Cover Page
Cover Page - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Jan. 31, 2021 | Jun. 30, 2020 | |
Cover [Abstract] | |||
Document Type | 10-K | ||
Amendment Flag | false | ||
Document Period End Date | Dec. 31, 2020 | ||
Document Fiscal Year Focus | 2020 | ||
Document Fiscal Period Focus | FY | ||
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 | 339,917,500 | ||
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 Annual Report | true | ||
Document Transition Report | false | ||
Title of 12(b) Security | Common Stock | ||
Security Exchange Name | NYSE | ||
Entity Voluntary Filers | No | ||
Entity Well-known Seasoned Issuer | Yes | ||
Entity Public Float | $ 25,836 | ||
ICFR Auditor Attestation Flag | true |
Consolidated Income Statements
Consolidated Income Statements - USD ($) shares in Thousands, $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Income Statement [Abstract] | |||
Revenues | $ 51,533 | $ 51,336 | $ 46,677 |
Salaries and benefits | 23,874 | 23,560 | 21,425 |
Supplies | 8,369 | 8,481 | 7,724 |
Other operating expenses | 9,307 | 9,481 | 8,608 |
Equity in earnings of affiliates | (54) | (43) | (29) |
Depreciation and amortization | 2,721 | 2,596 | 2,278 |
Interest expense | 1,584 | 1,824 | 1,755 |
Losses (gains) on sales of facilities | 7 | (18) | (428) |
Losses on retirement of debt | 295 | 211 | 9 |
Total expenses including equity in earnings of affiliates | 46,103 | 46,092 | 41,342 |
Income before income taxes | 5,430 | 5,244 | 5,335 |
Provision for income taxes | 1,043 | 1,099 | 946 |
Net income | 4,387 | 4,145 | 4,389 |
Net income attributable to noncontrolling interests | 633 | 640 | 602 |
Net income attributable to HCA Healthcare, Inc. | $ 3,754 | $ 3,505 | $ 3,787 |
Per share data: | |||
Basic earnings per share | $ 11.10 | $ 10.27 | $ 10.90 |
Diluted earnings per share | $ 10.93 | $ 10.07 | $ 10.66 |
Shares used in earnings per share calculations (in millions): | |||
Basic | 338,274 | 341,210 | 347,297 |
Diluted | 343,605 | 348,226 | 355,303 |
Consolidated Comprehensive Inco
Consolidated Comprehensive Income Statements - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Statement of Comprehensive Income [Abstract] | |||
Net income | $ 4,387 | $ 4,145 | $ 4,389 |
Other comprehensive income (loss) before taxes: | |||
Foreign currency translation | 18 | 5 | (71) |
Unrealized gains (losses) on available-for-sale securities | 14 | 15 | (7) |
Defined benefit plans | (71) | (63) | 44 |
Pension costs included in salaries and benefits | 28 | 13 | 21 |
Total defined benefit plans | (43) | (50) | 65 |
Change in fair value of derivative financial instruments | (66) | (50) | 23 |
Interest costs (benefits) included in interest expense | 24 | (17) | (10) |
Total change in fair value of derivative financial instruments | (42) | (67) | 13 |
Other comprehensive loss before taxes | (53) | (97) | 0 |
Income taxes (benefits) related to other comprehensive income items | (11) | (18) | 8 |
Other comprehensive loss | (42) | (79) | (8) |
Comprehensive income | 4,345 | 4,066 | 4,381 |
Comprehensive income attributable to noncontrolling interests | 633 | 640 | 602 |
Comprehensive income attributable to HCA Healthcare, Inc. | $ 3,712 | $ 3,426 | $ 3,779 |
Consolidated Balance Sheets
Consolidated Balance Sheets - USD ($) $ in Millions | Dec. 31, 2020 | Dec. 31, 2019 |
Current assets: | ||
Cash and cash equivalents | $ 1,793 | $ 621 |
Accounts receivable | 7,051 | 7,380 |
Inventories | 2,025 | 1,849 |
Other | 1,464 | 1,346 |
Total current assets | 12,333 | 11,196 |
Property and equipment, at cost: | ||
Land | 2,269 | 2,178 |
Buildings | 18,471 | 17,669 |
Equipment | 27,082 | 25,756 |
Construction in progress | 1,495 | 1,632 |
Property and equipment, at cost | 49,317 | 47,235 |
Accumulated depreciation | (26,118) | (24,520) |
Property and equipment, net | 23,199 | 22,715 |
Investments of insurance subsidiaries | 388 | 315 |
Investments in and advances to affiliates | 422 | 249 |
Goodwill and other intangible assets | 8,578 | 8,269 |
Right-of-use operating lease assets | 2,024 | 1,834 |
Other | 546 | 480 |
Total assets | 47,490 | 45,058 |
Current liabilities: | ||
Accounts payable | 3,535 | 2,905 |
Accrued salaries | 1,720 | 1,775 |
Other accrued expenses | 3,240 | 2,932 |
Long-term debt due within one year | 209 | 145 |
Total current liabilities | 8,704 | 7,757 |
Long-term debt, less debt issuance costs and discounts of $236 and $239 | 30,795 | 33,577 |
Professional liability risks | 1,486 | 1,370 |
Right-of-use operating lease obligations | 1,673 | 1,499 |
Income taxes and other liabilities | 1,940 | 1,420 |
Stockholders' equity (deficit): | ||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 339,425,600 shares — 2020 and 338,445,600 shares — 2019 | 3 | 3 |
Capital in excess of par value | 294 | 0 |
Accumulated other comprehensive loss | (502) | (460) |
Retained earnings (deficit) | 777 | (2,351) |
Stockholders' equity (deficit) attributable to HCA Healthcare, Inc. | 572 | (2,808) |
Noncontrolling interests | 2,320 | 2,243 |
Total stockholders' equity (deficit) | 2,892 | (565) |
Total liabilities and stockholders' equity (deficit) | $ 47,490 | $ 45,058 |
Consolidated Balance Sheets (Pa
Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions | Dec. 31, 2020 | Dec. 31, 2019 |
Statement of Financial Position [Abstract] | ||
Debt issuance costs | $ 236 | $ 239 |
Common stock, par value | $ 0.01 | $ 0.01 |
Common stock, shares authorized | 1,800,000,000 | 1,800,000,000 |
Common stock, shares outstanding | 339,425,600 | 338,445,600 |
Consolidated Statements of Stoc
Consolidated Statements of Stockholders' Deficit - 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, 2017 | $ (4,995) | $ 4 | $ (278) | $ (6,532) | $ 1,811 | |
Balance, shares at Dec. 31, 2017 | 350,092,000 | |||||
Comprehensive income (loss) | 4,381 | (8) | 3,787 | 602 | ||
Repurchase of common stock | $ (1,530) | $ (1) | $ (103) | (1,426) | ||
Repurchase of common stock, shares | (14,070,000) | (14,070,000) | ||||
Share-based benefit plans | $ 115 | 115 | ||||
Share-based benefit plans, shares | 6,873,000 | |||||
Cash dividends declared | (496) | (496) | ||||
Distributions | (441) | (441) | ||||
Reclassification of stranded tax effects | (95) | 95 | ||||
Other | 48 | (12) | 60 | |||
Balance at Dec. 31, 2018 | (2,918) | $ 3 | (381) | (4,572) | 2,032 | |
Balance, shares at Dec. 31, 2018 | 342,895,000 | |||||
Comprehensive income (loss) | 4,066 | (79) | 3,505 | 640 | ||
Repurchase of common stock | $ (1,031) | (302) | (729) | |||
Repurchase of common stock, shares | (7,949,000) | (7,949,000) | ||||
Share-based benefit plans | $ 313 | 313 | ||||
Share-based benefit plans, shares | 3,500,000 | |||||
Cash dividends declared | (555) | (555) | ||||
Distributions | (542) | (542) | ||||
Other | 102 | (11) | 113 | |||
Balance at Dec. 31, 2019 | (565) | $ 3 | (460) | (2,351) | 2,243 | |
Balance, shares at Dec. 31, 2019 | 338,446,000 | |||||
Comprehensive income (loss) | 4,345 | (42) | 3,754 | 633 | ||
Repurchase of common stock | $ (441) | (441) | ||||
Repurchase of common stock, shares | (3,287,000) | (3,287,000) | ||||
Share-based benefit plans | $ 265 | 300 | (35) | |||
Share-based benefit plans, shares | 4,267,000 | |||||
Cash dividends declared | (150) | (150) | ||||
Distributions | (626) | (626) | ||||
Other | 64 | (6) | 70 | |||
Balance at Dec. 31, 2020 | $ 2,892 | $ 3 | $ 294 | $ (502) | $ 777 | $ 2,320 |
Balance, shares at Dec. 31, 2020 | 339,426,000 |
Consolidated Statements of St_2
Consolidated Statements of Stockholders' Deficit (Parenthetical) - $ / shares | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Statement of Stockholders' Equity [Abstract] | |||
Cash dividends declared, per share | $ 0.43 | $ 1.60 | $ 1.40 |
Consolidated Statements of Cash
Consolidated Statements of Cash Flows - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Cash flows from operating activities: | |||
Net income | $ 4,387 | $ 4,145 | $ 4,389 |
Increase (decrease) in cash from operating assets and liabilities: | |||
Accounts receivable | 327 | (326) | (423) |
Inventories and other assets | (304) | (158) | (242) |
Accounts payable and accrued expenses | 1,255 | 396 | 698 |
Depreciation and amortization | 2,721 | 2,596 | 2,278 |
Income taxes | 41 | 250 | 74 |
Losses (gains) on sales of facilities | 7 | (18) | (428) |
Losses on retirement of debt | 295 | 211 | 9 |
Amortization of debt issuance costs | 30 | 30 | 31 |
Share-based compensation | 362 | 347 | 268 |
Other | 111 | 129 | 107 |
Net cash provided by operating activities | 9,232 | 7,602 | 6,761 |
Cash flows from investing activities: | |||
Purchase of property and equipment | (2,835) | (4,158) | (3,573) |
Acquisition of hospitals and health care entities | (568) | (1,682) | (1,253) |
Sales of hospitals and health care entities | 68 | 61 | 808 |
Change in investments | (20) | 25 | 57 |
Other | (38) | 34 | 60 |
Net cash used in investing activities | (3,393) | (5,720) | (3,901) |
Cash flows from financing activities: | |||
Issuances of long-term debt | 2,700 | 6,451 | 2,000 |
Net change in revolving credit facilities | (2,480) | (560) | (640) |
Repayment of long-term debt | (3,437) | (5,324) | (1,704) |
Distributions to noncontrolling interests | (626) | (542) | (441) |
Payment of debt issuance costs | (35) | (73) | (25) |
Payment of dividends | (153) | (550) | (487) |
Repurchase of common stock | (441) | (1,031) | (1,530) |
Other | (205) | (142) | (248) |
Net cash used in financing activities | (4,677) | (1,771) | (3,075) |
Effect of exchange rate changes on cash and cash equivalents | 10 | 8 | (15) |
Change in cash and cash equivalents | 1,172 | 119 | (230) |
Cash and cash equivalents at beginning of period | 621 | 502 | 732 |
Cash and cash equivalents at end of period | 1,793 | 621 | 502 |
Interest payments | 1,607 | 1,914 | 1,744 |
Income tax payments, net | $ 1,002 | $ 849 | $ 872 |
Accounting Policies
Accounting Policies | 12 Months Ended |
Dec. 31, 2020 | |
Accounting Policies [Abstract] | |
