Cover Page
Cover Page - shares | 3 Months Ended | |
Mar. 31, 2022 | Apr. 29, 2022 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Mar. 31, 2022 | |
Document Fiscal Year Focus | 2022 | |
Document Fiscal Period Focus | Q1 | |
Trading Symbol | HCA | |
Entity Registrant Name | HCA Healthcare, Inc. | |
Entity Central Index Key | 0000860730 | |
Current Fiscal Year End Date | --12-31 | |
Entity Current Reporting Status | Yes | |
Entity Filer Category | Large Accelerated Filer | |
Entity Shell Company | false | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Common Stock, Shares Outstanding | 295,484,400 | |
Entity Interactive Data Current | Yes | |
Entity File Number | 1-11239 | |
Entity Incorporation, State or Country Code | DE | |
Entity Tax Identification Number | 27-3865930 | |
Entity Address, Address Line One | One Park Plaza | |
Entity Address, City or Town | Nashville | |
Entity Address, State or Province | TN | |
Entity Address, Postal Zip Code | 37203 | |
City Area Code | 615 | |
Local Phone Number | 344-9551 | |
Document Quarterly Report | true | |
Document Transition Report | false | |
Title of 12(b) Security | Voting common stock, $.01 par value | |
Security Exchange Name | NYSE |
Condensed Consolidated Income S
Condensed Consolidated Income Statements (Unaudited) - USD ($) shares in Thousands, $ in Millions | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Income Statement [Abstract] | ||
Revenues | $ 14,945 | $ 13,977 |
Salaries and benefits | 6,939 | 6,301 |
Supplies | 2,321 | 2,224 |
Other operating expenses | 2,752 | 2,421 |
Equity in earnings of affiliates | (11) | (21) |
Depreciation and amortization | 732 | 697 |
Interest expense | 408 | 384 |
Gains on sales of facilities | (10) | (2) |
Total expenses including equity in earnings of affiliates | 13,131 | 12,004 |
Income before income taxes | 1,814 | 1,973 |
Provision for income taxes | 349 | 393 |
Net income | 1,465 | 1,580 |
Net income attributable to noncontrolling interests | 192 | 157 |
Net income attributable to HCA Healthcare, Inc. | $ 1,273 | $ 1,423 |
Per share data: | ||
Basic earnings | $ 4.21 | $ 4.21 |
Diluted earnings | $ 4.14 | $ 4.14 |
Shares used in earnings per share calculations (in millions): | ||
Basic | 302,446 | 338,123 |
Diluted | 307,374 | 343,321 |
Condensed Consolidated Comprehe
Condensed Consolidated Comprehensive Income Statements (Unaudited) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Statement of Comprehensive Income [Abstract] | ||
Net income | $ 1,465 | $ 1,580 |
Other comprehensive income (loss) before taxes: | ||
Foreign currency translation | (34) | 8 |
Unrealized losses on available-for-sale securities | (26) | (11) |
Defined benefit plans | 0 | 0 |
Pension costs included in salaries and benefits | 2 | 7 |
Total defined benefit plans | 2 | 7 |
Change in fair value of derivative financial instruments | 4 | 1 |
Interest costs included in interest expense | 2 | 9 |
Total change in fair value of derivative financial instruments | 6 | 10 |
Other comprehensive income (loss) before taxes | (52) | 14 |
Income taxes (benefits) related to other comprehensive income ("OCI") items | (9) | 3 |
Other comprehensive income (loss) | (43) | 11 |
Comprehensive income | 1,422 | 1,591 |
Comprehensive income attributable to noncontrolling interests | 192 | 157 |
Comprehensive income attributable to HCA Healthcare, Inc. | $ 1,230 | $ 1,434 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Millions | Mar. 31, 2022 | Dec. 31, 2021 |
Current assets: | ||
Cash and cash equivalents | $ 2,371 | $ 1,451 |
Accounts receivable | 8,520 | 8,095 |
Inventories | 2,003 | 1,986 |
Other | 2,112 | 2,010 |
Total current assets | 15,006 | 13,542 |
Property and equipment, at cost | 52,042 | 51,350 |
Accumulated depreciation | (27,814) | (27,287) |
Property and equipment, net | 24,228 | 24,063 |
Investments of insurance subsidiaries | 408 | 438 |
Investments in and advances to affiliates | 441 | 448 |
Goodwill and other intangible assets | 9,525 | 9,540 |
Right-of-use operating lease assets | 2,138 | 2,113 |
Other | 462 | 598 |
Total assets | 52,208 | 50,742 |
Current liabilities: | ||
Accounts payable | 4,010 | 4,111 |
Accrued salaries | 1,865 | 1,912 |
Other accrued expenses | 3,157 | 3,322 |
Long-term debt due within one year | 1,486 | 237 |
Total current liabilities | 10,518 | 9,582 |
Long-term debt, less debt issuance costs and discounts of $323 and $248 | 36,210 | 34,342 |
Professional liability risks | 1,508 | 1,514 |
Right-of-use operating lease obligations | 1,790 | 1,755 |
Income taxes and other liabilities | 1,768 | 2,060 |
Stockholders' equity: | ||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 298,980,900 shares - 2022 and 305,476,800 shares - 2021 | 3 | 3 |
Accumulated other comprehensive loss | (447) | (404) |
Retained deficit | (1,589) | (532) |
Stockholders' deficit attributable to HCA Healthcare, Inc. | (2,033) | (933) |
Noncontrolling interests | 2,447 | 2,422 |
Total stockholders' equity | 414 | 1,489 |
Total liabilities and stockholders' equity | $ 52,208 | $ 50,742 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions | Mar. 31, 2022 | Dec. 31, 2021 |
Statement of Financial Position [Abstract] | ||
Debt issuance costs | $ 323 | $ 248 |
Common stock, par value | $ 0.01 | $ 0.01 |
Common stock, shares authorized | 1,800,000,000 | 1,800,000,000 |
Common stock, shares outstanding | 298,980,900 | 305,476,800 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($) $ in Millions | Total | Common Stock [Member] | Capital in Excess of Par Value [Member] | Accumulated Other Comprehensive Loss [Member] | Retained Earnings (Deficit) [Member] | Equity Attributable to Noncontrolling Interests [Member] |
Balances at Dec. 31, 2020 | $ 2,892 | $ 3 | $ 294 | $ (502) | $ 777 | $ 2,320 |
Balance, shares at Dec. 31, 2020 | 339,426,000 | |||||
Comprehensive income | 1,591 | 11 | 1,423 | 157 | ||
Repurchase of common stock | (1,527) | (225) | (1,302) | |||
Repurchase of common stock, shares | (8,477,000) | |||||
Share-based benefit plans | (75) | (75) | ||||
Share-based benefit plans, shares | 2,765,000 | |||||
Cash dividends declared | (163) | (163) | ||||
Distributions | (234) | (234) | ||||
Other | (2) | 6 | (8) | |||
Balance at Mar. 31, 2021 | 2,482 | $ 3 | (491) | 735 | 2,235 | |
Balance, shares at Mar. 31, 2021 | 333,714,000 | |||||
Comprehensive income | 1,680 | 16 | 1,450 | 214 | ||
Repurchase of common stock | (2,287) | (142) | (2,145) | |||
Repurchase of common stock, shares | (11,261,000) | |||||
Share-based benefit plans | 140 | 140 | ||||
Share-based benefit plans, shares | 372,000 | |||||
Cash dividends declared | (161) | (161) | ||||
Distributions | (123) | (123) | ||||
Other | 59 | 2 | 57 | |||
Balance at Jun. 30, 2021 | 1,790 | $ 3 | (475) | (121) | 2,383 | |
Balance, shares at Jun. 30, 2021 | 322,825,000 | |||||
Comprehensive income | 2,455 | (17) | 2,269 | 203 | ||
Repurchase of common stock | (2,329) | (130) | (2,199) | |||
Repurchase of common stock, shares | (9,605,000) | |||||
Share-based benefit plans | 127 | 127 | ||||
Share-based benefit plans, shares | 282,000 | |||||
Cash dividends declared | (155) | (155) | ||||
Distributions | (144) | (144) | ||||
