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The U.S.’s largest health care facility operator reported a decrease in profit and revenue growth in 2022 versus the year prior, partly due to the phasing out of government assistance that accompanied the pandemic. 
<ul> 
 	<li>HCA Healthcare, which operates in 20 states in the U.S., has in aggregate removed hospitals from its portfolio and added outpatient surgery centers since 2020, reflecting a broader shift to outpatient care among hospital conglomerates.</li> 
 	<li>The health care giant has struggled with staffing issues, like many in the industry, employing higher-cost temporary staffing during the pandemic’s onset. A survey conducted by union researchers found that HCA staffed its hospitals at 30% below the national average in 2020. Responding to the survey, HCA said that its staffing was “safe, appropriate," and “in line” with its industry.</li> 
 	<li>The company has repeatedly fought with the Federal Trade Commission over its acquisition of more hospitals, first in Utah in June 2022, and then in Louisiana in April 2023.</li> 
</ul>

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F500 2022-HCA Healthcare

Tennessee-based national health care facility operator HCA Healthcare retains its 2021 position after a year that saw profits rise to nearly $59 billion from $51.5 billion. The company was called into action multiple times throughout 2021 as COVID-19 waves swept the country and sent hospital visits ticking upward. HCA has faced criticism in some areas of the country from consumer advocates who contend that it has boosted profits at its hospitals during the pandemic by reducing staffing and services; HCA says that such changes haven’t affected the quality of care. In the first months of 2022, HCA has received 2.1% more same-facility admissions relative to 2021 and 14.6% more emergency room visits.

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G500-2021-207-HCA Healthcare

<span data-sheets-value="{&quot;1&quot;:2,&quot;2&quot;:&quot;As with many other hospital companies, Nashville-based HCA Healthcare faced considerable financial pressure related to the pandemic, suspending its quarterly dividend last spring. Admissions to its hospitals dropped 4.7% for the year owing to fewer procedures and less emergency-room traffic. COVID-19 cases in 2020 made up about 8% of its hospitals’ overall admissions. But HCA finished the year strong: It brought in annual revenue of $51.5 billion, a hair above the previous year’s tally, as revenue per hospitalized patient increased 10.5%. Net income attributable to the company rose 7.1% to nearly $3.8 billion, compared with $3.5 billion in 2019.\n\n\n&quot;}" data-sheets-userformat="{&quot;2&quot;:12673,&quot;3&quot;:{&quot;1&quot;:0},&quot;10&quot;:2,&quot;11&quot;:4,&quot;15&quot;:&quot;Calibri&quot;,&quot;16&quot;:11}">As with many other hospital companies, Nashville, Tenn.-based HCA Healthcare faced considerable financial pressure related to the pandemic, suspending its quarterly dividend last spring. Admissions to its hospitals dropped 4.7% for the year owing to fewer procedures and less emergency-room traffic. COVID-19 cases in 2020 made up about 8% of its hospitals’ overall admissions. But HCA finished the year strong: It brought in annual revenue of $51.5 billion, a hair above the previous year’s tally, as revenue per hospitalized patient increased 10.5%. Net income attributable to the company rose 7.1% to nearly $3.8 billion, compared with $3.5 billion in 2019.

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F500-2021-62-HCA Healthcare

<span data-sheets-value="{&quot;1&quot;:2,&quot;2&quot;:&quot;As with many other hospital companies, Nashville-based HCA Healthcare faced considerable financial pressure related to the pandemic, suspending its quarterly dividend last spring. Admissions to its hospitals dropped 4.7% for the year owing to fewer procedures and less emergency-room traffic. COVID-19 cases in 2020 made up about 8% of its hospitals’ overall admissions. But HCA finished the year strong: It brought in annual revenue of $51.5 billion, a hair above the previous year’s tally, as revenue per hospitalized patient increased 10.5%. Net income attributable to the company rose 7.1% to nearly $3.8 billion, compared with $3.5 billion in 2019.\n\n\n&quot;}" data-sheets-userformat="{&quot;2&quot;:12673,&quot;3&quot;:{&quot;1&quot;:0},&quot;10&quot;:2,&quot;11&quot;:4,&quot;15&quot;:&quot;Calibri&quot;,&quot;16&quot;:11}">As with many other hospital companies, Nashville-based HCA Healthcare faced considerable financial pressure related to the pandemic, suspending its quarterly dividend last spring. Admissions to its hospitals dropped 4.7% for the year owing to fewer procedures and less emergency-room traffic. COVID-19 cases in 2020 made up about 8% of its hospitals’ overall admissions. But HCA finished the year strong: It brought in annual revenue of $51.5 billion, a hair above the previous year’s tally, as revenue per hospitalized patient increased 10.5%. Net income attributable to the company rose 7.1% to nearly $3.8 billion, compared with $3.5 billion in 2019.

