View Filing Data

Document and Entity Information - shares	6 Months Ended
Document and Entity Information - shares	Jun. 30, 2015	Aug. 07, 2015
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2015
Document Fiscal Year Focus	2015
Document Fiscal Period Focus	Q2
Trading Symbol	MPW
Entity Registrant Name	MEDICAL PROPERTIES TRUST INC.
Entity Central Index Key	0001287865
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		208,914,827
MPT Operating Partnership, L.P. [Member]
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2015
Document Fiscal Year Focus	2015
Document Fiscal Period Focus	Q2
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

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2015	Dec. 31, 2014
Real estate assets
Land, buildings and improvements, and intangible lease assets	$ 2,720,011	$ 2,172,775
Mortgage loans	437,587	397,594
Net investment in direct financing leases	455,020	439,516
Gross investment in real estate assets	3,612,618	3,009,885
Accumulated depreciation and amortization	(231,909)	(202,627)
Net investment in real estate assets	3,380,709	2,807,258
Cash and cash equivalents	45,904	144,541
Interest and rent receivables	56,792	41,137
Straight-line rent receivables	68,927	59,128
Other loans	548,865	573,167
Other assets	124,928	122,105
Total Assets	4,226,125	3,747,336
Liabilities
Debt, net	2,262,861	2,201,654
Accounts payable and accrued expenses	130,505	112,623
Deferred revenue	27,541	27,207
Lease deposits and other obligations to tenants	9,341	23,805
Total Liabilities	2,430,248	2,365,289
Equity / Capital
Preferred stock, $0.001 par value. Authorized 10,000 shares; no shares outstanding
Common stock, $0.001 par value. Authorized 250,000 shares; issued and outstanding - 207,804 shares at June 30, 2015 and 172,743 shares at December 31, 2014	208	172
Limited Partners:
Additional paid in capital	2,250,894	1,765,381
Distributions in excess of net income	(395,078)	(361,330)
Accumulated other comprehensive loss	(59,885)	(21,914)
Treasury shares, at cost	(262)	(262)
Total Equity / Capital	1,795,877	1,382,047
Total Liabilities and Equity / Capital	4,226,125	3,747,336
MPT Operating Partnership, L.P. [Member]
Real estate assets
Land, buildings and improvements, and intangible lease assets	2,720,011	2,172,775
Mortgage loans	437,587	397,594
Net investment in direct financing leases	455,020	439,516
Gross investment in real estate assets	3,612,618	3,009,885
Accumulated depreciation and amortization	(231,909)	(202,627)
Net investment in real estate assets	3,380,709	2,807,258
Cash and cash equivalents	45,904	144,541
Interest and rent receivables	56,792	41,137
Straight-line rent receivables	68,927	59,128
Other loans	548,865	573,167
Other assets	124,928	122,105
Total Assets	4,226,125	3,747,336
Liabilities
Debt, net	2,262,861	2,201,654
Accounts payable and accrued expenses	84,550	74,195
Deferred revenue	27,541	27,207
Lease deposits and other obligations to tenants	9,341	23,805
Payable due to Medical Properties Trust, Inc.	45,565	38,038
Total Liabilities	2,429,858	2,364,899
Limited Partners:
Accumulated other comprehensive loss	(59,885)	(21,914)
Total Equity / Capital	1,796,267	1,382,437
Total Liabilities and Equity / Capital	4,226,125	3,747,336
MPT Operating Partnership, L.P. [Member] \| Common Units [Member]
Limited Partners:
Limited Partners Capital	1,837,577	1,390,296
MPT Operating Partnership, L.P. [Member] \| General Partner [Member]
Equity / Capital
General Partner - issued and outstanding - 2,073 units at June 30, 2015 and 1,722 units at December 31, 2014	18,575	14,055
MPT Operating Partnership, L.P. [Member] \| LTIP Units [Member]
Limited Partners:
Limited Partners Capital	$ 0	$ 0

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Jun. 30, 2015	Dec. 31, 2014
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	250,000,000	250,000,000
Common stock, shares issued	207,804,000	172,743,000
Common stock, shares outstanding	207,804,000	172,743,000
General Partner [Member] \| MPT Operating Partnership, L.P. [Member]
General partner, units issued	2,073,000	1,722,000
General partner, units outstanding	2,073,000	1,722,000
LTIP Units [Member] \| MPT Operating Partnership, L.P. [Member]
LTIP Units, shares issued	292,000	292,000
LTIP Units, shares outstanding	292,000	292,000
Common Units [Member] \| MPT Operating Partnership, L.P. [Member]
Limited Partners, units issued	205,731,000	171,021,000
Limited Partners, units outstanding	205,731,000	171,021,000

Condensed Consolidated Statements of Operations (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014	Jun. 30, 2015	Jun. 30, 2014
Revenues
Rent billed	$ 53,893	$ 45,928	$ 106,994	$ 88,889
Straight-line rent	5,252	3,178	9,980	5,366
Income from direct financing leases	12,808	12,263	25,363	24,479
Interest and fee income	27,848	15,191	53,425	30,915
Total revenues	99,801	76,560	195,762	149,649
Expenses
Real estate depreciation and amortization	14,956	12,442	29,712	26,131
Impairment charges		29,631		50,128
Property-related	530	(38)	881	700
General and administrative	10,642	8,206	21,547	17,165
Acquisition expenses	25,809	2,535	32,048	3,047
Total operating expenses	51,937	52,776	84,188	97,171
Operating income	47,864	23,784	111,574	52,478
Other income (expense)
Interest and other income (expense)	225	19	(571)	(30)
Earnings from equity and other interests	1,853	686	1,956	905
Interest expense	(26,890)	(24,362)	(53,318)	(45,974)
Debt refinancing costs		(290)	(238)	(290)
Income tax (expense) benefit	(563)	(40)	(938)	16
Net other expense	(25,375)	(23,987)	(53,109)	(45,373)
Income (loss) from continuing operations	22,489	(203)	58,465	7,105
Income (loss) from discontinued operations				(2)
Net income (loss)	22,489	(203)	58,465	7,103
Net income (loss) attributable to non-controlling interests	(82)		(161)	(65)
Net income (loss) attributable to MPT common stockholders	$ 22,407	$ (203)	$ 58,304	$ 7,038
Earnings per common share - basic and diluted
Income (loss) from continuing operations attributable to MPT common stockholders	$ 0.11		$ 0.28	$ 0.04
Income (loss) from discontinued operations attributable to MPT common stockholders	0	$ 0	0	0
Net income (loss) attributable to MPT common stockholders	$ 0.11		$ 0.28	$ 0.04
Weighted average shares / units outstanding:
Basic	208,071	171,718	205,515	167,846
Diluted	208,640	172,369	206,127	168,459
Dividends declared per common share / unit	$ 0.22	$ 0.21	$ 0.44	$ 0.42
MPT Operating Partnership, L.P. [Member]
Revenues
Rent billed	$ 53,893	$ 45,928	$ 106,994	$ 88,889
Straight-line rent	5,252	3,178	9,980	5,366
Income from direct financing leases	12,808	12,263	25,363	24,479
Interest and fee income	27,848	15,191	53,425	30,915
Total revenues	99,801	76,560	195,762	149,649
Expenses
Real estate depreciation and amortization	14,956	12,442	29,712	26,131
Impairment charges		29,631		50,128
Property-related	530	(38)	881	700
General and administrative	10,642	8,206	21,547	17,165
Acquisition expenses	25,809	2,535	32,048	3,047
Total operating expenses	51,937	52,776	84,188	97,171
Operating income	47,864	23,784	111,574	52,478
Other income (expense)
Interest and other income (expense)	225	19	(571)	(30)
Earnings from equity and other interests	1,853	686	1,956	905
Interest expense	(26,890)	(24,362)	(53,318)	(45,974)
Debt refinancing costs		(290)	(238)	(290)
Income tax (expense) benefit	(563)	(40)	(938)	16
Net other expense	(25,375)	(23,987)	(53,109)	(45,373)
Income (loss) from continuing operations	22,489	(203)	58,465	7,105
Income (loss) from discontinued operations				(2)
Net income (loss)	22,489	(203)	58,465	7,103
Net income (loss) attributable to non-controlling interests	(82)		(161)	(65)
Net income (loss) attributable to MPT common stockholders	$ 22,407	$ (203)	$ 58,304	$ 7,038
Earnings per common share - basic and diluted
Income (loss) from continuing operations attributable to MPT common stockholders	$ 0.11		$ 0.28	$ 0.04
Income (loss) from discontinued operations attributable to MPT common stockholders	0	$ 0	0	0
Net income (loss) attributable to MPT common stockholders	$ 0.11		$ 0.28	$ 0.04
Weighted average shares / units outstanding:
Basic	208,071	171,718	205,515	167,846
Diluted	208,640	172,369	206,127	168,459
Dividends declared per common share / unit	$ 0.22	$ 0.21	$ 0.44	$ 0.42

Condensed Consolidated Statements of Comprehensive Income (Loss) (Unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014	Jun. 30, 2015	Jun. 30, 2014
Net income (loss)	$ 22,489	$ (203)	$ 58,465	$ 7,103
Other comprehensive income:
Unrealized gain on interest rate swap	730	486	1,315	1,206
Foreign currency translation gain (loss)	20,307	73	(39,286)	46
Total comprehensive income	43,526	356	20,494	8,355
Comprehensive income attributable to non-controlling interests	(82)		(161)	(65)
Comprehensive income attributable to MPT common stockholders (Operating partnership partners)	43,444	356	20,333	8,290
MPT Operating Partnership, L.P. [Member]
Net income (loss)	22,489	(203)	58,465	7,103
Other comprehensive income:
Unrealized gain on interest rate swap	730	486	1,315	1,206
Foreign currency translation gain (loss)	20,307	73	(39,286)	46
Total comprehensive income	43,526	356	20,494	8,355
Comprehensive income attributable to non-controlling interests	(82)		(161)	(65)
Comprehensive income attributable to MPT common stockholders (Operating partnership partners)	$ 43,444	$ 356	$ 20,333	$ 8,290