Other | 81 | 3 | 78 | |||
Balance at Sep. 30, 2021 | 1,825 | $ 3 | (492) | (206) | 2,520 | |
Balance, shares at Sep. 30, 2021 | 313,502,000 | |||||
Comprehensive income | 2,093 | 88 | 1,814 | 191 | ||
Repurchase of common stock | (2,072) | (81) | (1,991) | |||
Repurchase of common stock, shares | (8,469,000) | |||||
Share-based benefit plans | 88 | 88 | ||||
Share-based benefit plans, shares | 444,000 | |||||
Cash dividends declared | (149) | (149) | ||||
Distributions | (248) | (248) | ||||
Other | (48) | $ (7) | (41) | |||
Balance at Dec. 31, 2021 | 1,489 | $ 3 | (404) | (532) | 2,422 | |
Balance, shares at Dec. 31, 2021 | 305,477,000 | |||||
Comprehensive income | 1,422 | (43) | 1,273 | 192 | ||
Repurchase of common stock | $ (2,101) | (2,101) | ||||
Repurchase of common stock, shares | (8,375,000) | (8,375,000) | ||||
Share-based benefit plans | $ (57) | (57) | ||||
Share-based benefit plans, shares | 1,879,000 | |||||
Cash dividends declared | (171) | (171) | ||||
Distributions | (171) | (171) | ||||
Other | 3 | (1) | 4 | |||
Balance at Mar. 31, 2022 | $ 414 | $ 3 | $ (447) | $ (1,589) | $ 2,447 | |
Balance, shares at Mar. 31, 2022 | 298,981,000 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Stockholders' Equity (Parenthetical) (Unaudited) - $ / shares | 3 Months Ended | ||||
Mar. 31, 2022 | Dec. 31, 2021 | Sep. 30, 2021 | Jun. 30, 2021 | Mar. 31, 2021 | |
Statement of Stockholders' Equity [Abstract] | |||||
Cash dividends declared, per share | $ 0.56 | $ 0.48 | $ 0.48 | $ 0.48 | $ 0.48 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Cash flows from operating activities: | ||
Net income | $ 1,465 | $ 1,580 |
Decrease in cash from operating assets and liabilities: | ||
Accounts receivable | (427) | (371) |
Inventories and other assets | (121) | (85) |
Accounts payable and accrued expenses | (771) | (371) |
Depreciation and amortization | 732 | 697 |
Income taxes | 346 | 406 |
Gains on sales of facilities | (10) | (2) |
Amortization of debt issuance costs and discounts | 7 | 8 |
Share-based compensation | 86 | 97 |
Other | 38 | 29 |
Net cash provided by operating activities | 1,345 | 1,988 |
Cash flows from investing activities: | ||
Purchase of property and equipment | (861) | (654) |
Acquisition of hospitals and health care entities | (2) | (22) |
Sales of hospitals and health care entities | 14 | 20 |
Change in investments | 10 | (2) |
Other | (6) | 9 |
Net cash used in investing activities | (845) | (649) |
Cash flows from financing activities: | ||
Issuance of long-term debt | 5,966 | 0 |
Net change in revolving credit facilities | (2,780) | 80 |
Repayment of long-term debt | (66) | (47) |
Distributions to noncontrolling interests | (171) | (234) |
Payment of debt issuance costs | (49) | 0 |
Payment of dividends | (177) | (169) |
Repurchase of common stock | (2,101) | (1,527) |
Other | (197) | (207) |
Net cash provided by (used in) financing activities | 425 | (2,104) |
Effect of exchange rate changes on cash and cash equivalents | (5) | 2 |
Change in cash and cash equivalents | 920 | (763) |
Cash and cash equivalents at beginning of period | 1,451 | 1,793 |
Cash and cash equivalents at end of period | 2,371 | 1,030 |
Interest payments | 408 | 375 |
Income tax payments, (refunds), net | $ 3 | $ (13) |
Basis of Presentation and Signi
Basis of Presentation and Significant Accounting Policies | 3 Months Ended |
Mar. 31, 2022 | |
Accounting Policies [Abstract] | |
Basis of Presentation and Significant Accounting Policies | NOTE 1 — BASIS OF PR ESENTATION AND SIGNIFICANT ACCOUNTING POLICIES Reporting Entity HCA Healthcare, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At March 31, 2022 , these affiliates owned and operated 182 hospitals, 124 freestanding surgery centers, 21 freestanding endoscopy centers and provided extensive outpatient and ancillary services. HCA Healthcare, Inc.’s facilities are located in 20 states and England. The terms “Company,” “HCA,” “we,” “our” or “us,” as used herein and unless otherwise stated or indicated by context, refer to HCA Healthcare, Inc. and its affiliates. The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA and the term “employees” refers to employees of affiliates of HCA. Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and footnotes required by generally accepted accounting principles for complete consolidated financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation have been included and are of a normal and recurring nature. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $ 95 million and $ 87 million for the quarters ended March 31, 2022 and 2021, respectively. Operating results for the quarter are not necessarily indicative of the results that may be expected for the year ending December 31, 2022. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K for the year ended December 31, 2021. COVID-19 On March 11, 2020, the World Health Organization designated COVID-19 as a global pandemic. We believe the extent of COVID-19’s impact on our operating results and financial condition has been and will continue to be driven by many factors, most of which are beyond our control and ability to forecast. Because of these uncertainties, we cannot estimate how long or to what extent COVID-19 will impact our operations. Revenues Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges . Our performance obligations for outpatient services are generally satisfied over a period of less than one day . The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals. NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (continued) Revenues (continued) Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Patients treated at our hospitals for non-elective care, who have income at or below 400 % of the federal poverty level, are eligible for charity care. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters ended March 31, 2022 and 2021 are summarized in the following table (dollars in millions): 2022 Ratio 2021 Ratio Medicare $ 2,726 18.2 % $ 2,559 18.3 % Managed Medicare 2,324 15.6 2,053 14.7 Medicaid 579 3.9 527 3.8 Managed Medicaid 1,110 7.4 725 5.2 Managed care and insurers 7,152 47.9 6,885 49.1 International (managed care and insurers) 356 2.4 333 2.4 Other 698 4.6 895 6.5 Revenues $ 14,945 100.0 % $ 13,977 100.0 % Managed Medicaid revenues for the quarter ended March 31, 2022 include $ 244 million, for the period September through December 2021, related to the March 2022 Centers for Medicare & Medicaid Services ("CMS") approval of a Texas directed payment program for the current program year that began September 1, 2021. To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters ended March 31, 2022 and 2021 follows (dollars in millions): 2022 2021 Patient care costs (salaries and benefits, supplies, other operating expense and depreciation $ 12,744 $ 11,643 Cost-to-charges ratio (patient care costs as percentage of gross patient charges) 11.3 % 11.4 % Total uncompensated care $ 7,005 $ 6,821 Multiply by the cost-to-charges ratio 11.3 % 11.4 % Estimated cost of total uncompensated care $ 792 $ 778 The total uncompensated care amounts for the quarters ended March 31, 2022 and 2021 include charity care of $ 3.458 billion and $ 2.942 billion, respectively, and the related estimated costs of charity care were $ 391 million and $ 335 million, respectively. Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Acquisitions and Dispositions