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G500-2020-219-HCA-Healthcare

HCA Healthcare, a Nashville-based hospital operator, continued its steady growth in 2019 with annual revenue of $51.3 billion, an increase of nearly $5 billion from the previous year, even as net income dipped 5%. HCA's facility admissions have increased over the past year, and it now operates 184 hospitals, up from 179 the year before. Its hospitals treated 35 million patients in 2019, a new record. And the company's goal of expanding clinical capacity has been boosted by multimillion-dollar capital investments. Like many hospital operators, HCA is facing considerable financial pressure related to the coronavirus pandemic; this spring, it suspended its quarterly dividend.

This year's Fortune 500 marks the 66th running of the list.

F500-2020-065-HCA-Healthcare

HCA Healthcare, a Nashville-based hospital operator, continued its steady growth in 2019 with annual revenue of $51.3 billion, an increase of nearly $5 billion from the previous year, even as net income dipped 5%. HCA's facility admissions have increased over the past year, and it now operates 184 hospitals, up from 179 the year prior. Its hospitals treated 35 million patients in 2019, a new record. And the company's goal of expanding clinical capacity has been boosted by multimillion-dollar capital investments. Like many hospital operators, HCA is facing considerable financial pressure related to the coronavirus pandemic; this spring, it suspended its quarterly dividend.

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Global business is back. After limping through a worldwide financial crisis and economic slowdown, the 500 largest companies ranked by revenues shattered all sorts of performance records in 2013: They racked up combined revenues of $31.1 trillion, up 2.5% from 2012, and profits soared 27% to nearly $2 trillion. China’s 95 companies (up from 89 last year) posted $5.8 trillion in revenues. The U.S. has four fewer companies on the list than last year but remains (for now) the country leader, with 128 corporations on the list—including No. 1 Wal-Mart Stores—reporting $8.6 trillion in revenues. 

Wal-Mart stayed on top as its sales crept closer to half-a-trillion dollars. Apple moved into the top five. And UnitedHealth Group continued its steady climb. 

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HCA Healthcare owns many of the largest chains of hospitals, clinics, surgery centers, medical labs, and freestanding emergency rooms in the U.S., in addition to operating locations in the U.K. The company was founded in 1968 as one of the first U.S. hospital conglomerates. Since then, along with its industry rivals, it has undergone tremendous growth, partly through acquisitions of smaller health care chains.

Q2 2026

Q1 2026

Q4 2025

Q3 2025

Q2 2025

Q1 2025

Q4 2024

HCA Healthcare (HCA): Company Profile, Stock Price, News, Rankings

legacy

HCA Healthcare

hca healthcare

Ladies and gentlemen, welcome to HCA Healthcare's Second Quarter twenty twenty five Earnings Conference Call. Today's call is being recorded. At this time, for opening remarks and introductions, I would like to turn the call over to Vice President of Investor Relations, Mr. Frank Morgan. Please go ahead, sir.

Good morning, and welcome to everyone on today's call. With me this morning is our CEO, Sam Hazen and our CFO, Mike Marks. Sam and Mike will provide some prepared remarks, and then we'll take questions. Before I turn the call over to Sam, let me remind everyone that should today's call contain any forward looking statements, they're based on management's current expectations. Numerous risks, uncertainties and other factors may cause actual results to differ materially from those that might be expressed today.

More information on forward looking statements and these factors are listed in today's press release and in our various SEC filings. On this morning's call, we may reference measures such as adjusted EBITDA, which is a non GAAP financial measure. A table providing supplemental information on adjusted EBITDA and reconciling net income attributable to HCA Healthcare Inc. Is included in today's release. This morning's call is being recorded and a replay of the call will be available later today.

With that, I'll now turn the call over to Sam.

Alright. Thank you, Frank, and good morning to everybody and thank you for joining the call. The company's financial results for the second quarter were strong with a 24 increase in diluted earnings per share as adjusted to $6.84 The results reflected solid revenue growth of 6.4%, which was driven by greater demand for our services, improved payer mix, and consistent patient acuity levels. In the quarter, we also experienced a stable operating environment, which allowed us to produce better margins. Because of the team's great start to the year, we increased our guidance for 2025 as reflected in our earnings release this morning.

This updated outlook also reflects the positive demand environment we expect in our markets, the effectiveness of our strategic initiatives, and the momentum we see in our business. During the quarter, we also improved quality outcomes, throughput measures in our emergency rooms, and patient satisfaction. We believe the HCA way of combining our high quality local health networks with the capabilities of a national system will continue to reinforce our competitive position, help us respond effectively to evolving market dynamics, and meet the needs of our patients. As a team, we remain relentless in our pursuits to innovate using technology, finding ways to increase efficiencies, and hold ourselves accountable for delivering results for our stakeholders. I want to thank our colleagues again for their outstanding work and their ongoing pursuits to deliver on our mission.

