Austin, TX	Freestanding ER		1,140		1,777		—		—		1,140		1,777		2,917		441		—	2014	May 29, 2014		40
Broomfield, CO	Freestanding ER		825		3,895		—		—		825		3,895		4,720		438		—	2014	July 3, 2014		40
Glendale, AZ	Freestanding ER		1,144		6,087		—		—		1,144		6,087		7,231		330		—	2016	October 21, 2016		40
New Orleans, LA	Freestanding ER		2,850		6,125		—		—		2,850		6,125		8,975		346		—	2016	September 23, 2016		40
Carrollton, TX	Acute care general hospital		729		34,342		—		—		729		34,342		35,071		2,933		—	2015	July 17, 2015		40
Cedar Hill. TX	Freestanding ER		1,122		3,644		—		—		1,122		3,644		4,766		410		—	2014	June 23, 2014		40
Spring, TX	Freestanding ER		1,310		3,639		—		—		1,310		3,639		4,949		409		—	2014	July 15, 2014		40

		Initial Costs				Additions Subsequent to Acquisition					Cost at December 31, 2018(1)						Accumulated						Life on which depreciation in latest income statements is
Location	Type of Property	Land		Buildings		Improve- ments		Carrying Costs			Land		Buildings		Total		Depreciation		Encum- brances		Date of Construction	Date Acquired	computed (Years)
	(Dollar amounts in thousands)
Chandler, AZ	Freestanding ER		—		4,783		—		—			—		4,783		4,783		438		—	2015	April 24, 2015		40
Chandler, AZ	Freestanding ER		750		3,852		0		—			750		3,852		4,602		313		—	2015	October 7, 2015		40
Cheraw, SC	Acute care general hospital		657		19,576		—		—			657		19,576		20,233		5,158		—	1982	April 1, 2008		42
Katy, TX	Freestanding ER		—		3,873		—		—			—		3,873		3,873		307		—	2015	October 21, 2015		40
Webster, TX	Long term acute care hospital		663		33,751		—		—			663		33,751		34,414		6,750		—	2004	December 21, 2010		40
Commerce City, TX	Freestanding ER		707		4,248		—		—			707		4,248		4,955		434		—	2014	December 11, 2014		40
Conroe, TX	Freestanding ER		1,338		3,712		—		—			1,338		3,712		5,050		317		—	2015	July 29, 2015		40
Converse, TX	Freestanding ER		750		4,423		—		—			750		4,423		5,173		415		—	2015	April 10, 2015		40
The Woodlands, TX	Freestanding ER		—		4,524		—		—			—		4,524		4,524		311		—	2016	March 28, 2016		40
Houston, TX	Freestanding ER		—		4,267		—		—			—		4,267		4,267		203		—	2017	May 8, 2017		35
Dallas, TX	Long term acute care hospital		1,000		13,589		—		368			1,421		13,536		14,957		4,173		—	2006	September 5, 2006		40
Denver, CO	Freestanding ER		—		4,276		—		—			—		4,276		4,276		383		—	2015	June 8, 2015		40
DeSoto, TX	Freestanding ER		750		4,234		—		—			750		4,234		4,984		273		—	2016	May 23, 2016		40
Detroit, MI	Long term acute care hospital		1,220		8,687		—		(365	)		1,220		8,322		9,542		2,274		—	1956	May 22, 2008		40
San Antonio, TX	Freestanding ER		—		4,801		—		—			—		4,801		4,801		250		—	2016	December 9, 2016		40
Dorchester, MA	Acute care general hospital		14,428		219,575		5,394		—			14,428		224,969		239,397		1,371		—	1953-2015	October 15, 2018		42
Dulles, TX	Freestanding ER		1,076		3,784		—		—			1,076		3,784		4,860		410		—	2014	September 12, 2014		40
Easton, PA	Acute care general hospital		13,898		40,245		2,921		—			13,898		43,166		57,064		1,786		—	1930-2005	May 1, 2017		41
Houston, TX	Freestanding ER		1,345		3,678		—		—			1,345		3,678		5,023		414		—	2014	June 20, 2014		40
Fairmont, CA	Acute care general hospital		1,000		6,072		5,278		—			1,277		11,073		12,350		1,798		—	1939, 1972, 1985	September 19, 2014		40
Fall River, MA	Acute care general hospital		3,526		82,358		22,205		—			3,525		104,564		108,089		4,977		—	1950-2012	October 3, 2016		41
Firestone, TX	Freestanding ER		495		3,963		—		—			495		3,963		4,458		454		—	2014	June 6, 2014		40
Flagstaff, AZ	Rehabilitation hospital		3,049		22,464		—		—			3,049		22,464		25,513		468		—	2016	August 23, 2016		40
Florence, AZ	Acute care general hospital		900		28,462		105		—			900		28,567		29,467		4,817		—	2012	February 7, 2012		40
Fort Lauderdale, FL	Rehabilitation hospital		3,499		21,939		—		1			3,499		21,940		25,439		5,862		—	1985	April 22, 2008		40
Fountain, CO	Freestanding ER		1,508		4,131		—		—			1,508		4,131		5,639		456		—	2014	July 31, 2014		40
Frisco, TX	Freestanding ER		—		1,806		—		—			—		1,806		1,806		336		—	2016	March 4, 2016		40
Frisco, TX	Freestanding ER		2,441		185		—		—			2,441		185		2,626		354		—	2015	November 13, 2015		40
Frisco, TX	Freestanding ER		1,500		3,863		27		(89	)		1,411		3,890		5,301		446		—	2014	June 13, 2014		40
Garden Grove, CA	Acute care general hospital		5,502		10,748		—		51			5,502		10,799		16,301		2,736		—	1982	November 25, 2008		40
Garland, TX	Freestanding ER		—		4,647		—		—			—		4,647		4,647		252		—	2016	November 15, 2016		40
Garden Grove, CA	Medical Office Building		862		7,888		—		28			862		7,916		8,778		1,999		—	1982	November 25, 2008		40
Gilbert, AZ	Acute care general hospital		150		15,553		—		—			150		15,553		15,703		3,111		—	2005	January 4, 2011		40
Gilbert, AZ	Freestanding ER		1,517		4,660		—		—			1,517		4,660		6,177		398		—	2015	July 22, 2015		40
Glendale, AZ	Freestanding ER		—		4,046		—		—			—		4,046		4,046		362		—	2015	June 5, 2015		40
Goodyear, AZ	Freestanding ER		1,800		4,713		—		—			1,800		4,713		6,513		324		—	2016	April 4, 2016		40
Hartsville, SC	Acute care general hospital		2,050		43,970		—		—			2,050		43,970		46,020		3,827		—	1999	August 31, 2015		34
Hausman, TX	Acute care general hospital		1,500		8,957		—		—			1,500		8,957		10,457		1,284		—	2013	March 1, 2013		40
Haverhill, MA	Acute care general hospital		5,651		105,848		1,888		—			5,651		107,736		113,387		936		—	1982-2005	August 31, 2018		40
Helotes, TX	Freestanding ER		1,900		5,115		—		—			1,900		5,115		7,015		362		—	2016	March 10, 2016		40

		Initial Costs				Additions Subsequent to Acquisition						Cost at December 31, 2018(1)						Accumulated						Life on which depreciation in latest income statements is
Location	Type of Property	Land		Buildings		Improve- ments			Carrying Costs			Land		Buildings		Total		Depreciation		Encum- brances		Date of Construction	Date Acquired	computed (Years)
	(Dollar amounts in thousands)
Highland Village, TX	Freestanding ER		—		1,551		—			—			—		1,551		1,551		326		—	2015	September 22, 2015		40
Hill County, TX	Acute care general hospital		1,120		17,882		—			—			1,120		17,882		19,002		9,890		—	1980	September 17, 2010		15
Warren, OH	Rehabilitation hospital		2,417		15,857		35			—			2,417		15,892		18,309		891		—	1922-2000	May 1, 2017		46
Hoboken, NJ	Acute care general hospital		1,387		44,351		—			—			1,387		44,351		45,738		15,838		—	1863	November 4, 2011		20
Hoover, AL	Freestanding ER		—		7,581		—			—			—		7,581		7,581		812		—	2015	May 1, 2015		34
Hoover, AL	Medical Office Building		—		1,034		—			—			—		1,034		1,034		111		—	2015	May 1, 2015		34
Hope, AR	Acute care general hospital		1,651		3,359		373			—			1,651		3,732		5,383		223		—	1984-2001	September 29, 2017		41
Hot Springs, AR	Acute care general hospital		7,100		59,432		21,221			—			7,100		80,653		87,753		6,795		—	1985	August 31, 2015		40
Houston, TX	Acute care general hospital		28,687		104,028		5,999			—			28,687		110,027		138,714		878		—	1940-1950	September 29, 2017		41
Highlands Ranch, CO	Freestanding ER		4,200		4,779		—			—			4,200		4,779		8,979		289		—	2016	July 25, 2016		40
Idaho Falls, ID	Acute care general hospital		1,822		37,467		441			4,665			1,822		42,573		44,395		11,201		—	2002	April 1, 2008		40
Kansas City, MO	Acute care general hospital		10,497		64,419		—			—			10,497		64,419		74,916		6,429		—	1978	February 13, 2015		40
Katy, TX	Freestanding ER		—		4,174		—			—			—		4,174		4,174		235		—	2016	October 10, 2016		40
Camden, SC	Acute care general hospital		—		22,739		—			—			—		22,739		22,739		1,555		—	1954-2004	October 30, 2015		39
Lafayette, IN	Rehabilitation hospital		800		14,968		(25	)		—			800		14,943		15,743		2,198		—	2013	February 1, 2013		40
Lehi, UT	Acute care general hospital		13,403		29,950		156			(35	)		13,368		30,106		43,474		1,108		—	2015	September 29, 2017		45
Lewiston, ID	Acute care general hospital		5,389		75,435		—			—			5,389		75,435		80,824		4,251		—	1922	May 1, 2017		40
Little Elm, TX	Freestanding ER		1,241		3,491		—			—			1,241		3,491		4,732		441		—	2013	December 1, 2013		40
Longmont, CO	Freestanding ER		—		4,181		—			—			—		4,181		4,181		305		—	2016	February 10, 2016		40
Lubbock, TX	Rehabilitation hospital		1,376		28,292		3,648			—			1,376		31,940		33,316		2,657		—	2008	June 16, 2015		40
Mandeville, LA	Freestanding ER		2,800		5,370		—			—			2,800		5,370		8,170		291		—	2016	October 28, 2016		40
Marrero, LA	Freestanding ER		—		5,801		—			—			—		5,801		5,801		364		—	2016	July 15, 2016		40
McKinney, TX	Freestanding ER		—		4,060		—			—			—		4,060		4,060		466		—	2015	July 31, 2015		30
McMinnville, OR	Acute care general hospital		5,000		97,900		—			—			5,000		97,900		102,900		6,652		—	1996	August 31, 2015		41
Melbourne, FL	Acute care general hospital		5,642		17,087		2,282			—			5,642		19,369		25,011		922		—	2002	May 1, 2017		42
Mesa, AZ	Acute care general hospital		6,534		100,042		289			—			6,533		100,332		106,865		13,819		—	2007	September 26, 2013		40
Phoenix, AZ	Acute care general hospital		5,576		45,782		—			—			5,576		45,782		51,358		2,194		—	2017	February 10, 2017		40
Methuen, MA	Acute care general hospital		23,809		89,505		5,698			—			23,809		95,203		119,012		5,766		—	1950-2011	October 3, 2016		41
Bloomington, IN	Acute care general hospital		2,392		28,212		5,000			408			2,392		33,620		36,012		10,377		—	2006	August 8, 2006		40
Montclair, NJ	Acute care general hospital		7,900		99,640		577			—			8,477		99,640		108,117		12,211		—	1920-2000	April 1, 2014		40
San Antonio, TX	Freestanding ER		351		3,952		—			—			351		3,952		4,303		468		—	2014	January 1, 2014		40
Colorado Springs, CO	Freestanding ER		600		4,231		—			—			600		4,231		4,831		485		—	2014	June 5, 2014		40
Northland, MO	Long term acute care hospital		834		17,182		—			—			834		17,182		18,016		3,401		—	2007	February 14, 2011		40
Norwood, MA	Acute care general hospital		7,073		154,496		7,745			—			7,073		162,241		169,314		1,781		—	1926-2001	June 27, 2018		46
Altoona, WI	Acute care general hospital		—		29,062		—			—			—		29,062		29,062		3,148		—	2014	August 31, 2014		40
Odessa, TX	Acute care general hospital		6,535		123,518		254			—			6,535		123,772		130,307		3,950		—	1973-2004	September 29, 2017		41
Ogden, UT	Rehabilitation hospital		1,759		16,414		—			—			1,759		16,414		18,173		1,971		—	2014	March 1, 2014		40
Olympia, WA	Acute care general hospital		7,220		89,348		15,930			—			7,220		105,278		112,498		6,138		—	1984	July 22, 2016		40
Overlook, TX	Acute care general hospital		2,452		9,666		7			—			2,452		9,673		12,125		1,411		—	2012	February 1, 2013		40
San Diego, CA	Acute care general hospital		6,550		15,653		—			77			6,550		15,730		22,280		4,586		—	1964	May 9, 2007		40

		Initial Costs				Additions Subsequent to Acquisition					Cost at December 31, 2018(1)						Accumulated						Life on which depreciation in latest income statements is
Location	Type of Property	Land		Buildings		Improve- ments		Carrying Costs			Land		Buildings		Total		Depreciation		Encum- brances		Date of Construction	Date Acquired	computed (Years)
	(Dollar amounts in thousands)
Parker, CO	Freestanding ER		1,300		4,448		—		—			1,300		4,448		5,748		352		—	2015	November 6, 2015		40
Pasco, WA	Acute care general hospital		2,594		13,195		—		—			2,594		13,195		15,789		150		—	1920	August 31, 2018		30
Pearland, TX	Freestanding ER		1,075		3,577		—		—			1,075		3,577		4,652		388		—	2014	September 8, 2014		40
Petersburg, VA	Rehabilitation hospital		1,302		9,121		—		—			1,302		9,121		10,423		2,394		—	2006	July 1, 2008		40
Phoenix, AZ	Acute care general hospital		2,396		26,521		2,931		—			2,396		29,452		31,848		817		—	1979	September 29, 2017		42
Phoenix, AZ	Acute care general hospital		12,695		73,774		2,432		—			12,695		76,206		88,901		2,502		—	1968-1976	September 29, 2017		43
Plano, TX	Freestanding ER		—		2,492		—		—			—		2,492		2,492		272		—	2016	September 30, 2016		40
Poplar Bluff, MO	Acute care general hospital		2,660		38,693		—		1			2,660		38,694		41,354		10,339		—	1980	April 22, 2008		40
Port Arthur, TX	Acute care general hospital		12,972		78,051		859		—			12,972		78,910		91,882		10,155		—	2005	September 26, 2013		40
Port Huron, MI	Acute care general hospital		3,029		14,622		—		—			3,029		14,622		17,651		1,498		—	1953, 1973-1983	December 31, 2015		30
Post Falls, ID	Rehabilitation hospital		417		12,175		1,905		—			767		13,730		14,497		1,725		—	2013	December 31, 2013		40
San Antonio, TX	Freestanding ER		—		4,253		—		—			—		4,253		4,253		230		—	2016	October 27, 2016		40
Redding, CA	Acute care general hospital		1,555		53,863		—		13			1,555		53,876		55,431		15,387		—	1974	August 10, 2007		40
Austin, TX	Freestanding ER		—		4,200		—		—			—		4,200		4,200		231		—	2017	March 2, 2017		40
Rockledge, FL	Acute care general hospital		13,919		23,282		1,831		—			13,919		25,113		39,032		1,460		—	1950, 1970	May 1, 2017		42
Rosenberg, TX	Freestanding ER		—		4,505		—		—			—		4,505		4,505		338		—	2016	January 15, 2016		40
Columbus, OH	Freestanding ER		1,726		—		—		—			1,726		—		1,726		—		—	2016	August 30, 2016	-
Salt Lake City, UT	Acute care general hospital		13,590		101,915		726		—			13,590		102,641		116,231		3,178		—	1906-1987	September 29, 2017		41
San Antonio, TX	Acute care general hospital		8,053		29,333		675		—			8,053		30,008		38,061		1,024		—	1978-2002	September 29, 2017		41
San Dimas, CA	Acute care general hospital		6,160		6,839		—		34			6,160		6,873		13,033		1,735		—	1972	November 25, 2008		40
San Dimas, CA	Medical Office Building		1,915		5,085		—		18			1,915		5,103		7,018		1,289		—	1979	November 25, 2008		40
Phoenix, AZ	Freestanding ER		1,132		5,052		—		—			1,132		5,052		6,184		221		—	2017	April 13, 2017		40
Sebastian, FL	Acute care general hospital		5,733		49,136		16,829		—			5,733		65,965		71,698		2,288		—	1974	May 1, 2017		41
Sharon, PA	Acute care general hospital		6,179		9,066		1,808		—			6,179		10,874		17,053		1,096		—	1950-1980	May 1, 2017		41
Sherman, TX	Acute care general hospital		4,493		11,081		—		—			4,493		11,081		15,574		2,703		—	1913, 1960-2010	October 31, 2014		40
Sienna, TX	Freestanding ER		1,000		3,591		—		—			1,000		3,591		4,591		389		—	2014	August 20, 2014		40
Spartanburg, SC	Rehabilitation hospital		1,135		15,717		—		—			1,135		15,717		16,852		2,112		—	2013	August 1, 2013		40
Houston, TX	Freestanding ER		1,423		3,772		—		—			1,423		3,772		5,195		361		—	2015	February 18, 2015		40
Taunton, MA	Acute care general hospital		4,428		73,228		2,951		—			4,428		76,179		80,607		4,400		—	1940-2015	October 3, 2016		41
Tempe, AZ	Acute care general hospital		6,050		10,986		871		—			6,050		11,857		17,907		476		—	1940	September 29, 2017		41
Texarkana, TX	Acute care general hospital		14,562		—		—		—			14,562		—		14,562		—		—	2017	September 29, 2017	-
Thornton, CO	Freestanding ER		1,350		4,259		—		—			1,350		4,259		5,609		461		—	2014	August 29, 2014		40
Toledo, OH	Rehabilitation hospital		—		17,740		—		—			—		17,740		17,740		1,220		—	2016	April 1, 2016		40
Tomball, TX	Long term acute care hospital		1,299		23,982		—		—			1,299		23,982		25,281		4,796		—	2005	December 21, 2010		40
Houston, TX	Acute care general hospital		4,047		36,862		—		—			4,047		36,862		40,909		2,304		—	2016	July 7, 2016		40
League City, TX	Freestanding ER		—		3,901		—		—			—		3,901		3,901		341		—	2015	June 19, 2015		40
Anaheim, CA	Acute care general hospital		1,875		21,813		—		10			1,875		21,823		23,698		6,638		—	1964	November 8, 2006		40
Warren, OH	Acute care general hospital		5,385		47,588		5,142		—			5,385		52,730		58,115		2,509		—	1982	May 1, 2017		41
West Monroe, LA	Acute care general hospital		12,000		69,433		11,013		—			12,552		79,894		92,446		9,746		—	1962	September 26, 2013		40
San Antonio, TX	Acute care general hospital		2,248		5,880		—		—			2,248		5,880		8,128		904		—	2012	October 2, 2012		40
West Valley City, UT	Acute care general hospital		5,516		58,314		2,478		(114	)		5,402		60,792		66,194		15,762		—	1980	April 22, 2008		40
Wichita, KS	Rehabilitation hospital		1,019		18,373		—		1			1,019		18,374		19,393		4,937		—	1992	April 4, 2008		40
Youngstown, OH	Acute care general hospital		4,335		3,565		604		—			4,334		4,170		8,504		965		—	1929-2003	May 1, 2017		41
		$	544,228	$	4,026,620	$	188,640	$	21,661		$	547,894	$	4,233,255	$	4,781,149	$	414,331	$	—