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014
Operating activities
Net income	$ 58,465	$ 7,103
Adjustments to reconcile net income to net cash provided by operating activities
Depreciation and amortization	30,564	26,715
Straight-line rent revenue	(9,980)	(6,316)
Straight-line rent write-off		950
Impairment charges		50,128
Direct financing lease interest accretion	(3,279)	(3,256)
Share / Unit-based compensation	5,645	4,433
Amortization and write-off of deferred financing costs and debt discount	2,770	2,484
Other adjustments	(2,383)	(8,406)
Changes in
Interest and rent receivable	(15,685)	(9,064)
Accounts payable and accrued expenses	21,327	(14,516)
Net cash provided by operating activities	87,444	50,255
Investing activities
Cash paid for acquisitions and other related investments	(562,633)	(115,000)
Principal received on loans receivable	354,952	6,829
Investment in loans receivable	(347,768)	(5,601)
Construction in progress and other	(86,053)	(55,159)
Net cash used for investing activities	(641,502)	(168,931)
Financing activities
Revolving credit facilities, net	80,586	(105,000)
Additions to term debt		425,000
Payments of term debt	(140)	(100,132)
Distributions paid	(84,487)	(71,809)
Proceeds from sale of common shares / units, net of offering costs	479,902	128,332
Lease deposits and other obligations to tenants	(14,453)	4,910
Debt issuance costs paid and other financing activities	(662)	(11,496)
Net cash provided by financing activities	460,746	269,805
Increase (decrease) in cash and cash equivalents for period	(93,312)	151,129
Effect of exchange rate changes	(5,325)	(85)
Cash and cash equivalents at beginning of period	144,541	45,979
Cash and cash equivalents at end of period	45,904	197,023
Interest paid	52,130	41,907
Supplemental schedule of non-cash financing activities:
Distributions declared, unpaid	46,026	36,277
MPT Operating Partnership, L.P. [Member]
Operating activities
Net income	58,465	7,103
Adjustments to reconcile net income to net cash provided by operating activities
Depreciation and amortization	30,564	26,715
Straight-line rent revenue	(9,980)	(6,316)
Straight-line rent write-off		950
Impairment charges		50,128
Direct financing lease interest accretion	(3,279)	(3,256)
Share / Unit-based compensation	5,645	4,433
Amortization and write-off of deferred financing costs and debt discount	2,770	2,484
Other adjustments	(2,383)	(8,406)
Changes in
Interest and rent receivable	(15,685)	(9,064)
Accounts payable and accrued expenses	21,327	(14,516)
Net cash provided by operating activities	87,444	50,255
Investing activities
Cash paid for acquisitions and other related investments	(562,633)	(115,000)
Principal received on loans receivable	354,952	6,829
Investment in loans receivable	(347,768)	(5,601)
Construction in progress and other	(86,053)	(55,159)
Net cash used for investing activities	(641,502)	(168,931)
Financing activities
Revolving credit facilities, net	80,586	(105,000)
Additions to term debt		425,000
Payments of term debt	(140)	(100,132)
Distributions paid	(84,487)	(71,809)
Proceeds from sale of common shares / units, net of offering costs	479,902	128,332
Lease deposits and other obligations to tenants	(14,453)	4,910
Debt issuance costs paid and other financing activities	(662)	(11,496)
Net cash provided by financing activities	460,746	269,805
Increase (decrease) in cash and cash equivalents for period	(93,312)	151,129
Effect of exchange rate changes	(5,325)	(85)
Cash and cash equivalents at beginning of period	144,541	45,979
Cash and cash equivalents at end of period	45,904	197,023
Interest paid	52,130	41,907
Supplemental schedule of non-cash financing activities:
Distributions declared, unpaid	$ 46,026	$ 36,277

Summary of Significant Accounting Policies

6 Months Ended

Jun. 30, 2015

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2. Summary of Significant Accounting Policies

Unaudited Interim Condensed Consolidated Financial Statements: The accompanying unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States for interim financial information, including rules and regulations of the Securities and Exchange Commission. Accordingly, they do not include all of the information and footnotes required by generally accepted accounting principles for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair presentation have been included. Operating results for the three and six month periods ended June 30, 2015, are not necessarily indicative of the results that may be expected for the year ending December 31, 2015. The condensed consolidated balance sheet at December 31, 2014 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by accounting principles generally accepted in the United States for complete financial statements.

For information about significant accounting policies, refer to the consolidated financial statements and footnotes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2014. During the six months ended June 30, 2015, there were no material changes to these policies.

Recent Accounting Developments:

Revenue from Contracts with Customers

In May 2014, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2014-09, “Revenue from Contracts with Customers.” Under the new standard, revenue is recognized at the time a good or service is transferred to a customer for the amount of consideration received for that specific good or service. Entities may use a full retrospective approach or report the cumulative effect as of the date of adoption.

On April 1, 2015, the FASB proposed deferring the effective date by one year to December 15, 2017, for annual reporting periods beginning after that date. The FASB also proposed permitting early adoption of the standard, but not before the original effective date of December 15, 2016. We do not expect this standard to have a significant impact on our financial results. as a substantial portion of our revenue consists of rental income from leasing arrangements, which are specifically excluded from ASU 2014-09.

Presentation of Debt Issuance Costs

In April 2015, the FASB issued ASU No. 2015-03, “Simplifying the Presentation of Debt Issuance Costs.” This standard amends existing guidance to require the presentation of debt issuance costs in the balance sheet as a deduction from the carrying amount of the related debt liability instead of a deferred charge. It is effective for annual reporting periods beginning after December 15, 2015, but early adoption is permitted.

Amendments to the Consolidation Analysis

In February 2015, the FASB issued an ASU 2015-02 that modifies the evaluation of whether limited partnerships and similar legal entities are VIEs, eliminates the presumption that a general partner should consolidate a limited partnership and affects the consolidation analysis of reporting entities that are involved with VIEs, particularly those that have fee arrangements and related party relationships. The guidance is effective for fiscal years beginning after December 15, 2015, but early adoption is permitted.

Variable Interest Entities

At June 30, 2015, we had loans to and/or equity investments in certain variable interest entities (“VIEs”), which are also tenants of our facilities, including Ernest Health, Inc. (“Ernest”). 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 June 30, 2015 (in thousands):


VIE Type	Maximum Loss Exposure(1)		Asset Type Classification	Carrying Amount(2)
Loans, net	$	277,941	Mortgage and other loans	$	224,482
Equity investments	$	61,323	Other assets	$	6,292

(1)

Our maximum loss exposure related to loans with VIEs represents our current aggregate gross carrying value of the loan plus accrued interest and any other related assets (such as rent receivables), less any liabilities. Our maximum loss exposure related to our equity investment in VIEs represents 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 loan or 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 borrower or investees) that most significantly impact the VIE’s economic performance. As of June 30, 2015, we were not required to provide any material 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.

See Note 3 for additional description of the nature, purpose and activities of our more significant VIEs and interests therein.

Real Estate and Lending Activities

6 Months Ended

Jun. 30, 2015

Text Block [Abstract]

Real Estate and Lending Activities

3. Real Estate and Lending Activities

Acquisitions

2015 Activity

MEDIAN Transaction Update

On April 29, 2015, we entered into a series of definitive agreements with Median Kliniken S.à r.l., (“MEDIAN”), a German provider of post-acute and acute rehabilitation services, to acquire the real estate assets of 32 hospitals owned by MEDIAN for an aggregate purchase price of approximately €688 million. Upon acquisition, each property became subject to a master lease between us and MEDIAN providing for the leaseback of the property to MEDIAN. The master lease has an initial term of 27 years and provides for an initial GAAP lease rate of 9.3%, with annual escalators at the greater of one percent or 70% of the German consumer price index. We expect to acquire three additional facilities from MEDIAN in a substantially similar sale-leaseback transaction subject to the master lease, resulting in an aggregate purchase price for all acquired facilities of approximately €705 million.

MEDIAN is owned by an affiliate of Waterland Private Equity Fund V C.V. (“Waterland”), which acquired 94.9% of the outstanding equity interests in MEDIAN, and by a subsidiary of our operating partnership, which acquired the remaining 5.1% of the outstanding equity interests in MEDIAN, each in December 2014. In December 2014, we provided interim acquisition loans to affiliates of Waterland and MEDIAN in connection with Waterland’s acquisition of its stake in MEDIAN in an aggregate amount of approximately €425 million. In addition, we made further loans to MEDIAN during the first half of 2015 in an aggregate amount of approximately €240 million, which were used by MEDIAN to repay existing debt on properties we have acquired or expect to acquire. We may make additional loans to MEDIAN for the purpose of repaying existing property debt, up to a total aggregate amount of all loans to Waterland and MEDIAN in the amount of approximately €705 million.

Closing of the sale-leaseback transactions, which began in the second quarter of 2015, is subject to customary real estate, regulatory and other closing conditions, including waiver of any statutory pre-emption rights by local municipalities and antitrust clearance. At each closing, the purchase price for each facility will be reduced and offset against the interim loans made to affiliates of Waterland and MEDIAN as described above and against the amount of any debt assumed or repaid by us in connection with the closing. As of June 30, 2015, we have closed on 17 of the 35 properties for an aggregate amount of €317 million ($354 million). As of August 1, 2015, we have closed on 30 of the 35 (including the three additional facilities) properties subject to the agreements for a cumulative purchase price to date of approximately €627 million.

Other Acquisitions

On June 16, 2015, we acquired the real estate of two facilities in Lubbock, Texas, a 60-bed inpatient rehabilitation hospital and a 37-bed long term acute care hospital, for an aggregate purchase price of $31.5 million. We entered into a 20-year lease with Ernest for the rehabilitation hospital, which provides for three five-year extension options, and separately entered into a lease with Ernest for the long-term acute care hospital that has a final term ending December 31, 2034. In connection with the transaction, we funded an acquisition loan to Ernest of approximately $12.0 million. Ernest will operate the rehabilitation hospital in a joint venture with Covenant Health System, while the long term acute care hospital will continue to be operated by Fundamental Health under a new sublease with Ernest.

On February 27, 2015, we acquired an inpatient rehabilitation hospital in Weslaco, Texas for $10.7 million leased to Ernest pursuant to the 2012 master lease which has a remaining 17-year fixed term and three five year extension options. This lease provides for consumer-priced-indexed annual rent increases, subject to a floor and a cap. In addition we agreed to fund an acquisition loan in the amount of $5 million.

On February 13, 2015, we acquired two general acute care hospitals in the Kansas City area for $110 million. Affiliates of Prime Healthcare Services, Inc. (“Prime”) is the tenant and operator pursuant to a new master lease that has similar terms and security enhancements as the other master lease agreements entered into in 2013. This master lease has a 10 year initial fixed term with two extension options of five years each. The lease provides for consumer-price-indexed annual rent increases, subject to a specified floor. In addition, we agreed to fund a mortgage loan in the amount of $40 million, which has a 10-year term.

2014 Activity

On March 31, 2014, we acquired a general acute care hospital and an adjacent parcel of land for an aggregate purchase price of $115 million from a joint venture of LHP Hospital Group, Inc. and Hackensack University Medical Center Mountainside. The facility was simultaneously leased back to the seller under a lease with a 15-year initial term with a 3-year extension option, followed by a further 12-year extension option at fair market value. The lease provides for consumer price-indexed annual rent increases, subject to a specified floor and ceiling. The lease includes a customary right of first refusal with respect to a subsequent proposed sale of the facility.

As part of these acquisitions, we acquired the following assets:


	2015		2014
Assets Acquired
Land and land improvements	$	21,591	$	8,477
Building		473,425		99,640
Intangible lease assets — subject to amortization (weighted average useful life 15 years)		—		6,883
Mortgage loans		40,000		—
Net investments in direct financing leases		10,700		—
Other loans		16,917		—


Total assets acquired	$	562,633	$	115,000

The purchase price allocations attributable to the 2015 acquisitions are preliminary. When all relevant information is obtained, resulting changes, if any, to our provisional purchase price allocation will be retrospectively adjusted to reflect new information obtained about the facts and circumstances that existed as of the respective acquisition dates that, if known, would have affected the measurement of the amounts recognized as of those dates.

From the respective acquisition dates, the properties and mortgage loans acquired in 2015 contributed $4.2 million and $3.5 million of revenue and income (excluding related acquisition expenses), respectively, for the three months ended June 30, 2015. From the respective acquisition dates, the properties and mortgage loans acquired in 2015 contributed $6.2 million and $4.9 million of revenue and income (excluding related acquisition expenses), respectively, for the six months ended June 30, 2015. In addition, we incurred $22.6 million and $26.7 million of acquisition related costs on the 2015 acquisitions for the three and six months ended June 30, 2015, respectively.

From the respective acquisition dates in 2014, the 2014 acquisitions contributed $2.3 million and $1.6 million of revenue and income (excluding related acquisition and financing expenses), respectively, for the three and six months ended June 30, 2014. In addition, we incurred $0.4 million of acquisition related costs on the 2014 acquisitions for the three and six months ended June 30, 2014.