Now let me transition to the federal policy environment and the recent passage of the One Big Beautiful Bill Act. With respect to the Medicaid component in this act, we believe the adverse impacts over the next few years are manageable. This belief is based on the grandfathering provisions for supplemental programs, which include a number of previously submitted applications for state directed payments and the timelines for phasing in work requirements and supplemental payment program changes. I will also note that the bifurcation of the policy between expansion and non expansion states lessens the expected impact to HCA Healthcare. Approximately 60% of our Medicaid volumes and revenue are in non expansion states.

With respect to the exchange provisions in the act, we do anticipate that some people will lose insurance coverage over the next few years, but we believe our financial resiliency program should offset these effects. We are also mindful of the scheduled expiration of the enhanced premium tax credits at the end of this year. We continue to advocate strongly for their extension, but at this point, we do not know what the outcome will be. Recent polling indicates that many Americans want them extended. Many believe they need them for their families, and many say their voting patterns could hinge on their ultimate fate.

We are working to develop and execute resiliency programs to offset as much as possible any adverse impact should they expire. Let me close with this. Regardless of the outcome with these federal policies, we are optimistic about the future of HCA Healthcare. Our balance sheet is strong. We have an experienced, capable, and disciplined team.

And where appropriate, we will adjust as we can as we can and continue delivering on our mission. With that, I'll turn the call to Mike for more details.

Thank you, Sam, and good morning, everyone. We are pleased with our second quarter earnings. Equivalent admissions increased 1.7% for the quarter and 2.3% for the year. Year to date managed care equivalent additions, including the exchanges, grew 4%, which is in line with our expectations. Medicare grew 3%, which is slightly below our expectation.

Medicaid was down slightly, and self pay was up slightly. Both were below our expectations and represent our lowest reimbursing payers. However, given the payer mix and acuity of our patients, we had revenue growth of 6.4%, slightly above the top end of our long term 4% to 6% guidance. Adjusted EBITDA margin improved 30 basis points compared to the prior year quarter. Salary and benefits, along with other operating expenses, both improved as a percentage of revenue when compared to the prior year.

Same facility contract labor improved 1% from the prior year quarter and represented 4.3% of total labor costs in the 2025 versus 4.6% in second quarter of twenty twenty four. Supply expense increased slightly as a percentage of revenue due primarily to increased spending on cardiac related devices. Adjusted EBITDA in the second quarter grew 8.4% over the prior year quarter, and we were pleased that a substantial portion came from core operations. Regarding Medicaid supplemental payment programs, as we've said in the past, these programs are complex, variable in time, and do not fully cover our cost to treat Medicaid patients. Considering Medicaid state supplemental payments and related provider taxes in isolation, we saw an approximate $100,000,000 increase in net benefit in the 2025 compared to the prior year quarter due to prior period reconciliation payments and program accrual time.

The new Tennessee directed payment program was approved in late June. As this is a newly approved program, we did not accrue any benefit from this program in 2025 and will record as we receive cash. Moving to capital allocation. We continue to deploy a balanced strategy of allocating capital for long term value creation. Cash flow from operations was $4,200,000,000 in the quarter.

Capital allocation in the 2025 was 1,200,000,000.0 in capital expenditures, 2,500,000,000.0 in share repurchases, and 171,000,000 in dividend. We were able to defer approximately 850,000,000 in tax payments to the fourth quarter due to the IRS providing relief to Tennessee taxpayers in the aftermath of severe weather in early April. Our debt to adjusted EBITDA leverage remains in the lower half of our stated guidance range, and we believe our balance sheet is strong and well positioned for the future. Sam discussed the health policy implications of the One Big Beautiful Bill Act. I will provide a few more detailed notes.

As it relates to tax policy, this act was positive for ACA, making 100 bonus depreciation permanent and effective back to inauguration debt, which is helpful given our capital investment program. The act did not include policies that would have materially increased our tax liability. We continue our work to develop and execute resiliency plans to offset as much of any adverse impact as possible from the act, the potential expiration of the EPTCs, and other administrative actions such as tariffs. We will provide more information on our resiliency efforts during our fourth quarter twenty twenty five earnings call when we issue our 2026 guidance. So with that, let me speak to our 2025 guidance.

As noted in our release this morning, we are updating the full year 2025 guidance as follows. We expect revenues to range between 74 and 76,000,000,000. We expect net income attributable to ACA Healthcare to range between 6,110,000,000 and 6,480,000,000.00. We expect adjusted EBITDA to range between 14,700,000,000.0 and 15,300,000,000.0. We expect diluted earnings per share to range between $25.50 and $27.