Acquisitions and Dispositions | 3 Months Ended |
Mar. 31, 2022 | |
Business Combinations [Abstract] | |
Acquisitions and Dispositions | NOTE 2 — ACQUISITIONS AND DISPOSITIONS During the quarters ended March 31, 2022 and 2021 , we paid $ 2 million and $ 22 million, respectively, to acquire nonhospital health care entities. Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values. NOTE 2 — ACQUISITIONS AND DISPOSITIONS (continued) During the quarters ended March 31, 2022 and 2021 , we received proceeds of $ 14 million and $ 20 million, respectively, and recognized pretax gains of $ 10 million and $ 2 million, respectively, related to sales of real estate and other health care entity investments. |
Income Taxes
Income Taxes | 3 Months Ended |
Mar. 31, 2022 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | NOTE 3 — INCOME TAXES Our provisions for income taxes for the quarters ended March 31, 2022 and 2021 were $ 349 million and $ 393 million, respectively, and the effective tax rates were 21.5 % and 21.7 %, respectively. Our provisions for income taxes included tax benefits related to settlements of employee equity awards of $ 64 million and $ 74 million for the quarters ended March 31, 2022 and 2021, respectively. Our liability for unrecognized tax benefits was $ 654 million, including accrued interest of $ 104 million, as of March 31, 2022 ($ 642 million and $ 99 million, respectively, as of December 31, 2021). Unrecognized tax benefits of $ 230 million ($ 217 million as of December 31, 2021) would affect the effective rate, if recognized. At March 31, 2022 , the Internal Revenue Service was conducting examinations of the Company’s 2016, 2017 and 2018 federal income tax returns and the 2019 return for one affiliated partnership. We are also subject to examination by state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change. |
Earnings Per Share
Earnings Per Share | 3 Months Ended |
Mar. 31, 2022 | |
Earnings Per Share [Abstract] | |
Earnings Per Share | NOTE 4 — EARNINGS PER SHARE We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards, computed using the treasury stock method. The following table sets forth the computation of basic and diluted earnings per share for the quarters ended March 31, 2022 and 2021 (dollars and shares in millions, except per share amounts): 2022 2021 Net income attributable to HCA Healthcare, Inc. $ 1,273 $ 1,423 Weighted average common shares outstanding 302.446 338.123 Effect of dilutive incremental shares 4.928 5.198 Shares used for diluted earnings per share 307.374 343.321 Earnings per share: Basic earnings $ 4.21 $ 4.21 Diluted earnings $ 4.14 $ 4.14 |
Investments of Insurance Subsid
Investments of Insurance Subsidiaries | 3 Months Ended |
Mar. 31, 2022 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments of Insurance Subsidiaries | NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES A summary of our insurance subsidiaries’ investments at March 31, 2022 and December 31, 2021 follows (dollars in millions): March 31, 2022 Unrealized Amortized Gains Losses Fair Debt securities $ 411 $ 4 $ ( 14 ) $ 401 Money market funds and other 112 — — 112 $ 523 $ 4 $ ( 14 ) 513 Amounts classified as current assets ( 105 ) Investment carrying value $ 408 December 31, 2021 Unrealized Amortized Gains Losses Fair Debt securities $ 400 $ 18 $ ( 2 ) $ 416 Money market funds and other 125 — — 125 $ 525 $ 18 $ ( 2 ) 541 Amounts classified as current assets ( 103 ) Investment carrying value $ 438 At March 31, 2022 and December 31, 2021, the investments in debt securities of our insurance subsidiaries were classified as “available-for-sale.” Changes in unrealized gains and losses that are not credit-related are recorded as adjustments to other comprehensive income (loss). Scheduled maturities of investments in debt securities at March 31, 2022 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 8 $ 8 Due after one year through five years 139 140 Due after five years through ten years 173 166 Due after ten years 91 87 $ 411 $ 401 The average expected maturity of the investments in debt securities at March 31, 2022 was 6.0 years, compared to the average scheduled maturity of 9.0 years. Expected and scheduled maturities may differ because the issuers of certain securities have the right to call, prepay or otherwise redeem such obligations prior to their scheduled maturity date. |
Financial Instruments
Financial Instruments | 3 Months Ended |
Mar. 31, 2022 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Financial Instruments | NOTE 6 — FINANCIAL INSTRUMENTS The following table sets forth our interest rate swap agreement, which has been designated as a cash flow hedge, at March 31, 2022 (dollars in millions): Notional Maturity Date Fair Pay-fixed interest rate swap $ 500 December 2022 $ ( 2 ) The following table presents the effect of our interest rate swap on our results of operations for the quarter ended March 31, 2022 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Gain Location of Loss Amount of Loss Interest rate swap $ 3 Interest expense $ 2 |
Assets and Liabilities Measured
Assets and Liabilities Measured at Fair Value | 3 Months Ended |
Mar. 31, 2022 | |
Fair Value Disclosures [Abstract] | |
Assets and Liabilities Measured at Fair Value | NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”), emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy). Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment. Investment Securities The investments of our insurance subsidiaries are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. Derivative Financial Instrument We have entered into an interest rate swap agreement to manage our exposure to fluctuations in interest rates. The valuation of this instrument is determined using widely accepted valuation techniques, including a discounted expected cash flow analysis. NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued) The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of March 31, 2022 and December 31, 2021, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): March 31, 2022 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 401 $ — $ 401 $ — Money market funds and other 112 112 — — Investments of insurance subsidiaries 513 112 401 — Less amounts classified as current assets ( 105 ) ( 105 ) — — $ 408 $ 7 $ 401 $ — Liabilities: Interest rate swap (Other accrued expenses) $ 2 $ — $ 2 $ — December 31, 2021 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 416 $ — $ 416 $ — Money market funds and other 125 125 — — Investments of insurance subsidiaries 541 125 416 — Less amounts classified as current assets ( 103 ) ( 103 ) — — $ 438 $ 22 $ 416 $ — Liabilities: Interest rate swap (Other accrued expenses) $ 8 $ — $ 8 $ — The estimated fair value of our long-term debt was $ 39.038 billion and $ 38.541 billion at March 31, 2022 and December 31, 2021, respectively, compared to carrying amounts, excluding debt issuance costs and discounts, aggregating $ 38.019 billion and $ 34.827 billion, respectively. The estimates of fair value are generally based upon the quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities. |