Pro Forma Information

The following unaudited supplemental pro forma operating data is presented for the three and six months ended June 30, 2015 and 2014, as if each acquisition (including completed development projects) was completed on January 1, 2014. Supplemental pro forma earnings were adjusted to exclude acquisition-related costs on consummated deals incurred. The unaudited supplemental pro forma operating data is not necessarily indicative of what the actual results of operations would have been assuming the transactions had been completed as set forth above, nor do they purport to represent our results of operations for future periods (in thousands, except per share/unit amounts).


	For the Three Months Ended June 30,				For the Six Months Ended June 30,
	2015		2014		2015		2014
Total revenues	$	108.8	$	106.2	$	218.7	$	211.5
Net income	$	50.2	$	20.6	$	99.8	$	44.6
Net income per share/unit — diluted	$	0.21	$	0.09	$	0.42	$	0.19

Development Activities

During the first six months of 2015, we completed construction and began recording rental income on the following facilities:

•

First Choice ER (a subsidiary of Adeptus Health) – We completed seven acute care facilities for this tenant during 2015. These facilities are leased pursuant to the master lease entered into in 2014 and are cross-defaulted with the original master lease executed with First Choice ER in 2013. One property is leased pursuant to the master lease entered into in 2015 and is cross-defaulted with the master leases entered into in 2014 and 2013.

•

UAB Medical West – This acute care facility and medical office building located in Birmingham, Alabama is leased to Medical West, an affiliate of The University of Alabama at Birmingham.

On June 16, 2015, we entered into definitive agreements to acquire the real estate of a general acute care hospital under development located in Spain, for an aggregate purchase and development price to us of approximately €21.4 million. The acquisition will be effected through a newly-formed joint venture between us and clients of AXA Real Estate, in which we will own a 50% interest. Upon completion, the facility will be leased to a Spanish operator of acute care hospitals, pursuant to a long-term lease. Closing of the transaction which is expected during the second half of 2015, is subject to customary real estate, regulatory and other closing conditions.

On May 5, 2015, we entered into an agreement to finance the development of and lease an inpatient rehabilitation facility in Toledo, Ohio for $19.2 million, which will be leased to Ernest under the 2012 master lease. The facility is expected to be completed in the second quarter of 2016.

In April 2015, we executed an agreement with Adeptus Health that provides for the acquisition and development of general acute care hospitals and free standing emergency facilities with an aggregate commitment of $250 million. These facilities will be leased to Adeptus Health pursuant to the terms of the 2014 master lease agreement that has a 15-year initial term with three extension options of five years each that provides for annual rent increases based on changes in the consumer price index with a 2% minimum.

See table below for a status update on our current development projects (in thousands):

Property

Location

Property Type

Operator

Commitment

Costs
Incurred
as of
06/30/15

Estimated
Completion
Date

First Choice ER- Aurora

Aurora, CO

Acute Care Hospital

Adeptus Health

5,273

1,614

3Q 2015

First Choice ER- Carrollton

Carrollton, TX

Acute Care Hospital

Adeptus Health

35,820

30,692

3Q 2015

First Choice ER- Conroe

Houston, TX

Acute Care Hospital

Adeptus Health

6,110

3,150

3Q 2015

First Choice ER- Gilbert

Gilbert, AZ

Acute Care Hospital

Adeptus Health

6,500

4,291

3Q 2015

First Choice ER- McKinney

McKinney, TX

Acute Care Hospital

Adeptus Health

4,750

2,582

3Q 2015

First Choice ER- Chandler-Ray

Chandler, AZ

Acute Care Hospital

Adeptus Health

5,261

1,741

4Q 2015

First Choice ER- Cinco Ranch

Katy, TX

Acute Care Hospital

Adeptus Health

5,105

162

4Q 2015

First Choice ER- Highland Village

Highland Village, TX

Acute Care Hospital

Adeptus Health

4,884

361

4Q 2015

First Choice ER- Parker

Parker, CO

Acute Care Hospital

Adeptus Health

6,868

1,843

4Q 2015

First Choice ER- Frisco Eldorado

Frisco, TX

Acute Care Hospital

Adeptus Health

5,124

1Q 2016

First Choice ER- Helotes

Helotes, TX

Acute Care Hospital

Adeptus Health

7,530

2,251

2Q 2016

Rehabilitation

Hospital of

Northwest Ohio

Toledo, OH

Inpatient Rehabilitation Hospital

Ernest Health

19,212

1,649

2Q 2016

First Choice ER-Vintage Preserve

Houston, TX

Acute Care Hospital

Adeptus Health

45,961

6,376

3Q 2016

First Choice Emergency Rooms

Various

Acute Care Hospital

Adeptus Health

231,649

—

Various

390,047

56,762

Leasing Operations

All of our leases are accounted for as operating leases except for the master lease of 15 Ernest facilities and five Prime facilities which are accounted for as direct financing leases (“DFLs”). The components of our net investment in DFLs consisted of the following (dollars in thousands):


	As of June 30, 2015			As of December 31, 2014
Minimum lease payments receivable	$	1,627,898		$	1,607,024
Estimated residual values		225,872			211,888
Less: Unearned income		(1,398,750	)		(1,379,396	)


Net investment in direct financing leases	$	455,020		$	439,516

Florence facility

On March 6, 2013, the tenant of our $27.1 million facility in Phoenix, Arizona filed for Chapter 11 bankruptcy. At June 30, 2015, we have approximately $1.1 million of receivables outstanding but the tenant continues to pay us in accordance with bankruptcy orders. In addition, we have a letter of credit for approximately $1.2 million to cover any rent and other monetary payments not paid. Although no assurances can be made that we will not have any impairment charges in the future, we believe our investment in Florence at June 30, 2015 is fully recoverable.

Gilbert facility

In the first quarter of 2014, the tenant of our facility in Gilbert, Arizona filed for Chapter 11 bankruptcy; however, we sent notice of termination of the lease prior to the bankruptcy filing. As a result of the lease terminating, we recorded a charge of approximately $1 million to reserve against the straight-line rent receivables. In addition, we accelerated the amortization of the related lease intangible asset resulting in $1.1 million of additional expense in the 2014 first quarter. The tenant has continued to pay its monetary obligations, and we have agreed to the terms of an amended lease upon the tenant’s bankruptcy exit. Although no assurances can be made that we will not have any impairment charges or write-offs of receivables in the future, we believe our real estate investment in Gilbert of $13.9 million at June 30, 2015 is fully recoverable.

Loans

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


	As of June 30, 2015		As of December 31, 2014
Mortgage loans	$	437,587	$	397,594
Acquisition loans		503,012		525,136
Working capital and other loans		45,853		48,031


	$	986,452	$	970,761

The increase in our mortgage loans is related to the two property acquisition with Prime. See “Acquisition” sub-section for further details.

Our non-mortgage loans typically consist of loans to our tenants for acquisitions and working capital purposes. At June 30, 2015, acquisition loans includes our $114.4 million loans to Ernest plus $376.8 million related to the MEDIAN transaction.

On March 1, 2012, pursuant to our convertible note agreement, we converted $1.7 million of our $5.0 million convertible note into a 9.9% equity interest in the operator of our Hoboken University Medical Center facility. At June 30, 2015, $3.3 million remains outstanding on the convertible note, and we retain the option, subject to regulatory approvals, to convert this remainder into 15.1% of equity interest in the operator.

Concentrations of Credit Risk

For the three months ended June 30, 2015 and 2014, revenue from affiliates of Prime (including rent and interest from mortgage loans) accounted for 25.9% and 27.9%, respectively, of total revenue. For the six months ended June 30, 2015 and 2014, revenue from affiliates of Prime (including rent and interest from mortgage loans) accounted for 25.5% and 28.5%, respectively, of total revenue. From an investment concentration perspective, assets leased and loaned to Prime represented 13.8% and 7.5%, respectively of our total assets, at June 30, 2015. Assets leased and loaned to Prime represented 12.6% and 7.4%, respectively, of our total assets at December 31, 2014.

For the three and six months ended June 30, 2015, revenue from affiliates of MEDIAN accounted for 11.1% and 10.3% of total revenue, respectively. From an investment concentration perspective, MEDIAN represented 17.3% and 11.3% of our total assets at June 30, 2015 and December 31, 2014, respectively.

For the three months ended June 30, 2015 and 2014, revenue from affiliates of Ernest (including rent and interest from mortgage and acquisition loans) accounted for 15.0% and 18.2%, respectively, of total revenue. For the six months ended June 30, 2015 and 2014, revenue from affiliates of Ernest (including rent and interest from mortgage and acquisition loans) accounted for 15.2% and 18.9%, respectively, of total revenue. From an investment concentration perspective, assets leased and loaned to Ernest represented 7.9% and 5.1%, respectively, of our total assets at June 30, 2015. Assets leased and loaned to Ernest represented 7.7% and 5.3%, respectively, of our total assets at December 31, 2014.

On an individual property basis, we had no investment of any single property greater than 3% of our total assets as of June 30, 2015.

From a global geographic perspective, approximately 75% of our total assets are in the United States while 25% reside in Europe (primarily in Germany) as of June 30, 2015. From a global geographic perspective, approximately 80% of our total assets are in the United States while 20% reside in Europe as of December 31, 2014.

For the three months ended June 30, 2015 and 2014, revenue from our European investments was $18.1 million and $5.5 million, respectively. For the six months ended June 30, 2015 and 2014, revenue from our European investments was $34.4 million and $10.9 million, respectively.

From a United States geographic perspective, investments located in Texas represented 19.8% of our total assets at June 30, 2015, compared to 20.2% at December 31, 2014. Investments located in California represented 12.9% of our total assets at June 30, 2015, compared to 14.6% at December 31, 2014.

Debt

6 Months Ended

Jun. 30, 2015

Debt Disclosure [Abstract]

Debt

4. Debt

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


	As of June 30, 2015					As of December 31, 2014
	Balance		Interest Rate			Balance		Interest Rate
Revolving credit facility (A)	$	674,034		Variable		$	593,490		Variable
2006 Senior Unsecured Notes		125,000		Various			125,000		Various
2011 Senior Unsecured Notes		450,000		6.875	%		450,000		6.875	%
2012 Senior Unsecured Notes:
Principal amount		350,000		6.375	%		350,000		6.375	%
Unamortized premium		2,345		—			2,522		—


		352,345					352,522

2013 Senior Unsecured Notes (B)		222,940		5.750	%		241,960		5.750	%
2014 Senior Unsecured Notes		300,000		5.500	%		300,000		5.500	%
Term loans		138,542		Various			138,682		Various


	$	2,262,861				$	2,201,654

(A)	As of June 30, 2015, we had €301.0 million of outstanding borrowings on the revolving credit facility, or $335.5 million based on the exchange rate in effect at June 30, 2015.

(B)	The change in balance from period to period is due to foreign currency fluctuations. These notes are Euro-denominated and reflect the exchange rate at June 30, 2015 and December 31, 2014, respectively.