We expect capital spending to be approximately 5,000,000,000. We are updating our guidance to project growth and equivalent admissions to be between 23% for the full year 2025. With the approval of the Tennessee program and with updated information from across our programs, we now anticipate our supplemental payment full year net benefit to be between flat and $100,000,000 favorable year over year. This projection does not include any potential impact in 2025 from the grandfathering of applications under the act. We believe one of the underlying strengths of HCA is our diversified portfolio of markets.

The recovery in our facilities impacted by Hurricane Saline and Milton in 2024 is going better than anticipated. However, we have a couple of markets below our expectations that are offsetting some of the better performance in the hurricane affected markets. We understand the challenges in these markets and have confidence in the plans in place to address them. Ultimately, the increase in our earnings guidance is equally weighted between the updated net benefit from the state supplemental payment programs and the improvement in our overall portfolio operational performance, including the hurricane impacted markets. With that, I will turn the call over to Frank for questions.

Thank you, Mike. As a reminder, please limit yourself to one question so we might give as many as possible in the queue an opportunity to ask a question. Abby, you may now give instructions to those who would like to ask a question.

Thank you. If you have dialed in and would like to ask a question, please press star one on your telephone keypad to raise your hand and join the queue. If you would like to withdraw your question, simply press star one a second time. If you are called upon to ask your question and are listening via speakerphone on your device, please pick up your handset and ensure that your phone is not on mute when asking your question. Again, it is star one if you'd like to join the queue.

And our first question comes from the line of AJ Rice with UBS. Your line is open.

Hi, Just maybe just asking around the guidance update. So you've raised your EBITDA, guidance, adjusted EBITDA by about 3 100,000,000 at the midpoint. I think that's roughly the amount of outperformance, that you saw in in the seen so far year to date in the first half. Just a couple, questions around that. Obviously, you now have the Tennessee DPP program.

Is that should we think of that as reflected in this updated outlook? And then second, I know you're making a modest tweak on the admissions number, down. You're not alone in that. Your some of your peers have already reported and done that. Any commentary on what you're seeing in terms of underlying demand, on the volume front?

Hey, Jake. Good morning. Let's talk about guidance first. So if I think about the $300,000,000 increase in guidance, in midpoint, as as I noted in my comments, about half of that is from state supplemental payment programs, and that does reflect the approval of the new Tennessee program. We expect to receive, start to receiving cash in that here in the back half of the year, and probably a material chunk of that in third quarter likely.

It also reflects in just better visibility as we always have here at midyear about the rest of our program. So that's about half of the the the increase. You know, if I think about the other half of our guidance increase, it really relates to our portfolio. And, again, as I mentioned in in my opening statement, you know, about a 150,000,000 of of that increase is related to the portfolio. And I would size that for you as follows.

It's about a $100,000,000 better, in our hurricane related markets. And, you know, you recall that we originally guided that to be flat to prior year, so that's that's a $100,000,000 of it. We have a couple of markets that are underperforming roughly in the $50,000,000 range of impact. So those two markets are offsetting some of the hurricane market improvements. And then, really, the the rest of our portfolio is performing better than anticipated.

So the net combined effect of of our combined portfolio, including the hurricane markets, really results in the other half. I might mention, though, just so that you guys can think through this as you prepare your your comments. But, I think third quarter, the guidance the the earnings growth will be a little bit lower, and fourth quarter is likely gonna be a little bit higher, in terms of growth rate compared to that that midpoint of the guidance. That that's largely related to both the timing of supplemental payment program payments and, you know, specifically the fourth quarter. You may recall that we received one time payments fourth quarter of last year that do not repeat.

And then we believe our hurricane markets, you know, the recovery that we're that we're showing is largely gonna be in fourth quarter, if not entirely. So a couple of notes on that. So on volume, let me start and then, Sam, please feel free to jump in. I know you will. The the the bit when I think about our volume, year to date through June equivalent efficient growth, and I and I compare that to our original three to 4% guidance coming into the year, there are a couple of moving parts that that I would mention.

The first is that Medicaid, you know, for for June year to date, Medicaid's down 1.2% to prior year. And we, originally, believed and built into our guidance the notion that Medicaid would flatten out this year, if not even show a bit of growth coming off of the Medicaid redetermination program. And then our self pay charity volumes are only up 1.5%, June year to date, and and we had believed originally that they would at least grow at the overall rate of volume growth. And, you know, just for context, our self pay volumes were up almost 7% in twenty four over twenty three. So the combined of Medicaid and self pay being below our expectations explain about half of the difference of our current year to date, volume growth versus our three to 4% original guidance.