Accounting Policies | NOTE 1 — 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 December 31, 2020 these affiliates owned and operated 185 hospitals, 121 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 preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates. The consolidated financial statements include all subsidiaries and entities controlled by HCA. We generally define “control” as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which we absorb a majority of the entity’s expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of ownership, contractual or other financial interests in the entity. The accounts of acquired entities are included in our consolidated financial statements for periods subsequent to our acquisition of controlling interests. Significant intercompany transactions have been eliminated. Investments in entities we do not control, but in which we have a substantial ownership interest and can exercise significant influence, are accounted for using the equity method. The majority of our expenses are “cost of revenue” items. Costs that could be classified as general and administrative include our corporate office costs, which were $416 million, $370 million and $344 million for the years ended December 31, 2020, 2019 and 2018, respectively. COVID-19 On March 11, 2020, the World Health Organization designated COVID-19 COVID-19 non-emergent re-imposed, During 2020, we received approximately $4.4 billion of accelerated Medicare payments and approximately $1.8 billion in general and targeted distributions from the Provider Relief Fund, both as provided for and established under the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act. During October 2020, million, related to amounts received by certain of our partnership entities, are recorded under the caption “other accrued expenses” in our consolidated balance sheet at December 31, 2020. Our share of these funds will be returned in 2021 after final determination of amounts earned and distributable to the members of each respective partnership. The CARES Act also provides for a deferral of payments of the employer portion of Social Security tax incurred during the pandemic, allowing half of such payroll taxes to be deferred until December 2021 and the remaining half until December 2022. At December 31, 2020, the Company had deferred $688 million of Social Security taxes. Additionally, the CARES Act created a payroll tax credit designed to encourage companies to retain employees during the pandemic. During the year ended December 31, 2020, the Company evaluated its eligibility for this credit and recorded $60 million of employee retention payroll tax credits pursuant to the CARES Act. These tax credits were recorded as a reduction of salaries and benefits in our consolidated income statement. We believe the extent of the COVID-19 pandemic’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. Such factors include, but are not limited to : 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 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. Our revenues by primary third-party payer classification and other (including uninsured patients) for the years ended December 31, are summarized in the following table (dollars in millions): Years Ended December 31, 2020 Ratio 2019 Ratio 2018 Ratio Medicare $ 10,420 20.2 % $ 10,798 21.0 % $ 9,831 21.1 % Managed Medicare 6,997 13.6 6,452 12.6 5,497 11.8 Medicaid 1,965 3.8 1,572 3.1 1,358 2.9 Managed Medicaid 2,621 5.1 2,450 4.8 2,403 5.1 Managed care and other insurers 26,535 51.5 26,544 51.6 24,467 52.4 International (managed care and other insurers) 1,120 2.2 1,162 2.3 1,156 2.5 Other 1,875 3.6 2,358 4.6 1,965 4.2 Revenues $ 51,533 100.0 % $ 51,336 100.0 % $ 46,677 100.0 % Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process). The adjustments to estimated Medicare and Medicaid reimbursement amounts and disproportionate-share funds related primarily to cost reports filed during the respective year resulted in net increases to revenues of $70 million, $51 million and $29 million in 2020, 2019 and 2018, respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in a net reduction The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive. Patients treated at hospitals for non-elective of the federal poverty level, were eligible for charity care, and we limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. Patients treated at hospitals for non-elective care, who have income above 400% of the federal poverty level, were eligible for certain other discounts which limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. We apply additional discounts to limit patient responsibility for certain emergency services. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. We may attempt to provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance, or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied. The collection of outstanding receivables for Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the age of those accounts. Accounts are written off when all reasonable collection efforts have been performed. The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period revenues 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 years ended December 31, follows (dollars in millions): 2020 2019 2018 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 44,271 $ 44,118 $ 40,035 Cost-to-charges 12.0 % 12.0 % 12.4 % Total uncompensated care $ 29,029 $ 31,105 $ 26,757 Multiply by the cost-to-charges 12.0 % 12.0 % 12.4 % Estimated cost of total uncompensated care $ 3,483 $ 3,733 $ 3,318 The total uncompensated care amounts include charity care of $13.763 billion, $13.260 billion and $8.611 billion for the years ended December 31, 2020, 2019 and 2018, respectively. The estimated costs of charity care were $1.652 billion, $1.591 billion and $1.068 billion for the years ended December 31, 2020, 2019 and 2018, respectively. Cash and Cash Equivalents Cash and cash equivalents include highly Our cash management system provides for daily investment of available balances and the funding of outstanding checks when presented for payment. Outstanding, but unpresented, checks totaling $495 million and $486 million at December 31, 2020 and 2019, respectively, have been included in “accounts payable” in the consolidated balance sheets. Upon presentation for payment, these checks are funded through available cash balances or our credit facility. Accounts Receivable We receive payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. We recognize that revenues and receivables from government agencies are significant to our operations, but do not believe there are significant credit risks associated with these government agencies. We do not believe there are any other significant concentrations of revenues from any particular payer that would subject us to any significant credit risks in the collection of our accounts receivable. Days revenues in accounts receivable were 45 days, 50 days and 51 days at December 31, 2020, 2019 and 2018, respectively. The five-day decline from December 31, 2019 to December 31, 2020 was primarily due to the combined impact of a $329 million decline in accounts receivable at December 31, 2020, compared to December 31, 2019, and a 5.7% increase in fourth quarter 2020 revenues per day compared to fourth quarter 2019 revenues per day. Changes in general economic conditions, patient accounting service center operations, payer mix, or federal or state governmental health care coverage could affect our collection of accounts receivable, cash flows and results of operations. Inventories Inventories are stated at the lower of cost (first-in, first-out) Property and Equipment Depreciation expense, computed using the straight-line method, was $2.693 billion in 2020, $2.579 billion in 2019 and $2.262 billion in 2018. Buildings and improvements are depreciated over estimated useful lives ranging generally from 10 to 40 years. Estimated useful lives of equipment vary generally from four When events, circumstances or operating results indicate the carrying values of certain long-lived assets expected to be held and used might be impaired, we prepare projections of the undiscounted future cash flows expected to result from the use of the assets and their eventual disposition. If the projections indicate the recorded amounts are not expected to be recoverable, such amounts are reduced to estimated fair value. Fair value may be estimated based upon internal evaluations that include quantitative analyses of revenues and cash flows, reviews of recent sales of similar assets and independent appraisals. Long-lived assets to be disposed of are reported at the lower of their carrying amounts or fair value less costs to sell or close. The estimates of fair value are usually based upon recent sales of similar assets and market responses based upon discussions with and offers received from potential buyers. Investments of Insurance Subsidiaries At December 31, 2020 and 2019, the investments of our 100% owned insurance subsidiaries were classified as “available-for-sale” Investments — Debt Securities Goodwill and Intangible Assets Goodwill is not amortized but is subject to annual impairment tests. In addition to the annual impairment review, impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Impairment testing for goodwill is done at the reporting unit level. Reporting units are one level below the business segment level, and our impairment testing is performed at the operating division level. We compare the fair value of the reporting unit assets to the carrying amount, on at least an annual basis, to determine if there is potential impairment. If the fair value of the reporting unit assets is less than their carrying value, an impairment loss is recognized. Fair value is estimated based upon internal evaluations of each reporting unit that include quantitative analyses of market multiples, revenues and cash flows and reviews of recent sales of similar facilities. No goodwill impairments were recognized during 2020, 2019 or 2018. During 2020, goodwill increased by $279 million related to acquisitions, including the finalization of the accounting for certain prior year acquisitions, and declined by $9 million related to foreign currency translation and other adjustments. During 2019, goodwill increased by $332 million related to acquisitions and declined by $4 million related to foreign currency translation and other adjustments. During 2020, identifiable intangible assets increased by $65 million related to acquisitions, including the finalization of the accounting for certain prior year acquisitions, and declined by $26 million due to amortization and other adjustments. During 2019, identifiable intangible assets declined by $12 million due to amortization, foreign currency translation and other adjustments. Identifiable intangible assets are amortized over estimated lives ranging generally from three The gross carrying amounts of identifiable intangible assets at December 31, 2020 and 2019 were $249 million and $184 million, respectively, and accumulated amortization was $149 million and $123 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2020 and 2019 was $269 million. Indefinite-lived identifiable intangible assets are not amortized but are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Debt Issuance Costs and Discounts Debt issuance costs and discounts are amortized based upon the terms of the respective debt obligations. The gross carrying amount of debt issuance costs and discounts at December 31, 2020 and 2019 was $411 million and $413 million, respectively, and accumulated amortization was $175 million and $174 million, respectively. Amortization of debt issuance costs and discounts is included in interest expense and was $30 million, $30 million and $31 million for 2020, 2019 and 2018, respectively. Professional Liability Claims Reserves for professional liability risks were $1.963 billion and $1.827 billion at December 31, 2020 and 2019, respectively. The current portion of the reserves, $477 million and $457 million at December 31, 2020 and 2019, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $435 million, $497 million and $447 million for 2020, 2019 and 2018, respectively, and are included in “other