Long-Term Debt
Long-Term Debt | 3 Months Ended |
Mar. 31, 2022 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | NOTE 8 — LONG-TERM DEBT A summary of long-term debt at March 31, 2022 and December 31, 2021, including related interest rates at March 31, 2022 follows (dollars in millions): March 31, December 31, Senior secured asset-based revolving credit facility $ — $ 2,780 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 2.3 %) 1,940 1,960 Senior secured notes (effective interest rate of 4.6 %) 22,200 16,200 Other senior secured debt (effective interest rate of 4.0 %) 927 935 Senior secured debt 25,067 21,875 Senior unsecured notes (effective interest rate of 5.5 %) 12,952 12,952 Debt issuance costs and discounts ( 323 ) ( 248 ) Total debt (average life of 10.2 years, rates averaging 4.8 %) 37,696 34,579 Less amounts due within one year 1,486 237 $ 36,210 $ 34,342 During March 2022, we issued $ 6.000 billion aggregate principal amount of senior secured notes comprised of (i) $ 1.000 billion aggregate principal amount of 3 1/8 % senior secured notes due 2027, (ii) $ 500 million aggregate principal amount of 3 3/8 % senior secured notes due 2029, (iii) $ 2.000 billion aggregate principal amount of 3 5/8 % senior secured notes due 2032, (iv) $ 500 million aggregate principal amount of 4 3/8 % senior secured notes due 2042 and (v) $ 2.000 billion aggregate principal amount of 4 5/8 % senior secured notes due 2052 . During March 2022, we used a portion of the net proceeds to pay down our revolving credit facilities. During April 2022, we redeemed all $ 1.250 billion outstanding aggregate principal amount of our 4.75 % senior secured notes due 2023 and provided a notice of our election to redeem all $ 1.250 billion outstanding aggregate principal amount of our 5.875 % senior notes due 2023. We expect to record aggregate pretax losses on retirement of debt for these two redemptions of approximately $ 80 million during the second quarter of 2022. |
Contingencies
Contingencies | 3 Months Ended |
Mar. 31, 2022 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | NOTE 9 — CONTINGENCIES We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us which may not be covered by insurance. We are also subject to claims by various taxing authorities for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations, financial position or liquidity. Health care companies are routinely subject to investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam , or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our results of operations, financial position or liquidity. NOTE 9 — CONTINGENCIES (continued) Texas operates a state Medicaid program pursuant to a waiver from CMS under Section 1115 of the Social Security Act (“Program”). The Program includes uncompensated-care pools; payments from these pools are intended to defray the uncompensated costs of services provided by our and other hospitals to Medicaid eligible or uninsured individuals. Separately, we and other hospitals provide charity care services in several communities in the state. In 2018, the Civil Division of the U.S. Department of Justice and the U.S. Attorney’s Office for the Southern District of Texas requested information about whether the Program, as operated in Harris County, complied with the laws and regulations applicable to provider related donations, and the Company cooperated with that request. On May 21, 2019, a qui tam lawsuit asserting violations of the FCA and the Texas Medicaid Fraud Prevention Act related to the Program, as operated in Harris County, was unsealed by the U.S. District Court for the Southern District of Texas. Both the federal and state governments declined to intervene in the qui tam lawsuit. The Company believes that our participation is and has been consistent with the requirements of the Program and is vigorously defending against the lawsuit being pursued by the relator. We cannot predict what effect, if any, the qui tam lawsuit could have on the Company. |
Share Repurchase Transactions a
Share Repurchase Transactions and Other Comprehensive Loss | 3 Months Ended |
Mar. 31, 2022 | |
Federal Home Loan Banks [Abstract] | |
Share Repurchases Transactions and Other Comprehensive Loss | NOTE 10 — SHARE REPURCHASE TRANSACTIONS AND OTHER COMPREHENSIVE LOSS During January 2022 and February 2021, our Board of Directors authorized share repurchase programs for up to $ 8 billion and $ 6 billion, respectively, of our outstanding common stock. During the quarter ended March 31, 2022 , we repurchased 8.375 million shares of our common stock at an average price of $ 250.89 per share through market purchases pursuant to the February 2021 authorization (which was completed during the first quarter of 2022) and the January 2022 authorization. At March 31, 2022 , we had $ 6.485 billion of repurchase authorization available under the January 2022 authorization. The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized Foreign Defined Change Total Balances at December 31, 2021 $ 12 $ ( 278 ) $ ( 132 ) $ ( 6 ) $ ( 404 ) Unrealized losses on available-for-sale 6 income tax benefit ( 20 ) ( 20 ) Foreign currency translation adjustments, net 4 income tax benefit ( 30 ) ( 30 ) Change in fair value of derivative instruments, 1 of income taxes 3 3 Expense reclassified into operations from other 2 2 4 Balances at March 31, 2022 $ ( 8 ) $ ( 308 ) $ ( 130 ) $ ( 1 ) $ ( 447 ) |
Segment and Geographic Informat
Segment and Geographic Information | 3 Months Ended |
Mar. 31, 2022 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | NOTE 11 — SEGMENT AND GEOGRAPHIC INFORMATION We operate in one line of business, which is operating hospitals and related health care entities. We operate in two geographically organized groups: the National and American Groups. The National Group includes 96 hospitals located in Alaska, California, Florida, Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, North Carolina, South Carolina, Utah and Virginia, and the American Group includes 79 hospitals located in Colorado, Kansas, southern Kentucky, Louisiana, Missouri, Tennessee and Texas. We also operate seven hospitals in England, and these facilities are included in the Corporate and other group. NOTE 11 — SEGMENT AND GEOGRAPHIC INFORMATION (continued) Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, gains on sales of facilities, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters ended March 31, 2022 and 2021 are summarized in the following table (dollars in millions): 2022 2021 Revenues: National Group $ 7,506 $ 7,056 American Group 6,616 6,291 Corporate and other 823 630 $ 14,945 $ 13,977 Equity in earnings of affiliates: National Group $ ( 1 ) $ ( 7 ) American Group ( 9 ) ( 12 ) Corporate and other ( 1 ) ( 2 ) $ ( 11 ) $ ( 21 ) Adjusted segment EBITDA: National Group $ 1,566 $ 1,705 American Group 1,486 1,501 Corporate and other ( 108 ) ( 154 ) $ 2,944 $ 3,052 Depreciation and amortization: National Group $ 355 $ 323 American Group 301 293 Corporate and other 76 81 $ 732 $ 697 Adjusted segment EBITDA $ 2,944 $ 3,052 Depreciation and amortization 732 697 Interest expense 408 384 Gains on sales of facilities ( 10 ) ( 2 ) Income before income taxes $ 1,814 $ 1,973 |