(1)	The aggregate cost for federal income tax purposes is $4,873,085.

The changes in total real estate assets (excluding construction in progress, intangible lease assets, investment in direct financing leases, and mortgage loans) are as follows for the years ended (in thousands):

	December 31, 2018				December 31, 2017				December 31, 2016
COST
Balance at beginning of period	$	5,438,148			$	3,968,042			$	2,991,590
Acquisitions		758,619				1,256,245				745,948
Transfers from construction in progress		25,513				74,441				163,080
Additions		96,775				36,828				33,279
Dispositions		(1,318,238	)			(53,372	)			(138,886	)
Other		(219,668	)	(2)		155,964		(2)		173,031
Balance at end of period	$	4,781,149			$	5,438,148		(3)	$	3,968,042

The changes in accumulated depreciation are as follows for the years ended (in thousands):

	December 31, 2018			December 31, 2017				December 31, 2016
ACCUMULATED DEPRECIATION
Balance at beginning of period	$	407,349		$	292,786			$	232,675
Depreciation		115,497			109,307				81,010
Depreciation on disposed property		(101,967	)		(1,438	)			(19,086	)
Other		(6,548	)		6,694				(1,813	)
Balance at end of period	$	414,331		$	407,349		(4)	$	292,786

(2)	Represents foreign currency fluctuations and purchase price allocation adjustments.

(3)	Includes $131.4 million of land and building cost reflected in real estate held for sale at December 31, 2017. Excludes intangible lease assets that are included in real estate held for sale of $15.8 million at December 31, 2017.

(4)	Includes $0.5 million of accumulated depreciation reflected in real estate held for sale at December 31, 2017. Excludes accumulated amortization related to intangible lease assets that are included in real estate held for sale of $0.1 million at December 31, 2017.

SCHEDULE IV - MORTGAGE LOANS ON REAL ESTATE

12 Months Ended

Dec. 31, 2018

Mortgage Loans On Real Estate [Abstract]

SCHEDULE IV - MORTGAGE LOANS ON REAL ESTATE

SCHEDULE IV — MORTGAGE LOANS ON REAL ESTATE

MEDICAL PROPERTIES TRUST, INC. AND MPT OPERATING PARTNERSHIP, L.P.

Column A	Column B			Column C	Column D	Column E			Column F		Column G(3)		Column H
Description	Interest Rate			Final Maturity Date	Periodic Payment Terms	Prior Liens			Face Amount of Mortgages		Carrying Amount of Mortgages		Principal Amount of Loans Subject to Delinquent Principal or Interest
	(Dollar amounts in thousands)
Long-term first mortgage loan:					Payable in monthly installments of interest plus principal payable in full at maturity
Desert Valley Hospital		11.0	%	2022			(1	)	$	70,000	$	70,000		(2	)
Desert Valley Hospital		12.2	%	2022			(1	)		20,000		20,000		(2	)
Desert Valley Hospital		11.0	%	2020			(1	)		12,500		12,500		(2	)
Chino Valley Medical Center		11.0	%	2022			(1	)		50,000		50,000		(2	)
Paradise Valley Hospital		11.0	%	2022			(1	)		25,000		25,000		(2	)
Ernest Mortgage Loan(4)		10.0	%	2032			(1	)		115,000		115,000		(2	)
Centinela Hospital Medical Center		11.6	%	2022			(1	)		100,000		100,000		(2	)
Olympia Medical Center		10.7	%	2024			(1	)		25,000		25,000		(2	)
St. Joseph Medical Center		9.0	%	2025			(1	)		30,000		30,000		(2	)
St. Mary’s Medical Center		9.0	%	2025			(1	)		10,000		10,000		(2	)
Lake Huron Medical Center		9.0	%	2020			(1	)		10,000		10,000		(2	)
Steward Mortgage Loan(6)		7.5	%	2031			(1	)		727,508		727,508		(2	)
Vibra Mortgage Loan		11.5	%	2024			(1	)		18,275		18,275		(2	)
									$	1,213,283	$	1,213,283		(5	)

(1)	There were no prior liens on loans as of December 31, 2018.

(2)	The mortgage loan was not delinquent with respect to principal or interest.

(3)	The aggregate cost for federal income tax purposes is $1,213,283.

(4)	Mortgage loans covering four properties in two tranches. Interest rate is weighted average of both tranches.

(5)	Excludes unamortized loan issue costs of $0.04 million at December 31, 2018.

(6)	Mortgage loans covering two properties.

Changes in mortgage loans (excluding unamortized loan issue costs) for the years ended December 31, 2018, 2017, and 2016 are summarized as follows:

	Year Ended December 31,
	2018			2017		2016
	(Dollar amounts in thousands)
Balance at beginning of year	$	1,778,264		$	1,060,336	$	757,500
Additions during year:
New mortgage loans and additional advances on existing loans		50,783			717,928		612,836
		1,829,047			1,778,264		1,370,336
Deductions during year:
Collection of principal		(615,764	)		—		(310,000	)
		(615,764	)		—		(310,000	)
Balance at end of year	$	1,213,283		$	1,778,264	$	1,060,336

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2018

Accounting Policies [Abstract]

Use of Estimates

Principles of Consolidation

VIE

Type

Maximum Loss

Exposure(1)

Asset Type

Classification

Carrying

Amount(2)

Equity investments

17,187

Other assets

—

(1)	Our maximum loss exposure related to our equity investment in VIEs represent the current carrying values of such investment plus any other related assets (such as rent receivables) less any liabilities.

(2)	Carrying amount reflects the net book value of our equity interest only in the VIE.

Investments in Unconsolidated Entities

Cash and Cash Equivalents

Revenue Recognition

Acquired Real Estate Purchase Price Allocation

Real Estate and Depreciation

Buildings and improvements		39.2 years
Tenant lease intangibles		26.0 years
Leasehold improvements		16.4 years
Furniture, equipment and other		9.8 years

Losses from Rent Receivables

Loans

Earnings Per Share/Units

Income Taxes

Stock-Based Compensation

Deferred Costs

Deferred Financing Costs

Foreign Currency Translation and Transactions

Derivative Financial Investments and Hedging Activities

Fair Value Measurement

•

Level 1 — quoted prices for identical instruments in active markets;

•

Level 3 — fair value measurements derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable.

Reclassification

Reclassifications: Certain amounts in the consolidated financial statements for prior periods have been reclassified to conform to the current period presentation.

Recent Accounting Developments

Recent Accounting Developments:

Leases

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2018

Accounting Policies [Abstract]

Carrying Value and Classification of Related Assets and Maximum Exposure to Loss

The carrying value and classification of the related assets and maximum exposure to loss as a result of our involvement with these VIEs are presented below at December 31, 2018 (in thousands):

VIE

Type

Maximum Loss

Exposure(1)

Asset Type

Classification

Carrying

Amount(2)

Equity investments

17,187

Other assets

—

(1)	Our maximum loss exposure related to our equity investment in VIEs represent the current carrying values of such investment plus any other related assets (such as rent receivables) less any liabilities.

(2)	Carrying amount reflects the net book value of our equity interest only in the VIE.

Estimated Useful Lives of Related Real Estate and Other Assets

Buildings and improvements		39.2 years
Tenant lease intangibles		26.0 years
Leasehold improvements		16.4 years
Furniture, equipment and other		9.8 years

- Definition

Tabular disclosure of the significant judgments and assumptions made in determining whether a variable interest (as defined) held by the entity requires the variable interest entity (VIE) (as defined) to be consolidated and (or) disclose information about its involvement with the VIE, individually or in aggregate (as applicable); the nature of restrictions, if any, on the consolidated VIE's assets and on the settlement of its liabilities reported by an entity in its statement of financial position, including the carrying amounts of such assets and liabilities; the nature of, and changes in, the risks associated with involvement in the VIE; how involvement with the VIE affects the entity's financial position, financial performance, and cash flows; the lack of recourse if creditors (or beneficial interest holders) of the consolidated VIE have no recourse to the general credit of the primary beneficiary (if applicable); the terms of arrangements, giving consideration to both explicit arrangements and implicit variable interests, if any, that could require the entity to provide financial support to the VIE, including events or circumstances that could expose the entity to a loss; the methodology used by the entity for determining whether or not it is the primary beneficiary of the variable interest entity; the significant factors considered and judgments made in determining that the power to direct the activities of a VIE that most significantly impact the VIE's economic performance are shared (as defined); the carrying amounts and classification of assets and liabilities of the VIE included in the statement of financial position; the entity's maximum exposure to loss, if any, as a result of its involvement with the VIE, including how the maximum exposure is determined and significant sources of the entity's exposure to the VIE; a comparison of the carrying amounts of the assets and liabilities and the entity's maximum exposure to loss; information about any liquidity arrangements, guarantees, and (or) other commitments by third parties that may affect the fair value or risk of the entity's variable interest in the VIE; whether or not the entity has provided financial support or other support (explicitly or implicitly) to the VIE that it was not previously contractually required to provide or whether the entity intends to provide that support, including the type and amount of the support and the primary reasons for providing the support; and supplemental information the entity determines necessary to provide.

+ References + Details

Real Estate Activities (Tables)

12 Months Ended

Dec. 31, 2018

Schedule of Revenue by Operator

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Schedule of Revenue from External Customers by Geographic Areas

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Assets Acquired

For the years ended December 31, 2018, 2017, and 2016, we acquired the following assets:

	2018			2017			2016
	(in thousands)
Assets Acquired
Land	$	71,880		$	240,993		$	91,071
Building		686,739			985,219			655,324
Intangible lease assets — subject to amortization (weighted average useful life of 27.9 years in 2018, 27.7 years in 2017, and 28.5 years in 2016)		90,651			181,004			94,167
Net investments in direct financing leases		—			40,450			178,000
Mortgage loans		—			700,000			600,000
Other loans		336,458			—			—
Equity investments and other assets		245,267			100,000			70,166
Liabilities assumed		—			(878	)		(6,319	)
Total assets acquired	$	1,430,995		$	2,246,788		$	1,682,409
Loans repaid(1)		(764,447	)		—			(193,262	)
Total net assets acquired	$	666,548		$	2,246,788		$	1,489,147

(1)

(2)	In 2018, LifePoint Health, Inc. (“LifePoint”) merged with RCCH, who acquired Capella Healthcare, Inc. (“Capella”) in 2016. Any reference to either LifePoint, RCCH, or Capella represent the same entity.

Summary of Status on Current Development Projects

See table below for a status summary of our current development projects (in thousands):

Property	Commitment		Costs Incurred as of December 31, 2018		Estimated Rent Commencement Date
Circle Health (Birmingham, England)	$	43,288	$	28,881	2Q 2019
Circle Health Rehabilitation (Birmingham, England)		21,505		9,081	3Q 2019
Surgery Partners (Idaho Falls, Idaho)		113,468		46,210	1Q 2020
	$	178,261	$	84,172

Amortization Expense from Existing Lease Intangible Assets

For the Year Ended December 31:
2019	$	16,687
2020		16,507
2021		16,493
2022		16,479
2023		16,413

Components of Net Investment in Direct Financing Leases

The components of our net investment in DFLs consisted of the following (in thousands):

	As of December 31, 2018			As of December 31, 2017
Minimum lease payments receivable	$	2,091,504		$	2,294,081
Estimated residual values		424,719			448,339
Less unearned income		(1,832,170	)		(2,043,693	)
Net investment in direct financing leases	$	684,053		$	698,727

Minimum Rental Payments Due over the Remaining Lease Term under Operating Leases

Minimum rental payments due to us over the remaining lease term under operating leases and DFLs at December 31, 2018, are as follows (amounts in thousands):

	Total Under Operating Leases		Total Under DFLs		Total
2019	$	433,542	$	64,971	$	498,513
2020		437,025		66,270		503,295
2021		445,598		67,595		513,193
2022		450,592		68,947		519,539
2023		457,732		70,326		528,058
Thereafter		9,612,430		1,544,035		11,156,465
	$	11,836,919	$	1,882,144	$	13,719,063

Summary of Loans

The following is a summary of our loans ($ amounts in thousands):

	As of December 31, 2018					As of December 31, 2017
	Balance		Weighted Average Interest Rate			Balance		Weighted Average Interest Rate
Mortgage loans	$	1,213,322		8.8	%	$	1,778,316		8.3	%
Acquisition loans		3,454		10.8	%		118,448		13.8	%
Working capital and other loans		369,744		5.4	%		31,760		7.6	%
	$	1,586,520				$	1,928,524

2018 [Member]

Summary of Operations for Disposed Assets

	For the Year Ended December 31,
	2018			2017			2016
Revenues	$	88,838		$	132,039		$	109,544
Real estate depreciation and amortization		(15,849	)		(31,870	)		(26,410	)
Property-related expenses		(531	)		(404	)		(45	)
Other income (expense) (1)		709,717			(14,168	)		(23,937	)
Income from real estate dispositions, net	$	782,175		$	85,597		$	59,152

(1)

Includes approximately $720 million of gains on sale for the twelve months ended December 31, 2018.

2016 [Member]

Summary of Operations for Disposed Assets

	For the Year Ended December 31, 2016
Revenues	$	8,350
Real estate depreciation and amortization		(2,870	)
Property-related expenses		(113	)
Other income(1)		60,283
Income from real estate dispositions, net	$	65,650

(1)

Includes approximately $60 million of net gains on sale for the year ended December 31, 2016.