operating expenses” in our consolidated income statements. Provisions for losses related to professional liability risks are based upon actuarially determined estimates. During 2020, 2019 and 2018, we recorded reductions to the provision for professional liability risks of $112 million , million and $70 million, respectively, due to the receipt of updated actuarial information. Loss and loss expense reserves represent the estimated ultimate net cost of all reported and unreported losses incurred through the respective consolidated balance sheet dates. The reserves for unpaid losses and loss expenses are estimated using individual case-basis valuations and actuarial analyses. Those estimates are subject to the effects of trends in loss severity and frequency. The estimates are continually reviewed and adjustments are recorded as experience develops or new information becomes known. Adjustments to the estimated reserve amounts are included in current operating results. The reserves for professional liability risks cover approximately 2,300 individual claims at both December 31, 2020 and 2019 and estimates for unreported potential claims. The time period required to resolve these claims can vary depending upon the jurisdiction and whether the claim is settled or litigated. During 2020 and 2019, $292 million and $408 million, respectively, of net payments were made for professional and general liability claims. The estimation of the timing of payments beyond a year can vary significantly. Although considerable variability is inherent in professional liability reserve estimates, we believe the reserves for losses and loss expenses are adequate; however, there can be no assurance the ultimate liability will not exceed our estimates. A portion of our professional liability risks is insured through a 100% owned insurance subsidiary. Subject, in most cases, to a $15 million per occurrence self-insured retention, our facilities are insured by our 100% owned insurance subsidiary for losses up to $50 million per occurrence. The insurance subsidiary has obtained reinsurance for professional liability risks generally above a retention level of either $25 million or $35 million per occurrence, depending on the jurisdiction for the related claim. We also maintain professional liability insurance with unrelated commercial carriers for losses in excess of amounts insured by our insurance subsidiary. The obligations covered by reinsurance and excess insurance contracts are included in the reserves for professional liability risks, as we remain liable to the extent the reinsurers and excess insurance carriers do not meet their obligations under the reinsurance and excess insurance contracts. The amounts receivable under the reinsurance contracts include $31 million and $37 million at December 31, 2020 and 2019, respectively, recorded in “other assets,” and $8 million and $9 million at December 31, 2020 and 2019, respectively, recorded in “other current assets.” Financial Instruments Derivative financial instruments are employed to manage interest rate risks, and are not used for trading or speculative purposes. We recognize our interest rate swap derivative instruments in the consolidated balance sheets at fair value. Changes in the fair value of derivatives are recognized periodically in stockholders’ equity, as a component of other comprehensive income (loss), provided the derivative financial instrument qualifies for hedge accounting. Gains and losses on derivatives designated as cash flow hedges, to the extent they are effective, are recorded in other comprehensive income (loss), and subsequently reclassified to earnings to offset the impact of the forecasted transactions when they occur. In the event the forecasted transaction to which a cash flow hedge relates is no longer likely, the amount in other comprehensive income is recognized in earnings and generally the derivative is terminated. The net interest paid or received on interest rate swaps is recognized as adjustments to interest expense. Gains and losses resulting from the early termination of interest rate swap agreements are deferred and amortized as adjustments to interest expense over the remaining term of the debt originally associated with the terminated swap. Noncontrolling Interests in Consolidated Entities The consolidated financial statements include all assets, liabilities, revenues and expenses of less than 100% owned entities that we control. Accordingly, we have recorded noncontrolling interests in the earnings and equity of such entities. |
Share-Based Compensation
Share-Based Compensation | 12 Months Ended |
Dec. 31, 2020 | |
Disclosure of Compensation Related Costs, Share-based Payments [Abstract] | |
Share-Based Compensation | NOTE 2 — SHARE-BASED COMPENSATION Reclassifications Certain prior year amounts have been reclassified to conform to the 2020 presentation. Stock Incentive Plans In May 2020, the 2020 Stock Incentive Plan for Key Employees of HCA Healthcare, Inc. and its Affiliates Holdings Affiliates (the “2006 Plan”). No further grants will be made under the 2006 Plan, and no shares under the 2006 Plan are available for grant under the 2020 Plan. Employee Stock Purchase Plan Our employee stock purchase plan (“ESPP”) provides our participating employees an opportunity to obtain shares of our common stock at a discount (through payroll deductions over three-month periods). At December 31, 2020, 5.865 million shares of common stock were reserved for issuance under the ESPP provisions. During 2020, 2019 and 2018, the Company recognized $13 million, $12 million and $10 million, respectively, of compensation expense related to the ESPP. Stock Option, SAR, RSU and PSU Activity – All Plans The fair value of each stock option and SAR award is estimated on the grant date, using valuation models and the weighted average assumptions indicated in the following table. Awards under our stock incentive plans generally vest based on continued employment (“Time Stock Options and SARs” and “Time RSUs”) and based upon continued employment and the achievement of certain financial targets (“Performance Stock Options and SARs”, “Performance RSUs” and “PSUs”). PSUs have a three-year cumulative earnings per share target, and the number of PSUs earned can vary from zero (for actual performance of less than 90% of target for 2020 and 2019 grants and less than 80% of target for 2018 and prior grants) to two times the original PSU grant (for actual performance of 110% or more of target for 2020 and 2019 grants and 120% or more of target for 2018 and prior grants). Each grant is valued as a single award with an expected term equal to the average expected term of the component vesting tranches. The expected term of the share-based award is limited by the contractual term. We use historical exercise behavior data and other factors to estimate the expected term of the options and SARs. Compensation cost is recognized on the straight-line attribution method. The straight-line attribution method requires that total compensation expense recognized must at least equal the vested portion of the grant-date fair value. The expected volatility is derived using historical stock price information for our common stock and the volatility implied by the trading of options to purchase our stock on open-market exchanges. The risk-free interest rate is the approximate yield on United States Treasury Strips having a life equal to the expected share-based award life on the date of grant. The expected life is an estimate of the number of years a share-based award will be held before it is exercised. The expected dividend yield is estimated based on the assumption that the dividend yield at date of grant will be maintained over the expected life of the grant. 2020 2019 2018 Risk-free interest rate 1.44 % 2.50 % 2.62 % Expected volatility 27 % 27 % 29 % Expected life, in years 6.15 6.18 6.15 Expected dividend yield 1.19 % 1.16 % 1.37 % Information regarding Time Stock Options and SARs and Performance Stock Options and SARs activity during 2020, 2019 and 2018 is summarized below (share amounts in thousands): Time Performance Total Weighted Weighted Aggregate Options and SARs outstanding, December 31, 2017 11,156 4,586 15,742 $ 43.47 Granted 2,342 — 2,342 101.96 Exercised (3,917 ) (1,774 ) (5,691 ) 27.86 Cancelled (221 ) (145 ) (366 ) 68.43 Options and SARs outstanding, December 31, 2018 9,360 2,667 12,027 61.49 Granted 1,349 — 1,349 138.31 Exercised (1,137 ) (523 ) (1,660 ) 44.45 Cancelled (522 ) — (522 ) 93.26 Options and SARs outstanding, December 31, 2019 9,050 2,144 11,194 71.79 Granted 1,120 — 1,120 144.47 Exercised (2,159 ) (1,325 ) (3,484 ) 44.07 Cancelled (175 ) — (175 ) 111.69 Options and SARs outstanding, December 31, 2020 7,836 819 8,655 $ 91.53 6.0 years $ 631 Options and SARs exercisable, December 31, 2020 4,562 819 5,381 $ 71.25 4.8 years $ 502 The weighted average fair values of stock options and SARs granted during 2020, 2019 and 2018 were $35.98, $38.21 and $28.90 per share, respectively. The total intrinsic value of stock options and SARs exercised during 2020, 2019 and 2018 was $328 million, $153 million and $456 million, respectively. As of December 31, 2020, the unrecognized compensation cost related to nonvested stock options and SARs was $53 million. Stock Option, SAR, RSU and PSU Activity – All Plans (continued) Information regarding Time RSUs, Performance RSUs and PSUs activity during 2020, 2019 and 2018 is summarized below (share amounts in thousands): Time RSUs Performance PSUs Total RSUs Weighted RSUs and PSUs outstanding, December 31, 2017 3,465 227 3,562 7,254 $ 72.05 Granted 1,464 — 1,261 2,725 101.85 Performance adjustment — — 1,250 1,250 69.27 Vested (1,487 ) (136 ) (2,500 ) (4,123 ) 67.33 Cancelled (319 ) (91 ) (151 ) (561 ) 78.82 RSUs and PSUs outstanding, December 31, 2018 3,123 — 3,422 6,545 86.32 Granted 973 — 796 1,769 138.45 Performance adjustment — — 227 227 69.94 Vested (1,216 ) — (1,251 ) (2,467 ) 75.97 Cancelled (260 ) — (159 ) (419 ) 103.27 RSUs and PSUs outstanding, December 31, 2019 2,620 — 3,035 5,655 105.23 Granted 1,048 — 808 1,856 144.17 Performance adjustment — — 206 206 81.89 Vested (1,030 ) — (1,364 ) (2,394 ) 88.63 Cancelled (162 ) — (93 ) (255 ) 124.50 RSUs and PSUs outstanding, December 31, 2020 2,476 — 2,592 5,068 $ 125.40 The total fair value of RSUs and PSUs that vested during 2020, 2019 and 2018 was $349 million, $346 million and $413 million, respectively. As of December 31, 2020, the unrecognized compensation cost related to RSUs and PSUs was $330 million. |
Acquisitions and Dispositions
Acquisitions and Dispositions | 12 Months Ended |
Dec. 31, 2020 | |
Business Combinations [Abstract] | |