Basis of Presentation and Sig_2
Basis of Presentation and Significant Accounting Policies (Policies) | 3 Months Ended |
Mar. 31, 2022 | |
Accounting Policies [Abstract] | |
Basis of Presentation | Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and footnotes required by generally accepted accounting principles for complete consolidated financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation have been included and are of a normal and recurring nature. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $ 95 million and $ 87 million for the quarters ended March 31, 2022 and 2021, respectively. Operating results for the quarter are not necessarily indicative of the results that may be expected for the year ending December 31, 2022. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K for the year ended December 31, 2021. COVID-19 On March 11, 2020, the World Health Organization designated COVID-19 as a global pandemic. We believe the extent of COVID-19’s impact on our operating results and financial condition has been and will continue to be driven by many factors, most of which are beyond our control and ability to forecast. Because of these uncertainties, we cannot estimate how long or to what extent COVID-19 will impact our operations. |
Revenues | Revenues Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges . Our performance obligations for outpatient services are generally satisfied over a period of less than one day . The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals. Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Patients treated at our hospitals for non-elective care, who have income at or below 400 % of the federal poverty level, are eligible for charity care. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters ended March 31, 2022 and 2021 are summarized in the following table (dollars in millions): 2022 Ratio 2021 Ratio Medicare $ 2,726 18.2 % $ 2,559 18.3 % Managed Medicare 2,324 15.6 2,053 14.7 Medicaid 579 3.9 527 3.8 Managed Medicaid 1,110 7.4 725 5.2 Managed care and insurers 7,152 47.9 6,885 49.1 International (managed care and insurers) 356 2.4 333 2.4 Other 698 4.6 895 6.5 Revenues $ 14,945 100.0 % $ 13,977 100.0 % Managed Medicaid revenues for the quarter ended March 31, 2022 include $ 244 million, for the period September through December 2021, related to the March 2022 Centers for Medicare & Medicaid Services ("CMS") approval of a Texas directed payment program for the current program year that began September 1, 2021. To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters ended March 31, 2022 and 2021 follows (dollars in millions): 2022 2021 Patient care costs (salaries and benefits, supplies, other operating expense and depreciation $ 12,744 $ 11,643 Cost-to-charges ratio (patient care costs as percentage of gross patient charges) 11.3 % 11.4 % Total uncompensated care $ 7,005 $ 6,821 Multiply by the cost-to-charges ratio 11.3 % 11.4 % Estimated cost of total uncompensated care $ 792 $ 778 The total uncompensated care amounts for the quarters ended March 31, 2022 and 2021 include charity care of $ 3.458 billion and $ 2.942 billion, respectively, and the related estimated costs of charity care were $ 391 million and $ 335 million, respectively. |
Reclassifications | Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Earnings Per Share | We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards, computed using the treasury stock method. |
Fair Value Measurements and Disclosures | Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”), emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy). Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment. |
Investment Securities | Investment Securities The investments of our insurance subsidiaries are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. |
Derivative Financial Instruments | Derivative Financial Instrument We have entered into an interest rate swap agreement to manage our exposure to fluctuations in interest rates. The valuation of this instrument is determined using widely accepted valuation techniques, including a discounted expected cash flow analysis. |
Basis of Presentation and Sig_3
Basis of Presentation and Significant Accounting Policies (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Accounting Policies [Abstract] | |
Schedule of Revenues from Third Party Payers, Uninsured and Other Payers | Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters ended March 31, 2022 and 2021 are summarized in the following table (dollars in millions): 2022 Ratio 2021 Ratio Medicare $ 2,726 18.2 % $ 2,559 18.3 % Managed Medicare 2,324 15.6 2,053 14.7 Medicaid 579 3.9 527 3.8 Managed Medicaid 1,110 7.4 725 5.2 Managed care and insurers 7,152 47.9 6,885 49.1 International (managed care and insurers) 356 2.4 333 2.4 Other 698 4.6 895 6.5 Revenues $ 14,945 100.0 % $ 13,977 100.0 % |
Schedule of Estimated Cost of Uncompensated Care | A summary of the estimated cost of total uncompensated care for the quarters ended March 31, 2022 and 2021 follows (dollars in millions): 2022 2021 Patient care costs (salaries and benefits, supplies, other operating expense and depreciation $ 12,744 $ 11,643 Cost-to-charges ratio (patient care costs as percentage of gross patient charges) 11.3 % 11.4 % Total uncompensated care $ 7,005 $ 6,821 Multiply by the cost-to-charges ratio 11.3 % 11.4 % Estimated cost of total uncompensated care $ 792 $ 778 |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Earnings Per Share [Abstract] | |
Schedule of Computations of Basic and Diluted Earnings Per Share | The following table sets forth the computation of basic and diluted earnings per share for the quarters ended March 31, 2022 and 2021 (dollars and shares in millions, except per share amounts): 2022 2021 Net income attributable to HCA Healthcare, Inc. $ 1,273 $ 1,423 Weighted average common shares outstanding 302.446 338.123 Effect of dilutive incremental shares 4.928 5.198 Shares used for diluted earnings per share 307.374 343.321 Earnings per share: Basic earnings $ 4.21 $ 4.21 Diluted earnings $ 4.14 $ 4.14 |
Investments of Insurance Subs_2
Investments of Insurance Subsidiaries (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | A summary of our insurance subsidiaries’ investments at March 31, 2022 and December 31, 2021 follows (dollars in millions): March 31, 2022 Unrealized Amortized Gains Losses Fair Debt securities $ 411 $ 4 $ ( 14 ) $ 401 Money market funds and other 112 — — 112 $ 523 $ 4 $ ( 14 ) 513 Amounts classified as current assets ( 105 ) Investment carrying value $ 408 December 31, 2021 Unrealized Amortized Gains Losses Fair Debt securities $ 400 $ 18 $ ( 2 ) $ 416 Money market funds and other 125 — — 125 $ 525 $ 18 $ ( 2 ) 541 Amounts classified as current assets ( 103 ) Investment carrying value $ 438 |