Debt (Tables)

12 Months Ended

Dec. 31, 2018

Debt Disclosure [Abstract]

Summary of Debt

The following is a summary of debt ($ amounts in thousands):

	As of December 31, 2018			As of December 31, 2017
Revolving credit facility(A)	$	28,059		$	840,810
Term loans		200,000			200,000
4.000% Senior Unsecured Notes due 2022(B)		573,350			600,250
5.500% Senior Unsecured Notes due 2024		300,000			300,000
6.375% Senior Unsecured Notes due 2024		500,000			500,000
3.325% Senior Unsecured Notes due 2025(B)		573,350			600,250
5.250% Senior Unsecured Notes due 2026		500,000			500,000
5.000% Senior Unsecured Notes due 2027		1,400,000			1,400,000
	$	4,074,759		$	4,941,310
Debt issue costs, net		(37,370	)		(42,643	)
	$	4,037,389		$	4,898,667

(A)	Includes £22 million and £8 million of GBP-denominated borrowings that reflect the exchange rate at December 31, 2018 and December 31, 2017, respectively.

(B)	These notes are Euro-denominated and reflect the exchange rate at December 31, 2018 and December 31, 2017, respectively.

Principal Payments Due on Debt

As of December 31, 2018, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows ($ amounts in thousands):

2019	$	—
2020		—
2021		28,059
2022		773,350
2023		—
Thereafter		3,273,350
Total	$	4,074,759

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2018

Income Tax Disclosure [Abstract]

Schedule of Income Tax Expense (Benefit)

From our TRS and our foreign operations, income tax expense (benefit) were as follows (in thousands):

	For the Years Ended December 31,
	2018			2017			2016
Current income tax (benefit) expense:
Domestic	$	(125	)	$	(41	)	$	42
Foreign		3,294			3,062			1,856
		3,169			3,021			1,898
Deferred income tax (benefit) expense:
Domestic		(3,713	)		(233	)		147
Foreign		1,471			(107	)		(8,875	)
		(2,242	)		(340	)		(8,728	)
Income tax expense (benefit)	$	927		$	2,681		$	(6,830	)

Summary of Reconciliation of the Income Tax Expense (Benefit) at the Statutory Income Tax Rate and the Effective Tax Rate for Income before Income Taxes

	2018			2017			2016
Income before income tax	$	1,019,404		$	293,919		$	219,107
Income tax at the U.S. statutory federal rate (21% in 2018 and 35% in 2017 and 2016)		214,075			102,872			76,687
Increase (decrease) resulting from:
Foreign rate differential		(2,643	)		(2,326	)		1,434
State income taxes, net of federal benefit		379			—			66
U.S. earnings not subject to federal income tax		(208,472	)		(98,026	)		(84,927	)
Equity investments		(46	)		3,293			4,297
Change in valuation allowance		(2,668	)		(5,391	)		(6,104	)
Other items, net		302			2,259			1,717
Total income tax expense (benefit)	$	927		$	2,681		$	(6,830	)

Schedule of Deferred Tax Assets and Liabilities

At December 31, 2018 and 2017, components of our deferred tax assets and liabilities were as follows (in thousands):

	2018			2017
Deferred tax assets:
Operating loss and interest deduction carry forwards	$	21,984		$	24,580
Other		277			504
Total deferred tax assets		22,261			25,084
Valuation allowance		(3,444	)		(11,101	)
Total net deferred tax assets	$	18,817		$	13,983
Deferred tax liabilities:
Property and equipment	$	(12,359	)	$	(4,336	)
Net unbilled revenue		(1,633	)		(6,113	)
Partnership investments		—			(2,099	)
Other		(300	)		(1,320	)
Total deferred tax liabilities		(14,292	)		(13,868	)
Net deferred tax asset (liability)	$	4,525		$	115

Schedule of Per Share Distributions to Stockholders

A schedule of per share distributions we paid and reported to our stockholders is set forth in the following:

	For the Years Ended December 31,
	2018		2017		2016
Common share distribution	$	0.990000	$	0.950000	$	0.900000
Ordinary income		0.438792		0.655535		0.619368
Capital gains(1)		0.551208		0.021022		0.102552
Unrecaptured Sec. 1250 gain		0.132280		0.004647		0.045432
Section 19A Dividends		0.438792		—		—
Return of capital		—		0.273443		0.178080

(1)	Capital gains include unrecaptured Sec. 1250 gains.

Earnings Per Share/Unit (Tables)

12 Months Ended

Dec. 31, 2018

Earnings Per Share [Abstract]

Calculation of Earnings Per Share

Medical Properties Trust, Inc.

Our earnings per share were calculated based on the following (amounts in thousands):

	For the Years Ended December 31,
	2018			2017			2016
Numerator:
Net income	$	1,018,477		$	291,238		$	225,937
Non-controlling interests’ share in earnings		(1,792	)		(1,445	)		(889	)
Participating securities’ share in earnings		(3,685	)		(1,409	)		(559	)
Net income, less participating securities’ share in earnings	$	1,013,000		$	288,384		$	224,489
Denominator:
Basic weighted average common shares		365,364			349,902			260,414
Dilutive potential common shares		907			539			658
Diluted weighted average common shares		366,271			350,441			261,072

MPT Operating Partnership, L.P.

Our earnings per unit were calculated based on the following (amounts in thousands):

	For the Years Ended December 31,
	2018			2017			2016
Numerator:
Net income	$	1,018,477		$	291,238		$	225,937
Non-controlling interests’ share in earnings		(1,792	)		(1,445	)		(889	)
Participating securities’ share in earnings		(3,685	)		(1,409	)		(559	)
Net income, less participating securities’ share in earnings	$	1,013,000		$	288,384		$	224,489
Denominator:
Basic weighted average units		365,364			349,902			260,414
Dilutive potential units		907			539			658
Diluted weighted average units		366,271			350,441			261,072

Stock Awards (Tables)

12 Months Ended

Dec. 31, 2018

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Restricted Equity Awards Activity

The following summarizes restricted equity award activity in 2018 and 2017 (which includes awards granted in 2018, 2017, 2016, and any applicable prior years), respectively:

For the Year Ended December 31, 2018:

	Vesting Based on Service					Vesting Based on Market/Performance Conditions
	Shares			Weighted Average Value at Award Date		Shares			Weighted Average Value at Award Date
Nonvested awards at beginning of the year		276,280		$	12.68		2,676,755		$	7.86
Awarded		958,480		$	14.31		1,750,834		$	11.61
Vested		(307,275	)	$	12.92		(288,404	)	$	11.25
Forfeited		(3,637	)	$	13.05		(5,750	)	$	9.35
Nonvested awards at end of year		923,848		$	14.29		4,133,435		$	9.21

For the Year Ended December 31, 2017:

	Vesting Based on Service					Vesting Based on Market/Performance Conditions
	Shares			Weighted Average Value at Award Date		Shares			Weighted Average Value at Award Date
Nonvested awards at beginning of the year		347,128		$	13.35		1,811,675		$	6.78
Awarded		249,841		$	12.40		1,741,003		$	8.21
Vested		(304,613	)	$	12.86		(491,071	)	$	6.84
Forfeited		(16,076	)	$	12.75		(384,852	)	$	5.65
Nonvested awards at end of year		276,280		$	12.68		2,676,755		$	7.86

Commitments and Contingencies (Tables)

12 Months Ended

Dec. 31, 2018

Commitments And Contingencies Disclosure [Abstract]

Fixed Minimum Rental Payable under Operating Leases Sublease Receivable And Net Payments Due with Non-cancelable Terms

	Fixed minimum payments		Amounts to be received from subleases			Net payments
2019	$	6,602	$	(3,284	)	$	3,318
2020		6,903		(3,458	)		3,445
2021		6,841		(3,551	)		3,290
2022		6,838		(3,632	)		3,206
2023		6,861		(3,636	)		3,225
Thereafter		198,932		(93,586	)		105,346	(1)
	$	232,977	$	(111,147	)	$	121,830

(1)

Fair Value of Financial Instruments (Tables)

12 Months Ended

Dec. 31, 2018

Fair Value Disclosures [Abstract]

Summary of Fair Value Information of Financial Instruments

The following table summarizes fair value estimates for our financial instruments (in thousands):

	December 31, 2018						December 31, 2017
Asset (Liability)	Book Value			Fair Value			Book Value			Fair Value
Interest and rent receivables	$	25,855		$	24,942		$	78,970		$	78,028
Loans(1)		1,471,520			1,490,758			1,698,471			1,722,101
Debt, net		(4,037,389	)		(3,947,795	)		(4,898,667	)		(5,073,707	)

(1)	Excludes loans to Ernest that are recorded at fair value – see below for further details.

Equity Interest in Related Party and Related Loans Measured at Fair Value on Recurring Basis

At December 31, 2018 and 2017, the amounts recorded under the fair value option method were as follows (in thousands):

	As of December 31, 2018				As of December 31, 2017				Asset Type
Asset (Liability)	Fair Value		Original Cost		Fair Value		Original Cost		Classification
Mortgage loans	$	115,000	$	115,000	$	115,000	$	115,000	Mortgage loans
Equity investment and other loans		—		—		114,554		118,354	Other loans/other assets
	$	115,000	$	115,000	$	229,554	$	233,354

Other Assets (Tables)

12 Months Ended

Dec. 31, 2018

Deferred Costs Capitalized Prepaid And Other Assets Disclosure [Abstract]

Summary of Other Assets

The following is a summary of our other assets (in thousands):

	At December 31,
	2018		2017
Debt issue costs, net(1)	$	4,793	$	7,093
Equity investments		520,058		288,398
Other corporate assets		115,416		117,827
Prepaids and other assets		61,757		55,176
Total other assets	$	702,024	$	468,494

(1)

Relates to revolving credit facility

Summary of Financial Information for Investees

	2018
Revenue	$	42,526
Net income	$	6,009

Assets	$	2,018,496
Liabilities	$	1,553,191

Quarterly Financial Data (unaudited) (Tables)

12 Months Ended

Dec. 31, 2018

Medical Properties Trust, Inc. [Member]

Unaudited Quarterly Financial Information

The following is a summary of the unaudited quarterly financial information for the years ended December 31, 2018 and 2017: (amounts in thousands, except for per share data)

	For the Three Month Periods in 2018 Ended
	March 31		June 30		September 30		December 31
Revenues	$	205,046	$	201,902	$	196,996	$	180,578
Net income		91,043		112,017		736,476		78,941
Net income attributable to MPT common stockholders		90,601		111,567		736,034		78,483
Net income attributable to MPT common stockholders per share — basic	$	0.25	$	0.30	$	2.01	$	0.21
Weighted average shares outstanding — basic		364,882		364,897		365,024		366,655
Net income attributable to MPT common stockholders per share — diluted	$	0.25	$	0.30	$	2.00	$	0.21
Weighted average shares outstanding — diluted		365,343		365,541		366,467		367,732

	For the Three Month Periods in 2017 Ended
	March 31		June 30		September 30		December 31
Revenues	$	156,397	$	166,807	$	176,580	$	204,961
Net income		68,185		73,796		76,881		72,376
Net income attributable to MPT common stockholders		67,970		73,415		76,464		71,944
Net income attributable to MPT common stockholders per share — basic	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average shares outstanding — basic		321,057		349,856		364,315		364,382
Net income attributable to MPT common stockholders per share —diluted	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average shares outstanding — diluted		321,423		350,319		365,046		364,977

MPT Operating Partnership, L.P. [Member]

Unaudited Quarterly Financial Information

The following is a summary of the unaudited quarterly financial information for the years ended December 31, 2018 and 2017: (amounts in thousands, except for per unit data)

	For the Three Month Periods in 2018 Ended
	March 31		June 30		September 30		December 31
Revenues	$	205,046	$	201,902	$	196,996	$	180,578
Net income		91,043		112,017		736,476		78,941
Net income attributable to MPT Operating Partnership partners		90,601		111,567		736,034		78,483
Net income attributable to MPT Operating Partnership partners per unit — basic	$	0.25	$	0.30	$	2.01	$	0.21
Weighted average units outstanding — basic		364,882		364,897		365,024		366,655
Net income attributable to MPT Operating Partnership partners per unit — diluted	$	0.25	$	0.30	$	2.00	$	0.21
Weighted average units outstanding — diluted		365,343		365,541		366,467		367,732

	For the Three Month Periods in 2017 Ended
	March 31		June 30		September 30		December 31
Revenues	$	156,397	$	166,807	$	176,580	$	204,961
Net income		68,185		73,796		76,881		72,376
Net income attributable to MPT Operating Partnership partners		67,970		73,415		76,464		71,944
Net income attributable to MPT Operating Partnership partners per unit — basic	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average units outstanding — basic		321,057		349,856		364,315		364,382
Net income attributable to MPT Operating Partnership partners per unit — diluted	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average units outstanding — diluted		321,423		350,319		365,046		364,977

Summary of Significant Accounting Policies - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Significant Accounting Policies [Line Items]
Threshold ownership percentage for inter company balances and transactions elimination	100.00%
Cumulative effect of change in accounting principles	$ 1,938
Expected lease-up periods for estimating lost rentals, in months	6 months
Percentage of ordinary taxable income to be distributed for real estate investment trust qualification	90.00%	90.00%	90.00%
Number of years of federal income tax at corporate rates on failure to qualify as REIT	4 years
Minimum [Member]
Significant Accounting Policies [Line Items]
Operating lease, right-of-use asset	$ 80,000
Operating lease, liability	$ 80,000
Maximum [Member]
Significant Accounting Policies [Line Items]
Stock award vesting period in years	10 years
Operating lease, right-of-use asset	$ 90,000
Operating lease, liability	$ 90,000
Time-Based Awards [Member]
Significant Accounting Policies [Line Items]
Stock award vesting period in years	3 years
Market Conditions Based Awards [Member] \| Minimum [Member]
Significant Accounting Policies [Line Items]
Stock award vesting period in years	3 years
Market Conditions Based Awards [Member] \| Maximum [Member]
Significant Accounting Policies [Line Items]
Stock award vesting period in years	5 years
Accounting Standards Update 2014-09 [Member]
Significant Accounting Policies [Line Items]
Cumulative effect of change in accounting principles	$ 2,000

Summary of Significant Accounting Policies - Carrying Value and Classification of Related Assets and Maximum Exposure to Loss (Detail)	Dec. 31, 2018 USD ($)
Equity investments [Member]
Variable Interest Entity [Line Items]
Maximum Loss Exposure	$ 17,187,000

Summary of Significant Accounting Policies - Estimated Useful Lives of Related Real Estate and Other Assets (Detail)	12 Months Ended
	Dec. 31, 2018
Buildings and improvements [Member]
Property, Plant and Equipment [Line Items]
Weighted average useful lives of related real estate and other assets	39 years 2 months 12 days
Tenant lease intangibles [Member]
Property, Plant and Equipment [Line Items]
Weighted average useful lives of related real estate and other assets	26 years
Leasehold improvements [Member]
Property, Plant and Equipment [Line Items]
Weighted average useful lives of related real estate and other assets	16 years 4 months 24 days
Furniture, equipment and other [Member]
Property, Plant and Equipment [Line Items]
Weighted average useful lives of related real estate and other assets	9 years 9 months 18 days

Real Estate Activities - Assets Acquired (Detail) - USD ($)
$ in Thousands

Dec. 31, 2018

Dec. 31, 2017

Dec. 31, 2016

Business Acquisition [Line Items]

Total assets acquired

$ 1,430,995

$ 2,246,788

$ 1,682,409

Equity investments and other assets

245,267

100,000

70,166

Liabilities assumed

(878)

(6,319)

Loans repaid

^[1]

(764,447)

(193,262)

Total net assets acquired

666,548

2,246,788

1,489,147

Land [Member]

Business Acquisition [Line Items]

Total assets acquired

71,880

240,993

91,071

Building [Member]

Business Acquisition [Line Items]

Total assets acquired

686,739

985,219

655,324

Intangible Lease Assets - Subject to Amortization [Member]

Business Acquisition [Line Items]

Total assets acquired

90,651

181,004

94,167

Net Investments in Direct Financing Leases [Member]

Business Acquisition [Line Items]

Total assets acquired

40,450

178,000

Mortgage Loans [Member]

Business Acquisition [Line Items]

Total assets acquired

$ 700,000

$ 600,000

Other Loans [Member]

Business Acquisition [Line Items]

Total assets acquired

$ 336,458

[1]

The 2018 column includes $0.8 billion of loans advanced to Steward in 2016 and repaid in 2018 as part of sale leaseback conversion described below. The 2016 column includes $93.3 million of loans advanced to Capella(2) in 2015 and repaid in 2016 as a part of the Capella transaction (2), along with $100.0 million of loans advanced to Prime Healthcare Services, Inc. (“Prime”) in 2015 and repaid in 2016 as part of the sale leaseback conversion of four properties in New Jersey.