Acquisitions and Dispositions | NOTE 3 — ACQUISITIONS AND DISPOSITIONS During 2020, we paid $568 million to acquire a hospital During 2020, we received proceeds of $68 million and recognized a pretax loss of $7 million ($9 million after tax) related to the sale of a hospital sale of a hospital market) and sales of real estate and other investments. During 2018, we received proceeds of $ 758 million and recognized a pretax gain of $353 million ($265 million after tax) related to the sale of two hospital facilities from our American Group (Oklahoma market). During 2018, we also received proceeds of $50 million and recognized pretax gains of $75 million ($59 million after tax) related to sales of real estate and other investments. |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2020 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | NOTE 4 — INCOME TAXES The provision for income taxes consists of the following (dollars in millions): 2020 2019 2018 Current: Federal $ 1,021 $ 670 $ 759 State 126 134 149 Foreign 5 17 23 Deferred: Federal (73 ) 254 9 State (39 ) 29 13 Foreign 3 (5 ) (7 ) $ 1,043 $ 1,099 $ 946 The 2017 Tax Cuts and Jobs Act (“Tax Act”) significantly revised U.S. corporate income taxes, including lowering the statutory corporate tax rate from 35% to 21% beginning in 2018. We completed our analysis of the impact of the Tax Act during 2018, reducing our provision for income taxes for the year ended December 31, 2018 by $67 million related to a remeasurement of certain deferred tax assets and liabilities for which we were unable to make reasonable estimates in 2017. Our provision for income taxes for the years ended December 31, 2020, 2019 and 2018 included tax benefits of $92 million, $65 million and $124 million, respectively, related to the settlement of employee equity awards. During 2018, we recorded a reduction to our provision for income taxes of $28 million for tax credits related to certain 2017 hurricane-related expenses. Our foreign pretax income was $9 million, $50 million and $86 million for the years ended December 31, 2020, 2019 and 2018, respectively. A reconciliation of the federal statutory rate to the effective income tax rate follows: 2020 2019 2018 Federal statutory rate 21.0 % 21.0 % 21.0 % State income taxes, net of federal tax benefit 1.9 2.7 2.9 Change in liability for uncertain tax positions (0.2 ) 0.4 (0.1 ) Tax benefit from settlements of employee equity awards (1.8 ) (1.3 ) (2.4 ) Impact of Tax Act on deferred tax balances — — (1.6 ) Other items, net 0.8 1.1 0.2 Effective income tax rate on income attributable to HCA Healthcare, Inc. 21.7 23.9 20.0 Income attributable to noncontrolling interests from consolidated partnerships (2.5 ) (2.9 ) (2.3 ) Effective income tax rate on income before income taxes 19.2 % 21.0 % 17.7 % A summary of the items comprising the deferred tax assets and liabilities at December 31 follows (dollars in millions): 2020 2019 Assets Liabilities Assets Liabilities Depreciation and fixed asset basis differences $ — $ 678 $ — $ 601 Allowances for professional liability and other risks 407 — 376 — Accounts receivable 283 — 307 — Compensation 487 — 292 — Right-of-use 416 409 369 366 Other 485 606 461 538 $ 2,078 $ 1,693 $ 1,805 $ 1,505 At December 31, 2020, federal and state net operating loss carryforwards (expiring in years 2023 through 2039) available to offset future taxable income approximated $56 million and $127 million, respectively. Utilization of net operating loss carryforwards in any one year may be limited. The following table summarizes the activity related to our unrecognized tax benefits (dollars in millions): 2020 2019 Balance at January 1 $ 522 $ 390 Additions (reductions) based on tax positions related to the current year (3 ) 29 Additions for tax positions of prior years 13 119 Reductions for tax positions of prior years (30 ) (3 ) Settlements (22 ) — Lapse of applicable statutes of limitations (11 ) (13 ) Balance at December 31 $ 469 $ 522 Our liability for unrecognized tax benefits was $508 million, including accrued interest of $73 million and excluding $34 million that was recorded as reductions of the related deferred tax assets, as of December 31, 2020 ($550 million, $62 million and $34 million, respectively, as of December 31, 2019). Unrecognized tax benefits of $157 million as of December 31, 2020 ($160 million as of December 31, 2019) would affect the effective rate, if recognized. The Internal Revenue Service (“IRS”) was conducting an examination of the Company’s 2016, 2017 and 2018 federal income tax returns at December 31, 2020. 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 | 12 Months Ended |
Dec. 31, 2020 | |
Earnings Per Share [Abstract] | |
Earnings Per Share | NOTE 5 — 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 stock options, SARs, RSUs and PSUs, computed using the treasury stock method. 2020 2019 2018 Net income attributable to HCA Healthcare, Inc. $ 3,754 $ 3,505 $ 3,787 Weighted average common shares outstanding 338.274 341.210 347.297 Effect of dilutive incremental shares 5.331 7.016 8.006 Shares used for diluted earnings per share 343.605 348.226 355.303 Earnings per share: Basic earnings per share $ 11.10 $ 10.27 $ 10.90 Diluted earnings per share $ 10.93 $ 10.07 $ 10.66 |
Investments of Insurance Subsid
Investments of Insurance Subsidiaries | 12 Months Ended |
Dec. 31, 2020 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments of Insurance Subsidiaries | NOTE 6 — INVESTMENTS OF INSURANCE SUBSIDIARIES A summary of the insurance subsidiaries’ investments at December 31 follows (dollars in millions): 2020 Amortized Unrealized Fair Gains Losses Debt securities $ 384 $ 32 $ — $ 416 Money market funds and other 88 — — 88 $ 472 $ 32 $ — 504 Amounts classified as current assets (116 ) Investment carrying value $ 388 2019 Amortized Unrealized Fair Gains Losses Debt securities $ 359 $ 18 $ — $ 377 Money market funds and other 85 — — 85 $ 444 $ 18 $ — 462 Amounts classified as current assets (147 ) Investment carrying value $ 315 At December 31, 2020 and 2019, the investments in debt securities of our insurance subsidiaries were classified as “available-for-sale.” Scheduled maturities of investments in debt securities at December 31, 2020 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 4 $ 4 Due after one year through five years 147 156 Due after five years through ten years 157 174 Due after ten years 76 82 $ 384 $ 416 The average expected maturity of the investments in debt securities at December 31, 2020 was 5.2 years, compared to the average scheduled maturity of 9.4 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 | 12 Months Ended |
Dec. 31, 2020 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Financial Instruments | NOTE 7 — FINANCIAL INSTRUMENTS Interest Rate Swap Agreements We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between us and our counterparties based on common notional principal amounts and maturity dates. Pay-fixed The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at December 31, 2020 (dollars in millions): Notional Maturity Date Fair Pay-fixed $ 2,000 December 2021 $ (27 ) Pay-fixed 500 December 2022 (19 ) During the next 12 months, we estimate $37 million will be reclassified from accumulated other comprehensive income (“OCI”) and will be included in interest expense. Derivatives — Results of Operations The following table presents the effect of our interest rate swaps on our results of operations for the year ended December 31, 2020 (dollars in millions): Derivatives in Cash Flow Hedging Amount of Loss Location of Loss Amount of Loss Interest rate swaps $ 51 Interest expense $ 24 Credit-risk-related Contingent Features We have agreements with each of our derivative counterparties that contain a provision where we could be declared in default on our derivative obligations if repayment of the underlying indebtedness is accelerated by the lender due to our default on the indebtedness. As of December 31, 2020, we have not been required to post any collateral related to these agreements. If we had breached these provisions at December 31, 2020, we would have been required to settle our obligations under the agreements at their aggregate, estimated termination value of $46 million. |
Assets and Liabilities Measured
Assets and Liabilities Measured at Fair Value | 12 Months Ended |
Dec. 31, 2020 | |
Fair Value Disclosures [Abstract] | |
Assets and Liabilities Measured at Fair Value | NOTE 8 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE Accounting Standards Codification 820, Fair Value Measurements and Disclosures 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. Cash Traded Investments Our cash traded investments 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 We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments. The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of December 31, 2020 and 2019, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): December 31, 2020 Fair Value Fair Value Measurements Using Quoted Prices in Significant Significant Assets: Investments of insurance subsidiaries: Debt securities $ 416 $ — $ 416 $ — Money market funds and other 88 88 — — Investments of insurance subsidiaries 504 88 416 — Less amounts classified as current assets (116 ) (87 ) (29 ) — $ 388 1 $ 387 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 46 $ — $ 46 $ — December 31, 2019 Fair Value Fair Value Measurements Using Quoted Prices in Significant Significant Assets: Investments of insurance subsidiaries: Debt securities $ 377 $ — $ 377 $ — Money market funds and other 85 85 — — Investments of insurance subsidiaries 462 85 377 — Less amounts classified as current assets (147 ) (83 ) (64 ) — $ 315 2 $ 313 $ — Interest rate swaps (Other) $ 3 $ — $ 3 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 7 $ — $ 7 $ — The estimated fair value of our long-term debt was $35.814 billion and $37.026 billion at December 31, 2020 and 2019, respectively, compared to carrying amounts, excluding debt issuance costs and discounts, aggregating $31.240 billion and $33.961 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 | 12 Months Ended |