And, really, the other half is Medicare. We, originally, expected Medicare to grow a bit faster than it is. Although I would note that a 3% growth in Medicare year to date through June is still pretty robust. So those are the two main categories of our volume, that are trailing our original expectation of three to four. And, Sam, I don't know

if you have me just add a couple of comments here, Mike, because I think context is always important. You know, you look at the headlines on volume metrics as Mike just suggested. There's there's one metric what everybody looks at and we get it. But when you start reading through the full story and not just focus on the headlines, you start to see the productive aspects and the qualitative value of the underlying business. For example, we had 14 out of 15 divisions that grew their admissions.

14 out of 15 domestic divisions grew their adjusted admissions. Our cardiac procedure volume was up 5%. Our obstetrics volumes were up 3%. Neonatal volumes up 13%. So the details, in many respects, reflect the power of a diversified portfolio of markets and services.

I think another point for us, and this is how we look at it, we've had 16 consecutive quarters of volume growth. And so that consistency tells us that the network model that we're investing in very heavily and we're focused around execution on it allows us to compete effectively. It's allowed us to sustain market share gains, and we think it adds value for our patients. It adds value for our physicians, and we think it adds value for our shareholders. So, yeah, the number is 1.7%, but when you look underneath it, the productive and qualitative aspects of it are more impactful, than, maybe first understood.

And our next question comes from the line of Anne Hines with Mizuho. Your line is open.

Hi, good morning. Thank you. Can you just provide more details on your resiliency programs? I think the Street really at this point doesn't believe that the subsidies will be extended. How much of the headwind do you think you can offset in 02/1926?

Is any of this benefit embedded in your 2025 guidance, or will it all be incremental to 02/1926? And any other incremental details about what type of cost savings you'll be doing, that'd be great. Thank you.

So let me, let me kinda summarize our thinking about, the the One Big Beautiful Bill Act, the EPTCs, and and how we're thinking about a resiliency program. And then and as I mentioned in my comments, we will, comment further and provide more details related to this in in our fourth quarter twenty five earnings call when we give guidance for 2026. First, let me start with the act itself. You know, I do believe the in the near term that our financial resiliency program should offset the exchange provisions in the act. In the longer term, as it relates to the act specifically, with both the delayed start and the phased in nature of these provider tax and state directed payment reimbursement reforms, along with the potential for the approval of the submitted supplemental payment applications, we believe ACA will be able to generally manage these impacts with our resiliency efforts without material impact to our long term guidance.

Specific to EPTCs, at this point, we do not know what the outcome will be. As noted, we are working to develop our resiliency programs to offset as much as possible any adverse impact should they expire, And, again, the potential approval of the grandfathered applications would certainly help. We will comment further as noted, when we do our 2026 guidance. Suffice it to say, our our resiliency efforts as we continue to work through them, and we've been working on them as you as we've talked about over the last year, in a very diligent way, address both benchmarking our corporate, departments and shared service organizations against best practices in finding operational improvement opportunities. We are deep in the middle of our field based resiliency efforts, many of which we commented on before, from a link to stay and improvement opportunities with our case management operations through significant opportunities around both our automation and our digital transformation agenda.

And our labor and supply related resiliency plans are also very, developed and mature. We will give more updates on that, Anne, when we get to, the fourth quarter call, but but hopefully that helps. Thanks.

And our next question comes from the line of Ben Hendrix with RBC Capital Markets. Your line is open.

Great. Thank you very much. I appreciate all the color about trends in the various payer classes. I was wondering if you could comment a little bit on commercial volume you're seeing. One of your peers talked about waning consumer confidence, driving some weakness in their book.

But wanted to see what you're seeing in that weight against any expectation for a pickup in activity assuming people are trying to get procedures done toward the end of the year in anticipation of losing the enhanced premium subsidies. Any thoughts there on on what we can expect through four q in commercial? Thanks.

So I'll give you, Ben, June year to date, our managed care and Hicks equivalent admissions are up 4% over prior year. If you think about how that compares to our expectations coming into the year, it's it's it's right there. I mean, that that's about what we expected, for as part of our original three to 4% guide. I would say that health care exchanges, which are up 15.8%, through June year to date, are a little better than our original expectation. And our commercial, managed care book, you know, excluding, the exchanges, which is up just short of a point, to prior year, maybe a little below our original guidance, but, that that's how we read it.

We're pleased with the payer mix through second quarter. Sam, I don't know if you have any comments about consumer

No. I don't think we can make any comments yet about consumer confidence. I think, again, the demand for, health care largely, over time, appears to have been inelastic. I don't know that anything is necessarily changing that. And so, it's, it it's difficult for us to point to consumer confidence at least across our portfolio as a driver of activity.

Again, we had good commercial growth in a lot of categories. We we had declines in areas, as Mike mentioned, that were government or no payer payer sponsored business. We saw declines in pediatrics. We we can point to a respiratory, environment last year that we didn't have this year that influenced our overall statistic. Behavioral health admissions were down in our company.