Schedule of Maturities of Investments | Scheduled maturities of investments in debt securities at March 31, 2022 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 8 $ 8 Due after one year through five years 139 140 Due after five years through ten years 173 166 Due after ten years 91 87 $ 411 $ 401 |
Financial Instruments (Tables)
Financial Instruments (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges | The following table sets forth our interest rate swap agreement, which has been designated as a cash flow hedge, at March 31, 2022 (dollars in millions): Notional Maturity Date Fair Pay-fixed interest rate swap $ 500 December 2022 $ ( 2 ) |
Effect of Interest Rate on Results of Operations | The following table presents the effect of our interest rate swap on our results of operations for the quarter ended March 31, 2022 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Gain Location of Loss Amount of Loss Interest rate swap $ 3 Interest expense $ 2 |
Assets and Liabilities Measur_2
Assets and Liabilities Measured at Fair Value (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Fair Value Disclosures [Abstract] | |
Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis | The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of March 31, 2022 and December 31, 2021, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): March 31, 2022 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 401 $ — $ 401 $ — Money market funds and other 112 112 — — Investments of insurance subsidiaries 513 112 401 — Less amounts classified as current assets ( 105 ) ( 105 ) — — $ 408 $ 7 $ 401 $ — Liabilities: Interest rate swap (Other accrued expenses) $ 2 $ — $ 2 $ — December 31, 2021 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 416 $ — $ 416 $ — Money market funds and other 125 125 — — Investments of insurance subsidiaries 541 125 416 — Less amounts classified as current assets ( 103 ) ( 103 ) — — $ 438 $ 22 $ 416 $ — Liabilities: Interest rate swap (Other accrued expenses) $ 8 $ — $ 8 $ — |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | A summary of long-term debt at March 31, 2022 and December 31, 2021, including related interest rates at March 31, 2022 follows (dollars in millions): March 31, December 31, Senior secured asset-based revolving credit facility $ — $ 2,780 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 2.3 %) 1,940 1,960 Senior secured notes (effective interest rate of 4.6 %) 22,200 16,200 Other senior secured debt (effective interest rate of 4.0 %) 927 935 Senior secured debt 25,067 21,875 Senior unsecured notes (effective interest rate of 5.5 %) 12,952 12,952 Debt issuance costs and discounts ( 323 ) ( 248 ) Total debt (average life of 10.2 years, rates averaging 4.8 %) 37,696 34,579 Less amounts due within one year 1,486 237 $ 36,210 $ 34,342 |
Share Repurchase Transactions_2
Share Repurchase Transactions and Other Comprehensive Loss (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Federal Home Loan Banks [Abstract] | |
Components of Accumulated Other Comprehensive Loss | The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized Foreign Defined Change Total Balances at December 31, 2021 $ 12 $ ( 278 ) $ ( 132 ) $ ( 6 ) $ ( 404 ) Unrealized losses on available-for-sale 6 income tax benefit ( 20 ) ( 20 ) Foreign currency translation adjustments, net 4 income tax benefit ( 30 ) ( 30 ) Change in fair value of derivative instruments, 1 of income taxes 3 3 Expense reclassified into operations from other 2 2 4 Balances at March 31, 2022 $ ( 8 ) $ ( 308 ) $ ( 130 ) $ ( 1 ) $ ( 447 ) |
Segment and Geographic Inform_2
Segment and Geographic Information (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Segment Reporting [Abstract] | |
Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization, Assets and Goodwill and other intangible assets. | The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters ended March 31, 2022 and 2021 are summarized in the following table (dollars in millions): 2022 2021 Revenues: National Group $ 7,506 $ 7,056 American Group 6,616 6,291 Corporate and other 823 630 $ 14,945 $ 13,977 Equity in earnings of affiliates: National Group $ ( 1 ) $ ( 7 ) American Group ( 9 ) ( 12 ) Corporate and other ( 1 ) ( 2 ) $ ( 11 ) $ ( 21 ) Adjusted segment EBITDA: National Group $ 1,566 $ 1,705 American Group 1,486 1,501 Corporate and other ( 108 ) ( 154 ) $ 2,944 $ 3,052 Depreciation and amortization: National Group $ 355 $ 323 American Group 301 293 Corporate and other 76 81 $ 732 $ 697 Adjusted segment EBITDA $ 2,944 $ 3,052 Depreciation and amortization 732 697 Interest expense 408 384 Gains on sales of facilities ( 10 ) ( 2 ) Income before income taxes $ 1,814 $ 1,973 |
Basis of Presentation and Sig_4
Basis of Presentation and Significant Accounting Policies - Additional Information (Detail) $ in Millions | 1 Months Ended | 3 Months Ended | |
Nov. 30, 2017 | Mar. 31, 2022USD ($)HospitalEndoscopyCenterStateSurgeryCenter | Mar. 31, 2021USD ($) | |
Summary Of Significant Accounting Policies [Line Items] | |||
Number of owned and operated hospitals | Hospital | 182 | ||
Number of freestanding surgery centers | SurgeryCenter | 124 | ||
Number of freestanding endoscopy centers | EndoscopyCenter | 21 | ||
Number of facilities locations | State | 20 | ||
General and administrative expense | $ 95 | $ 87 | |
Charity care amount | 3,458 | 2,942 | |
Estimated costs of charity care | 391 | 335 | |
Revenues | $ 14,945 | $ 13,977 | |
Inpatient Services [Member] | |||
Summary Of Significant Accounting Policies [Line Items] | |||
Performance obligations for inpatient/ outpatient services satisfied period | Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges | ||
Centers for Medicare and Medicaid Services ("CMS") [Member] | |||
Summary Of Significant Accounting Policies [Line Items] | |||
Revenues | $ 244 | ||
Maximum [Member] | |||
Summary Of Significant Accounting Policies [Line Items] | |||
Percentage of income of federal poverty level eligible for charity care | 400.00% | ||
Maximum [Member] | Outpatient Services [Member] | |||
Summary Of Significant Accounting Policies [Line Items] | |||
Performance obligations for inpatient/ outpatient services satisfied period | Our performance obligations for outpatient services are generally satisfied over a period of less than one day |
Basis of Presentation and Sig_5
Basis of Presentation and Significant Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Revenues From Third Party Payers [Line Items] | ||
Revenues | $ 14,945 | $ 13,977 |
Revenues ratio from third party payers | 100.00% | 100.00% |
Medicare [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 2,726 | $ 2,559 |
Revenues from third party payers, Ratio | 18.20% | 18.30% |
Managed Medicare [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 2,324 | $ 2,053 |
Revenues from third party payers, Ratio | 15.60% | 14.70% |
Medicaid [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 579 | $ 527 |
Revenues from third party payers, Ratio | 3.90% | 3.80% |
Managed Medicaid [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 1,110 | $ 725 |
Revenues from third party payers, Ratio | 7.40% | 5.20% |
Managed Care and Insurers [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 7,152 | $ 6,885 |