As of June 30, 2015, principal payments due for our debt (which exclude the effects of any premiums recorded) are as follows (in thousands):


2015	$	142
2016		125,299
2017		320
2018		686,815
2019		125,000
Thereafter		1,322,940


Total	$	2,260,516

During the second quarter 2010, we entered into an interest rate swap to manage our exposure to variable interest rates by fixing $65 million of our 2006 Senior Unsecured Notes, which started July 31, 2011 (date on which the interest rate turned variable) through maturity date (or July 2016), at a rate of 5.507%. We also entered into an interest rate swap to fix $60 million of our 2006 Senior Unsecured Notes which started October 31, 2011 (date on which the related interest rate turned variable) through the maturity date (or October 2016) at a rate of 5.675%. The fair value of the interest rate swaps was $4.7 million and $6.0 million as of June 30, 2015 and December 31, 2014, respectively, which is reflected in accounts payable and accrued expenses on the consolidated balance sheets.

We account for our interest rate swaps as cash flow hedges. Accordingly, the effective portion of changes in the fair value of our swaps is recorded as a component of accumulated other comprehensive income/loss on the balance sheet and reclassified into earnings in the same period, or periods, during which the hedged transactions effect earnings, while any ineffective portion is recorded through earnings immediately. We did not have any hedge ineffectiveness from inception of our interest rate swaps through June 30, 2015 and therefore, there was no income statement effect recorded during the three or six month periods ended June 30, 2015 or 2014. At June 30, 2015, we do not expect any of the current losses included in accumulated other comprehensive loss to be reclassified into earnings in the next 12 months. At June 30, 2015 and December 31, 2014, we have posted $2.5 million and $3.3 million of collateral related to our interest rate swaps, respectively, which is reflected in other assets on our consolidated balance sheets.

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 revolving credit facility and term loan limit the amount of dividends we can pay as a percentage of normalized adjusted funds from operations, as defined in the agreements, on a rolling four quarter basis. At June 30, 2015, the dividend restriction was 95% of normalized adjusted FFO. The indentures governing our senior unsecured notes also limit the amount of dividends we can pay based on the sum of 95% of funds from operations, 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 revolving credit facility and term loan contain customary financial and operating covenants, including covenants relating to our total leverage ratio, fixed charge coverage ratio, mortgage secured leverage ratio, recourse mortgage secured leverage ratio, consolidated adjusted net worth, unsecured leverage ratio, and unsecured interest coverage ratio. This 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 facility, the entire outstanding balance may become immediately due and payable. At June 30, 2015, we were in compliance with all such financial and operating covenants.

Fair Value of Financial Instruments

6 Months Ended

Jun. 30, 2015

Fair Value Disclosures [Abstract]

Fair Value of Financial Instruments

7. 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. Included in our accounts payable and accrued expenses are our interest rate swaps, which are recorded at fair value based on Level 2 observable market assumptions using standardized derivative pricing models. 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 loans 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 (excluding our 2006 Senior Unsecured Notes) using Level 2 inputs such as quotes from securities dealers and market makers. We estimate the fair value of our 2006 Senior Unsecured Notes, 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):


	June 30, 2015						December 31, 2014
Asset (Liability)	Book Value			Fair Value			Book Value			Fair Value
Interest and rent receivables	$	56,792		$	56,683		$	41,137		$	41,005
Loans (1)		771,284			801,457			773,311			803,824
Debt, net		(2,262,861	)		(2,341,637	)		(2,201,654	)		(2,285,727	)

(1)	Excludes loans related to Ernest since they are recorded at fair value and discussed below.

Items Measured at Fair Value on a Recurring Basis

Our equity interest in Ernest and related loans, which were acquired in 2012, are being measured at fair value on a recurring basis as we elected to account for these investments using the fair value option method. 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 made in or prior to 2015.

At June 30, 2015, these amounts were as follows (in thousands):


Asset Type	Fair Value		Cost		Asset Type Classification
Mortgage loans	$	100,000	$	100,000		Mortgage loans
Acquisition loans		114,367		114,367		Other loans
Other loans		801		801		Other loans
Equity investments		3,300		3,300		Other assets


	$	218,468	$	218,468

Our mortgage loans with Ernest are recorded at fair value based on Level 3 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 acquisition loans and equity investments in Ernest are 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 forecast assumptions associated with the investee. We classify these loans and equity investments as Level 3, as we use certain unobservable inputs to the valuation methodology that are significant to the fair value measurement, and the valuation requires management judgment due to the absence of quoted market prices. For these cash flow models, our observable inputs include 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 includes an adjustment for a marketability discount (“DLOM”) on our equity investment of 40% at June 30, 2015.

In regards to the underlying projection of revenues and expenses used in the discounted cash flow model, such projections are provided by Ernest. However, we will modify such projections (including underlying assumptions used) as needed based on our review and analysis of Ernest’s historical results, meetings with key members of management, and our understanding of trends and developments within the healthcare industry.

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. To illustrate the effect of movements in the DLOM, we performed a sensitivity analysis below by using basis point variations (dollars in thousands):


Basis Point Change in Marketability Discount	Estimated Increase (Decrease) In Fair Value
+100 basis points	$	(59	)
- 100 basis points		59

Because the fair value of Ernest investments noted above approximate their original cost, we did not recognize any unrealized gains/losses during the first half of 2015 or 2014.

- 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

Earnings Per Share/Common Unit

6 Months Ended

Jun. 30, 2015

Earnings Per Share [Abstract]

Earnings Per Share/Common Unit

8. Earnings Per Share/Common Unit

Medical Properties Trust, Inc.

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


	For the Three Months Ended June 30,
	2015			2014
Numerator:
Income (loss) from continuing operations	$	22,489		$	(203	)
Non-controlling interests’ share in continuing operations		(82	)		—
Participating securities’ share in earnings		(250	)		(195	)


Income (loss) from continuing operations, less participating securities’ share in earnings		22,157			(398	)
Income from discontinued operations attributable to MPT common stockholders		—			—


Net income (loss), less participating securities’ share in earnings	$	22,157		$	(398	)


Denominator:
Basic weighted-average common shares		208,071			171,718
Dilutive potential common shares		569			651


Dilutive weighted-average common shares		208,640			172,369


	For the Six Months Ended June 30,
	2015			2014
Numerator:
Income from continuing operations	$	58,465		$	7,105
Non-controlling interests’ share in continuing operations		(161	)		(65	)
Participating securities’ share in earnings		(516	)		(404	)


Income from continuing operations, less participating securities’ share in earnings		57,788			6,636
Loss from discontinued operations attributable to MPT common stockholders		—			(2	)


Net income, less participating securities’ share in earnings	$	57,788		$	6,634


Denominator:
Basic weighted-average common shares		205,515			167,846
Dilutive potential common shares		612			613


Dilutive weighted-average common shares		206,127			168,459

MPT Operating Partnership, L.P.

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


	For the Three Months Ended June 30,
	2015			2014
Numerator:
Income (loss) from continuing operations	$	22,489		$	(203	)
Non-controlling interests’ share in continuing operations		(82	)		—
Participating securities’ share in earnings		(250	)		(195	)


Income (loss) from continuing operations, less participating securities’ share in earnings		22,157			(398	)
Income from discontinued operations attributable to MPT Operating Partnership partners		—			—


Net income (loss), less participating securities’ share in earnings	$	22,157		$	(398	)


Denominator:
Basic weighted-average units		208,071			171,718
Dilutive potential units		569			651


Dilutive weighted-average units		208,640			172,369


	For the Six Months Ended June 30,
	2015			2014
Numerator:
Income from continuing operations	$	58,465		$	7,105
Non-controlling interests’ share in continuing operations		(161	)		(65	)
Participating securities’ share in earnings		(516	)		(404	)


Income from continuing operations, less participating securities’ share in earnings		57,788			6,636
Loss from discontinued operations attributable to MPT Operating Partnership partners		—			(2	)


Net income, less participating securities’ share in earnings	$	57,788		$	6,634


Denominator:
Basic weighted-average units		205,515			167,846
Dilutive potential units		612			613


Dilutive weighted-average units		206,127			168,459

Subsequent Events

6 Months Ended

Jun. 30, 2015

Subsequent Events [Abstract]

Subsequent Events

10. Subsequent Events

Acquisition of Capella Healthcare Hospital Portfolio

In July 2015, we entered into definitive agreements pursuant to which we will acquire a portfolio of seven acute care hospitals currently owned and operated by Capella Healthcare, Inc. (“Capella”), a privately held company, as well as acquire an equity interest in the ongoing operator of the facilities. The table below sets forth pertinent details with respect to the hospitals in the portfolio:


Hospital	Location	Type	Licensed Beds
Capital Medical Center	Olympia, WA	Acute care		110
EASTAR Health System	Muskogee, OK	Acute care		320
Carolina Pines Regional Medical Center	Hartsville, SC	Acute care		116
St. Mary’s Regional Medical Center	Russellville, AR	Acute care		170
National Park Medical Center	Hot Springs, AR	Acute care		166
Southwestern Medical Center	Lawton, OK	Acute care		199
Willamette Valley Medical Center	McMinnville, OR	Acute care		88


Total Licensed Beds				1,169

Our investment in the portfolio will include our acquisition of real estate assets, the making of mortgage and acquisition loans, and an equity contribution to the operator of the facilities, for a combined purchase price and investment of approximately $900 million. We and current Capella management, who will continue to manage and operate the facilities, have formed a joint venture that will be the acquirer of Capella. After closing of the merger, we will acquire from and lease back to Capella its interests in five acute care hospitals for an aggregate purchase price of approximately $390 million and fund loans secured by first lien mortgages on two hospitals for an aggregate of approximately $210 million. The real estate leases and mortgage loans will have an initial combined GAAP yield of 9.1%, which is reflective of their 15-year terms with four 5-year extension options, plus consumer price-indexed increases, limited to a 2% floor and a 4% ceiling annually. The remaining approximately $300 million investment in the operations of Capella will be in the form of a $290 million acquisition loan to Capella, which will have a fixed interest rate equivalent to the initial lease and mortgage loan rate, and we would have a 49% interest in the equity of the operator, with management owning the remaining 51%. We expect to complete this transaction in the second half of 2015.

Financing

On July 27, 2015, we received commitment to provide a senior unsecured bridge loan facility in the original principal amount of $1.0 billion to fund the Capella transactions, if necessary. Borrowings under the bridge facility, if any, will bear interest at a rate equal to, at our option, LIBOR plus an applicable margin varying from 1.025% to 2.250% per annum or a Base Rate plus an applicable margin varying from 0.025% to 1.25% per annum, depending upon the ratings of our unsecured senior indebtedness and the total leverage ratio or unsecured leverage ratio. We will pay certain customary structuring and underwriting fees and, in the event we make any borrowings, funding and other fees in connection with the bridge facility. The bridge facility will mature 364 days after the closing date of the Capella transactions. The funding of the bridge facility is contingent of customary conditions, including but not limited to the execution and delivery of definitive documentation and the consummation of the Cappella transactions as described above. We cannot assure you that we will be able to successfully borrow under the bridge facility on the terms described herein or at all.

On August 4, 2015, we entered into an amendment to our revolving credit and term loan agreement to increase the current aggregate committed size to $1.25 billion and amend certain covenants in order to permit us to consummate and finance the Capella transactions. The increase in the credit agreement availability reduced the availability of the bridge facility by $100 million to $900 million.

On August 6, 2015, we completed an underwritten public offering of 28.75 million shares of our common stock, resulting in net proceeds of approximately $337.1 million, after deducting estimated offering expenses (which is inclusive of the underwriters’ option to purchase 3.8 million additional shares). The offering is expected to close August 11, 2015, subject to customary closing conditions. We intend to use the net proceeds from the offering to partially fund our Capella acquisition described above. Once the offering is completed, our availability under the bridge loan facility will be reduced to approximately $0.6 billion.