Some of that was because we shrunk supply in certain facilities. Again, that doesn't have as good a payer mix as the rest of our business. So I think from that standpoint, we're still pretty, you know, confident as we mentioned in the demand for health care across our markets, and we don't see that being disrupted too much in the, in the short run here.

You know, Ben, the only other thing I might mention is that the it's a pretty tough prior year comp to prior year, and I I think everyone realizes that the prior year had really robust volume growth. You know, just a couple of notes here when you think about, this the first half of this year compared to the first half of last year. You know, we we we still have a bit of a leap year impact. That's about 50 basis points of of volume impact. Medicaid redeterminations last year were fueling, you know, big exchange growth last year.

You may recall that our exchange, you know, volume growth, last year was robust over 40%. Kind of an interesting statistic. From first quarter to second quarter of twenty four, our exchange, equivalent emissions increased, 14%. This year, from first quarter to second quarter of twenty five, they're up about 3%. So we still saw growth, sequentially from first quarter to second quarter, but I think prior year just had robust exchange, you know, volume growth.

And then just the other thing just to keep in mind when you're thinking about the prior year comp is that the Medicare Advantage two midnight rule did impact admissions in '24, and that has sunset into '25. So I think the prior year comparison is also a bit of a story here.

And our next question comes from the line of Brian Tanquilut with Jefferies. Your line is open.

Hey, good morning guys. Maybe Sam, just to follow-up on some of these discussions on I appreciate your comments on the growth rates that you saw with the different regions. But how are we thinking about market share that you're seeing in the local market? Maybe also in the context of the payers are talking about high utilization rates and that translating to the volume trends that you're reporting. So just curious if you're seeing any dynamics at the local level you can share with us. Thank you.

Yeah. Brian, thank you. As I mentioned, you know, we've had sustained market share gains, and we think we've continued to accomplish that, with the most recent data that we've seen in our market share, if you really sort of, know, exclude behavioral health, given that we put some pressure ourselves. We're we're we're above 28%, and we're, you know, we're we're showing signs of broad based market share growth across service lines as well as across many of our markets. We do have a few markets as we always do.

We have 43 US markets that we focus our our share on and, some are doing better than others. But, you know, we're we're fairly agile in responding to those dynamics. I mean, there's there's a lot of investments that we're making in our business. We still have about 5 and a half billion dollars worth of capital that it's in flight that will add to our networks both with outpatient facilities as well as inpatient capacity where appropriate. We think that will continue to produce the necessary overall capacity to meet the demands as well as the share gains that we anticipate with our initiatives.

So we continue to find ways to improve what we call the integrity of our network and keep patients inside the system where appropriate for them, and that's an area of focus for us also. So I'm pretty pleased with how our teams are executing on the ground, so to speak, to deliver value for our patients, grow their business, and so forth. We recently create finished our midyear reviews with all of our divisions, and, you know, we're optimistic that their assessments of the markets are continually favorable and, will, you know, allow us to achieve our objectives as we push forward.

And our next question comes from the line of Pito Chickering with Deutsche Bank. Your line is open.

Yeah. Good morning, And thanks for taking my questions. One quick clarification and then a real question. For clarification, on supplemental payments, I believe you raised the annual guidance by about $170,000,000 at the midpoint. I believe the first quarter was $80,000,000 ahead, second quarter was $100,000,000 ahead.

It's confirming that you were not changing supplemental payment guidance for the back half of the year. And then the real question is, do have any color of how many of your Hicks patients have access to employer sponsored health care, but have chosen Hicks due to lower costs? I'm just struggling as I look at the millions of jobs created in your states and yet the employer sponsored growth is tracking below job growth. Thanks.

Thanks, Peter. Let let me start with guidance. As I noted in my comments, about half of our increased guidance at Midpoint is coming from state supplemental payments. So a 150,000,000, increase of our guidance is coming from state supplemental payments. That reflects, not only the fact that the Tennessee program is approved, it has been approved, but that we expect to start receiving cash here in the back half of the year.

I would think about it it it is this way, as you think about kind of the part second half of the year versus the first half of the year. In in terms of the the the first half of year, we've had a $180,000,000 of supplemental payment net benefit to year over year earnings in the first half. In the second half of the year, we anticipate a $130,000,000 decline in net benefits compared to the 2024 and really entirely in the fourth quarter. And so, you know, just just as you think about, the inside guidance rate, in our in our revised guidance, The second half, after considering the the hurricane market improvement in fourth quarter and the safe supplemental payment, declined in the back half of the year, we think that the the second half of the year's growth rate is roughly comparable to the first half after considering those factors. We do not, at this point, have a good enough insights relative to what percentage of the people who potentially, would leave the exchanges if the EPTCs expire that would go back to employee sponsored insurance.