Real Estate Activities - Assets Acquired (Parenthetical) (Detail)
$ in Thousands

12 Months Ended

Dec. 31, 2018

USD ($)

Dec. 31, 2017

Hospital

Dec. 31, 2016

USD ($)

Business Acquisition [Line Items]

Weighted average useful life of acquired intangible lease assets (in years)

26 years

Loans repaid

^[1]

$ 764,447

$ 193,262

Number of sale leaseback conversion properties | Hospital

Steward [Member]

Business Acquisition [Line Items]

Loans repaid

$ 800,000

Capella [Member]

Business Acquisition [Line Items]

Loans repaid

93,300

Prime Healthcare Services, Inc [Member]

Business Acquisition [Line Items]

Loans repaid

$ 100,000

Intangible Lease Assets - Subject to Amortization [Member]

Business Acquisition [Line Items]

Weighted average useful life of acquired intangible lease assets (in years)

27 years 10 months 24 days

27 years 8 months 12 days

28 years 6 months

[1]

The 2018 column includes $0.8 billion of loans advanced to Steward in 2016 and repaid in 2018 as part of sale leaseback conversion described below. The 2016 column includes $93.3 million of loans advanced to Capella(2) in 2015 and repaid in 2016 as a part of the Capella transaction (2), along with $100.0 million of loans advanced to Prime Healthcare Services, Inc. (“Prime”) in 2015 and repaid in 2016 as part of the sale leaseback conversion of four properties in New Jersey.

Real Estate Activities - 2018 Activity - Additional Information (Detail) $ in Thousands, € in Millions				1 Months Ended					3 Months Ended	12 Months Ended
	Aug. 31, 2018 USD ($)	Aug. 28, 2018 EUR (€) Hospital	Mar. 31, 2017 USD ($)	Aug. 31, 2018 USD ($) Hospital	Aug. 31, 2018 EUR (€) Hospital	Jun. 30, 2018 EUR (€) Hospital	Mar. 31, 2018 USD ($)	Oct. 31, 2016 USD ($) RenewalOption	Dec. 31, 2018 EUR (€) Hospital	Dec. 31, 2018 USD ($) Hospital	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)
Business Acquisition [Line Items]
Ownership interest in joint venture under the equity method value included in other assets \| $										$ 520,058	$ 288,398
Gain on sale of real estate \| $			$ 7,400
Mortgage financing \| $										$ 50,783	$ 717,928	$ 612,836
Germany [Member] \| Rehabilitation Hospital with Covenant Health System [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital										3
Primotop Holdings S.a.r.l. [Member] \| Germany [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Gain on sale of real estate \| $	$ 500
2018 [Member] \| General Acute Care Hospital and Healthcare System [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital										5
Term of lease								15 years
Mortgage financing \| $							$ 764,400	$ 764,400
Number of lease extension options \| RenewalOption								3
Term of lease extension, years								5 years
2018 [Member] \| Germany [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Ownership interest in joint venture under the equity method					50.00%
Ownership interest in joint venture under the equity method value included in other assets \| €					€ 210.0
Shareholder loan to joint venture \| €					290.0
Gain on sale of real estate					500.0					$ 720,000
2018 [Member] \| Germany [Member] \| Rehabilitation Hospital with Covenant Health System [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital		3				4			4
Purchase price of acquisition \| €		€ 17.3				€ 23.0			€ 23.0
2018 [Member] \| Germany [Member] \| Rehabilitation Hospital with Covenant Health System [Member] \| MEDIAN [Member]
Business Acquisition [Line Items]
Term of lease		27 years
Lease rent increase percentage		70.00%
Lease rate		1.00%
2018 [Member] \| Germany [Member] \| Fair Value [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Aggregate fair value of ownership interest \| €					€ 1,635.0
2018 [Member] \| Pasco, Washington [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| $				$ 17,500
2018 [Member] \| Massachusetts [Member] \| General Acute Care Hospital and Healthcare System [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital										4
2018 [Member] \| Texas [Member] \| General Acute Care Hospital and Healthcare System [Member] \| Steward Health Care System LLC [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital										1
2018 [Member] \| Primotop Holdings S.a.r.l. [Member] \| Germany [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Ownership interest in joint venture under the equity method					50.00%
Number of facilities acquired \| Hospital				71	71
Proceeds from joint venture \| €					€ 1,140.0

Real Estate Activities - 2017 Activity - Additional Information (Detail) $ in Thousands, € in Millions						1 Months Ended			3 Months Ended		5 Months Ended	12 Months Ended
	Nov. 29, 2017 EUR (€) Hospital	Sep. 29, 2017 USD ($) Hospital Health_Center	Jun. 22, 2017 EUR (€)	Jun. 01, 2017 USD ($) RenewalOption Bed	May 01, 2017 USD ($) Hospital Bed	Jan. 30, 2017 EUR (€)	Dec. 31, 2016 EUR (€) Property	Jul. 31, 2016 EUR (€) Hospital	Sep. 30, 2017 EUR (€) Hospital	Jun. 30, 2017 EUR (€) Hospital	Jan. 30, 2017 EUR (€) Hospital	Dec. 31, 2018 USD ($) Hospital	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)
Business Acquisition [Line Items]
Amount of mortgage loan \| $												$ 50,783	$ 717,928	$ 612,836
2017 [Member] \| Subsidiaries [Member]
Business Acquisition [Line Items]
Amount of mortgage loan \| $		$ 700,000
Number of mortgage facilities \| Hospital		2
Equity interest acquired \| $		$ 100,000										$ 210,000
Combined purchase price and investment amount \| $		1,500,000
2017 [Member] \| Subsidiaries [Member] \| IASIS Healthcare [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| $		$ 700,000
Acute Care Hospital [Member] \| 2017 [Member] \| Germany [Member] \| MEDIAN [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| €			€ 19.4
Lease agreement, end date			2042-12
Lease rate			1.00%
Lease rent increase percentage			70.00%
Purchase price of acquisition funded \| €			€ 18.6
Remaining payment period			4 years
Acute Care Hospital [Member] \| 2017 [Member] \| West Virginia and Ohio [Member] \| Alecto Healthcare Services [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| $				$ 40,000
Term of lease				15 years
Percentage of increase in annual rent				2.00%
Number of lease extension options \| RenewalOption				3
Term of lease extension, years				5 years
Ownership interest percentage in operator facility				20.00%
Acute Care Hospital [Member] \| 2017 [Member] \| IDAHO, Lewiston \| St. Joseph Regional Medical Center [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| $					$ 87,500
Number of beds acquired \| Bed					145
Acute Care Hospital [Member] \| 2017 [Member] \| IASIS Healthcare [Member]
Business Acquisition [Line Items]
Number of facilities closed \| Hospital		10
Acute Care Hospital [Member] \| 2017 [Member] \| Ohio Valley Medical Center [Member] \| Alecto Healthcare Services [Member]
Business Acquisition [Line Items]
Number of beds acquired \| Bed				218
Acute Care Hospital [Member] \| 2017 [Member] \| East Ohio Regional Hospital [Member] \| Alecto Healthcare Services [Member]
Business Acquisition [Line Items]
Number of beds acquired \| Bed				139
Acute Care Hospital [Member] \| 2017 [Member] \| Subsidiaries [Member] \| IASIS Healthcare [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital		8
Behavioral Health Care Facility [Member] \| 2017 [Member] \| IASIS Healthcare [Member]
Business Acquisition [Line Items]
Number of facilities closed \| Health_Center		1
Behavioral Health Care Facility [Member] \| 2017 [Member] \| Subsidiaries [Member] \| IASIS Healthcare [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Health_Center		1
Community Health Systems, Inc. [Member] \| 2017 [Member] \| Florida, Ohio, and Pennsylvania [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital					8
Purchase price of acquisition \| $					$ 301,300
Rehabilitation Hospital with Covenant Health System [Member] \| Germany [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital												3
Rehabilitation Hospital with Covenant Health System [Member] \| 2017 [Member] \| Germany [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital											6
Purchase price of acquisition \| €						€ 8.4					€ 44.1
Rehabilitation Hospital with Covenant Health System [Member] \| 2017 [Member] \| Germany [Member] \| Third Master Lease [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital								20	2	11
Acquisition costs \| €								€ 215.7	€ 39.2	€ 127.0
Number of properties closed \| Property							7
Amount of properties closed \| €							€ 49.5
Rehabilitation Hospital with Covenant Health System [Member] \| 2017 [Member] \| Germany [Member] \| MEDIAN [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital	3
Acquisition costs \| €	€ 80.0
Term of lease	27 years
Lease agreement, end date	2044-11
Lease rate	1.00%
Lease rent increase percentage	70.00%

Real Estate Activities - 2016 Activity - Additional Information (Detail)
$ in Thousands, € in Millions

1 Months Ended

12 Months Ended

Oct. 21, 2016

USD ($)

Hospital

RenewalOption

Oct. 03, 2016

USD ($)

Hospital

RenewalOption

Facility

Jul. 22, 2016

USD ($)

May 02, 2016

USD ($)

Sep. 30, 2015

USD ($)

Dec. 31, 2018

USD ($)

Hospital

Dec. 31, 2017

USD ($)

Dec. 31, 2016

USD ($)

Hospital

Dec. 31, 2016

EUR (€)

Hospital

Jun. 22, 2016

EUR (€)

Business Acquisition [Line Items]

Loans repaid

^[1]

$ 764,447

$ 193,262

Mortgage financing

50,783

$ 717,928

612,836

Mortgage financing funded

$ 615,764

310,000

Capella [Member]

Business Acquisition [Line Items]

Loans repaid

$ 93,300

Rehabilitation Hospital with Covenant Health System [Member] | Germany [Member]

Business Acquisition [Line Items]

Number of facilities acquired | Hospital

2016 [Member] | Olympia, Washington [Member] | Capella [Member]

Business Acquisition [Line Items]

Cash paid for acquisition transaction

$ 7,000

Loans repaid

$ 93,300

2016 [Member] | New Jersey [Member] | Acute Care Hospital [Member]

Business Acquisition [Line Items]

Acquisition costs

$ 63,000

Commitment to advance an additional amount for capital additions

$ 30,000

Commitment period to advance an additional amount for capital additions

3 years

2016 [Member] | Rehabilitation Hospital with Covenant Health System [Member] | Germany [Member]

Business Acquisition [Line Items]

Number of facilities acquired | Hospital

Acquisition costs | €

€ 85.2

2016 [Member] | General Acute Care Hospital and Healthcare System [Member]

Business Acquisition [Line Items]

Term of lease, years

15 years

Number of lease extension options | RenewalOption

Number of facilities acquired | Hospital

Lease agreement, end date

2031-05

Number of free-standing emergency department and health center | Hospital

Mortgage financing

$ 100,000

Mortgage financing funded

$ 15,000

2016 [Member] | 2015 Master Lease [Member] | Rehabilitation Hospital with Covenant Health System [Member] | Germany [Member]

Business Acquisition [Line Items]

Number of facilities acquired | Hospital

Acquisition costs | €

€ 35.6

2016 [Member] | Third Master Lease [Member] | Rehabilitation Hospital with Covenant Health System [Member] | Germany [Member]

Business Acquisition [Line Items]

Number of facilities acquired | Hospital

Acquisition costs | €

€ 49.5

Lease agreement, end date

2043-08

Term of lease

27 years

2016 [Member] | Steward [Member]

Business Acquisition [Line Items]

Number of hospitals closed | Hospital

Combined purchase price and investment amount

$ 1,250,000

Number of licensed hospitals | Hospital

Cash paid for acquisition transaction

$ 600,000

Loans repaid

600,000

Equity interest acquired

$ 50,000

Term of lease, years

15 years

Number of lease extension options | RenewalOption

Number of facilities for making mortgage loans | Facility

Lease expiration date

Oct. 31, 2031

2016 [Member] | MEDIAN [Member]

Business Acquisition [Line Items]

Value of properties closed | €

€ 41.6

[1]

The 2018 column includes $0.8 billion of loans advanced to Steward in 2016 and repaid in 2018 as part of sale leaseback conversion described below. The 2016 column includes $93.3 million of loans advanced to Capella(2) in 2015 and repaid in 2016 as a part of the Capella transaction (2), along with $100.0 million of loans advanced to Prime Healthcare Services, Inc. (“Prime”) in 2015 and repaid in 2016 as part of the sale leaseback conversion of four properties in New Jersey.

Real Estate Activities - Development Activities - Additional Information (Detail) € in Millions, £ in Millions, $ in Millions		1 Months Ended	12 Months Ended
	Dec. 19, 2017 USD ($)	Apr. 30, 2017 GBP (£)	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($) Facility	Dec. 31, 2017 EUR (€) Facility	Dec. 31, 2016 USD ($) Facility
Birmingham, England [Member]
Business Acquisition [Line Items]
Term of lease, years		15 years
Purchase price of acquisition \| £		£ 2.7
Total development costs anticipated \| £		£ 50.0
Acute Care Hospital [Member] \| Idaho Falls, ID [Member]
Business Acquisition [Line Items]
Estimated total development cost	$ 113.5
Development Activities [Member] \| Acute Care Facilities [Member]
Business Acquisition [Line Items]
Number of facilities constructed \| Facility						19
Acquisition costs						$ 136.6
Ernest [Member] \| Development Activities [Member]
Business Acquisition [Line Items]
Estimated total development cost			$ 25.5			$ 18.4
Adeptus Health [Member] \| Development Activities [Member] \| Acute Care Facilities [Member]
Business Acquisition [Line Items]
Number of facilities constructed \| Facility				4	4
Acquisition costs				$ 68.0
IMED [Member] \| Development Activities [Member] \| Acute Care Facilities [Member] \| Spain [Member]
Business Acquisition [Line Items]
Acquisition costs \| €					€ 21
Lessor direct financing lease description			Quarterly fixed rent payments that started on October 1, 2017 with annual increases of 1% beginning April 1, 2020.
Lease rent increase percentage				1.00%	1.00%
Ownership interests acquired				50.00%	50.00%
Term of lease, years				30 years	30 years

Real Estate Activities - Summary of Status on Current Development Projects (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2018 USD ($)
Business Acquisition [Line Items]
Commitment	$ 178,261
Costs Incurred as of December 31, 2018	84,172
Circle Health [Member] \| Birmingham, England [Member]
Business Acquisition [Line Items]
Commitment	43,288
Costs Incurred as of December 31, 2018	$ 28,881
Estimated Rent Commencement Date	2Q 2019
Circle Health Rehabilitation [Member] \| Birmingham, England [Member]
Business Acquisition [Line Items]
Commitment	$ 21,505
Costs Incurred as of December 31, 2018	$ 9,081
Estimated Rent Commencement Date	3Q 2019
Surgery Partners [Member] \| Idaho Falls, ID [Member]
Business Acquisition [Line Items]
Commitment	$ 113,468
Costs Incurred as of December 31, 2018	$ 46,210
Estimated Rent Commencement Date	1Q 2020

Real Estate Activities - Disposals - Additional Information (Detail) $ in Thousands, € in Millions							12 Months Ended
	Oct. 04, 2018 USD ($)	Aug. 31, 2018 USD ($) Hospital	Aug. 31, 2018 EUR (€) Hospital	Jun. 04, 2018 USD ($) Hospital	Mar. 01, 2018 USD ($)	Mar. 31, 2017 USD ($)	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)
Debt Instrument [Line Items]
Proceeds from sale of facilities						$ 64,000
Gain on real estate dispositions						7,400
Gain offset by non-cash charges						$ 600
Loans, Balance							$ 1,586,520	$ 1,928,524
Net proceeds from sale of real estate							1,513,666	64,362	$ 198,767
Working Capital Loans [Member]
Debt Instrument [Line Items]
Loans, Balance							369,744	31,760
Mortgage Loans [Member]
Debt Instrument [Line Items]
Loans, Balance							$ 1,213,322	$ 1,778,316
Houston, Texas [Member] \| Steward Health Care System LLC [Member] \| St. Joseph Medical Center [Member]
Debt Instrument [Line Items]
Gain on real estate dispositions					$ 1,500
Gain offset by non-cash charges					1,700
Net proceeds from sale of real estate					$ 148,000
Primotop Holdings S.a.r.l. [Member] \| Germany [Member] \| Acute Care Hospital [Member]
Debt Instrument [Line Items]
Proceeds from sale of facilities \| €			€ 1,635
Number of properties sold \| Hospital		71	71
Gain on real estate dispositions		$ 500
Ernest [Member]
Debt Instrument [Line Items]
Proceeds from sale of facilities	$ 176,000
North Cypress [Member] \| Houston, Texas [Member]
Debt Instrument [Line Items]
Proceeds from sale of facilities		148,000
Gain on real estate dispositions		102,400
Gain offset by non-cash charges		$ 2,500
North Cypress [Member] \| General Acute Care Hospital and Healthcare System [Member] \| Houston, Texas [Member]
Debt Instrument [Line Items]
Number of properties sold \| Hospital		1	1
Vibra Healthcare, LLC [Member] \| California, Texas, and Oregon [Member]
Debt Instrument [Line Items]
Proceeds from sale of facilities				$ 53,300
Gain on real estate dispositions				24,200
Gain offset by non-cash charges				5,100
Vibra Healthcare, LLC [Member] \| California, Texas, and Oregon [Member] \| Working Capital Loans [Member]
Debt Instrument [Line Items]
Loans, Balance				1,500
Vibra Healthcare, LLC [Member] \| California, Texas, and Oregon [Member] \| Mortgage Loans [Member]
Debt Instrument [Line Items]
Loans, Balance				$ 18,300
Vibra Healthcare, LLC [Member] \| California, Texas, and Oregon [Member] \| Long-term Acute Care Hospital [Member]
Debt Instrument [Line Items]
Number of properties sold \| Hospital				3

Real Estate Activities - Summary of Operations for Disposed Assets (Detail) - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2018

Dec. 31, 2017

Dec. 31, 2016

2018 [Member]

Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]

Revenues

$ 88,838

$ 132,039

$ 109,544

Real estate depreciation and amortization

(15,849)

(31,870)

(26,410)

Property-related expenses

(531)

(404)

(45)

Other income (expense)

^[1]

709,717

(14,168)

(23,937)

Income from real estate dispositions, net

$ 782,175

$ 85,597

59,152

2016 [Member]

Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]

Revenues

8,350

Real estate depreciation and amortization

(2,870)

Property-related expenses

(113)

Other income (expense)

^[2]

60,283

Income from real estate dispositions, net

$ 65,650

[1]	Includes approximately $720 million of gains on sale for the twelve months ended December 31, 2018.
[2]	Includes approximately $60 million of net gains on sale for the year ended December 31, 2016.