Revenues from third party payers, Ratio | 47.90% | 49.10% |
International (Managed Care and Insurers) [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 356 | $ 333 |
Revenues from third party payers, Ratio | 2.40% | 2.40% |
Other [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues | $ 698 | $ 895 |
Other, Ratio | 4.60% | 6.50% |
Basis of Presentation and Sig_6
Basis of Presentation and Significant Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Accounting Policies [Abstract] | ||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | $ 12,744 | $ 11,643 |
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) | 11.30% | 11.40% |
Total uncompensated care | $ 7,005 | $ 6,821 |
Multiply by the cost-to-charges ratio | 11.30% | 11.40% |
Estimated cost of total uncompensated care | $ 792 | $ 778 |
Acquisitions and Dispositions -
Acquisitions and Dispositions - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Business Acquisition [Line Items] | ||
Proceeds from sale of business | $ 14 | $ 20 |
Real Estate and Other Investments [Member] | ||
Business Acquisition [Line Items] | ||
Proceeds from sale of business | 14 | 20 |
Pretax gain (loss) before tax | 10 | 2 |
Nonhospital Health Care [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | $ 2 | $ 22 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | ||
Mar. 31, 2022 | Mar. 31, 2021 | Dec. 31, 2021 | |
Income Tax Disclosure [Abstract] | |||
Provision for income taxes | $ 349 | $ 393 | |
Effective tax rate | 21.50% | 21.70% | |
Provision for tax benefits related to settlement of employee awards | $ 64 | $ 74 | |
Liability for unrecognized tax benefits | 654 | $ 642 | |
Unrecognized tax benefits, accrued interest | 104 | 99 | |
Unrecognized tax benefits that would impact effective tax rate | $ 230 | $ 217 |
Earnings Per Share - Schedule o
Earnings Per Share - Schedule of Computations of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Earnings Per Share [Abstract] | ||
Net income attributable to HCA Healthcare, Inc. | $ 1,273 | $ 1,423 |
Weighted average common shares outstanding | 302,446 | 338,123 |
Effect of dilutive incremental shares | 4,928 | 5,198 |
Shares used for diluted earnings per share | 307,374 | 343,321 |
Basic earnings per share | $ 4.21 | $ 4.21 |
Diluted earnings per share | $ 4.14 | $ 4.14 |
Investments of Insurance Subs_3
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions | Mar. 31, 2022 | Dec. 31, 2021 |
Debt Securities, Available-for-sale [Line Items] | ||
Amounts classified as current assets | $ (105) | $ (103) |
Investment carrying value | 408 | 438 |
Amortized Cost | 523 | 525 |
Unrealized Amounts, Gains | 4 | 18 |
Unrealized Amounts, Losses | (14) | (2) |
Fair Value | 513 | 541 |
Money Market Funds and Other [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 112 | 125 |
Fair Value | 112 | 125 |
Debt Securities [Member] | States and Municipalities [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 411 | 400 |
Unrealized Amounts, Gains | 4 | 18 |
Unrealized Amounts, Losses | (14) | (2) |
Fair Value | $ 401 | $ 416 |
Investments of Insurance Subs_4
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions | Mar. 31, 2022USD ($) |
Investments, Debt and Equity Securities [Abstract] | |
Due in one year or less, Amortized Cost | $ 8 |
Due after one year through five years, Amortized Cost | 139 |
Due after five years through ten years, Amortized Cost | 173 |
Due after ten years, Amortized Cost | 91 |
Amortized Cost, Total | 411 |
Due in one year or less, Fair Value | 8 |
Due after one year through five years, Fair Value | 140 |
Due after five years through ten years, Fair Value | 166 |
Due after ten years, Fair Value | 87 |
Fair Value, Total | $ 401 |
Investments of Insurance Subs_5
Investments of Insurance Subsidiaries - Additional Information (Detail) | 3 Months Ended |
Mar. 31, 2022 | |
Investments, Debt and Equity Securities [Abstract] | |
Available for sale securities expected maturity of debt securities | 6 years |
Available for sale securities average scheduled maturity | 9 years |
Financial Instruments - Schedul
Financial Instruments - Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges (Detail) - Maturity Date, 2022 [Member] - Pay-Fixed Interest Rate Swap [Member] $ in Millions | 3 Months Ended |
Mar. 31, 2022USD ($) | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 500 |
Maturity Date | 2022-12 |
Fair Value | $ (2) |
Financial Instruments - Effect
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Derivative Instruments, Gain (Loss) [Line Items] | ||
Amount of Gain Recognized in OCI on Derivatives, Net of Tax | $ 4 | $ 1 |
Interest Rate Swaps [Member] | ||
Derivative Instruments, Gain (Loss) [Line Items] | ||
Amount of Gain Recognized in OCI on Derivatives, Net of Tax | 3 | |
Interest Rate Swaps [Member] | Reclassification out of Accumulated Other Comprehensive Income into Operations [Member] | ||
Derivative Instruments, Gain (Loss) [Line Items] | ||
Interest rate swaps | $ 2 |
Assets and Liabilities Measur_3
Assets and Liabilities Measured at Fair Value - Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Millions | Mar. 31, 2022 | Dec. 31, 2021 |
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | $ 513 | $ 541 |
Less amounts classified as current assets | (105) | (103) |
Investments of insurance subsidiaries, noncurrent | 408 | 438 |
Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Securities, Available-for-sale Securities | 401 | 416 |
Money Market Funds and Other [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 112 | 125 |
Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Derivative Liability | 2 | 8 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 112 | 125 |
Less amounts classified as current assets | (105) | (103) |
Investments of insurance subsidiaries, noncurrent | 7 | 22 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Money Market Funds and Other [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 112 | 125 |
Significant Other Observable Inputs (Level 2) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 401 | 416 |
Investments of insurance subsidiaries, noncurrent | 401 | 416 |
Significant Other Observable Inputs (Level 2) [Member] | Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Securities, Available-for-sale Securities | 401 | 416 |
Significant Other Observable Inputs (Level 2) [Member] | Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Derivative Liability | $ 2 | $ 8 |
Assets and Liabilities Measur_4
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions | Mar. 31, 2022 | Dec. 31, 2021 |
Fair Value Disclosures [Abstract] | ||
Estimated fair value of long-term debt | $ 39,038 | $ 38,541 |
Carrying amounts of long-term debt | $ 38,019 | $ 34,827 |
Long-Term Debt - Schedule of Lo
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($) $ in Millions | Mar. 31, 2022 | Dec. 31, 2021 |
Debt Instrument [Line Items] | ||
Senior secured debt | $ 25,067 | $ 21,875 |
Debt issuance costs and discounts | (323) | (248) |
Total debt (average life of 9.5 years, rates averaging 4.9%) | 37,696 | 34,579 |
Less amounts due within one year | 1,486 | 237 |
Long-term debt | 36,210 | 34,342 |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 0 | 2,780 |