Other than to say that we believe that there would be a component of those people, who lose EPTCs would go back, to employee sponsored insurance. And as you noted, in in our key states, especially our non expansion states, given the job growth that we've seen over the last several years, in places like, you know, Florida and Texas, we believe it would be a component, of the of the storage. A little early to probably get inside yet until we know what happens with APTC.

And our next question comes from the line of Whit Mayo with Leerink Partners. Your line is open.

Hey, thanks. Good morning. Just wondering if there are any changes that you guys are seeing in MA behavior denials, anything to call out that's maybe changed versus last year and any, investments maybe that you've made around, documentation or revenue cycle that's also, changed? Thanks.

So, just on Medicare Advantage, just a couple of numbers here. So Medicare Advantage now represents 58% of our total, Medicare admissions at, you know just one note on the on the two midnight rule. That that seems to to be fully implemented in 2024. We're really not seeing any, you know, additional movement from observation to inpatient there. You know, as it relates to the payers, with, you know, we we are not seeing, you know, any significant impact on our results from denial activities.

But I think that does reflect the significant work that we have, put into our revenue cycle over the last couple of years, you know, to strengthen our organization's management of denials. I'll mention that, we have over the last year or so, we have initiated, several partnership, activities with our key partners and our key managed care payer partners. These partnership activities focus on things like digital integration, administrative simplification, and better management of disputes. I think there's a lot of good work in flight between us and our and our payer partners and and hopeful that we can continue to manage through these things and and and as we have been in in a really meaningful way. We need them.

They need us. And and I think, we have a a good relationship in flight to work through these these areas.

And our next question comes from the line of Andrew Mock with Barclays. Your line is open.

Hi, good morning. Maybe just one quick info request and then a question. Can you give us the latest quote on ACA revenue and admissions? And maybe just a question on the hurricane performance. Appreciate all the color there. But I think the headwind, at least to start the year, $250,000,000 versus last year. Now you're attributing $100,000,000 of the guidance raise to hurricane. So does that mean there's still a 150,000,000 of continuing headwinds embedded in the guidance for the back half? And can you give us a sense for how occupancy, payer mix, and profitability stand in that Mission North Carolina market versus pre hurricane? Thanks.

Let me start with the the exchanges. About 8% equivalent admissions and just a smidge over 10% on net revenues, for, the exchanges as a percentage of total. So on the hurricane markets, remember, if you think about last year for third and fourth quarter of last year, a a piece of that 250,000,000 were, lost revenues, and a piece of that was additional expenses. And, I think it's roughly sixty forty additional expenses, 40% lost revenue. So you don't get the lost revenue back, Andrew.

And and, clearly, you get you you you do get to go year over year on the, on the additional expenses for prior year. So when we were constructing our original guidance for hurricane markets, you know, we we had pretty good confidence and insight that the Largo hospital would have year over year growth in our because it reopened on December 1. And a lot of the impact there was repairs and maintenance expenses to reopen that facility. And then in in our North Carolina division, you may recall, we were concerned because we didn't we never closed operations, but we were concerned about the lingering effects of the hurricane in that market because of, the the broad impact to the population in Western North Carolina. And so, our best estimates at at the time when we issued our original guidance was that we thought that that that when combined, the hurricane markets would be flat year over year, '25 compared to '24.

As we've gone through the first two quarters, you know, what we've seen is a little better recovery, than our original anticipation. You may recall that in first quarter, the the the year over year impact of those two markets was relatively flat. The second quarter was a bit negative, and there was a decline in earnings year over year. It wasn't material at the company level, but it was certainly a bit negative. We think third quarter could be a bit negative as well, and then we see a recovery, year over year in fourth quarter.

But, for the full year, we believe that the hurricane related markets will come in at about a $100,000,000, better, year over year, which is, again, is compared to our original fall of flat. Hopefully, that helps on

the Yeah. And, Mike, let me add, one thing. I mean, what we've seen in North Carolina is greater demand than we anticipated. Unfortunately, we've seen the labor market get more tight, and that's required us to use more contract labor in North Carolina to service that demand. And so those are really the two big items there. Again, this is still a very short period after the storm.

We don't know the long term effects on Asheville, North Carolina in particular and what it means to economic development and tourism and so forth. But we're really pleased with how our teams have dealt with the operational requirements, the patient requirements with with the the situation there, and they continue to push on in a very effective way. And we remain very bullish about our system in North Carolina, and we continue to add where we can underneath the rules in that state. We continue to improve the quality, and we continue to engage with our stakeholders in a very effective way. So we're excited about, the position of Mission Hospital in particular and where it stands, and we'll continue to, execute on the plan that's in front of us.

And our next question comes from the line of Justin Lake with Wolfe Research. Your line is open.