Other

On August 4, 2015, we filed Articles of Amendment to our charter with the Maryland State Department of Assessments and Taxation increasing the number of authorized shares of common stock, par value $0.001 per share available for issuance from 250,000,000 to 500,000,000.

On July 31, 2015, we entered into definitive agreements to acquire several acute care hospitals and a freestanding clinic in northern Italy for an aggregate purchase price to us of approximately €90 million. The acquisition will be effected through a newly-formed joint venture between us and affiliates of AXA Real Estate, in which we will own a 50% interest. Upon closing, the facilities will be leased to an Italian acute care hospital operator, pursuant to a long-term master lease. Closing of the transaction, which is expected during the second half of 2015, is subject to customary real estate, regulatory and other closing conditions.

On July 30, 2015, we sold a long-term acute care facility in Luling, Texas for approximately $9.7 million, resulting in a gain of $1.5 million. Due to this sale, we wrote off $0.9 million of straight-line receivables. On August 5, 2015, we sold six wellness centers in the United States for total proceeds of approximately $9.5 million (of which $1.5 million is in the form of a note), resulting in a small net gain.

Summary of Significant Accounting Policies (Policies)

6 Months Ended

Jun. 30, 2015

Accounting Policies [Abstract]

Unaudited Interim Condensed Consolidated Financial Statements

Recent Accounting Developments

Recent Accounting Developments:

Revenue from Contracts with Customers

Presentation of Debt Issuance Costs

Amendments to the Consolidation Analysis

Variable Interest Entities

Variable Interest Entities


VIE Type	Maximum Loss Exposure(1)		Asset Type Classification	Carrying Amount(2)
Loans, net	$	277,941	Mortgage and other loans	$	224,482
Equity investments	$	61,323	Other assets	$	6,292

(1)

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

See Note 3 for additional description of the nature, purpose and activities of our more significant VIEs and interests therein.

- Definition

Disclosure of accounting policy for consolidation to describe the significant judgments and assumptions made in determining whether a variable interest held by the entity requires the variable interest entity to be consolidated and (or) disclose information about its involvement with the variable interest entity; the methodology used by the entity for determining whether or not it is the primary beneficiary of the variable interest entity; and the significant factors considered and judgments made in determining that the power to direct the activities that significantly impact the economic performance of the variable interest entity are shared (as defined).

+ References + Details

Real Estate and Lending Activities (Tables)

6 Months Ended

Jun. 30, 2015

Text Block [Abstract]

Schedule of Unaudited Supplemental Pro Forma Operating Data


	For the Three Months Ended June 30,				For the Six Months Ended June 30,
	2015		2014		2015		2014
Total revenues	$	108.8	$	106.2	$	218.7	$	211.5
Net income	$	50.2	$	20.6	$	99.8	$	44.6
Net income per share/unit — diluted	$	0.21	$	0.09	$	0.42	$	0.19

Summary of Status Update on Current Development Projects

See table below for a status update on our current development projects (in thousands):

Property

Location

Property Type

Operator

Commitment

Costs
Incurred
as of
06/30/15

Estimated
Completion
Date

First Choice ER- Aurora

Aurora, CO

Acute Care Hospital

Adeptus Health

5,273

1,614

3Q 2015

First Choice ER- Carrollton

Carrollton, TX

Acute Care Hospital

Adeptus Health

35,820

30,692

3Q 2015

First Choice ER- Conroe

Houston, TX

Acute Care Hospital

Adeptus Health

6,110

3,150

3Q 2015

First Choice ER- Gilbert

Gilbert, AZ

Acute Care Hospital

Adeptus Health

6,500

4,291

3Q 2015

First Choice ER- McKinney

McKinney, TX

Acute Care Hospital

Adeptus Health

4,750

2,582

3Q 2015

First Choice ER- Chandler-Ray

Chandler, AZ

Acute Care Hospital

Adeptus Health

5,261

1,741

4Q 2015

First Choice ER- Cinco Ranch

Katy, TX

Acute Care Hospital

Adeptus Health

5,105

162

4Q 2015

First Choice ER- Highland Village

Highland Village, TX

Acute Care Hospital

Adeptus Health

4,884

361

4Q 2015

First Choice ER- Parker

Parker, CO

Acute Care Hospital

Adeptus Health

6,868

1,843

4Q 2015

First Choice ER- Frisco Eldorado

Frisco, TX

Acute Care Hospital

Adeptus Health

5,124

1Q 2016

First Choice ER- Helotes

Helotes, TX

Acute Care Hospital

Adeptus Health

7,530

2,251

2Q 2016

Rehabilitation

Hospital of

Northwest Ohio

Toledo, OH

Inpatient Rehabilitation Hospital

Ernest Health

19,212

1,649

2Q 2016

First Choice ER-Vintage Preserve

Houston, TX

Acute Care Hospital

Adeptus Health

45,961

6,376

3Q 2016

First Choice Emergency Rooms

Various

Acute Care Hospital

Adeptus Health

231,649

—

Various

390,047

56,762

Components of Net Investment in Direct Financing Leases

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


	As of June 30, 2015			As of December 31, 2014
Minimum lease payments receivable	$	1,627,898		$	1,607,024
Estimated residual values		225,872			211,888
Less: Unearned income		(1,398,750	)		(1,379,396	)


Net investment in direct financing leases	$	455,020		$	439,516

Summary of Loans

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


	As of June 30, 2015		As of December 31, 2014
Mortgage loans	$	437,587	$	397,594
Acquisition loans		503,012		525,136
Working capital and other loans		45,853		48,031


	$	986,452	$	970,761

Fair Value of Financial Instruments (Tables)

6 Months Ended

Jun. 30, 2015

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):


	June 30, 2015						December 31, 2014
Asset (Liability)	Book Value			Fair Value			Book Value			Fair Value
Interest and rent receivables	$	56,792		$	56,683		$	41,137		$	41,005
Loans (1)		771,284			801,457			773,311			803,824
Debt, net		(2,262,861	)		(2,341,637	)		(2,201,654	)		(2,285,727	)

(1)	Excludes loans related to Ernest since they are recorded at fair value and discussed below.

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

At June 30, 2015, these amounts were as follows (in thousands):


Asset Type	Fair Value		Cost		Asset Type Classification
Mortgage loans	$	100,000	$	100,000		Mortgage loans
Acquisition loans		114,367		114,367		Other loans
Other loans		801		801		Other loans
Equity investments		3,300		3,300		Other assets


	$	218,468	$	218,468

Summary Showing Sensitivity Analysis by Using Basis Point Variations

To illustrate the effect of movements in the DLOM, we performed a sensitivity analysis below by using basis point variations (dollars in thousands):


Basis Point Change in Marketability Discount	Estimated Increase (Decrease) In Fair Value
+100 basis points	$	(59	)
- 100 basis points		59

Earnings Per Share/Common Unit (Tables)

6 Months Ended

Jun. 30, 2015

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 Three Months Ended June 30,
	2015			2014
Numerator:
Income (loss) from continuing operations	$	22,489		$	(203	)
Non-controlling interests’ share in continuing operations		(82	)		—
Participating securities’ share in earnings		(250	)		(195	)


Income (loss) from continuing operations, less participating securities’ share in earnings		22,157			(398	)
Income from discontinued operations attributable to MPT common stockholders		—			—


Net income (loss), less participating securities’ share in earnings	$	22,157		$	(398	)


Denominator:
Basic weighted-average common shares		208,071			171,718
Dilutive potential common shares		569			651


Dilutive weighted-average common shares		208,640			172,369


	For the Six Months Ended June 30,
	2015			2014
Numerator:
Income from continuing operations	$	58,465		$	7,105
Non-controlling interests’ share in continuing operations		(161	)		(65	)
Participating securities’ share in earnings		(516	)		(404	)


Income from continuing operations, less participating securities’ share in earnings		57,788			6,636
Loss from discontinued operations attributable to MPT common stockholders		—			(2	)


Net income, less participating securities’ share in earnings	$	57,788		$	6,634


Denominator:
Basic weighted-average common shares		205,515			167,846
Dilutive potential common shares		612			613


Dilutive weighted-average common shares		206,127			168,459

MPT Operating Partnership, L.P.

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


	For the Three Months Ended June 30,
	2015			2014
Numerator:
Income (loss) from continuing operations	$	22,489		$	(203	)
Non-controlling interests’ share in continuing operations		(82	)		—
Participating securities’ share in earnings		(250	)		(195	)


Income (loss) from continuing operations, less participating securities’ share in earnings		22,157			(398	)
Income from discontinued operations attributable to MPT Operating Partnership partners		—			—


Net income (loss), less participating securities’ share in earnings	$	22,157		$	(398	)


Denominator:
Basic weighted-average units		208,071			171,718
Dilutive potential units		569			651


Dilutive weighted-average units		208,640			172,369


	For the Six Months Ended June 30,
	2015			2014
Numerator:
Income from continuing operations	$	58,465		$	7,105
Non-controlling interests’ share in continuing operations		(161	)		(65	)
Participating securities’ share in earnings		(516	)		(404	)


Income from continuing operations, less participating securities’ share in earnings		57,788			6,636
Loss from discontinued operations attributable to MPT Operating Partnership partners		—			(2	)


Net income, less participating securities’ share in earnings	$	57,788		$	6,634


Denominator:
Basic weighted-average units		205,515			167,846
Dilutive potential units		612			613


Dilutive weighted-average units		206,127			168,459

Real Estate and Lending Activities - 2015 Activity - Additional Information (Detail) € in Millions, $ in Millions	Aug. 01, 2015 EUR (€) Property	Jun. 30, 2015 USD ($) Property Hospital	Jun. 16, 2015 USD ($) Bed Property	Apr. 29, 2015 EUR (€) Facility Hospital	Feb. 27, 2015 USD ($) Leases	Feb. 13, 2015 USD ($) RenewalOptions Facility	Jul. 31, 2015 EUR (€)	Jun. 30, 2015 EUR (€)	Dec. 31, 2014 EUR (€)
Subsequent Event [Member] \| Acute Care Hospital [Member]
Significant Acquisitions and Disposals [Line Items]
Ownership percentage							50.00%
Purchase price of acquisition \| €							€ 90
2015 [Member] \| Acute Care Hospital [Member] \| Kansas [Member]
Significant Acquisitions and Disposals [Line Items]
Term of lease, years						10 years
Term of lease extension, years						5 years
Number of facilities acquired \| Facility						2
Purchase price of acquisition \| $						$ 110.0
Number of lease extensions options in current lease contract \| RenewalOptions						2,000,000
Mortgage financing \| $						$ 40.0
Mortgage financing term						10 years
2015 [Member] \| Ernest Health, Inc [Member]
Significant Acquisitions and Disposals [Line Items]
Acquisition costs \| $			$ 31.5
Term of lease, years			20 years
Loans provided for acquisition \| $			$ 12.0
Number of properties acquired \| Property			2
2015 [Member] \| Ernest Health, Inc [Member] \| Minimum [Member]
Significant Acquisitions and Disposals [Line Items]
Term of lease extension, years			3 years
2015 [Member] \| Ernest Health, Inc [Member] \| Maximum [Member]
Significant Acquisitions and Disposals [Line Items]
Term of lease extension, years			5 years
2015 [Member] \| Ernest Health, Inc [Member] \| Rehabilitation Hospital with Covenant Health System [Member]
Significant Acquisitions and Disposals [Line Items]
Number of beds acquired \| Bed			60
2015 [Member] \| Ernest Health, Inc [Member] \| Acute Care Hospital [Member]
Significant Acquisitions and Disposals [Line Items]
Number of beds acquired \| Bed			37
2015 [Member] \| Ernest Health, Inc [Member] \| Inpatient Rehabilitation Hospital [Member] \| Weslaco, Texas [Member]
Significant Acquisitions and Disposals [Line Items]
Acquisition costs \| $					$ 10.7
Term of lease extension, years					5 years
Payments to fund long-term loans to related parties \| $					$ 5.0
Lease remaining term					17 years
Number of lease extension options \| Leases					3
2015 [Member] \| Median Kliniken [Member]
Significant Acquisitions and Disposals [Line Items]
Number of hospitals acquired \| Hospital		35		32
Acquisition costs \| €				€ 688
Term of lease, years				27 years
Lease rate				9.30%
Lease rent increase percentage				70.00%
Number of facilities expected to acquire \| Facility				3
Expected aggregate purchase price \| €				€ 705
Ownership percentage									94.90%
Ownership percentage by others in Median									5.10%
Loans provided for acquisition \| €								€ 240	€ 425
Number of properties closed \| Property		17
Value of properties closed		$ 354.0						317
2015 [Member] \| Median Kliniken [Member] \| Subsequent Event [Member]
Significant Acquisitions and Disposals [Line Items]
Number of properties closed \| Property	30
Value of properties closed \| €	€ 627
2015 [Member] \| Median and Waterland [Member]
Significant Acquisitions and Disposals [Line Items]
Loans provided for acquisition \| €								€ 705