Senior Secured Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 0 | 0 |
Senior Secured Term Loan Facilities [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 1,940 | 1,960 |
Senior Secured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 22,200 | 16,200 |
Other Senior Secured Debt [Member] | ||
Debt Instrument [Line Items] | ||
Other senior secured debt | 927 | 935 |
Senior Unsecured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior unsecured notes | $ 12,952 | $ 12,952 |
Long-Term Debt - Schedule of _2
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) | 3 Months Ended |
Mar. 31, 2022 | |
Debt Instrument [Line Items] | |
Total debt average term | 10 years 2 months 12 days |
Total debt average rate | 4.80% |
Senior Secured Term Loan Facilities [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 2.30% |
Senior Secured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 4.60% |
Other Senior Secured Debt [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 4.00% |
Senior Unsecured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 5.50% |
Long-Term Debt - Additional Inf
Long-Term Debt - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | ||
Jun. 30, 2022 | Apr. 30, 2022 | Mar. 31, 2022 | |
Forecast [Member] | |||
Debt Instrument [Line Items] | |||
Gain (loss) on extinguishment of debt | $ (80) | ||
Senior Notes Due 2023 [Member] | Subsequent Event [Member] | |||
Debt Instrument [Line Items] | |||
Debt instrument, stated interest | 5.875% | ||
Debt instrument, redemption principal amount | $ 1,250 | ||
Senior Notes [Member] | |||
Debt Instrument [Line Items] | |||
Debt instrument, principal amount | $ 6,000 | ||
Senior Notes [Member] | Senior Secured Notes Due 2027 [Member] | |||
Debt Instrument [Line Items] | |||
Debt instrument, principal amount | $ 1,000 | ||
Debt instrument, stated interest | 3.125% | ||
Senior Notes [Member] | Senior Secured Notes Due 2029 [Member] | |||
Debt Instrument [Line Items] | |||
Debt instrument, principal amount | $ 500 | ||
Debt instrument, stated interest | 3.375% | ||
Senior Notes [Member] | Senior Secured Notes Due 2032 [Member] | |||
Debt Instrument [Line Items] | |||
Debt instrument, principal amount | $ 2,000 | ||
Debt instrument, stated interest | 3.625% | ||
Senior Notes [Member] | Senior Secured Notes Due 2042 [Member] | |||
Debt Instrument [Line Items] | |||
Debt instrument, principal amount | $ 500 | ||
Debt instrument, stated interest | 4.375% | ||
Senior Notes [Member] | Senior Secured Notes Due 2052 [Member] | |||
Debt Instrument [Line Items] | |||
Debt instrument, principal amount | $ 2,000 | ||
Debt instrument, stated interest | 4.625% | ||
Senior Notes [Member] | Senior Secured Notes Due 2023 [Member] | Subsequent Event [Member] | |||
Debt Instrument [Line Items] | |||
Debt instrument, stated interest | 4.75% | ||
Debt instrument, redemption principal amount | $ 1,250 |
Share Repurchase Transactions_3
Share Repurchase Transactions and Other Comprehensive Loss - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions | 3 Months Ended | ||
Mar. 31, 2022 | Jan. 31, 2022 | Feb. 28, 2021 | |
Repurchase of common stock, shares | 8,375,000 | ||
Repurchase price of common stock, per share | $ 250.89 | ||
Board of Directors Chairman [Member] | |||
Share repurchase program authorized amount | $ 6,485 | $ 8,000 | $ 6,000 |
Share Repurchase Transactions_4
Share Repurchase Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2022USD ($) | |
Equity [Abstract] | |
Unrealized gains (losses) on available-for-sale securities, beginning balances | $ 12 |
Unrealized losses on available-for-sale securities, net of income tax benefit | (20) |
Unrealized gains (losses) on available-for-sale securities, ending balances | (8) |
Foreign currency translation adjustments, beginning balances | (278) |
Foreign currency translation adjustments, net of income tax benefit | (30) |
Foreign currency translation adjustments, ending balances | (308) |
Defined benefit plans, beginning balances | (132) |
Defined benefit plans, expense reclassified into operations from other comprehensive income | 2 |
Defined benefit plans, ending balances | (130) |
Change in fair value of derivative instruments, beginning balances | (6) |
Change in fair value of derivative instruments, net of income taxes | 3 |
Change in fair value of derivatives instruments, expense reclassified into operations from other comprehensive income | 2 |
Change in fair value of derivative instruments, ending balances | (1) |
Accumulated other comprehensive loss, net of tax, beginning balances | (404) |
Unrealized losses on available-for-sale securities, net of income tax benefit | (20) |
Foreign currency translation adjustments, net of income tax benefit | (30) |
Change in fair value of derivative instruments, net of income tax benefit | 3 |
Expense reclassified into operations from other comprehensive income, Total | 4 |
Accumulated other comprehensive loss, net of tax, ending balances | $ (447) |
Share Repurchase Transactions_5
Share Repurchase Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2022USD ($) | |
Equity [Abstract] | |
Unrealized losses on available-for-sale securities, tax benefit | $ 6 |
Foreign currency translation adjustments, income tax benefit | 4 |
Change in fair value of derivative instruments, income taxes | $ 1 |
Segment and Geographic Inform_3
Segment and Geographic Information - Additional Information (Detail) | 3 Months Ended |
Mar. 31, 2022Hospital | |
Segment Reporting Information [Line Items] | |
Number of geographically organized groups | 2 |
Number of owned and operated hospitals | 182 |
Reorganization Group [Member] | National Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 96 |
Reorganization Group [Member] | American Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 79 |
Reorganization Group [Member] | Corporate and Other [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 7 |
Segment and Geographic Inform_4
Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization and Assets (Detail) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Segment Reporting Information [Line Items] | ||
Revenues | $ 14,945 | $ 13,977 |
Equity in earnings of affiliates | (11) | (21) |
Adjusted segment EBITDA | 2,944 | 3,052 |
Depreciation and amortization | 732 | 697 |
Interest expense | 408 | 384 |
Gains on sales of facilities | (10) | (2) |
Income before income taxes | 1,814 | 1,973 |
National Group [Member] | ||
Segment Reporting Information [Line Items] | ||
Revenues | 7,506 | 7,056 |
Equity in earnings of affiliates | (1) | (7) |
Adjusted segment EBITDA | 1,566 | 1,705 |
Depreciation and amortization | 355 | 323 |
American Group [Member] | ||
Segment Reporting Information [Line Items] | ||
Revenues | 6,616 | 6,291 |
Equity in earnings of affiliates | (9) | (12) |
Adjusted segment EBITDA | 1,486 | 1,501 |
Depreciation and amortization | 301 | 293 |
Corporate and Other [Member] | ||
Segment Reporting Information [Line Items] | ||
Revenues | 823 | 630 |
Equity in earnings of affiliates | (1) | (2) |
Adjusted segment EBITDA | (108) | (154) |
Depreciation and amortization | $ 76 | $ 81 |