Real Estate Activities - Summary of Operations for Disposed Assets (Parenthetical) (Detail) € in Millions, $ in Millions		1 Months Ended	12 Months Ended
	Mar. 31, 2017 USD ($)	Aug. 31, 2018 EUR (€)	Dec. 31, 2018 USD ($)	Dec. 31, 2016 USD ($)
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Gain on sale of real estate	$ 7.4
2018 [Member] \| Germany [Member] \| Acute Care Hospital [Member]
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Gain on sale of real estate		€ 500	$ 720.0
2016 [Member]
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Gain on sale of real estate				$ 60.0

Real Estate Activities - Capella Transaction - Additional Information (Detail) $ in Thousands		12 Months Ended
	Apr. 30, 2016 USD ($) Hospital	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)
Business Acquisition [Line Items]
New loan for hospital property		$ 50,783	$ 717,928	$ 612,836
Capella [Member]
Business Acquisition [Line Items]
Net proceeds from transaction	$ 550,000
Net proceeds from equity investment and loans	492,000
Proceeds from prepayment of mortgage loans	210,000
New loan for hospital property	93,300
Investment on unsecured senior notes	50,000
Transaction costs incurred	$ 6,300
Number of hospital owned \| Hospital	5
Write off of unbilled direct finance lease rent				$ 2,600
Capella [Member] \| Master Lease [Member]
Business Acquisition [Line Items]
Term of lease, years	13 years 6 months
Capella [Member] \| Other Stand-Alone Lease [Member]
Business Acquisition [Line Items]
Term of lease, years	11 years 6 months

Real Estate Activities - Post Acute Transaction - Additional Information (Detail) $ in Millions	Mar. 31, 2017 USD ($)	Jun. 17, 2016 USD ($)	May 23, 2016 USD ($) Property
Business Acquisition [Line Items]
Proceeds from sale of real estate	$ 64.0
Gain on real estate dispositions	$ 7.4
Post Acute [Member]
Business Acquisition [Line Items]
Number of properties sold \| Property			5
Outstanding loans paid in full			$ 4.0
Proceeds from sale of real estate		$ 28.0	71.0
Gain on real estate dispositions			$ 15.0
Post Acute [Member] \| Texas [Member]
Business Acquisition [Line Items]
Number of properties sold \| Property			3
Post Acute [Member] \| Louisiana [Member]
Business Acquisition [Line Items]
Number of properties sold \| Property			2

Real Estate Activities - Corinth Transaction - Additional Information (Detail) - USD ($) $ in Millions	Mar. 31, 2017	Jun. 17, 2016	May 23, 2016
Proceeds from sale of real estate	$ 64.0
Gain offset by non-cash charges	$ 0.6
Post Acute [Member]
Proceeds from sale of real estate		$ 28.0	$ 71.0
Gain on sale of real estate		8.0
Post Acute [Member] \| Texas [Member]
Gain offset by non-cash charges		$ 9.0

Real Estate Activities - HealthSouth Transaction - Additional Information (Detail) $ in Millions	Mar. 31, 2017 USD ($)	Jul. 20, 2016 USD ($) Hospital
Proceeds from sale of facilities	$ 64.0
Gain on real estate dispositions	$ 7.4
Encompass Health [Member]
Proceeds from sale of facilities		$ 111.5
Gain on real estate dispositions		$ 45.0
Encompass Health [Member] \| Texas [Member]
Number of hospitals sold \| Hospital		3

Real Estate Activities - Intangible Assets - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Business Combinations [Abstract]
Intangible lease assets	$ 403,138	$ 443,134
Accumulated amortization, net	352,500	394,000
Amortization expense related to intangible lease assets	$ 17,600	$ 15,800	$ 13,400
Capitalized lease intangibles, weighted average life (in years)	26 years

Real Estate Activities - Amortization Expense from Existing Lease Intangible Assets (Detail) $ in Thousands	Dec. 31, 2018 USD ($)
Business Combinations [Abstract]
2019	$ 16,687
2020	16,507
2021	16,493
2022	16,479
2023	$ 16,413

Real Estate Activities - Leasing Operations - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2018 Lease
Alecto Healthcare Services [Member]
Business Acquisition [Line Items]
Number of direct financing leases	2
Ernest [Member]
Business Acquisition [Line Items]
Number of direct financing leases	15
Prime Facilities [Member]
Business Acquisition [Line Items]
Number of direct financing leases	10

Real Estate Activities - Components of Net Investment in Direct Financing Leases (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Business Combinations [Abstract]
Minimum lease payments receivable	$ 2,091,504	$ 2,294,081
Estimated residual values	424,719	448,339
Less unearned income	(1,832,170)	(2,043,693)
Net investment in direct financing leases	$ 684,053	$ 698,727

Real Estate Activities - Minimum Rental Payments Due over the Remaining Lease Term under Operating Leases (Detail) $ in Thousands	Dec. 31, 2018 USD ($)
Leases User Charges And Commitments [Line Items]
2019	$ 6,602
2020	6,903
2021	6,841
2022	6,838
2023	6,861
Thereafter	198,932
Minimum rental payments, total	232,977
Minimum [Member]
Leases User Charges And Commitments [Line Items]
2019	498,513
2020	503,295
2021	513,193
2022	519,539
2023	528,058
Thereafter	11,156,465
Minimum rental payments, total	13,719,063
Minimum [Member] \| Operating Leases [Member]
Leases User Charges And Commitments [Line Items]
2019	433,542
2020	437,025
2021	445,598
2022	450,592
2023	457,732
Thereafter	9,612,430
Minimum rental payments, total	11,836,919
Minimum [Member] \| Direct Financing Leases [Member]
Leases User Charges And Commitments [Line Items]
2019	64,971
2020	66,270
2021	67,595
2022	68,947
2023	70,326
Thereafter	1,544,035
Minimum rental payments, total	$ 1,882,144

Real Estate Activities - Adeptus Health - Additional Information (Detail) $ in Thousands						1 Months Ended		12 Months Ended
	Dec. 31, 2018 Property	Dec. 07, 2017 USD ($) Lease	Oct. 18, 2017 RenewalOption	Oct. 02, 2017 Facility	Mar. 31, 2017 USD ($)	Oct. 31, 2018 Facility	Aug. 31, 2018 Facility	Dec. 31, 2018 USD ($) Facility	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)	Apr. 04, 2017 USD ($)
Business Acquisition [Line Items]
Real estate impairment charge								$ 18,002	$ 5,340	$ 3,063
Gain offset by non-cash charges					$ 600
Colorado [Member] \| University of Colorado Hospital [Member]
Business Acquisition [Line Items]
Number of leased properties \| Lease		11
Total budgeted investment		$ 60,000
Term of lease, years		15 years
Number of lease extension options \| Lease		3
Term of lease extension, years		5 years
Lease rent increase percentage		2.00%
Louisiana [Member] \| Ochsner [Member]
Business Acquisition [Line Items]
Total budgeted investment											$ 25,000
Term of lease, years			15 years
Number of lease extension options \| RenewalOption			3
Term of lease extension, years			5 years
Gain offset by non-cash charges								500
Average minimum lease rate on development and construction cost			9.20%
Adeptus Health [Member]
Business Acquisition [Line Items]
Number of properties closed \| Property	14
Amortization of straight line rent receivables, reduction in rent revenue								$ 6,100
Number of facilities transitioned \| Facility				16
Number of properties re-leased \| Facility						5	3
Number of transitioned facilities not re-leased \| Facility								7
Percentage of investment in remaining transition facilities on total assets								0.50%
Real estate impairment charge								$ 18,000

Real Estate Activities - Gilbert and Florence Facilities - Additional Information (Detail) - USD ($) $ in Millions		12 Months Ended
	Mar. 31, 2017	Dec. 31, 2018
Business Acquisition [Line Items]
Gain offset by non-cash charges	$ 0.6
Gilbert and Florence Facilities [Member]
Business Acquisition [Line Items]
Gain offset by non-cash charges		$ 1.1
Gilbert and Florence Facilities [Member] \| Total Gross Assets [Member] \| Credit Concentration Risk [Member]
Business Acquisition [Line Items]
Percentage of Total Gross Assets		0.20%

Real Estate Activities - Alecto Healthcare facilities - Additional Information (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2018 USD ($) Property	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)
Business Acquisition [Line Items]
Real estate impairment charge	$ 18,002	$ 5,340	$ 3,063
Alecto Healthcare Services [Member]
Business Acquisition [Line Items]
Number of leased properties \| Property	4
Real estate impairment charge	$ 30,000
Alecto Healthcare Services [Member] \| Total Gross Assets [Member] \| Customer Concentration Risk
Business Acquisition [Line Items]
Percentage of Total Gross Assets	1.00%

Real Estate Activities - Summary of Loans (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Loans [Line Items]
Loans, Balance	$ 1,586,520	$ 1,928,524
Mortgage Loans [Member]
Loans [Line Items]
Loans, Balance	$ 1,213,322	$ 1,778,316
Loans, Weighted Average Interest Rate	8.80%	8.30%
Acquisition Loans [Member]
Loans [Line Items]
Loans, Balance	$ 3,454	$ 118,448
Loans, Weighted Average Interest Rate	10.80%	13.80%
Working Capital and Other Loans [Member]
Loans [Line Items]
Loans, Balance	$ 369,744	$ 31,760
Loans, Weighted Average Interest Rate	5.40%	7.60%

Real Estate Activities - Loans - Additional Information (Detail) $ in Thousands	Dec. 31, 2018 USD ($) Property Operator
Primotop Holdings S.a.r.l. [Member]
Business Acquisition [Line Items]
Shareholder loan to joint venture \| $	$ 290
Mortgage Loans [Member] \| Steward [Member]
Business Acquisition [Line Items]
Number of Real Estate Properties \| Property	10
Number Of Operators \| Operator	4

Real Estate Activities - Concentration of Credit Risks and Related Party Transactions - Additional Information (Detail) $ in Millions	12 Months Ended
	Dec. 31, 2018 USD ($) Investment	Dec. 31, 2017 USD ($) Investment	Dec. 31, 2016 USD ($)
Related Party Transactions [Member]
Business Acquisition [Line Items]
Lease and interest revenue earned from tenants \| $	$ 501.4	$ 422.4	$ 282.9
Total Gross Assets [Member] \| Geographic Concentration [Member] \| U.S. [Member]
Business Acquisition [Line Items]
Percentage of revenue from affiliates of total revenue	80.00%	80.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Europe [Member]
Business Acquisition [Line Items]
Percentage of revenue from affiliates of total revenue	20.00%	20.00%
Revenue [Member] \| Credit Concentration Risk [Member] \| Steward [Member]
Business Acquisition [Line Items]
Percentage of revenue from affiliates of total revenue	39.00%	27.00%
Revenue [Member] \| Credit Concentration Risk [Member] \| Prime [Member]
Business Acquisition [Line Items]
Percentage of revenue from affiliates of total revenue	16.00%	18.00%
Revenue [Member] \| Credit Concentration Risk [Member] \| MEDIAN [Member]
Business Acquisition [Line Items]
Percentage of revenue from affiliates of total revenue	13.00%	14.00%
Revenue [Member] \| Credit Concentration Risk [Member] \| Ernest [Member]
Business Acquisition [Line Items]
Percentage of revenue from affiliates of total revenue	8.00%	10.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| General Acute Care Hospital and Healthcare System [Member]
Business Acquisition [Line Items]
Percentage of revenue from affiliates of total revenue	76.00%	69.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Rehabilitation Hospital with Covenant Health System [Member]
Business Acquisition [Line Items]
Percentage of revenue from affiliates of total revenue	20.00%	25.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Long-term Acute Care Hospital [Member]
Business Acquisition [Line Items]
Percentage of revenue from affiliates of total revenue	4.00%	6.00%
Pro Forma [Member] \| Total Gross Assets [Member] \| Customer Concentration Risk [Member]
Business Acquisition [Line Items]
Number of investment in property \| Investment	0	0
Maximum percentage of entity's assets invested on single property	4.20%	4.20%

Debt - Summary of Debt (Detail) - USD ($)
$ in Thousands

Dec. 31, 2018

Dec. 31, 2017

Debt Instrument [Line Items]

Debt

$ 4,074,759

Debt issue costs, net

(37,370)

$ (42,643)

Debt, net

4,037,389

4,898,667

Revolving Credit Facility [Member]

Debt Instrument [Line Items]

Debt

^[1]

28,059

840,810

Term Loans [Member]

Debt Instrument [Line Items]

Debt

200,000

4.000% Senior Unsecured Notes due 2022 [Member]

Debt Instrument [Line Items]

Debt

^[2]

573,350

600,250

5.500% Senior Unsecured Notes Due 2024 [Member]

Debt Instrument [Line Items]

Debt

300,000

6.375% Senior Unsecured Notes due 2024 [Member]

Debt Instrument [Line Items]

Debt

500,000

3.325% Senior Unsecured Notes Due 2025 [Member]

Debt Instrument [Line Items]

Debt

^[2]

573,350

600,250

5.250% Senior Unsecured Notes Due 2026 [Member]

Debt Instrument [Line Items]

Debt

500,000

5.000% Senior Unsecured Notes Due 2027 [Member]

Debt Instrument [Line Items]

Debt

1,400,000

Senior Unsecured Debt [Member]

Debt Instrument [Line Items]

Debt

$ 4,074,759

$ 4,941,310

[1]	Includes £22 million and £8 million of GBP-denominated borrowings that reflect the exchange rate at December 31, 2018 and December 31, 2017, respectively.
[2]	These notes are Euro-denominated and reflect the exchange rate at December 31, 2018 and December 31, 2017, respectively.

Debt - Summary of Debt (Parenthetical) (Detail)
$ in Thousands, £ in Millions

Dec. 31, 2018

USD ($)

Dec. 31, 2018

GBP (£)

Dec. 31, 2017

USD ($)

Dec. 31, 2017

GBP (£)

Sep. 07, 2017

Mar. 24, 2017

Apr. 17, 2014

Debt Instrument [Line Items]

Debt

$ 4,074,759

4.000% Senior Unsecured Notes due 2022 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

4.00%

Debt

^[1]

$ 573,350

$ 600,250

5.500% Senior Unsecured Notes Due 2024 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

5.50%

Debt

$ 300,000

6.375% Senior Unsecured Notes due 2024 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

6.375%

Debt

$ 500,000

3.325% Senior Unsecured Notes Due 2025 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

3.325%

Debt

^[1]

$ 573,350

$ 600,250

5.250% Senior Unsecured Notes Due 2026 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

5.25%

Debt

$ 500,000

5.000% Senior Unsecured Notes Due 2027 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

5.00%

Debt

$ 1,400,000

GBP-denominated Borrowings [Member]

Debt Instrument [Line Items]

Debt | £

£ 22

£ 8

[1]	These notes are Euro-denominated and reflect the exchange rate at December 31, 2018 and December 31, 2017, respectively.