Real Estate and Lending Activities - 2014 Activity - Additional Information (Detail) - USD ($)		3 Months Ended		6 Months Ended
	Mar. 31, 2014	Jun. 30, 2015	Jun. 30, 2014	Jun. 30, 2015	Jun. 30, 2014
Significant Acquisitions and Disposals [Line Items]
Income contributed by the acquired entity		$ 50,200	$ 20,600	$ 99,800	$ 44,600
Acquisition related costs		25,809,000	2,535,000	32,048,000	3,047,000
2015 [Member] \| Business Acquisitions [Member]
Significant Acquisitions and Disposals [Line Items]
Revenue contributed by the acquired entity		4,200,000		6,200,000
Income contributed by the acquired entity		3,500,000		4,900,000
Acquisition related costs		$ 22,600,000		$ 26,700,000
2014 [Member] \| Acute Care Hospital [Member]
Significant Acquisitions and Disposals [Line Items]
Acquisition costs	$ 115,000,000
Term of lease, years	15 years
Term of lease extension, years	3 years
2014 [Member] \| Acute Care Hospital [Member] \| Fair value market [Member]
Significant Acquisitions and Disposals [Line Items]
Term of lease extension, years	12 years
2014 [Member] \| Business Acquisitions [Member]
Significant Acquisitions and Disposals [Line Items]
Revenue contributed by the acquired entity			2,300,000		2,300,000
Income contributed by the acquired entity			1,600,000		1,600,000
Acquisition related costs			$ 400,000		$ 400,000

Real Estate and Lending Activities - Summary of Status Update on Current Development Projects (Detail) $ in Thousands	6 Months Ended
	Jun. 30, 2015 USD ($)
Business Acquisition [Line Items]
Commitment	$ 390,047
Costs Incurred as of 06/30/2015	56,762
First Choice ER - Aurora [Member] \| Aurora, CO [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	5,273
Costs Incurred as of 06/30/2015	1,614
First Choice ER- Carrollton [Member] \| Carrollton, TX [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	35,820
Costs Incurred as of 06/30/2015	30,692
First Choice ER - Conroe [Member] \| Houston, TX [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	6,110
Costs Incurred as of 06/30/2015	3,150
First Choice ER - Gilbert [Member] \| Gilbert, AZ [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	6,500
Costs Incurred as of 06/30/2015	4,291
First Choice ER- McKinney [Member] \| McKinney, TX [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	4,750
Costs Incurred as of 06/30/2015	2,582
First Choice ER - Chandler - Ray [Member] \| Chandler, AZ [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	5,261
Costs Incurred as of 06/30/2015	$ 1,741
Estimated Completion Date	4Q 2015
First Choice ER - Cinco Ranch [Member] \| Katy, TX [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	$ 5,105
Costs Incurred as of 06/30/2015	$ 162
Estimated Completion Date	4Q 2015
First Choice ER - Highland Village [Member] \| Highland Village, TX [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	$ 4,884
Costs Incurred as of 06/30/2015	$ 361
Estimated Completion Date	4Q 2015
First Choice ER - Parker [Member] \| Parker, CO [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	$ 6,868
Costs Incurred as of 06/30/2015	$ 1,843
Estimated Completion Date	4Q 2015
First Choice ER - Frisco Eldorado [Member] \| Frisco, TX [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	$ 5,124
Costs Incurred as of 06/30/2015	$ 50
Estimated Completion Date	1Q 2016
First Choice ER - Helotes [Member] \| Helotes, TX [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	$ 7,530
Costs Incurred as of 06/30/2015	$ 2,251
Estimated Completion Date	2Q 2016
Rehabilitation Hospital of Northwest Ohio [Member] \| Toledo, OH [Member] \| Inpatient Rehabilitation Hospital [Member] \| Ernest Health, Inc [Member]
Business Acquisition [Line Items]
Commitment	$ 19,212
Costs Incurred as of 06/30/2015	$ 1,649
Estimated Completion Date	2Q 2016
First Choice ER - Vintage Preserve [Member] \| Houston, TX [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	$ 45,961
Costs Incurred as of 06/30/2015	$ 6,376
Estimated Completion Date	2Q 2016
First Choice Emergency Rooms [Member] \| Various [Member] \| Acute Care Hospital [Member] \| Adeptus Health [Member]
Business Acquisition [Line Items]
Commitment	$ 231,649
Estimated Completion Date	Various

Real Estate and Lending Activities - Concentrations of Credit Risk - Additional Information (Detail) $ in Thousands	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2015 USD ($) Investment	Jun. 30, 2014 USD ($)	Jun. 30, 2015 USD ($) Investment	Jun. 30, 2014 USD ($)	Dec. 31, 2014
Significant Acquisitions and Disposals [Line Items]
Revenue	$ 99,801	$ 76,560	$ 195,762	$ 149,649
Assets, Total [Member] \| Customer Concentration Risk [Member]
Significant Acquisitions and Disposals [Line Items]
Number of investment in property \| Investment	0		0
Maximum percentage of entity's total assets invested on single property	3.00%		3.00%
Assets, Total [Member] \| Customer Concentration Risk [Member] \| Median Kliniken [Member]
Significant Acquisitions and Disposals [Line Items]
Percentage of entity revenue from affiliates			17.30%		11.30%
Assets, Total [Member] \| Geographic Concentration Risk [Member] \| California [Member]
Significant Acquisitions and Disposals [Line Items]
Percentage of entity revenue from affiliates			12.90%		14.60%
Assets, Total [Member] \| Geographic Concentration Risk [Member] \| Texas [Member]
Significant Acquisitions and Disposals [Line Items]
Percentage of entity revenue from affiliates			19.80%		20.20%
Assets, Total [Member] \| Geographic Concentration Risk [Member] \| European [Member]
Significant Acquisitions and Disposals [Line Items]
Percentage of entity revenue from affiliates			25.00%		20.00%
Assets, Total [Member] \| Geographic Concentration Risk [Member] \| United States
Significant Acquisitions and Disposals [Line Items]
Percentage of entity revenue from affiliates			75.00%		80.00%
Sales Revenue, Net [Member] \| European [Member]
Significant Acquisitions and Disposals [Line Items]
Revenue	$ 18,100	$ 5,500	$ 34,400	$ 10,900
Sales Revenue, Net [Member] \| Customer Concentration Risk [Member] \| Median Kliniken [Member]
Significant Acquisitions and Disposals [Line Items]
Percentage of entity revenue from affiliates	11.10%		10.30%
Sales Revenue, Net [Member] \| Customer Concentration Risk [Member] \| Prime Health Care Services [Member]
Significant Acquisitions and Disposals [Line Items]
Percentage of entity revenue from affiliates	25.90%	27.90%	25.50%	28.50%
Sales Revenue, Net [Member] \| Customer Concentration Risk [Member] \| Ernest Health, Inc [Member]
Significant Acquisitions and Disposals [Line Items]
Percentage of entity revenue from affiliates	15.00%	18.20%	15.20%	18.90%
Asset Leased [Member] \| Customer Concentration Risk [Member] \| Prime Health Care Services [Member]
Significant Acquisitions and Disposals [Line Items]
Percentage of entity revenue from affiliates			13.80%		12.60%
Asset Leased [Member] \| Customer Concentration Risk [Member] \| Ernest Health, Inc [Member]
Significant Acquisitions and Disposals [Line Items]
Percentage of entity revenue from affiliates			7.90%		7.70%
Loaned to Prime [Member] \| Customer Concentration Risk [Member] \| Prime Health Care Services [Member]
Significant Acquisitions and Disposals [Line Items]
Percentage of entity revenue from affiliates			7.50%		7.40%
Loaned to Ernest [Member] \| Customer Concentration Risk [Member] \| Ernest Health, Inc [Member]
Significant Acquisitions and Disposals [Line Items]
Percentage of entity revenue from affiliates			5.10%		5.30%

Debt - Summary of Debt (Detail) - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
Debt - Summary of Debt (Detail) - USD ($) $ in Thousands	Jun. 30, 2015	Dec. 31, 2014
Debt Instrument [Line Items]
Principal amount	$ 2,260,516
Debt	$ 2,262,861	$ 2,201,654
2011 Senior Unsecured Notes [Member]
Debt Instrument [Line Items]
Senior unsecured notes, interest rate	6.875%	6.875%
Debt	$ 450,000	$ 450,000
Revolving credit facility [Member]
Debt Instrument [Line Items]
Interest rate	Variable	Variable
Debt	$ 674,034	$ 593,490
2006 Senior Unsecured Notes [Member]
Debt Instrument [Line Items]
Interest rate	Various	Various
Debt	$ 125,000	$ 125,000
2012 Senior Unsecured Notes [Member]
Debt Instrument [Line Items]
Principal amount	$ 350,000	$ 350,000
Senior unsecured notes, interest rate	6.375%	6.375%
Unamortized premium	$ 2,345	$ 2,522
Debt	$ 352,345	$ 352,522
2013 Senior Unsecured Notes [Member]
Debt Instrument [Line Items]
Senior unsecured notes, interest rate	5.75%	5.75%
Debt	$ 222,940	$ 241,960
2014 Senior Unsecured Notes [Member]
Debt Instrument [Line Items]
Senior unsecured notes, interest rate	5.50%	5.50%
Debt	$ 300,000	$ 300,000
Term Loans [Member]
Debt Instrument [Line Items]
Interest rate	Various	Various
Debt	$ 138,542	$ 138,682

Debt - Principal Payments Due for Debt (Detail) $ in Thousands	Jun. 30, 2015 USD ($)
Debt Disclosure [Abstract]
2015	$ 142
2016	125,299
2017	320
2018	686,815
2019	125,000
Thereafter	1,322,940
Total	$ 2,260,516