Dec. 31, 2020 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | NOTE 9 — LONG-TERM DEBT A summary of long-term debt at December 31, including related interest rates at December 31, 2020, follows (dollars in millions): 2020 2019 Senior secured asset-based revolving credit facility $ — $ 2,480 Senior secured revolving credit facility — — Senior secured 364-day — — Senior secured term loan facilities (effective interest rate of 2.8%) 3,671 3,725 Senior secured notes (effective interest rate of 5.1%) 13,850 13,850 Other senior secured debt (effective interest rate of 4.7%) 767 654 Senior secured debt 18,288 20,709 Senior unsecured notes (effective interest rate of 5.5%) 12,952 13,252 Net debt issuance costs (236 ) (239 ) Total debt (average life of 8.9 years, rates averaging 5.0%) 31,004 33,722 Less amounts due within one year 209 145 $ 30,795 $ 33,577 During February 2020, we issued $2.700 billion aggregate principal amount of 3.50% senior notes due 2030. During March 2020, we used the net proceeds for the redemption of all $1.000 billion outstanding aggregate principal amount of HCA Healthcare, Inc.’s 6.25% senior notes due 2021 and, together with available funds, for the redemption of all $2.000 billion outstanding aggregate principal amount of HCA Inc.’s 7.50% senior notes due 2022. The pretax loss on retirement of debt was $295 million. During March 2020 in response to the risks the COVID-19 pandemic presents to our business, we entered into a credit agreement that provides for a 364-day secured term loan facility for an aggregate principal amount of up to $2.000 billion. As of December 31, 2020 there was no amount outstanding or draw notices pending under the facility. We terminated this credit agreement during January 2021. Senior Secured Credit Facilities And Other Senior Secured Debt We have entered into the following senior secured credit facilities: billion asset-based revolving credit facility maturing on with a borrowing base of of eligible accounts receivable, subject to customary reserves and eligibility criteria outstanding at December 31, 2020) (the “ABL credit facility”); (ii) a $2.000 billion senior secured revolving credit facility maturing on June 28, 2022 (none billion senior secured 364-day term loan facility maturing on March 18, 2021 (none the facility was billion senior secured term loan A-6 facility maturing on billion senior secured term loan B-12 facility maturing on billion senior secured term loan B-13 facility maturing on We refer to the facilities described under (ii) through (vi) above, collectively, as the “cash flow credit facility” and, together with the ABL credit facility, the “senior secured credit facilities.” Borrowings under the senior secured credit facilities bear interest at a rate equal to, at our option, either (a) a base rate determined by reference to the higher of (1) the federal funds rate plus 0.50% or (2) the prime rate of Bank of America or (b) a LIBOR rate for the currency of such borrowing for the relevant interest period, plus, in each case, an applicable margin. The applicable margin for borrowings under the senior secured credit facilities may be reduced subject to attaining certain leverage ratios. The senior secured credit facilities contain a number of covenants that restrict, subject to certain exceptions, our (and some or all of our subsidiaries’) ability to incur additional indebtedness, repay subordinated indebtedness, create liens on assets, sell assets, make investments, loans or advances, engage in certain transactions with affiliates, pay dividends and distributions, and enter into sale and leaseback transactions. In addition, we are required to satisfy and maintain a maximum total leverage ratio covenant under the cash flow credit facility and, in certain situations under the ABL credit facility, a minimum interest coverage ratio covenant. Senior secured notes consists of (i) $1.250 billion aggregate principal amount of 4.75% first lien notes due 2023; (ii) $2.000 billion aggregate principal amount of 5.00% first lien notes due 2024; (iii) $1.400 billion aggregate principal amount of 5.25% first lien notes due 2025; (iv) $1.500 billion aggregate principal amount of 5.25% first lien notes due 2026; (v) $1.200 billion aggregate principal amount of 4.50% first lien notes due 2027; (vi) $2.000 billion aggregate principal amount of 4 1/8 5 1/4 We use interest rate swap agreements to manage the variable rate exposure of our debt portfolio. At December 31, 2020, we had entered into effective interest rate swap agreements, in a total notional amount of $2.500 billion, in order to hedge a portion of our exposure to variable rate interest payments associated with the senior secured credit facilities. The effect of the interest rate swaps is reflected in the effective interest rates for the senior secured credit facilities. Senior Unsecured Notes Senior unsecured notes consist of (i) $12.091 billion aggregate principal amount of senior notes with maturities ranging from 2023 to 2033; (ii) an aggregate principal amount of $125 million medium-term notes maturing 2025; and (iii) an aggregate principal amount of $736 million debentures with maturities ranging from 2023 to 2095. General Debt Information The senior secured credit facilities and senior secured notes are fully and unconditionally guaranteed by substantially all existing and future, direct and indirect, 100% owned material domestic subsidiaries that are “Unrestricted Subsidiaries” under our Indenture (the “1993 Indenture”) dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our ABL credit facility). All obligations under the ABL credit facility, and the guarantees of those obligations, are secured, subject to permitted liens and other exceptions, by a first-priority lien on substantially all of the receivables of the borrowers and each guarantor under such ABL credit facility (the “Receivables Collateral”). All obligations under the cash flow credit facility and the guarantees of such obligations are secured, subject to permitted liens and other exceptions, by: • a first-priority lien on the capital stock owned by HCA Inc., or by any guarantor, in each of their respective first-tier subsidiaries; • a first-priority lien on substantially all present and future assets of HCA Inc. and of each guarantor other than (i) “Principal Properties” (as defined in the 1993 Indenture), (ii) certain other real properties and (iii) deposit accounts, other bank or securities accounts, cash, leaseholds, motor-vehicles and certain other exceptions; and • a second-priority lien on certain of the Receivables Collateral. Our senior secured notes and the related guarantees are secured by first-priority liens, subject to permitted liens, on our and our subsidiary guarantors’ assets, subject to certain exceptions, that secure our cash flow credit facility on a first-priority basis and are secured by second-priority liens, subject to permitted liens, on our and our subsidiary guarantors’ assets that secure our ABL credit facility on a first-priority basis and our other cash flow credit facility on a second-priority basis. Maturities of long-term debt in years 2022 through 2025 are $233 million, $2.799 billion, $3.163 billion and $5.872 billion, respectively. |
Leases
Leases | 12 Months Ended |
Dec. 31, 2020 | |
Leases [Abstract] | |
Leases | NOTE 10 — LEASES We adopted ASU No. 2016-02, Leases (Topic 842) The following table presents our lease-related assets and liabilities at December 31, 2020 and 2019 (dollars in millions): Balance Sheet Classification 2020 2019 Assets: Operating leases Right-of-use operating lease assets $ 2,024 $ 1,834 Finance leases Property and equipment 553 520 Total lease assets $ 2,577 $ 2,354 Liabilities: Current: Operating leases Other accrued expenses $ 379 $ 350 Finance leases Long-term debt due within one year 128 87 Noncurrent: Operating leases Right-of-use operating lease obligations 1,673 1,499 Finance leases Long-term debt 494 470 Total lease liabilities $ 2,674 $ 2,406 Weighted-average remaining term: Operating leases 10.4 years 10.8 years Finance leases 11.5 years 12.0 years Weighted-average discount rate: Operating leases 4.8 % 5.3 % Finance leases 5.4 % 6.0 % The following table presents certain information related to lease expense for finance and operating leases for the years ended December 31, 2020 and 2019 (dollars in millions): 2020 2019 Finance lease expense: Depreciation and amortization $ 106 $ 93 Interest 31 32 Operating leases( 1 ) 447 389 Short-term lease expense( 1 322 316 Variable lease expense( 1 154 150 $ 1,060 $ 980 ( 1 ) Expenses are included in “other operating expenses” in our consolidated income statements. The following table presents supplemental cash flow information for the years ended December 31, 2020 and 2019 (dollars in millions): 2020 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 445 $ 404 Operating cash flows for finance leases 31 32 Financing cash flows for finance leases 86 79 Maturities of Lease Liabilities The following table reconciles the undiscounted minimum lease payment amounts to the operating and finance lease liabilities recorded on the balance sheet at December 31, 2020 and 2019 (dollars in millions): 2020 2019 Operating Finance Operating Finance Year 1 $ 431 $ 155 $ 411 $ 110 Year 2 366 125 350 105 Year 3 307 81 285 99 Year 4 255 82 228 58 Year 5 207 51 182 60 Thereafter 1,136 353 1,074 368 Total minimum lease payments 2,702 847 2,530 800 Less: amount of lease payments representing interest (650 ) (225 ) (681 ) (243 ) Present value of future minimum lease payments 2,052 622 1,849 557 Less: current lease obligations (379 ) (128 ) (350 ) (87 ) Long-term lease obligations $ 1,673 $ 494 $ 1,499 $ 470 |
Contingencies
Contingencies | 12 Months Ended |
Dec. 31, 2020 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | NOTE 11 — 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 , Government Investigations, Claims and Litigation Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam 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. Texas operates a state Medicaid program pursuant to a waiver from the Centers for Medicare & Medicaid Services 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 qui tam qui tam |
Capital Stock
Capital Stock | 12 Months Ended |
Dec. 31, 2020 | |
Federal Home Loan Banks [Abstract] | |
Capital Stock | NOTE 12 — CAPITAL STOCK The amended and restated certificate of incorporation authorizes the Company to issue up to 1,800,000,000 shares of common stock, and our amended and restated by-laws Share Repurchase Transactions During January 2020, January 2019 and October 2017, our Board of Directors authorized share repurchase programs for up to $6 billion ($2 billion for each authorization) of our outstanding common stock. During March 2020 COVID-19 our During 2020, we repurchased 3.287 million shares of our common stock at an average price of $134.18 per share through market purchases pursuant to the $ 2.0 |
Employee Benefit Plans
Employee Benefit Plans | 12 Months Ended |
Dec. 31, 2020 | |
Retirement Benefits [Abstract] | |
Employee Benefit Plans | NOTE 13 — EMPLOYEE BENEFIT PLANS We maintain defined contribution benefit plans that are available to employees who meet certain minimum requirements. Certain of the plans require that we match specified percentages of participant contributions up to certain maximum levels (generally, depending upon years of vesting service, of compensation deferred by participants). The cost of these plans totaled million for 2020, million for 20 19 and million for 2018. Our matching contributions are funded during the year following the participant contributions. We maintain the noncontributory, nonqualified Restoration Plan to provide certain retirement benefits for eligible employees. Eligibility for the Restoration Plan is based upon earning eligible compensation in excess of a base amount and attaining 1,000 or more hours of service during the plan year. Company credits to participants’ hypothetical account balances (the Restoration Plan is not funded) depend upon participants’ compensation, years of vesting service, hypothetical investment returns (gains or losses) and certain IRS limitations. Benefits expense under this plan was $35 million for 2020, $44 million for 2019 and $22 million for 2018. Accrued benefits liabilities under this plan totaled $242 million at December 31, 2020 and $227 million at December 31, 2019. We maintain a Supplemental Executive Retirement Plan (“SERP”) for certain executives (the SERP is not funded). The plan is designed to ensure that upon retirement the participant receives the value of a prescribed life annuity from the combination of the SERP and our other benefit plans. Benefits expense under the plan was $24 million for 2020, $19 million for 2019 and $26 million for 2018. Accrued benefits liabilities under this plan totaled $204 million at December 31, 2020 and $192 million at December 31, 2019. We maintain defined benefit pension plans which resulted from certain hospital acquisitions in prior years. Benefits expense under these plans was million for 2020, million for 2019, and million for 2018. Accrued benefits liabilities under these plans totaled million at December 31, 2020 and million at December 31, 2019. |