Debt - Principal Payments Due for Debt (Detail) $ in Thousands	Dec. 31, 2018 USD ($)
Debt Disclosure [Abstract]
2019	$ 0
2020	0
2021	28,059
2022	773,350
2023	0
Thereafter	3,273,350
Total	$ 4,074,759

Debt - Credit Facility - Additional Information (Detail) € in Millions	Feb. 01, 2017 USD ($)	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Feb. 01, 2017 EUR (€)
Debt Instrument [Line Items]
Aggregate committed amount of credit facility	$ 500,000,000
Minimum [Member]
Debt Instrument [Line Items]
Commitment fee	0.125%
Maximum [Member]
Debt Instrument [Line Items]
Commitment fee	0.30%
Unsecured Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Amount of senior unsecured debt	$ 1,300,000,000
Debt instrument, maturity date	Feb. 28, 2021
Aggregate committed amount of credit facility		$ 1,270,000,000
Credit facilities, amount outstanding		$ 28,100,000	$ 840,800,000
Credit facilities, weighted average interest rate		2.70%	2.40%
Term Loans [Member]
Debt Instrument [Line Items]
Amount of senior unsecured debt	$ 200,000,000			€ 200
Debt instrument, maturity date	Feb. 01, 2022
Decrease in unsecured debt from previous facility	$ 50,000,000
Aggregate committed amount of credit facility			$ 1,000,000,000
Interest rate at end of period		3.89%	2.98%
Alternate Base Rate [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Applicable margin	0.00%
Applicable margin for revolving loans	0.00%
Alternate Base Rate [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Applicable margin	0.95%
Applicable margin for revolving loans	0.65%
Eurodollar Loans [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Applicable margin	0.90%
Applicable margin for revolving loans	0.875%
Eurodollar Loans [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Applicable margin	1.95%
Applicable margin for revolving loans	1.65%
Euro [Member] \| Term Loans [Member]
Debt Instrument [Line Items]
Debt instrument, maturity date	Jan. 31, 2020

Debt - 4.000% Senior Unsecured Notes Due 2022 - Additional Information (Detail) - 4.000% Senior Unsecured Notes Due 2022 [Member] - EUR (€)		12 Months Ended
	Aug. 19, 2015	Dec. 31, 2018
Debt Instrument [Line Items]
Senior unsecured notes face amount	€ 500,000,000
Senior unsecured notes, interest rate	4.00%
Senior unsecured notes, payable term		Interest on the notes is payable annually on August 19 of each year.
Senior unsecured notes, maturity date	Aug. 19, 2022
Senior unsecured notes, redemption period	90 days
Senior notes, repurchased price percentage on principal amount plus accrued and unpaid interest	101.00%
Senior unsecured notes, redemption description		Notes are redeemed prior to 90 days before maturity, the redemption price will be 100% of their principal amount, plus a make-whole premium, plus accrued and unpaid interest to, but excluding, the applicable redemption date. Within the period beginning on or after 90 days before maturity, the notes may be redeemed, in whole or in part, at a redemption price equal to 100% of their principal amount, plus accrued and unpaid interest to, but excluding, the applicable redemption date. The 4.000% Senior Unsecured Notes due 2022 are fully and unconditionally guaranteed on an unsecured basis by us. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of the purchase.
Redeemed Prior to 90 Days [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption price percentage	100.00%
Redeemed Beginning on or After 90 Days [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption price percentage	100.00%

Debt - 5.500% Senior Unsecured Notes Due 2024 - Additional Information (Detail) - 5.500% Senior Unsecured Notes Due 2024 [Member] - USD ($)		12 Months Ended
	Apr. 17, 2014	Dec. 31, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Senior unsecured notes face amount	$ 300,000,000
Senior unsecured notes, interest rate	5.50%	5.50%	5.50%
Senior unsecured notes, payable term		Interest on the notes is payable semi-annually on May 1 and November 1 of each year.
Senior unsecured notes, maturity date	May 01, 2024
Senior notes, earliest redemption date	May 01, 2019
Senior notes, repurchased price percentage on principal amount plus accrued and unpaid interest	101.00%
Senior unsecured notes, redemption description		We may redeem some or all of the notes at any time prior to May 1, 2019 at a “make-whole” redemption price. On or after May 1, 2019, we may redeem some or all of the notes at a premium that will decrease over time. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

Debt - 6.375% Senior Unsecured Notes Due 2024 - Additional Information (Detail) - 6.375% Senior Unsecured Notes due 2024 [Member] - USD ($)		12 Months Ended
	Feb. 22, 2016	Dec. 31, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Senior unsecured notes, interest rate		6.375%	6.375%
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Senior unsecured notes face amount	$ 500,000,000
Senior unsecured notes, maturity date	Mar. 01, 2024
Senior unsecured notes, interest rate	6.375%
Debt instrument, redemption price percentage	106.375%
Senior notes, repurchased price percentage on principal amount plus accrued and unpaid interest	101.00%
Senior unsecured notes, payable term		Interest on the notes is payable on March 1 and September 1 of each year.
Senior notes, earliest redemption date	Mar. 01, 2019
Senior unsecured notes, redemption description		We may redeem up to 35% of the notes at a redemption price equal to 106.375% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.
Maximum [Member] \| Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption percentage on principal amount	35.00%

Debt - 3.325% Senior Unsecured Notes Due 2025 - Additional Information (Detail) - 3.325% Senior Unsecured Notes Due 2025 [Member] - EUR (€)		12 Months Ended
	Mar. 24, 2017	Dec. 31, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Senior unsecured notes face amount	€ 500,000,000
Senior unsecured notes, interest rate	3.325%	3.325%	3.325%
Senior unsecured notes, payable term		Interest on the notes is payable annually on March 24 of each year.
Senior notes, repurchased price percentage on principal amount plus accrued and unpaid interest	101.00%
Senior unsecured notes, maturity date	Mar. 24, 2025
Senior unsecured notes, redemption period	90 days
Senior unsecured notes, redemption description		Notes are redeemed prior to 90 days before maturity, the redemption price will be equal to 100% of their principal amount, plus a make-whole premium, plus accrued and unpaid interest up to, but excluding, the applicable redemption date. Within the period beginning on or after 90 days before maturity, the notes may be redeemed, in whole or in part, at a redemption price equal to 100% of their principal amount, plus accrued and unpaid interest to, but excluding, the applicable redemption date. The 3.325% Senior Unsecured Notes due 2025 are fully and unconditionally guaranteed on a senior unsecured basis by us. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest up to, but excluding, the date of the purchase.
Redeemed Prior to 90 Days [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption price percentage	100.00%
Redeemed Beginning on or After 90 Days [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption price percentage	100.00%

Debt - 5.250% Senior Unsecured Notes Due 2026 - Additional Information (Detail) - 5.250% Senior Unsecured Notes Due 2026 [Member] - USD ($)		12 Months Ended
	Jul. 22, 2016	Dec. 31, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Senior unsecured notes, interest rate		5.25%	5.25%
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Senior unsecured notes face amount	$ 500,000,000
Senior unsecured notes, payable term		Interest on the notes is payable on February 1 and August 1 of each year.
Senior unsecured notes, interest rate	5.25%
Senior unsecured notes, maturity date	Aug. 01, 2026
Senior notes, earliest redemption date	Aug. 01, 2021
Senior unsecured notes, redemption description		We may redeem some or all of the notes at any time prior to August 1, 2021 at a “make whole” redemption price. On or after August 1, 2021, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to August 1, 2019, we may redeem up to 35% of the notes at a redemption price equal to 105.250% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.
Debt instrument, redemption price percentage	105.25%
Senior notes, repurchased price percentage on principal amount plus accrued and unpaid interest	101.00%
Revolving Credit Facility [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption percentage on principal amount	35.00%

Debt - 5.000% Senior Unsecured Notes Due 2027 - Additional Information (Detail) - USD ($)				12 Months Ended
	Sep. 07, 2017	Feb. 01, 2017	Jul. 22, 2016	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Debt Instrument [Line Items]
Debt refinancing costs					$ 32,574,000	$ 22,539,000
Aggregate committed amount of credit facility		$ 500,000,000
Term Loans [Member]
Debt Instrument [Line Items]
Senior unsecured notes, maturity date		Feb. 01, 2022
Debt refinancing costs					32,600,000
Aggregate committed amount of credit facility					$ 1,000,000,000
Term Loans [Member] \| J P Morgan Chase Bank [Member]
Debt Instrument [Line Items]
Cancellation of loan	$ 1,000,000,000
5.000% Senior Unsecured Notes Due 2027 [Member]
Debt Instrument [Line Items]
Senior unsecured notes face amount	$ 1,400,000,000
Senior unsecured notes, payable term				Interest on the notes is payable on April 15 and October 15 of each year
Senior unsecured notes, interest rate	5.00%			5.00%	5.00%
Senior unsecured notes, maturity date	Oct. 15, 2027
Senior notes, earliest redemption date	Oct. 15, 2022
Senior unsecured notes, redemption description				We may redeem up to 40% of the notes at a redemption price equal to 105% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.
Debt instrument, redemption price percentage	105.00%
Senior notes, repurchased price percentage on principal amount plus accrued and unpaid interest	101.00%
5.000% Senior Unsecured Notes Due 2027 [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption percentage on principal amount	40.00%
6.875% Senior Unsecured Notes Due 2021 [Member]
Debt Instrument [Line Items]
Debt refinancing costs			$ 22,500,000
Note redeemed			450,000,000
Redemption Premium			$ 15,500,000

Debt - Additional Information (Detail) - Primotop Holdings S.a.r.l. [Member] - Germany [Member] - Acute Care Hospital [Member] € in Millions	Aug. 31, 2018 Hospital	Aug. 03, 2018 EUR (€)
Debt Instrument [Line Items]
Proceeds from issuance of new secured debt \| €		€ 655
Secured Debt [Member]
Debt Instrument [Line Items]
Number of facilities acquired \| Hospital	71
Debt instrument term	7 years
Debt instrument swapped fixed rate	2.30%

Debt - Term Loan - Northland Mortgage - Additional Information (Detail) - Mortgage Loans [Member] - Northland LTACH Hospital [Member] - USD ($) $ in Millions			12 Months Ended
	Sep. 29, 2017	Feb. 14, 2011	Dec. 31, 2018
Debt Instrument [Line Items]
Liabilities acquired		$ 14.6
Amortization period			30 years
Interest rate			6.20%
Debt instrument, maturity date			Jan. 01, 2018
Term of loan to pay without penalty			120 days
Prepayment of mortgage loans	$ 12.9

Debt - 6.375% Senior Unsecured Notes Due 2022 - Additional Information (Detail) - 6.375% Senior Unsecured Notes Due 2022 [Member] - USD ($)	Oct. 07, 2017	Aug. 20, 2013	Feb. 17, 2012
Debt Instrument [Line Items]
Senior unsecured notes face amount		$ 150,000,000	$ 200,000,000
Senior unsecured notes, interest rate			6.375%
Senior unsecured notes, maturity date			Feb. 15, 2022
Debt instrument redemption price		102.00%
Debt instrument effective rate		5.998%
Redemption Premium	$ 11,200,000

Debt - 5.750% Senior Unsecured Notes Due 2020 - Additional Information (Detail) - 5.750% Senior Unsecured Notes Due 2020 [Member] € in Millions, $ in Millions				12 Months Ended
	Mar. 04, 2017 USD ($)	Mar. 04, 2017 EUR (€)	Oct. 10, 2013 EUR (€)	Dec. 31, 2018
Debt Instrument [Line Items]
Senior unsecured notes, value of offering			€ 200
Senior unsecured notes, interest rate	5.75%	5.75%	5.75%
Debt instrument, maturity date			Oct. 01, 2020
Senior notes, redemption date	Mar. 04, 2017	Mar. 04, 2017
Amount of senior unsecured debt redeemed		€ 200
Senior unsecured notes, redemption description				We redeemed the €200 million aggregate principal amount of our 5.750% Senior Unsecured Notes due 2020 and incurred a redemption premium of approximately $9 million.
Redemption Premium \| $	$ 9

Debt - Other - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Feb. 01, 2017
Debt Instrument [Line Items]
Aggregate committed amount of credit facility			$ 500,000,000
Debt refinancing costs	$ 32,574,000	$ 22,539,000
Term Loans [Member]
Debt Instrument [Line Items]
Aggregate committed amount of credit facility	1,000,000,000
Debt refinancing costs	$ 32,600,000

Debt - Covenants - Additional Information (Detail)	12 Months Ended
Debt - Covenants - Additional Information (Detail)	Dec. 31, 2018
Debt Disclosure [Abstract]
Percentage of dividends which could be paid from adjusted operating funds	95.00%
Percentage of dividends which could be paid from operation funds	95.00%
Maximum percentage of total unencumbered assets	150.00%

Income Taxes - Additional Information (Detail) - USD ($)	3 Months Ended	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Taxes [Line Items]
Percentage of ordinary taxable income to be distributed for real estate investment trust qualification		90.00%	90.00%	90.00%
Percentage of taxable income to be distributed for federal income tax assumption		100.00%
Amount of foreign income (loss) before income taxes		$ 18,600,000	$ (100,000)	$ (23,500,000)
Amount of domestic income (loss) before income taxes		8,000,000	$ 13,900,000	$ (1,400,000)
U.S federal NOLs	$ 78,300,000	78,300,000
U.S. state NOLs	99,900,000	99,900,000
U.S federal alternative minimum tax credits carry forward	100,000	$ 100,000
Tax credit description		Alternative minimum tax credits exceed regular tax liability in tax years 2019 through 2021
Percentage of credit refundable		50.00%
Foreign NOLs	$ 8,600,000	$ 8,600,000
Cumulative pre-tax loss position period	3 years
Valuation allowance not expected to be realized	$ 4,400,000
Uncertain tax position liabilities and related interest or penalties	$ 0	$ 0
Maximum [Member]
Income Taxes [Line Items]
U.S. federal and state NOLs, expiration period		2036
Minimum [Member]
Income Taxes [Line Items]
U.S. federal and state NOLs, expiration period		2022

Income Taxes - Schedule of Income Tax Expense (Benefit) (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Current income tax (benefit) expense:
Domestic	$ (125)	$ (41)	$ 42
Foreign	3,294	3,062	1,856
Total income tax expense	3,169	3,021	1,898
Deferred income tax (benefit) expense:
Domestic	(3,713)	(233)	147
Foreign	1,471	(107)	(8,875)
Total income tax expense	(2,242)	(340)	(8,728)
Income tax expense (benefit)	$ 927	$ 2,681	$ (6,830)

Income Taxes - Summary of Reconciliation of the Income Tax Expense (Benefit) at the Statutory Income Tax Rate and the Effective Tax Rate for Income before Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Income before income tax	$ 1,019,404	$ 293,919	$ 219,107
Income tax at the U.S. statutory federal rate (21% in 2018 and 35% in 2017 and 2016)	214,075	102,872	76,687
Increase (decrease) resulting from:
Foreign rate differential	(2,643)	(2,326)	1,434
State income taxes, net of federal benefit	379		66
U.S. earnings not subject to federal income tax	(208,472)	(98,026)	(84,927)
Equity investments	(46)	3,293	4,297
Change in valuation allowance	(2,668)	(5,391)	(6,104)
Other items, net	302	2,259	1,717
Income tax expense (benefit)	$ 927	$ 2,681	$ (6,830)

Income Taxes - Summary of Reconciliation of the Income Tax Expense (Benefit) at the Statutory Income Tax Rate and the Effective Tax Rate for Income before Income Taxes (Parenthetical) (Detail)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Income tax at the US statutory federal rate	21.00%	35.00%	35.00%

Income Taxes - Schedule of Deferred Tax Assets and liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Operating loss and interest deduction carry forwards	$ 21,984	$ 24,580
Other	277	504
Total deferred tax assets	22,261	25,084
Valuation allowance	(3,444)	(11,101)
Total net deferred tax assets	18,817	13,983
Property and equipment	(12,359)	(4,336)
Net unbilled revenue	(1,633)	(6,113)
Partnership investments		(2,099)
Other	(300)	(1,320)
Total deferred tax liabilities	(14,292)	(13,868)
Net deferred tax asset (liability)	$ 4,525	$ 115

Income Taxes - Schedule of Per Share Distributions to Stockholders (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Common share distribution	$ 0.990000	$ 0.950000	$ 0.900000
Ordinary income	0.438792	0.655535	0.619368
Capital gains	0.551208	0.021022	0.102552
Unrecaptured Sec. 1250 gain	0.132280	0.004647	0.045432
Section 19A Dividends	$ 0.438792
Return of capital		$ 0.273443	$ 0.178080

Earnings Per Share/Unit - Calculation of Earnings Per Share (Detail) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 78,941	$ 736,476	$ 112,017	$ 91,043	$ 72,376	$ 76,881	$ 73,796	$ 68,185	$ 1,018,477	$ 291,238	$ 225,937
Net income attributable to non-controlling interests									(1,792)	(1,445)	(889)
Participating securities’ share in earnings									(3,685)	(1,409)	(559)
Net income, less participating securities’ share in earnings									$ 1,013,000	$ 288,384	$ 224,489
Weighted average shares outstanding — basic	366,655	365,024	364,897	364,882	364,382	364,315	349,856	321,057	365,364	349,902	260,414
Dilutive potential common shares									907	539	658
Diluted weighted average common shares	367,732	366,467	365,541	365,343	364,977	365,046	350,319	321,423	366,271	350,441	261,072
MPT Operating Partnership, L.P. [Member]
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 78,941	$ 736,476	$ 112,017	$ 91,043	$ 72,376	$ 76,881	$ 73,796	$ 68,185	$ 1,018,477	$ 291,238	$ 225,937
Net income attributable to non-controlling interests									(1,792)	(1,445)	(889)
Participating securities’ share in earnings									(3,685)	(1,409)	(559)
Net income, less participating securities’ share in earnings									$ 1,013,000	$ 288,384	$ 224,489
Weighted average shares outstanding — basic	366,655	365,024	364,897	364,882	364,382	364,315	349,856	321,057	365,364	349,902	260,414
Dilutive potential common shares									907	539	658
Diluted weighted average common shares	367,732	366,467	365,541	365,343	364,977	365,046	350,319	321,423	366,271	350,441	261,072

- Definition

The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest.