Debt - Interest Rate Swap - Additional Information (Detail) - USD ($)	3 Months Ended			6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014	Jun. 30, 2010	Jun. 30, 2015	Jun. 30, 2014	Dec. 31, 2014	Oct. 31, 2011
Interest Rate Contract [Member]
Debt Instrument [Line Items]
Fair value of the interest rate swaps	$ 4,700,000			$ 4,700,000		$ 6,000,000
Interest Rate Contract One [Member]
Debt Instrument [Line Items]
Interest rate of interest rate derivative instrument	5.507%			5.507%
Maturity date of interest rate swap				July 2016
Interest Rate Contract Two [Member]
Debt Instrument [Line Items]
Maturity date of interest rate swap				October 2016
Interest rate swap, amount fixed							$ 60,000,000
Interest rate of derivative instrument				5.675%
Interest Rate Swap [Member]
Debt Instrument [Line Items]
Hedge ineffectiveness and income statement effect in period	$ 0	$ 0		$ 0	$ 0
Other assets, collateral	$ 2,500,000			$ 2,500,000		$ 3,300,000
2006 Senior Unsecured Notes [Member]
Debt Instrument [Line Items]
Portion of debt instrument face amount			$ 65,000,000

Common Stock/Partners' Capital - Additional Information (Detail) $ / shares in Units, shares in Thousands			1 Months Ended	3 Months Ended	6 Months Ended
	Jan. 14, 2015 USD ($) shares	Mar. 11, 2014 USD ($) shares	Jan. 31, 2014 USD ($)	Mar. 31, 2014 USD ($) $ / shares shares	Jun. 30, 2015 USD ($) Employee Director Partner shares	Jun. 30, 2014 USD ($) shares	Dec. 31, 2014 shares
Class of Stock [Line Items]
Common stock, shares issued \| shares					207,804		172,743
Proceeds from sale of common shares/units, net of offering costs					$ 479,902,000	$ 128,332,000
MPT Operating Partnership, L.P. [Member]
Class of Stock [Line Items]
Proceeds from sale of common shares/units, net of offering costs					$ 479,902,000	$ 128,332,000
Ownership interest in equity					99.86%
Number of units sold \| shares					34,500	9,800
Number of other partners \| Partner					3
Market Equity Offering Program [Member]
Class of Stock [Line Items]
Common stock, shares issued \| shares				900
Proceeds from sale of common shares/units, net of offering costs				$ 12,300,000
Sales commission percentage			1.25%
Market Equity Offering Program [Member] \| IPO [Member]
Class of Stock [Line Items]
Public offering price for common stock per share \| $ / shares				$ 13.21
Market Equity Offering Program [Member] \| Maximum [Member]
Class of Stock [Line Items]
Number of shares can be sold out			$ 250,000,000
Employee [Member]
Class of Stock [Line Items]
Number of partners shared remaining ownership percentage \| Employee					2
Director [Member]
Class of Stock [Line Items]
Number of partners shared remaining ownership percentage \| Director					1
Public Offering [Member]
Class of Stock [Line Items]
Common stock, shares issued \| shares	34,500	7,700
Additional shares purchased by underwriters \| shares	4,500	1,200
Proceeds from sale of common shares/units, net of offering costs	$ 480,000,000	$ 100,200,000
Time granted to underwriters to purchase shares					30 days
Net proceeds from additional issuance of shares		$ 16,000,000

Earnings Per Share/Common Unit - Calculation of Earnings Per Share (Detail) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014	Jun. 30, 2015	Jun. 30, 2014
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Income (loss) from continuing operations	$ 22,489	$ (203)	$ 58,465	$ 7,105
Non-controlling interests' share in continuing operations	(82)		(161)	(65)
Participating securities' share in earnings	(250)	(195)	(516)	(404)
Income (loss) from continuing operations, less participating securities' share in earnings	22,157	(398)	57,788	6,636
Income (loss) from discontinued operations attributable to MPT common stockholders				(2)
Net income (loss), less participating securities' share in earnings	$ 22,157	$ (398)	$ 57,788	$ 6,634
Basic weighted-average common shares	208,071	171,718	205,515	167,846
Dilutive potential common shares	569	651	612	613
Dilutive weighted-average common shares	208,640	172,369	206,127	168,459
MPT Operating Partnership, L.P. [Member]
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Income (loss) from continuing operations	$ 22,489	$ (203)	$ 58,465	$ 7,105
Non-controlling interests' share in continuing operations	(82)		(161)	(65)
Participating securities' share in earnings	(250)	(195)	(516)	(404)
Income (loss) from continuing operations, less participating securities' share in earnings	22,157	(398)	57,788	6,636
Income (loss) from discontinued operations attributable to MPT common stockholders				(2)
Net income (loss), less participating securities' share in earnings	$ 22,157	$ (398)	$ 57,788	$ 6,634
Basic weighted-average common shares	208,071	171,718	205,515	167,846
Dilutive potential common shares	569	651	612	613
Dilutive weighted-average common shares	208,640	172,369	206,127	168,459

Subsequent Events - Additional Information (Detail) $ / shares in Units, € in Millions								1 Months Ended	6 Months Ended
	Aug. 06, 2015 USD ($) shares	Aug. 05, 2015 USD ($) Hospital	Aug. 04, 2015 USD ($) $ / shares shares	Jul. 30, 2015 USD ($)	Jul. 27, 2015 USD ($)	Jan. 14, 2015 USD ($) shares	Mar. 11, 2014 USD ($) shares	Jul. 31, 2015 USD ($) Facility Leases	Jun. 30, 2015 USD ($) $ / shares shares	Jun. 30, 2014 USD ($)	Jul. 31, 2015 EUR (€) Facility	Dec. 31, 2014 $ / shares shares
Subsequent Event [Line Items]
Common stock, shares issued \| shares									207,804,000			172,743,000
Proceeds from sale of common shares/units, net of offering costs									$ 479,902,000	$ 128,332,000
Common stock, shares authorized \| shares									250,000,000			250,000,000
Common stock, par value \| $ / shares									$ 0.001			$ 0.001
Public Offering [Member]
Subsequent Event [Line Items]
Common stock, shares issued \| shares						34,500,000	7,700,000
Proceeds from sale of common shares/units, net of offering costs						$ 480,000,000	$ 100,200,000
Net proceeds from additional issuance of shares							$ 16,000,000
Subsequent Event [Member]
Subsequent Event [Line Items]
Common stock, shares authorized \| shares			500,000,000
Common stock, par value \| $ / shares			$ 0.001
Subsequent Event [Member] \| Capella Healthcare, Inc. [Member]
Subsequent Event [Line Items]
Interests acquired, number of hospitals \| Facility								5
Combined purchase price and investment amount								$ 900,000,000
Acquisition costs								$ 390,000,000
Number of hospitals used to secure loans \| Facility								2			2
Secured loans granted in connection with acquisition								$ 210,000,000
Merger consideration net of real estate investments								300,000,000
Merger consideration in the form of acquisition loan								$ 290,000,000
Ownership interests acquired								49.00%			49.00%
Term of lease, years								15 years
Number of lease extension options \| Leases								4
Term of lease extension, years								5 years
Increase in consumer price-index, floor rate								2.00%
Increase in consumer price-index, ceiling rate								4.00%
Aggregate committed size of credit facility			$ 1,250,000,000
Senior unsecured bridge loan facility, maturity period					364 days
Subsequent Event [Member] \| Texas [Member]
Subsequent Event [Line Items]
Proceeds from sale of real estate				$ 9,700,000
Gain (loss) on sale of real estate				1,500,000
Straight line rent receivables write-off				$ 900,000
Subsequent Event [Member] \| United States
Subsequent Event [Line Items]
Proceeds from sale of real estate		$ 9,500,000
Number of hospitals sold \| Hospital		6
Consideration received as note receivable		$ 1,500,000
Subsequent Event [Member] \| Bridge Loan [Member] \| Capella Healthcare, Inc. [Member]
Subsequent Event [Line Items]
Aggregate committed size of credit facility					$ 1,000,000,000
Increase (decrease) in credit facility	$ (600,000,000)		(100,000,000)
Remaining borrowing capacity			$ 900,000,000
Subsequent Event [Member] \| Public Offering [Member] \| Capella Healthcare, Inc. [Member]
Subsequent Event [Line Items]
Common stock, shares issued \| shares	28,750,000
Proceeds from sale of common shares/units, net of offering costs	$ 337,100,000
Net proceeds from additional issuance of shares	$ 3,800,000
Subsequent Event [Member] \| LIBOR Rate [Member] \| Minimum [Member] \| Bridge Loan [Member] \| Capella Healthcare, Inc. [Member]
Subsequent Event [Line Items]
Interest rate, applicable margin					1.025%
Subsequent Event [Member] \| LIBOR Rate [Member] \| Maximum [Member] \| Bridge Loan [Member] \| Capella Healthcare, Inc. [Member]
Subsequent Event [Line Items]
Interest rate, applicable margin					2.25%
Subsequent Event [Member] \| Base Rate [Member] \| Minimum [Member] \| Bridge Loan [Member] \| Capella Healthcare, Inc. [Member]
Subsequent Event [Line Items]
Interest rate, applicable margin					0.025%
Subsequent Event [Member] \| Base Rate [Member] \| Maximum [Member] \| Bridge Loan [Member] \| Capella Healthcare, Inc. [Member]
Subsequent Event [Line Items]
Interest rate, applicable margin					1.25%
Subsequent Event [Member] \| Capella Management [Member] \| Capella Healthcare, Inc. [Member]
Subsequent Event [Line Items]
Ownership interests acquired								51.00%			51.00%
Subsequent Event [Member] \| Acute Care Hospital [Member]
Subsequent Event [Line Items]
Purchase price of acquisition \| €											€ 90
Ownership interest percentage, parent								50.00%			50.00%
Subsequent Event [Member] \| Acute Care Hospital [Member] \| Capella Healthcare, Inc. [Member]
Subsequent Event [Line Items]
Interests acquired, number of hospitals \| Facility								7

Organization	6 Months Ended
Organization	Jun. 30, 2015
Accounting Policies [Abstract]
Organization	1. Organization Medical Properties Trust, Inc., a Maryland corporation, was formed on August 27, 2003, under the Maryland General Corporation Law for the purpose of engaging in the business of investing in, owning, and leasing commercial real estate. Our operating partnership subsidiary, MPT Operating Partnership, L.P., (the “Operating Partnership”) 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 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. Certain activities we undertake must be conducted by entities which we elected to be treated as taxable REIT subsidiaries (“TRSs”). Our TRSs are subject to both U.S. federal and state income taxes. For our properties located outside the United States, we are subject to local taxes; however, we do not expect to incur additional taxes in the United States as such income will flow through our REIT. 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 United States and Europe.

Common Stock/Partners' Capital	6 Months Ended
Common Stock/Partners' Capital	Jun. 30, 2015
Equity [Abstract]
Common Stock/Partners' Capital	5. Common Stock/Partners’ Capital Medical Properties Trust, Inc. On January 14, 2015, we completed an underwritten public offering of 34.5 million shares (including the exercise of the underwriters’ 30-day option to purchase an additional 4.5 million shares) of our common stock, resulting in net proceeds of approximately $480 million, after deducting estimated offering expenses. On March 11, 2014, we completed an underwritten public offering of 7.7 million shares of our common stock, resulting in net proceeds of approximately $100.2 million, after deducting estimated offering expenses. We also granted the underwriters a 30-day option to purchase up to an additional 1.2 million shares of common stock. The option, which was exercised in full, closed on April 8, 2014 and resulted in additional net proceeds of approximately $16 million. In January 2014, we put an at-the-market equity offering program in place, giving us the ability to sell up to $250 million of stock with a commission of 1.25%. During the first quarter of 2014, we sold 0.9 million shares of our common stock under our at-the-market equity offering program, at an average price of $13.21 per share resulting in total proceeds, net of commission, of $12.3 million. MPT Operating Partnership, L.P. At June 30, 2015, the Company has a 99.86% ownership interest in the Operating Partnership with the remainder owned by three other partners, two of whom are employees and one of whom is a director. During the six months ended June 30, 2015 and 2014, the partnership issued 34.5 million and 9.8 million units, respectively, in direct response to the common stock offerings by Medical Properties Trust, Inc.