Segment and Geographic Informat
Segment and Geographic Information | 12 Months Ended |
Dec. 31, 2020 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | NOTE 14 — 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. At December 31, 2020, the National Group included 96 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, North Carolina, South Carolina, Utah and Virginia, and the American Group included 82 hospitals located in Colorado, northern Georgia, 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. Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses and gains on sales of facilities, losses on retirement of debt, 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, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions): For the Years Ended December 31, 2020 2019 2018 Revenues: National Group $ 25,694 $ 25,913 $ 22,581 American Group 23,593 23,173 21,959 Corporate and other 2,246 2,250 2,137 $ 51,533 $ 51,336 $ 46,677 Equity in earnings of affiliates: National Group $ (28 ) $ (2 ) $ (4 ) American Group (42 ) (44 ) (40 ) Corporate and other 16 3 15 $ (54 ) $ (43 ) $ (29 ) Adjusted segment EBITDA: National Group $ 5,532 $ 5,634 $ 4,980 American Group 5,333 4,904 4,593 Corporate and other (828 ) (681 ) (624 ) $ 10,037 $ 9,857 $ 8,949 Depreciation and amortization: National Group $ 1,216 $ 1,161 $ 946 American Group 1,164 1,117 1,027 Corporate and other 341 318 305 $ 2,721 $ 2,596 $ 2,278 For the Years Ended December 31, 2020 2019 2018 Adjusted segment EBITDA $ 10,037 $ 9,857 $ 8,949 Depreciation and amortization 2,721 2,596 2,278 Interest expense 1,584 1,824 1,755 Losses (gains) on sales of facilities 7 (18 ) (428 ) Losses on retirement of debt 295 211 9 Income before income taxes $ 5,430 $ 5,244 $ 5,335 December 31, 2020 2019 2018 Assets: National Group $ 18,913 $ 18,290 $ 14,839 American Group 20,760 20,608 19,122 Corporate and other 7,817 6,160 5,246 $ 47,490 $ 45,058 $ 39,207 National American Corporate Total Goodwill and other intangible assets: Balance at December 31, 2017 $ 1,474 $ 5,265 $ 655 $ 7,394 Acquisitions 132 504 — 636 Foreign currency translation, amortization and other (9 ) (40 ) (28 ) (77 ) Balance at December 31, 2018 1,597 5,729 627 7,953 Acquisitions 155 39 138 332 Foreign currency translation, amortization and other (13 ) (3 ) — (16 ) Balance at December 31, 2019 1,739 5,765 765 8,269 Acquisitions 38 27 279 344 Foreign currency translation, amortization and other (2 ) (17 ) (16 ) (35 ) Balance at December 31, 2020 $ 1,775 $ 5,775 $ 1,028 $ 8,578 |
Other Comprehensive Loss
Other Comprehensive Loss | 12 Months Ended |
Dec. 31, 2020 | |
Equity [Abstract] | |
Other Comprehensive Loss | NOTE 15 — OTHER COMPREHENSIVE LOSS The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized for-Sale Foreign Defined Change Total Balances at December 31, 2017 $ 7 $ (149 ) $ (168 ) $ 32 $ (278 ) Unrealized losses on available-for-sale income tax benefit (5 ) — — — (5 ) Foreign currency translation adjustments, net of $8 income tax benefit — (63 ) — — (63 ) Defined benefit plans, net of $10 of income taxes — — 34 — 34 Change in fair value of derivative instruments, net of $5 of income taxes — — — 18 18 Expense (income) reclassified into operations from other comprehensive income, net of $5 income tax benefit and $2 of income taxes, respectively — — 16 (8 ) 8 Reclassification of stranded tax effects 1 (71 ) (30 ) 5 (95 ) Balances at December 31, 2018 3 (283 ) (148 ) 47 (381 ) Unrealized gains on available-for-sale income taxes 11 — — — 11 Foreign currency translation adjustments, net of $5 of income taxes — — — — — Defined benefit plans, net of $14 income tax benefit — — (49 ) — (49 ) Change in fair value of derivative instruments, net of $13 income tax benefit — — — (37 ) (37 ) Expense (income) reclassified into operations from other comprehensive income, net of $3 income tax benefit and $3 of income taxes, respectively — — 10 (14 ) (4 ) Balances at December 31, 2019 14 (283 ) (187 ) (4 ) (460 ) Unrealized gains on available-for-sale income taxes 11 — — — 11 Foreign currency translation adjustments, net of $6 of income taxes — 12 — — 12 Defined benefit plans, net of $16 income tax benefit — — (55 ) — (55 ) Change in fair value of derivative instruments, net of $15 income tax benefit — — — (51 ) (51 ) Expense reclassified into operations from other comprehensive income, net of $6 and $5 income tax benefits, respectively — — 22 19 41 Balances at December 31, 2020 $ 25 $ (271 ) $ (220 ) $ (36 ) $ (502 ) |
Accrued Expenses
Accrued Expenses | 12 Months Ended |
Dec. 31, 2020 | |
Text Block [Abstract] | |
Accrued Expenses | NOTE 16 — ACCRUED EXPENSES A summary of other accrued expenses at December 31 follows (dollars in millions): 2020 2019 Professional liability risks $ 477 $ 457 Defined contribution benefit plan 547 528 Right-of-use operating lease 379 350 Taxes other than income 343 325 Interest 315 368 Government stimulus refund liability 83 — Other 1,096 904 $ 3,240 $ 2,932 |
Accounting Policies (Policies)
Accounting Policies (Policies) | 12 Months Ended |
Dec. 31, 2020 | |
Basis of Presentation | Basis of Presentation The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates. The consolidated financial statements include all subsidiaries and entities controlled by HCA. We generally define “control” as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which we absorb a majority of the entity’s expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of ownership, contractual or other financial interests in the entity. The accounts of acquired entities are included in our consolidated financial statements for periods subsequent to our acquisition of controlling interests. Significant intercompany transactions have been eliminated. Investments in entities we do not control, but in which we have a substantial ownership interest and can exercise significant influence, are accounted for using the equity method. The majority of our expenses are “cost of revenue” items. Costs that could be classified as general and administrative include our corporate office costs, which were $416 million, $370 million and $344 million for the years ended December 31, 2020, 2019 and 2018, respectively. COVID-19 On March 11, 2020, the World Health Organization designated COVID-19 COVID-19 non-emergent re-imposed, During 2020, we received approximately $4.4 billion of accelerated Medicare payments and approximately $1.8 billion in general and targeted distributions from the Provider Relief Fund, both as provided for and established under the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act. During October 2020, million, related to amounts received by certain of our partnership entities, are recorded under the caption “other accrued expenses” in our consolidated balance sheet at December 31, 2020. Our share of these funds will be returned in 2021 after final determination of amounts earned and distributable to the members of each respective partnership. The CARES Act also provides for a deferral of payments of the employer portion of Social Security tax incurred during the pandemic, allowing half of such payroll taxes to be deferred until December 2021 and the remaining half until December 2022. At December 31, 2020, the Company had deferred $688 million of Social Security taxes. Additionally, the CARES Act created a payroll tax credit designed to encourage companies to retain employees during the pandemic. During the year ended December 31, 2020, the Company evaluated its eligibility for this credit and recorded $60 million of employee retention payroll tax credits pursuant to the CARES Act. These tax credits were recorded as a reduction of salaries and benefits in our consolidated income statement. We believe the extent of the COVID-19 pandemic’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. Such factors include, but are not limited to : |
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 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. Our revenues by primary third-party payer classification and other (including uninsured patients) for the years ended December 31, are summarized in the following table (dollars in millions): Years Ended December 31, 2020 Ratio 2019 Ratio 2018 Ratio Medicare $ 10,420 20.2 % $ 10,798 21.0 % $ 9,831 21.1 % Managed Medicare 6,997 13.6 6,452 12.6 5,497 11.8 Medicaid 1,965 3.8 1,572 3.1 1,358 2.9 Managed Medicaid 2,621 5.1 2,450 4.8 2,403 5.1 Managed care and other insurers 26,535 51.5 26,544 51.6 24,467 52.4 International (managed care and other insurers) 1,120 2.2 1,162 2.3 1,156 2.5 Other 1,875 3.6 2,358 4.6 1,965 4.2 Revenues $ 51,533 100.0 % $ 51,336 100.0 % $ 46,677 100.0 % Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process). The adjustments to estimated Medicare and Medicaid reimbursement amounts and disproportionate-share funds related primarily to cost reports filed during the respective year resulted in net increases to revenues of $70 million, $51 million and $29 million in 2020, 2019 and 2018, respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in a net reduction The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive. Patients treated at hospitals for non-elective of the federal poverty level, were eligible for charity care, and we limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. Patients treated at hospitals for non-elective care, who have income above 400% of the federal poverty level, were eligible for certain other discounts which limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. We apply additional discounts to limit patient responsibility for certain emergency services. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. We may attempt to provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance, or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied. The collection of outstanding receivables for Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the age of those accounts. Accounts are written off when all reasonable collection efforts have been performed. The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period revenues 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 years ended December 31, follows (dollars in millions): 2020 2019 2018 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 44,271 $ 44,118 $ 40,035 Cost-to-charges 12.0 % 12.0 % 12.4 % Total uncompensated care $ 29,029 $ 31,105 $ 26,757 Multiply by the cost-to-charges 12.0 % 12.0 % 12.4 % Estimated cost of total uncompensated care $ 3,483 $ 3,733 $ 3,318 The total uncompensated care amounts include charity care of $13.763 billion, $13.260 billion and $8.611 billion for the years ended December 31, 2020, 2019 and 2018, respectively. The estimated costs of charity care were $1.652 billion, $1.591 billion and $1.068 billion for the years ended December 31, 2020, 2019 and 2018, respectively. |