+ References

+ Details

Stock Awards - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share / (Unit)-based compensation expense	$ 16,505	$ 9,949	$ 7,942
Stock-based compensation expense, unrecognized cost	$ 34,900
Stock-based compensation expense, unrecognized cost, reorganization period (in years)	2 years 1 month 6 days
Restricted equity awards, fair value	$ 8,400	$ 10,400	$ 12,700
Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock awards vesting period in years	10 years
Equity Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Reserved shares of common stock for awards under the Equity Incentive Plan	8,196,770,000
Common stock remaining for future stock awards transferred to the equity incentive plan	976,073,000
Maximum number of shares of common stock that may be awarded	5,000,000,000
Service-Based Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement by share based payment award, expected service period (in years)	3 years
40% of 2018 Performance Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Annual total shareholder return (in years)	1 year
Stock-based awards expiration date	Dec. 31, 2020
Percentage of performance award grant in period	40.00%
EBITDA achieving period	1 year
40% of 2018 Performance Awards [Member] \| Return on Equity Equal to 12.5% [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned	12.50%
40% of 2018 Performance Awards [Member] \| Return on Equity Greater than or Equal to 13.5% [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned	13.50%
Percentage of performance award to be earned of shareholder return reaches shareholder limit	200.00%
40% of 2018 Performance Awards [Member] \| EBITDA Equal to $720 Million [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
EBITDA to be earned	$ 720,000
Percentage of performance award to be earned if EBITDA reaches limit	50.00%
40% of 2018 Performance Awards [Member] \| EBITDA Equal to $775 Million [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
EBITDA to be earned	$ 775,000
Percentage of performance award to be earned if EBITDA reaches limit	50.00%
40% of 2018 Performance Awards [Member] \| EBITDA Equal to $740 Million [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
EBITDA to be earned	$ 740,000
Percentage of performance award to be earned if EBITDA reaches limit	100.00%
40% of 2018 Performance Awards [Member] \| EBITDA Equal to $800 Million [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
EBITDA to be earned	$ 800,000
Percentage of performance award to be earned if EBITDA reaches limit	100.00%
40% of 2018 Performance Awards [Member] \| EBITDA Equal to $760 Million [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
EBITDA to be earned	$ 760,000
Percentage of performance award to be earned if EBITDA reaches limit	200.00%
40% of 2018 Performance Awards [Member] \| EBITDA Equal to $825 Million [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
EBITDA to be earned	$ 825,000
Percentage of performance award to be earned if EBITDA reaches limit	200.00%
40% of 2018 Performance Awards [Member] \| Maximum [Member] \| Return on Equity Equal to 12.5% [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of performance award to be earned of shareholder return reaches shareholder limit	100.00%
40% of 2018 Performance Awards [Member] \| Minimum [Member] \| Return on Equity Equal to 12.5% [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of performance award to be earned of shareholder return reaches shareholder limit	50.00%
20% of 2018 Performance Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based awards expiration date	Dec. 31, 2020
Percentage of performance award grant in period	20.00%
Acquisition achieving period	1 year
20% of 2018 Performance Awards [Member] \| Acquisitions Equal to $500 Million [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Acquisitions	$ 500,000
Percentage of performance award to be earned if acquisitions reaches threshold limit	50.00%
20% of 2018 Performance Awards [Member] \| Acquisitions Equal to $1.5 Billion [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Acquisitions	$ 1,500,000
Percentage of performance award to be earned if acquisitions reaches threshold limit	50.00%
20% of 2018 Performance Awards [Member] \| Acquisitions Equal to $750 Million [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Acquisitions	$ 750,000
Percentage of performance award to be earned if acquisitions reaches threshold limit	100.00%
20% of 2018 Performance Awards [Member] \| Acquisitions Equal to $2.25 Billion [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Acquisitions	$ 2,250,000
Percentage of performance award to be earned if acquisitions reaches threshold limit	100.00%
20% of 2018 Performance Awards [Member] \| Acquisitions Equal to $1.0 Billion [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Acquisitions	$ 1,000,000
Percentage of performance award to be earned if acquisitions reaches threshold limit	200.00%
20% of 2018 Performance Awards [Member] \| Acquisitions Equal to $3.0 Billion [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Acquisitions	$ 3,000,000
Percentage of performance award to be earned if acquisitions reaches threshold limit	200.00%
Final Portion of 2018 Performance Awards [Member] \| SNL Index, Greater than Seventy Five Percent [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned	75.00%
Increase (decrease) in percentage of performance award to be earned If shareholder return reaches shareholder limit	25.00%
Final Portion of 2018 Performance Awards [Member] \| SNL Index, Greater than Fifty Five Percent [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned	55.00%
Increase (decrease) in percentage of performance award to be earned If shareholder return reaches shareholder limit	0.00%
Final Portion of 2018 Performance Awards [Member] \| SNL Index, Greater than Thirty Five Percent [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned	35.00%
Increase (decrease) in percentage of performance award to be earned If shareholder return reaches shareholder limit	(25.00%)
Final Portion of 2018 Performance Awards [Member] \| SNL Index, Greater than Ninety Five Percent [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned	95.00%
2018 Performance Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of performance awards forfeited	2,000
Number of performance awards earned and unvested	508,566
Number of performance awards to be earned	1,238,748
42% of 2017 Performance Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement by share based payment award, expected service period (in years)		3 years
Annual total shareholder return (in years)		1 year
Stock-based awards expiration date		Dec. 31, 2017
Percentage of performance award grant in period		42.00%
Share based payment award, weighted average risk-free rate of return		1.00%
Share based payment award, expected volatility rate		25.00%
Common stock options awarded, dividend yield		6.90%
42% of 2017 Performance Awards [Member] \| U.S. REIT Healthcare Index Minus 3% [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned		3.00%
Percentage of performance award to be earned of shareholder return reaches shareholder limit		50.00%
42% of 2017 Performance Awards [Member] \| U.S. REIT Healthcare Index Plus 3% [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned		3.00%
Percentage of performance award to be earned of shareholder return reaches shareholder limit		200.00%
47% of 2017 Performance Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Annual total shareholder return (in years)		1 year
Stock-based awards expiration date		Dec. 31, 2017
Percentage of performance award grant in period		47.00%
47% of 2017 Performance Awards [Member] \| Return on Equity Equal to 12.5% [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned		12.50%
Percentage of performance award to be earned of shareholder return reaches shareholder limit		50.00%
47% of 2017 Performance Awards [Member] \| Return on Equity Greater than or Equal to 13.5% [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned		13.50%
Percentage of performance award to be earned of shareholder return reaches shareholder limit		200.00%
11% of 2017 Performance Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Annual total shareholder return (in years)		1 year
Stock-based awards expiration date		Dec. 31, 2017
Percentage of performance award to be earned of shareholder return reaches shareholder limit		11.00%
11% of 2017 Performance Awards [Member] \| General and Administrative Expense to Revenue Ratio Equal to 10% [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of performance award to be earned if G&A stays at or below limit		50.00%
11% of 2017 Performance Awards [Member] \| General and Administrative Expense to Revenue Ratio is Less Than Equal to 9% [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of performance award to be earned if G&A stays at or below limit		200.00%
G&A as a percentage of revenue threshold		9.00%
11% of 2017 Performance Awards [Member] \| General and Administrative Expenses to Revenue Ratio Less Than Equal to Ten Percent [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
G&A as a percentage of revenue threshold		10.00%
65% of 2017 Performance Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement by share based payment award, expected service period (in years)		5 years
Share based payment award, weighted average risk-free rate of return		1.90%
Share based payment award, expected volatility rate		25.00%
Common stock options awarded, dividend yield		6.90%
65% of 2017 Performance Awards [Member] \| 2019 Award [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based awards expiration date		Dec. 31, 2019
Percentage of performance award to be earned of shareholder return reaches shareholder limit		30.00%
65% of 2017 Performance Awards [Member] \| 2020 Award [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based awards expiration date		Dec. 31, 2020
Percentage of performance award to be earned of shareholder return reaches shareholder limit		30.00%
65% of 2017 Performance Awards [Member] \| 2019 and 2020 Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based awards expiration date		Dec. 31, 2021
65% of 2017 Performance Awards [Member] \| Maximum [Member] \| 2019 and 2020 Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of performance award to be earned of shareholder return reaches shareholder limit		30.00%
65% of 2017 Performance Awards [Member] \| Minimum [Member] \| 2019 Award [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned		27.00%
65% of 2017 Performance Awards [Member] \| Minimum [Member] \| 2020 Award [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned		36.00%
65% of 2017 Performance Awards [Member] \| Minimum [Member] \| 2019 and 2020 Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned		45.00%
Final Portion of 2017 Performance Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement by share based payment award, expected service period (in years)		3 years
Stock-based awards expiration date		Dec. 31, 2019
Share based payment award, weighted average risk-free rate of return		1.50%
Share based payment award, expected volatility rate		25.00%
Common stock options awarded, dividend yield		6.90%
Share-based compensation award vesting rights	Vest in equal annual amounts on January 1, 2020, 2021, and 2022.
Final Portion of 2017 Performance Awards [Member] \| SNL Index, Greater than Three Percent [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned		3.00%
Percentage of performance award to be earned of shareholder return reaches shareholder limit		100.00%
2017 Performance Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of performance awards forfeited	3,750	14,000
Number of performance awards earned and unvested	396,142	596,472
Number of performance awards to be earned	1,125,281
50% of 2016 Performance Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement by share based payment award, expected service period (in years)			5 years
Stock-based awards expiration date		Dec. 31, 2018
Percentage of performance award grant in period			50.00%
Percentage of performance award to be earned of shareholder return reaches shareholder limit			100.00%
Share based payment award, weighted average risk-free rate of return			1.00%
Share based payment award, expected volatility rate			24.40%
Common stock options awarded, dividend yield			7.00%
50% of 2016 Performance Awards [Member] \| If Any Shares are Earned from this Award [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation award vesting rights	Vest in equal annual amounts on January 1, 2019, 2020, and 2021.
50% of 2016 Performance Awards [Member] \| Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned			35.00%
50% of 2016 Performance Awards [Member] \| Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned			27.00%
Remaining % of 2016 Performance Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement by share based payment award, expected service period (in years)			5 years
Stock-based awards expiration date	Dec. 31, 2018
Share based payment award, weighted average risk-free rate of return			1.00%
Share based payment award, expected volatility rate			24.40%
Common stock options awarded, dividend yield			7.00%
Remaining % of 2016 Performance Awards [Member] \| If Any Shares are Earned from this Award [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation award vesting rights	Vest in equal annual amounts on January 1, 2019, 2020, and 2021.
Remaining % of 2016 Performance Awards [Member] \| Within Three Percent of MSCI Index [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned			3.00%
Remaining % of 2016 Performance Awards [Member] \| MSCI Index Plus Three Percent [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of shareholder return to be earned			300.00%
Percentage of performance award to be earned of shareholder return reaches shareholder limit			100.00%
2016 Performance Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of performance awards forfeited	0	16,000	2,400
Number of performance awards to be earned		0	0
Number of performance awards earned and unvested	779,004

Stock Awards - Restricted Equity Awards Activity (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Vesting Based on Service [Member]
Employee Restricted Equity Awards Vesting Activity [Line Items]
Nonvested awards at beginning of the year, Shares	276,280	347,128
Awarded, Shares	958,480	249,841
Vested, Shares	(307,275)	(304,613)
Forfeited, Shares	(3,637)	(16,076)
Nonvested awards at end of year, Shares	923,848	276,280
Nonvested awards at beginning of the year, Weighted Average Value at Award Date	$ 12.68	$ 13.35
Awarded, Weighted Average Value at Award Date	14.31	12.40
Vested, Weighted Average Value at Award Date	12.92	12.86
Forfeited, Weighted Average Value at Award Date	13.05	12.75
Nonvested awards at end of year, Weighted Average Value at Award Date	$ 14.29	$ 12.68
Vesting Based on Market/Performance Conditions [Member]
Employee Restricted Equity Awards Vesting Activity [Line Items]
Nonvested awards at beginning of the year, Shares	2,676,755	1,811,675
Awarded, Shares	1,750,834	1,741,003
Vested, Shares	(288,404)	(491,071)
Forfeited, Shares	(5,750)	(384,852)
Nonvested awards at end of year, Shares	4,133,435	2,676,755
Nonvested awards at beginning of the year, Weighted Average Value at Award Date	$ 7.86	$ 6.78
Awarded, Weighted Average Value at Award Date	11.61	8.21
Vested, Weighted Average Value at Award Date	11.25	6.84
Forfeited, Weighted Average Value at Award Date	9.35	5.65
Nonvested awards at end of year, Weighted Average Value at Award Date	$ 9.21	$ 7.86

Commitments and Contingencies - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Commitments And Contingencies Disclosure [Abstract]
Term of lease period	30 years or more
Lease and Rental Expenses	$ 9.4	$ 9.8	$ 6.8
Sublease rental income	$ 4.3	$ 6.6	$ 4.2

Commitments and Contingencies - Fixed Minimum Rental Payments Due under Operating Leases with Non-Cancelable Terms (Detail)
$ in Thousands

Dec. 31, 2018

USD ($)

Commitments And Contingencies Disclosure [Abstract]

$ 6,602

6,903

6,841

6,838

6,861

198,932

Minimum rental payments, total

232,977

(3,284)

(3,458)

(3,551)

(3,632)

(3,636)

(93,586)

Sub lease minimum rental payments receivable, total

(111,147)

3,318

3,445

3,290

3,206

3,225

105,346

^[1]

Minimum rental payments, total

$ 121,830

[1]