Stock Awards	6 Months Ended
Stock Awards	Jun. 30, 2015
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock Awards	6. Stock Awards We adopted the 2013 Equity Incentive Plan (the “Equity Incentive Plan”) during second quarter of 2013, which 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. The Equity Incentive Plan is administered by the Compensation Committee of the Board of Directors. We have reserved 7,643,651 shares of common stock for awards under the Equity Incentive Plan for which 5,419,441 shares remain available for future stock awards as of June 30, 2015. We awarded the following stock awards during 2015 and 2014: Time-based awards —We granted 217,177 and 406,055 shares in 2015 and 2014, respectively, of time-based restricted stock to management, independent directors and certain employees. These awards vest quarterly based on service, over three years, in equal amounts. Performance-based awards —Our management team and certain employees were awarded 176,046 and 384,823 of performance based awards in 2015 and 2014, respectively. These awards vest ratably over a three year period based on the achievement of certain total shareholder return measures, with a carry-back and carry-forward provision through December 31, 2018 (for the 2014 awards) and December 31, 2017 (for the 2015 awards). Dividends on these awards are paid only upon achievement of the performance measures. Multi-year Performance-based awards —We awarded 505,050 and 500,000 shares in 2015 and 2014, respectively, of multi-year performance-based awards to management. These shares are subject to three-year cumulative performance hurdles based on measures of total shareholder return. At the end of the three-year performance period, any earned shares will be subject to an additional two years of ratable time-based vesting on an annual basis. Dividends are paid on these shares only upon achievement of the performance measures.

Commitments and Contingencies	6 Months Ended
Commitments and Contingencies	Jun. 30, 2015
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	9. Commitments and Contingencies 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 those proceedings is not presently expected to materially affect our financial position, results of operations or cash flows.

Summary of Significant Accounting Policies - Carrying Value and Classification of Related Assets and Maximum Exposure to Loss (Detail)	Jun. 30, 2015 USD ($)
Mortgage and other loans [Member]
Variable Interest Entity [Line Items]
Carrying Amount	$ 224,482,000
Loans, net [Member]
Variable Interest Entity [Line Items]
Maximum Loss Exposure	277,941,000
Other assets [Member]
Variable Interest Entity [Line Items]
Carrying Amount	6,292,000
Equity investments [Member]
Variable Interest Entity [Line Items]
Maximum Loss Exposure	$ 61,323,000

Real Estate and Lending Activities - Assets Acquired (Detail) - USD ($) $ in Thousands	Jun. 30, 2015	Jun. 30, 2014
Significant Acquisitions and Disposals [Line Items]
Total assets acquired	$ 562,633	$ 115,000
Land and Land Improvements [Member]
Significant Acquisitions and Disposals [Line Items]
Total assets acquired	21,591	8,477
Building [Member]
Significant Acquisitions and Disposals [Line Items]
Total assets acquired	473,425	99,640
Intangible lease assets - subject to amortization [Member]
Significant Acquisitions and Disposals [Line Items]
Total assets acquired		$ 6,883
Net investments in direct financing leases [Member]
Significant Acquisitions and Disposals [Line Items]
Total assets acquired	10,700
Other loans [Member]
Significant Acquisitions and Disposals [Line Items]
Total assets acquired	16,917
Mortgage loans [Member]
Significant Acquisitions and Disposals [Line Items]
Total assets acquired	$ 40,000

Real Estate and Lending Activities - Development Activities - Additional Information (Detail) - Development Activities [Member] € in Millions, $ in Millions			1 Months Ended
	Jun. 16, 2015 EUR (€)	May 05, 2015 USD ($)	Apr. 30, 2015 USD ($)	Jun. 30, 2015 Facility Property
Ernest Health, Inc [Member]
Significant Acquisitions and Disposals [Line Items]
Estimated total development cost		$ 19.2
First Choice [Member]
Significant Acquisitions and Disposals [Line Items]
Number of facilities leased \| Facility				7
Number of property leased \| Property				1
Acute Care Hospital [Member] \| Adeptus Health [Member]
Significant Acquisitions and Disposals [Line Items]
Estimated total development cost			$ 250.0
Term of lease, years			15 years
Acute Care Hospital [Member] \| Adeptus Health [Member] \| Minimum [Member]
Significant Acquisitions and Disposals [Line Items]
Term of lease extension, years			3 years
Acute Care Hospital [Member] \| Adeptus Health [Member] \| Maximum [Member]
Significant Acquisitions and Disposals [Line Items]
Term of lease extension, years			5 years
Percentage change in annual consumer price index minimum rate			2.00%
IMED Hospitales [Member]
Significant Acquisitions and Disposals [Line Items]
Ownership interest percentage, parent	50.00%
IMED Hospitales [Member] \| Acute Care Hospital [Member]
Significant Acquisitions and Disposals [Line Items]
Estimated total development cost \| €	€ 21.4

Real Estate and Lending Activities - Leasing Operations - Additional Information (Detail)	6 Months Ended
	Jun. 30, 2015 Leases
Ernest Health, Inc [Member]
Significant Acquisitions and Disposals [Line Items]
Number of direct financing leases	15
Prime Facilities [Member]
Significant Acquisitions and Disposals [Line Items]
Number of direct financing leases	5

Real Estate and Lending Activities - Components of Net Investment in Direct Financing Leases (Detail) - USD ($) $ in Thousands	Jun. 30, 2015	Dec. 31, 2014
Business Combinations [Abstract]
Minimum lease payments receivable	$ 1,627,898	$ 1,607,024
Estimated residual values	225,872	211,888
Less: Unearned income	(1,398,750)	(1,379,396)
Net investment in direct financing leases	$ 455,020	$ 439,516

Real Estate and Lending Activities - Florence Facility - Additional Information (Detail) - Florence Acute Care Facility [Member] - USD ($) $ in Millions	Jun. 30, 2015	Mar. 06, 2013
Significant Acquisitions and Disposals [Line Items]
Real estate investment		$ 27.1
Outstanding rent receivables	$ 1.1
Letter of credit outstanding	$ 1.2

Real Estate and Lending Activities - Summary of Loans (Detail) - USD ($) $ in Thousands	Jun. 30, 2015	Dec. 31, 2014
Loans [Line Items]
Loans, Balance	$ 986,452	$ 970,761
Mortgage loans [Member]
Loans [Line Items]
Loans, Balance	437,587	397,594
Acquisition loans [Member]
Loans [Line Items]
Loans, Balance	503,012	525,136
Working capital and other loans [Member]
Loans [Line Items]
Loans, Balance	$ 45,853	$ 48,031

Real Estate and Lending Activities - Loans - Additional Information (Detail) - USD ($) $ in Millions		3 Months Ended
	Mar. 01, 2012	Jun. 30, 2015
Significant Acquisitions and Disposals [Line Items]
Amount of convertible note converted into equity interest	$ 1.7
Convertible note	$ 5.0
Percentage of equity shares from convertible debt	9.90%	15.10%
Remaining convertible debt after conversion of part of debt		$ 3.3
Ernest Transaction and Other Acquisitions [Member]
Significant Acquisitions and Disposals [Line Items]
Existing mortgage loans		114.4
Median Kliniken [Member]
Significant Acquisitions and Disposals [Line Items]
Existing mortgage loans		$ 376.8

Debt - Summary of Debt (Parenthetical) (Detail) - Jun. 30, 2015 € in Millions, $ in Millions	USD ($)	EUR (€)
Revolving credit facility [Member]
Debt Instrument [Line Items]
Outstanding borrowings on the revolving credit facility	$ 335.5	€ 301.0

Debt - Covenants - Additional Information (Detail)	6 Months Ended
Debt - Covenants - Additional Information (Detail)	Jun. 30, 2015
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%

Stock Awards - Additional Information (Detail) - shares	6 Months Ended
Stock Awards - Additional Information (Detail) - shares	Jun. 30, 2015	Jun. 30, 2014
Time-Based Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation, multi-year performance-based awards	217,177	406,055
Stock awards vesting period in years	3 years
Performance Shares [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation, multi-year performance-based awards	176,046	384,823
Stock awards vesting period in years	3 years
Multi-year performance-based awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation, multi-year performance-based awards	505,050	500,000
Stock awards vesting period in years	3 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	7,643,651
Common stock remaining for future stock awards transferred to the equity incentive plan	5,419,441

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Detail) - USD ($) $ in Thousands	Jun. 30, 2015	Dec. 31, 2014
Fair Value Disclosures [Abstract]
Interest and rent receivables, Book value	$ 56,792	$ 41,137
Loans, Book value	771,284	773,311
Debt, net Book value	(2,262,861)	(2,201,654)
Interest and rent receivables, Fair value	56,683	41,005
Loans, Fair value	801,457	803,824
Debt, net Fair value	$ (2,341,637)	$ (2,285,727)

Fair Value of Financial Instruments - Equity Interest in Ernest and Related Loans Measured at Fair Value on Recurring Basis (Detail) $ in Thousands	Jun. 30, 2015 USD ($)
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	$ 218,468
Cost	218,468
Fair Value Measurements, Recurring [Member] \| Equity investments [Member] \| Other assets [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	3,300
Cost	3,300
Fair Value Measurements, Recurring [Member] \| Acquisition loans [Member] \| Other loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	114,367
Cost	114,367
Fair Value Measurements, Recurring [Member] \| Other real estate loans [Member] \| Other loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	801
Cost	801
Fair Value Measurements, Recurring [Member] \| Mortgage loans [Member] \| Mortgage loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	100,000
Cost	$ 100,000

Fair Value of Financial Instruments - Additional information (Detail)	6 Months Ended
	Jun. 30, 2015
Fair Value Disclosures [Abstract]
Adjustment for marketability discount	40.00%

Fair Value of Financial Instruments - Summary Showing Sensitivity Analysis by Using Basis Point Variations (Detail) $ in Thousands	6 Months Ended
	Jun. 30, 2015 USD ($)
+100 basis points [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Estimated Increase (Decrease) In Fair Value of Financial Instruments	$ (59)
- 100 basis points [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Estimated Increase (Decrease) In Fair Value of Financial Instruments	$ 59

Subsequent Events - Summary of Hospitals in Acquisition Portfolio (Detail) - Subsequent Event [Member]	Jul. 31, 2015 Bed
Business Acquisition [Line Items]
Total Licensed Beds	1,169
Capital Medical Center [Member] \| Olympia, WA [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Total Licensed Beds	110
EASTAR Health System [Member] \| Muskogee, OK [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Total Licensed Beds	320
Carolina Pines Regional Medical Center [Member] \| Hartsville, SC [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Total Licensed Beds	116
St. Mary's Regional Medical Center [Member] \| Russellville, AR [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Total Licensed Beds	170
National Park Medical Center [Member] \| Hot Springs, AR [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Total Licensed Beds	166
Southwestern Medical Center [Member] \| Lawton, OK [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Total Licensed Beds	199
Willamette Valley Medical Center [Member] \| McMinnville, OR [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Total Licensed Beds	88