Thanks. Good morning. I'm going to try to get at this resiliency stuff and maybe another way without trying to pin you down on it. The you know, if the world looks at your, you know, at what's coming, right, there's gonna be a bunch of lost revenue. And when we think about exchanges and these provider taxes, they're certainly very high margin revenue.

Right? So if that goes away, there's the potential for a big impact. Right? I don't think I'm telling you anything you don't know. The the I think the main question I'd love to get from you guys here is just, you know, you've done an incredible job over time in different, operating environments and staying around a 19 to 20% margin.

And is that a reasonable framework? Like, look. We're gonna lose revenue, but we're gonna stay at know, you we think with the resiliency efforts, we keep within that typical margin target. Is that a reasonable framework to think about the next few years?

You know, Justin, this is Sam. I I don't know if I'm gonna put a frame of reference on, any of that at this particular juncture. We need to get through the last half of the year to understand, exactly where this premium tax credits land. We will score that. We are actively, developing our, you know, cost plan in order to respond to that. I will tell you this. We have a pattern of owning our realities, whatever they happen to be, and finding pathways forward to accomplish our financial objectives, our growth objectives, our return on capital objectives, our quality objectives, and I'm confident that we'll we will do that in an appropriate fashion as we push forward. And so we're not ready to give you a margin range. We're not ready to give you a revenue implication just yet because it would be inappropriate for us to do that until we have greater clarity on exactly how this lands, where some of these people go if they do in fact lose coverage. And, and we understand, everybody's concern and desire to wanna try to score it, but you gotta give us, some sense of time here and and and ability to sort of process it. But when I pull up and I think about who this organization is, the people we have on our team, the position we have in the markets that we serve, I'm pretty confident that we'll get to where we need to be.

our next question comes from the line of Matthew Gillmor with KeyBanc. Your line is open.

Hey. Thanks for the question. Going back to the guidance discussion, there was a comment about, a handful of markets that were underperforming. Can you give us some sense for the drivers of that underperformance and then the actions that are underway to improve results?

Yeah. This is Sam. We have 16, geographic divisions in HCA when you include, The UK. We have 15, obviously, in the in The US. Every year, we have one or two of them that aren't accomplishing what we hope they accomplish for a variety of reasons.

You know, certain volumes don't materialize as we anticipate. Competitors do something that we we didn't expect. Physicians have dynamics that create, you know, flow of business. It it it's so variable. So we have two divisions.

I'm not gonna call them out on this call other than to say we're confident positioning in both of them and what they're doing in order to respond. These are seasoned leaders in these hospitals and in these divisions. There's been some competitive dynamics in one division that's, dislocated some of our business, but we're responding to that appropriately. In the other division, there was a bit of service mix change. Nothing structural, but it hit us pretty hard in the second quarter.

And we're reacting to that appropriately with our calls, but we we expect fully that that will recover in the second half of the year. And so this is sort of the normal give and take with what's uniquely, I think, our diversified portfolio. And, again, having geography differences across the company allows us to absorb two divisions that didn't have the performance that we anticipated. And and that's that's what happened last year. We had a couple of divisions that did not accomplish their objectives in '24, and we overcame it last year, and we're doing it again this year.

And our next question comes from the line of Josh Raskin with Nephron Research. Your line is open.

Hi, thanks. Good morning. Could you provide just a little bit more color on maybe surgery volumes both on the inpatient and outpatient side? And maybe any changes in trends you're seeing around site of care?

So outpatient surgery is a is a continuation of kind of our past stories here, Josh. I I mean, I would note that on the pure case count standpoint, we were down point 6% for the quarter, which is, you know, better than our most recent trends. And still, almost entirely driven by Medicaid and self pay and a and a and a bit of a drop in lower acuity cases. I would note, as we've noted before, that we are seeing good revenue growth in our outpatient surgery book of business, you know, call it seven and half, 8% growth here, that we're seeing on the revenue side. So that that's good.

And, really, if I if I pull up outside of this outpatient surgery and look at outpatient in total, we had a good quarter. I mean, our our total outpatient revenue grew, you know, almost 8%. So all four categories of our outpatient book that we track performed well. The inpatient surgery is is very similar story on payer mix, and the biggest impact was a drop in Medicaid cases on the inpatient side. So inpatient surgeries on the same facility basis were relatively flat in the quarter, and it's pretty much payer mix on Medicaid drip.

And our next question comes from the line of Sarah James with Cantor Fitzgerald. Your line is open.

Thank you. Can you talk about how commercial exchange and self pay compare historically on fee schedule and revenue collection rate? And to the degree we see some shifting in volume to self pay in the future, is there anything that your team can do on the revenue collection strategy side to improve collection rates on self pay?

HCA Healthcare (HCA) Q2 2025 Earnings Call Transcript

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