Common Stock/Partners' Capital - Additional Information (Detail) $ / shares in Units, $ in Thousands					3 Months Ended	12 Months Ended
	Nov. 13, 2017 USD ($)	May 01, 2017 USD ($) shares	Oct. 07, 2016 USD ($) $ / shares shares	Sep. 30, 2016 USD ($) shares	Dec. 31, 2018 USD ($) shares	Dec. 31, 2018 USD ($) Partner Employee shares	Dec. 31, 2017 USD ($) shares	Dec. 31, 2016 USD ($) shares
Class of Stock [Line Items]
Proceeds from sale of common shares / units, net of offering costs					$ 95	$ 94,239	$ 547,785	$ 1,173,651
Common stock, shares issued \| shares					370,637,000	370,637,000	364,424,000
Redemption of common units						$ 816
Employee [Member]
Class of Stock [Line Items]
Number of partners shared remaining ownership percentage \| Employee						2
MPT Operating Partnership, L.P. [Member]
Class of Stock [Line Items]
Proceeds from sale of common shares / units, net of offering costs						$ 94,239	$ 547,785	1,173,651
Percentage of ownership of general partner						100.00%
Number of other partners \| Partner						2
Redemption of common units						$ 816
MPT Operating Partnership, L.P. [Member] \| Medical Properties Trust, Inc. [Member]
Class of Stock [Line Items]
Ownership interest in equity					99.90%	99.90%
Market Equity Offering Program [Member]
Class of Stock [Line Items]
Proceeds from sale of common shares / units, net of offering costs								224,000
Sales commissions, amount								$ 2,800
Market Equity Offering Program [Member] \| Maximum [Member]
Class of Stock [Line Items]
Value of stock	$ 750,000
Sales commission percentage	2.00%
Public Offering [Member]
Class of Stock [Line Items]
Proceeds from sale of common shares / units, net of offering costs		$ 548,000		$ 799,500
Common stock, shares issued \| shares		43,100,000		57,500,000
Additional shares purchased by underwriters \| shares		5,600,000		7,500,000
Common Units [Member]
Class of Stock [Line Items]
Number of share sold \| shares					5,600	5,614,000	43,125,000	82,749,000
Common Units [Member] \| MPT Operating Partnership, L.P. [Member] \| Limited Partner [Member]
Class of Stock [Line Items]
Number of share sold \| shares						5,558,000	42,694,000	81,918,000
Conversion of LTIP units to common units \| shares						60,000
Redemption of common units						$ 816
Common Units [Member] \| Market Equity Offering Program [Member]
Class of Stock [Line Items]
Number of share sold \| shares							0	15,000,000
Common Units [Member] \| Private Placement [Member] \| Cerberus Capital Management [Member]
Class of Stock [Line Items]
Number of share sold \| shares			10,300,000
Proceeds from sale of common shares / units, net of offering costs			$ 150,000
Sale of Stock, price per share \| $ / shares			$ 14.50

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Fair Value Disclosures [Abstract]
Interest and rent receivables, Book value	$ 25,855	$ 78,970
Loans, Book value	1,471,520	1,698,471
Debt, net Book value	(4,037,389)	(4,898,667)
Interest and rent receivables, Fair value	24,942	78,028
Loans, Fair value	1,490,758	1,722,101
Debt, net Fair value	$ (3,947,795)	$ (5,073,707)

Fair Value of Financial Instruments - Equity Interest in Related Party and Related Loans Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	$ 115,000	$ 229,554
Original Cost	115,000	233,354
Fair Value Measurements, Recurring [Member] \| Mortgage Loans [Member] \| Mortgage Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	115,000	115,000
Original Cost	$ 115,000	115,000
Fair Value Measurements, Recurring [Member] \| Equity Method Investment and Other Loans [Member] \| Other Loans and Other Assets [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value		114,554
Original Cost		$ 118,354

Fair Value of Financial Instruments - Additional information (Detail)	12 Months Ended
	Dec. 31, 2016 USD ($)	Dec. 31, 2018
Ernest [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Unrealized gains/losses on investments	$ 0
Valuation Technique, Discounted Cash Flow [Member] \| Measurement Input, Discount Rate [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Adjustment for DLOM on our equity investment		40

Other Assets - Summary of Other Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Other Assets [Abstract]
Debt issue costs, net	$ 4,793	$ 7,093
Equity investments	520,058	288,398
Other corporate assets	115,416	117,827
Prepaids and other assets	61,757	55,176
Total other assets	$ 702,024	$ 468,494

Other Assets - Additional Information (Detail) - USD ($) $ in Millions		12 Months Ended
	Sep. 29, 2017	Dec. 31, 2018
2017 [Member] \| Subsidiaries [Member]
Other Assets [Line Items]
Equity interest acquired	$ 100	$ 210

Other Assets - Summary of Financial Information For Investees (Detail) - MEDIAN [Member] $ in Thousands	12 Months Ended
	Dec. 31, 2018 USD ($)
Other Assets [Line Items]
Revenue	$ 42,526
Net income	6,009
Assets	2,018,496
Liabilities	$ 1,553,191

Quarterly Financial Data (Unaudited) - Unaudited Quarterly Financial Information (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Quarterly Financial Information [Line Items]
Revenues	$ 180,578	$ 196,996	$ 201,902	$ 205,046	$ 204,961	$ 176,580	$ 166,807	$ 156,397	$ 784,522	$ 704,745	$ 541,137
Net income	78,941	736,476	112,017	91,043	72,376	76,881	73,796	68,185	1,018,477	291,238	225,937
Net income attributable to MPT common stockholders	$ 78,483	$ 736,034	$ 111,567	$ 90,601	$ 71,944	$ 76,464	$ 73,415	$ 67,970	$ 1,016,685	$ 289,793	$ 225,048
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 0.21	$ 2.01	$ 0.30	$ 0.25	$ 0.19	$ 0.21	$ 0.21	$ 0.21	$ 2.77	$ 0.82	$ 0.86
Weighted average shares outstanding — basic	366,655	365,024	364,897	364,882	364,382	364,315	349,856	321,057	365,364	349,902	260,414
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 0.21	$ 2.00	$ 0.30	$ 0.25	$ 0.19	$ 0.21	$ 0.21	$ 0.21	$ 2.76	$ 0.82	$ 0.86
Weighted average shares outstanding — diluted	367,732	366,467	365,541	365,343	364,977	365,046	350,319	321,423	366,271	350,441	261,072
MPT Operating Partnership, L.P. [Member]
Quarterly Financial Information [Line Items]
Revenues	$ 180,578	$ 196,996	$ 201,902	$ 205,046	$ 204,961	$ 176,580	$ 166,807	$ 156,397	$ 784,522	$ 704,745	$ 541,137
Net income	78,941	736,476	112,017	91,043	72,376	76,881	73,796	68,185	1,018,477	291,238	225,937
Net income attributable to MPT common stockholders	$ 78,483	$ 736,034	$ 111,567	$ 90,601	$ 71,944	$ 76,464	$ 73,415	$ 67,970	$ 1,016,685	$ 289,793	$ 225,048
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 0.21	$ 2.01	$ 0.30	$ 0.25	$ 0.19	$ 0.21	$ 0.21	$ 0.21	$ 2.77	$ 0.82	$ 0.86
Weighted average shares outstanding — basic	366,655	365,024	364,897	364,882	364,382	364,315	349,856	321,057	365,364	349,902	260,414
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 0.21	$ 2.00	$ 0.30	$ 0.25	$ 0.19	$ 0.21	$ 0.21	$ 0.21	$ 2.76	$ 0.82	$ 0.86
Weighted average shares outstanding — diluted	367,732	366,467	365,541	365,343	364,977	365,046	350,319	321,423	366,271	350,441	261,072

- Definition

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

+ References

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+ Details

- Definition

The amount of net income (loss) for the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

+ References

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+ Details

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References + Details

- Definition

The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest.

+ References

+ Details

Subsequent Events - Additional Information (Detail) € in Millions, $ in Millions				1 Months Ended	3 Months Ended	12 Months Ended
	Feb. 06, 2019 EUR (€) Hospital	Jan. 31, 2019 USD ($) Hospital	Aug. 28, 2018 EUR (€) Hospital	Jun. 30, 2018 EUR (€) Hospital	Dec. 31, 2018 EUR (€) Hospital	Dec. 31, 2018 Hospital
Germany [Member] \| Rehabilitation Hospital with Covenant Health System [Member]
Subsequent Event [Line Items]
Number of facilities acquired						3
Subsequent Event [Member] \| Germany [Member] \| Rehabilitation Hospital with Covenant Health System [Member]
Subsequent Event [Line Items]
Number of facilities acquired	4
Purchase price of acquisition \| €	€ 5.8
2018 [Member] \| Germany [Member] \| Rehabilitation Hospital with Covenant Health System [Member]
Subsequent Event [Line Items]
Number of facilities acquired			3	4	4
Purchase price of acquisition \| €			€ 17.3	€ 23.0	€ 23.0
Healthscope [Member] \| Subsequent Event [Member]
Subsequent Event [Line Items]
Number of facilities acquired		11
Purchase price of acquisition \| $		$ 859
Term of lease		20 years
Healthscope [Member] \| Subsequent Event [Member] \| Maximum [Member]
Subsequent Event [Line Items]
Ownership interests acquired		100.00%

Schedule II - Schedule of Valuation and Qualifying Accounts (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Valuation And Qualifying Accounts [Abstract]
Balance at Beginning of Year	$ 16,397	$ 18,852	$ 27,384
Additions charged against operations	57,285	2,525	2,722
Deductions,Net recoveries/write offs	(7,551)	(4,980)	(11,254)
Balance at end of year	$ 66,131	$ 16,397	$ 18,852

Schedule II - Schedule of Valuation and Qualifying Accounts (Parenthetical) (Detail) - USD ($) $ in Millions	3 Months Ended		12 Months Ended
	Dec. 31, 2018	Dec. 31, 2016	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Increase in real estate impairment reserve			$ 48.0
Increase in accounts receivable reserve			9.3
Increase (decrease) in valuation allowance			$ (7.7)	$ (4.9)	$ (6.1)
Domestic Valuation Allowances [Member]
Increase (decrease) in valuation allowance	$ (4.4)
Foreign Valuation Allowances [Member]
Increase (decrease) in valuation allowance		$ (4.0)
Twelve Oaks Facility [Member]
Rent reserves		1.9			1.9
Write offs related to payment of rent, late fees, and loans		3.3			3.3
Corinth Facility [Member]
Rent reserves		0.8			0.8
Write offs for rent and interest reserves		0.8			0.8
M/C Healthcare Loan [Member]
Write offs related to loan		$ 0.1			$ 0.1

Schedule III - Real Estate Investments and Accumulated Depreciation (Parenthetical) (Detail) $ in Thousands	Dec. 31, 2018 USD ($)
Real Estate And Accumulated Depreciation Disclosure [Abstract]
Aggregate cost for federal income tax purposes	$ 4,873,085

Schedule III - Changes in Total Real Estate Assets (Detail) - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2018

Dec. 31, 2017

Dec. 31, 2016

Real Estate And Accumulated Depreciation Disclosure [Abstract]

Balance at beginning of period

$ 5,438,148

^[1]

$ 3,968,042

$ 2,991,590

Acquisitions

758,619

1,256,245

745,948

Transfers from construction in progress

25,513

74,441

163,080

Additions

96,775

36,828

33,279

Dispositions

(1,318,238)

(53,372)

(138,886)

Other

(219,668)

^[2]

155,964

^[2]

173,031

Balance at end of period

$ 4,781,149

$ 5,438,148

^[1]

$ 3,968,042

[1]	Includes $131.4 million of land and building cost reflected in real estate held for sale at December 31, 2017. Excludes intangible lease assets that are included in real estate held for sale of $15.8 million at December 31, 2017.
[2]	Represents foreign currency fluctuations and purchase price allocation adjustments.

Schedule III - Changes in Accumulated Depreciation (Detail) - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2018

Dec. 31, 2017

Dec. 31, 2016

Real Estate And Accumulated Depreciation Disclosure [Abstract]

Balance at beginning of period

$ 407,349

^[1]

$ 292,786

$ 232,675

Depreciation

115,497

109,307

81,010

Depreciation on disposed property

(101,967)

(1,438)

(19,086)

Other

(6,548)

6,694

(1,813)

Balance at end of period

$ 414,331

$ 407,349

^[1]

$ 292,786

[1]	Includes $0.5 million of accumulated depreciation reflected in real estate held for sale at December 31, 2017. Excludes accumulated amortization related to intangible lease assets that are included in real estate held for sale of $0.1 million at December 31, 2017.

Schedule III - Changes in Accumulated Depreciation (Parenthetical) (Detail) - USD ($)
$ in Thousands

Dec. 31, 2018

Dec. 31, 2017

Dec. 31, 2016

Dec. 31, 2015

SEC Schedule III, Real Estate and Accumulated Depreciation [Line Items]

Real estate held for sale

$ 146,615

Intangible lease assets

$ 403,138

443,134

Accumulated Depreciation

414,331

407,349

^[1]

$ 292,786

$ 232,675

Accumulated amortization

$ 50,653

48,857

Real Estate Held For Sale [Member]

SEC Schedule III, Real Estate and Accumulated Depreciation [Line Items]

Intangible lease assets

15,800

Accumulated Depreciation

500

Accumulated amortization

100

Real Estate Held For Sale [Member] | Land and Building [Member]

SEC Schedule III, Real Estate and Accumulated Depreciation [Line Items]

Real estate held for sale

$ 131,400

[1]	Includes $0.5 million of accumulated depreciation reflected in real estate held for sale at December 31, 2017. Excludes accumulated amortization related to intangible lease assets that are included in real estate held for sale of $0.1 million at December 31, 2017.

Schedule IV - Schedule of Mortgage Loans on Real Estate (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Mortgage Loans on Real Estate [Line Items]
Prior Liens	$ 0
Face Amount of Mortgages	1,213,283,000
Carrying Amount of Mortgages	1,213,283,000	$ 1,778,264,000	$ 1,060,336,000	$ 757,500,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member]
Mortgage Loans on Real Estate [Line Items]
Periodic Payment Terms	Payable in monthly installments of interest plus principal payable in full at maturity
Long-Term First Mortgage Loan [Member] \| Desert Valley Hospital [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	11.00%
Final Maturity Date	2022
Face Amount of Mortgages	$ 70,000,000
Carrying Amount of Mortgages	70,000,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member] \| Desert Valley Hospital [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	12.20%
Final Maturity Date	2022
Face Amount of Mortgages	$ 20,000,000
Carrying Amount of Mortgages	20,000,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member] \| Desert Valley Hospital [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	11.00%
Final Maturity Date	2020
Face Amount of Mortgages	$ 12,500,000
Carrying Amount of Mortgages	12,500,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member] \| Chino Valley Medical Center [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	11.00%
Final Maturity Date	2022
Face Amount of Mortgages	$ 50,000,000
Carrying Amount of Mortgages	50,000,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member] \| Paradise Valley Hospital [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	11.00%
Final Maturity Date	2022
Face Amount of Mortgages	$ 25,000,000
Carrying Amount of Mortgages	25,000,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member] \| Ernest Mortgage Loan [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	10.00%
Final Maturity Date	2032
Face Amount of Mortgages	$ 115,000,000
Carrying Amount of Mortgages	115,000,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member] \| Centinela Hospital Medical Center [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	11.60%
Final Maturity Date	2022
Face Amount of Mortgages	$ 100,000,000
Carrying Amount of Mortgages	100,000,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member] \| Olympia Medical Center [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	10.70%
Final Maturity Date	2024
Face Amount of Mortgages	$ 25,000,000
Carrying Amount of Mortgages	25,000,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member] \| St. Joseph Medical Center [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	9.00%
Final Maturity Date	2025
Face Amount of Mortgages	$ 30,000,000
Carrying Amount of Mortgages	30,000,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member] \| St. Mary's Medical Center [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	9.00%
Final Maturity Date	2025
Face Amount of Mortgages	$ 10,000,000
Carrying Amount of Mortgages	10,000,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member] \| Lake Huron Medical Center [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	9.00%
Final Maturity Date	2020
Face Amount of Mortgages	$ 10,000,000
Carrying Amount of Mortgages	10,000,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member] \| Steward Mortgage Loan [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	7.50%
Final Maturity Date	2031
Face Amount of Mortgages	$ 727,508,000
Carrying Amount of Mortgages	727,508,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0
Long-Term First Mortgage Loan [Member] \| Vibra Mortgage Loan [Member]
Mortgage Loans on Real Estate [Line Items]
Interest Rate	11.50%
Final Maturity Date	2024
Face Amount of Mortgages	$ 18,275,000
Carrying Amount of Mortgages	18,275,000
Principal Amount of Loans Subject to Delinquent Principal or Interest	$ 0

Schedule IV - Schedule of Mortgage Loans on Real Estate (Parenthetical) (Detail)	Dec. 31, 2018 USD ($) Property
Mortgage Loans on Real Estate [Line Items]
Prior Liens	$ 0
Carrying amount of mortgages, federal income tax purposes	1,213,283,000
Unamortized loan issue costs	$ 40,000
Ernest Mortgage Loan [Member] \| Long-Term First Mortgage Loan [Member]
Mortgage Loans on Real Estate [Line Items]
Number of properties \| Property	4
Steward Mortgage Loan [Member] \| Long-Term First Mortgage Loan [Member]
Mortgage Loans on Real Estate [Line Items]
Number of properties \| Property	2

Schedule IV - Changes in Mortgage Loans Excluding Unamortized Loan Issue Costs (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Mortgage Loans On Real Estate [Abstract]
Balance at beginning of year	$ 1,778,264	$ 1,060,336	$ 757,500
New mortgage loans and additional advances on existing loans	50,783	717,928	612,836
Mortgage loans on real estate including additions during year	1,829,047	1,778,264	1,370,336
Collection of principal	(615,764)		(310,000)
Deductions during year	(615,764)		(310,000)
Balance at end of year	$ 1,213,283	$ 1,778,264	$ 1,060,336