Cash and Cash Equivalents | Cash and Cash Equivalents Cash and cash equivalents include highly Our cash management system provides for daily investment of available balances and the funding of outstanding checks when presented for payment. Outstanding, but unpresented, checks totaling $495 million and $486 million at December 31, 2020 and 2019, respectively, have been included in “accounts payable” in the consolidated balance sheets. Upon presentation for payment, these checks are funded through available cash balances or our credit facility. |
Accounts Receivable | Accounts Receivable We receive payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. We recognize that revenues and receivables from government agencies are significant to our operations, but do not believe there are significant credit risks associated with these government agencies. We do not believe there are any other significant concentrations of revenues from any particular payer that would subject us to any significant credit risks in the collection of our accounts receivable. Days revenues in accounts receivable were 45 days, 50 days and 51 days at December 31, 2020, 2019 and 2018, respectively. The five-day decline from December 31, 2019 to December 31, 2020 was primarily due to the combined impact of a $329 million decline in accounts receivable at December 31, 2020, compared to December 31, 2019, and a 5.7% increase in fourth |
Inventories | Inventories Inventories are stated at the lower of cost (first-in, first-out) |
Property and Equipment | Property and Equipment Depreciation expense, computed using the straight-line method, was $2.693 billion in 2020, $2.579 billion in 2019 and $2.262 billion in 2018. Buildings and improvements are depreciated over estimated useful lives ranging generally from 10 to 40 years. Estimated useful lives of equipment vary generally from four When events, circumstances or operating results indicate the carrying values of certain long-lived assets expected to be held and used might be impaired, we prepare projections of the undiscounted future cash flows expected to result from the use of the assets and their eventual disposition. If the projections indicate the recorded amounts are not expected to be recoverable, such amounts are reduced to estimated fair value. Fair value may be estimated based upon internal evaluations that include quantitative analyses of revenues and cash flows, reviews of recent sales of similar assets and independent appraisals. Long-lived assets to be disposed of are reported at the lower of their carrying amounts or fair value less costs to sell or close. The estimates of fair value are usually based upon recent sales of similar assets and market responses based upon discussions with and offers received from potential buyers. |
Investments of Insurance Subsidiaries | Investments of Insurance Subsidiaries At December 31, 2020 and 2019, the investments of our 100% owned insurance subsidiaries were classified as “available-for-sale” Investments — Debt Securities |
Goodwill and Intangible Assets | Goodwill and Intangible Assets Goodwill is not amortized but is subject to annual impairment tests. In addition to the annual impairment review, impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Impairment testing for goodwill is done at the reporting unit level. Reporting units are one level below the business segment level, and our impairment testing is performed at the operating division level. We compare the fair value of the reporting unit assets to the carrying amount, on at least an annual basis, to determine if there is potential impairment. If the fair value of the reporting unit assets is less than their carrying value, an impairment loss is recognized. Fair value is estimated based upon internal evaluations of each reporting unit that include quantitative analyses of market multiples, revenues and cash flows and reviews of recent sales of similar facilities. No goodwill impairments were recognized during 2020, 2019 or 2018. During 2020, goodwill increased by $279 million related to acquisitions, including the finalization of the accounting for certain prior year acquisitions, and declined by $9 million related to foreign currency translation and other adjustments. During 2019, goodwill increased by $332 million related to acquisitions and declined by $4 million related to foreign currency translation and other adjustments. During 2020, identifiable intangible assets increased by $65 million related to acquisitions, including the finalization of the accounting for certain prior year acquisitions, and declined by $26 million due to amortization and other adjustments. During 2019, identifiable intangible assets declined by $12 million due to amortization, foreign currency translation and other adjustments. Identifiable intangible assets are amortized over estimated lives ranging generally from three The gross carrying amounts of identifiable intangible assets at December 31, 2020 and 2019 were $249 million and $184 million, respectively, and accumulated amortization was $149 million and $123 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2020 and 2019 was $269 million. Indefinite-lived identifiable intangible assets are not amortized but are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist. |
Debt Issuance Costs | Debt Issuance Costs and Discounts Debt issuance costs and discounts are amortized based upon the terms of the respective debt obligations. The gross carrying amount of debt issuance costs and discounts at December 31, 2020 and 2019 was $411 million and $413 million, respectively, and accumulated amortization was $175 million and $174 million, respectively. Amortization of debt issuance costs and discounts is included in interest expense and was $30 million, $30 million and $31 million for 2020, 2019 and 2018, respectively. |
Professional Liability Claims | Professional Liability Claims Reserves for professional liability risks were $1.963 billion and $1.827 billion at December 31, 2020 and 2019, respectively. The current portion of the reserves, $477 million and $457 million at December 31, 2020 and 2019, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $435 million, $497 million and $447 million for 2020, 2019 and 2018, respectively, and are included in “other operating expenses” in our consolidated income statements. Provisions for losses related to professional liability risks are based upon actuarially determined estimates. During 2020, 2019 and 2018, we recorded reductions to the provision for professional liability risks of $112 million , million and $70 million, respectively, due to the receipt of updated actuarial information. Loss and loss expense reserves represent the estimated ultimate net cost of all reported and unreported losses incurred through the respective consolidated balance sheet dates. The reserves for unpaid losses and loss expenses are estimated using individual case-basis valuations and actuarial analyses. Those estimates are subject to the effects of trends in loss severity and frequency. The estimates are continually reviewed and adjustments are recorded as experience develops or new information becomes known. Adjustments to the estimated reserve amounts are included in current operating results. The reserves for professional liability risks cover approximately 2,300 individual claims at both December 31, 2020 and 2019 and estimates for unreported potential claims. The time period required to resolve these claims can vary depending upon the jurisdiction and whether the claim is settled or litigated. During 2020 and 2019, $292 million and $408 million, respectively, of net payments were made for professional and general liability claims. The estimation of the timing of payments beyond a year can vary significantly. Although considerable variability is inherent in professional liability reserve estimates, we believe the reserves for losses and loss expenses are adequate; however, there can be no assurance the ultimate liability will not exceed our estimates. A portion of our professional liability risks is insured through a 100% owned insurance subsidiary. Subject, in most cases, to a $15 million per occurrence self-insured retention, our facilities are insured by our 100% owned insurance subsidiary for losses up to $50 million per occurrence. The insurance subsidiary has obtained reinsurance for professional liability risks generally above a retention level of either $25 million or $35 million per occurrence, depending on the jurisdiction for the related claim. We also maintain professional liability insurance with unrelated commercial carriers for losses in excess of amounts insured by our insurance subsidiary. The obligations covered by reinsurance and excess insurance contracts are included in the reserves for professional liability risks, as we remain liable to the extent the reinsurers and excess insurance carriers do not meet their obligations under the reinsurance and excess insurance contracts. The amounts receivable under the reinsurance contracts include $31 million and $37 million at December 31, 2020 and 2019, respectively, recorded in “other assets,” and $8 million and $9 million at December 31, 2020 and 2019, respectively, recorded in “other current assets.” |
Financial Instruments | Financial Instruments Derivative financial instruments are employed to manage interest rate risks, and are not used for trading or speculative purposes. We recognize our interest rate swap derivative instruments in the consolidated balance sheets at fair value. Changes in the fair value of derivatives are recognized periodically in stockholders’ equity, as a component of other comprehensive income (loss), provided the derivative financial instrument qualifies for hedge accounting. Gains and losses on derivatives designated as cash flow hedges, to the extent they are effective, are recorded in other comprehensive income (loss), and subsequently reclassified to earnings to offset the impact of the forecasted transactions when they occur. In the event the forecasted transaction to which a cash flow hedge relates is no longer likely, the amount in other comprehensive income is recognized in earnings and generally the derivative is terminated. The net interest paid or received on interest rate swaps is recognized as adjustments to interest expense. Gains and losses resulting from the early termination of interest rate swap agreements are deferred and amortized as adjustments to interest expense over the remaining term of the debt originally associated with the terminated swap. |
