For-profit hospital companies are gearing up to spend billions buying hospitals this year following a two-year lull on the acquisition front, and several deals are already in the works. One of the largest involves Vanguard Health Systems Inc., which signed a letter of intent in June to buy the eight- hospital Detroit Medical Center in a deal valued at $1.27 billion. Two weeks later, Brentwood, TN-based Life Point Hospitals Inc. announced it would buy Clark Regional Medical Center in Kentucky and spend about $60 million to build and equip a replacement hospital Meanwhile, Ardent Health Systems confirmed its interest in Forum Health, a three hospital system in Ohio that filed for bankruptcy last year. And Community Health Systems Inc., the world's largest publicly traded hospital company, not only has deals pending in West Virginia and South Carolina but is also courting a third in Colorado.

It is clearly a buyer's market, with poor economic conditions and healthcare reform pushing many already distressed hospitals to the breaking point. According to turnaround consulting firm Alvarez & Marsal, half of all US hospitals were insolvent, or close, in 2008-and that was before the full brunt of the economic downturn hit.

"The recession brought some otherwise sound hospitals to the