Noncontrolling Interests in Consolidated Entities | Noncontrolling Interests in Consolidated Entities The consolidated financial statements include all assets, liabilities, revenues and expenses of less than 100% owned entities that we control. Accordingly, we have recorded noncontrolling interests in the earnings and equity of such entities. |
Reclassifications | Certain prior year amounts have been reclassified to conform to the 2020 presentation. |
Earning 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 stock options, SARs, RSUs and PSUs, computed using the treasury stock method. |
Fair Value Measurements and Disclosures | Accounting Standards Codification 820, Fair Value Measurements and Disclosures 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. |
Cash Traded Investments | Cash Traded Investments Our cash traded investments 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 Instruments We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments. |
Interest Rate Swaps [Member] | |
Financial Instruments | Interest Rate Swap Agreements We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between us and our counterparties based on common notional principal amounts and maturity dates. Pay-fixed |
Accounting Policies (Tables)
Accounting Policies (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
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 years ended December 31, are summarized in the following table (dollars in millions): Years Ended December 31, 2020 Ratio 2019 Ratio 2018 Ratio Medicare $ 10,420 20.2 % $ 10,798 21.0 % $ 9,831 21.1 % Managed Medicare 6,997 13.6 6,452 12.6 5,497 11.8 Medicaid 1,965 3.8 1,572 3.1 1,358 2.9 Managed Medicaid 2,621 5.1 2,450 4.8 2,403 5.1 Managed care and other insurers 26,535 51.5 26,544 51.6 24,467 52.4 International (managed care and other insurers) 1,120 2.2 1,162 2.3 1,156 2.5 Other 1,875 3.6 2,358 4.6 1,965 4.2 Revenues $ 51,533 100.0 % $ 51,336 100.0 % $ 46,677 100.0 % |
Schedule of Estimated Cost of Uncompensated Care | A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions): 2020 2019 2018 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 44,271 $ 44,118 $ 40,035 Cost-to-charges 12.0 % 12.0 % 12.4 % Total uncompensated care $ 29,029 $ 31,105 $ 26,757 Multiply by the cost-to-charges 12.0 % 12.0 % 12.4 % Estimated cost of total uncompensated care $ 3,483 $ 3,733 $ 3,318 |
Share-Based Compensation (Table
Share-Based Compensation (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Disclosure of Compensation Related Costs, Share-based Payments [Abstract] | |
Schedule of Fair Value of Each Stock Option Award is Estimated on Grant Date, Using Option Valuation Models | The expected dividend yield is estimated based on the assumption that the dividend yield at date of grant will be maintained over the expected life of the grant. 2020 2019 2018 Risk-free interest rate 1.44 % 2.50 % 2.62 % Expected volatility 27 % 27 % 29 % Expected life, in years 6.15 6.18 6.15 Expected dividend yield 1.19 % 1.16 % 1.37 % |
Schedule of Stock Option Activity | Information regarding Time Stock Options and SARs and Performance Stock Options and SARs activity during 2020, 2019 and 2018 is summarized below (share amounts in thousands): Time Performance Total Weighted Weighted Aggregate Options and SARs outstanding, December 31, 2017 11,156 4,586 15,742 $ 43.47 Granted 2,342 — 2,342 101.96 Exercised (3,917 ) (1,774 ) (5,691 ) 27.86 Cancelled (221 ) (145 ) (366 ) 68.43 Options and SARs outstanding, December 31, 2018 9,360 2,667 12,027 61.49 Granted 1,349 — 1,349 138.31 Exercised (1,137 ) (523 ) (1,660 ) 44.45 Cancelled (522 ) — (522 ) 93.26 Options and SARs outstanding, December 31, 2019 9,050 2,144 11,194 71.79 Granted 1,120 — 1,120 144.47 Exercised (2,159 ) (1,325 ) (3,484 ) 44.07 Cancelled (175 ) — (175 ) 111.69 Options and SARs outstanding, December 31, 2020 7,836 819 8,655 $ 91.53 6.0 years $ 631 Options and SARs exercisable, December 31, 2020 4,562 819 5,381 $ 71.25 4.8 years $ 502 |
Schedule of Restricted Stock Units Activity | Stock Option, SAR, RSU and PSU Activity – All Plans (continued) Information regarding Time RSUs, Performance RSUs and PSUs activity during 2020, 2019 and 2018 is summarized below (share amounts in thousands): Time RSUs Performance PSUs Total RSUs Weighted RSUs and PSUs outstanding, December 31, 2017 3,465 227 3,562 7,254 $ 72.05 Granted 1,464 — 1,261 2,725 101.85 Performance adjustment — — 1,250 1,250 69.27 Vested (1,487 ) (136 ) (2,500 ) (4,123 ) 67.33 Cancelled (319 ) (91 ) (151 ) (561 ) 78.82 RSUs and PSUs outstanding, December 31, 2018 3,123 — 3,422 6,545 86.32 Granted 973 — 796 1,769 138.45 Performance adjustment — — 227 227 69.94 Vested (1,216 ) — (1,251 ) (2,467 ) 75.97 Cancelled (260 ) — (159 ) (419 ) 103.27 RSUs and PSUs outstanding, December 31, 2019 2,620 — 3,035 5,655 105.23 Granted 1,048 — 808 1,856 144.17 Performance adjustment — — 206 206 81.89 Vested (1,030 ) — (1,364 ) (2,394 ) 88.63 Cancelled (162 ) — (93 ) (255 ) 124.50 RSUs and PSUs outstanding, December 31, 2020 2,476 — 2,592 5,068 $ 125.40 |
Income Taxes (Tables)
Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Income Tax Disclosure [Abstract] | |
Schedule of Provision for Income Taxes | The provision for income taxes consists of the following (dollars in millions): 2020 2019 2018 Current: Federal $ 1,021 $ 670 $ 759 State 126 134 149 Foreign 5 17 23 Deferred: Federal (73 ) 254 9 State (39 ) 29 13 Foreign 3 (5 ) (7 ) $ 1,043 $ 1,099 $ 946 |
Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate | A reconciliation of the federal statutory rate to the effective income tax rate follows: 2020 2019 2018 Federal statutory rate 21.0 % 21.0 % 21.0 % State income taxes, net of federal tax benefit 1.9 2.7 2.9 Change in liability for uncertain tax positions (0.2 ) 0.4 (0.1 ) Tax benefit from settlements of employee equity awards (1.8 ) (1.3 ) (2.4 ) Impact of Tax Act on deferred tax balances — — (1.6 ) Other items, net 0.8 1.1 0.2 Effective income tax rate on income attributable to HCA Healthcare, Inc. 21.7 23.9 20.0 Income attributable to noncontrolling interests from consolidated partnerships (2.5 ) (2.9 ) (2.3 ) Effective income tax rate on income before income taxes 19.2 % 21.0 % 17.7 % |
Schedule of Deferred Tax Assets and Liabilities | A summary of the items comprising the deferred tax assets and liabilities at December 31 follows (dollars in millions): 2020 2019 Assets Liabilities Assets Liabilities Depreciation and fixed asset basis differences $ — $ 678 $ — $ 601 Allowances for professional liability and other risks 407 — 376 — Accounts receivable 283 — 307 — Compensation 487 — 292 — Right-of-use 416 409 369 366 Other 485 606 461 538 $ 2,078 $ 1,693 $ 1,805 $ 1,505 |
Schedule of Activity Related to Unrecognized Tax Benefits | The following table summarizes the activity related to our unrecognized tax benefits (dollars in millions): 2020 2019 Balance at January 1 $ 522 $ 390 Additions (reductions) based on tax positions related to the current year (3 ) 29 Additions for tax positions of prior years 13 119 Reductions for tax positions of prior years (30 ) (3 ) Settlements (22 ) — Lapse of applicable statutes of limitations (11 ) (13 ) Balance at December 31 $ 469 $ 522 |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Earnings Per Share [Abstract] | |
Schedule of Computations of Basic and Diluted Earnings Per Share | 2020 2019 2018 Net income attributable to HCA Healthcare, Inc. $ 3,754 $ 3,505 $ 3,787 Weighted average common shares outstanding 338.274 341.210 347.297 Effect of dilutive incremental shares 5.331 7.016 8.006 Shares used for diluted earnings per share 343.605 348.226 355.303 Earnings per share: Basic earnings per share $ 11.10 $ 10.27 $ 10.90 Diluted earnings per share $ 10.93 $ 10.07 $ 10.66 |
Investments of Insurance Subs_2
Investments of Insurance Subsidiaries (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | A summary of the insurance subsidiaries’ investments at December 31 follows (dollars in millions): 2020 Amortized Unrealized Fair Gains Losses Debt securities $ 384 $ 32 $ — $ 416 Money market funds and other 88 — — 88 $ 472 $ 32 $ — 504 Amounts classified as current assets (116 ) Investment carrying value $ 388 2019 Amortized Unrealized Fair Gains Losses Debt securities $ 359 $ 18 $ — $ 377 Money market funds and other 85 — — 85 $ 444 $ 18 $ — 462 Amounts classified as current assets (147 ) Investment carrying value $ 315 |
Schedule of Maturities of Investments | Scheduled maturities of investments in debt securities at December 31, 2020 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 4 $ 4 Due after one year through five years 147 156 Due after five years through ten years 157 174 Due after ten years 76 82 $ 384 $ 416 |
Financial Instruments (Tables)
Financial Instruments (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
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 agreements, which have been designated as cash flow hedges, at December 31, 2020 (dollars in millions): Notional Maturity Date Fair Pay-fixed $ 2,000 December 2021 $ (27 ) Pay-fixed 500 December 2022 (19 ) |
Effect of Interest Rate on Results of Operations | The following table presents the effect of our interest rate swaps on our results of operations for the year ended December 31, 2020 (dollars in millions): Derivatives in Cash Flow Hedging Amount of Loss Location of Loss Amount of Loss Interest rate swaps $ 51 Interest expense $ 24 |
Assets and Liabilities Measur_2
Assets and Liabilities Measured at Fair Value (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Fair Value Disclosures [Abstract] | |
Schedule of Assets 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 December 31, 2020 and 2019, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): December 31, 2020 Fair Value Fair Value Measurements Using Quoted Prices in Significant Significant Assets: Investments of insurance subsidiaries: Debt securities $ 416 $ — $ 416 $ — Money market funds and other 88 88 — — Investments of insurance subsidiaries 504 88 416 — Less amounts classified as current assets (116 ) (87 ) (29 ) — $ 388 1 $ 387 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 46 $ — $ 46 $ — December 31, 2019 Fair Value Fair Value Measurements Using Quoted Prices in Significant Significant Assets: Investments of insurance subsidiaries: Debt securities $ 377 $ — $ 377 $ — Money market funds and other 85 85 — — Investments of insurance subsidiaries 462 85 377 — Less amounts classified as current assets (147 ) (83 ) (64 ) — $ 315 2 $ 313 $ — Interest rate swaps (Other) $ 3 $ — $ 3 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 7 $ — $ 7 $ — |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | A summary of long-term debt at December 31, including related interest rates at December 31, 2020, follows (dollars in millions): 2020 2019 Senior secured asset-based revolving credit facility $ — $ 2,480 Senior secured revolving credit facility — — Senior secured 364-day — — Senior secured term loan facilities (effective interest rate of 2.8%) 3,671 3,725 Senior secured notes (effective interest rate of 5.1%) 13,850 13,850 Other senior secured debt (effective interest rate of 4.7%) 767 654 Senior secured debt 18,288 20,709 Senior unsecured notes (effective interest rate of 5.5%) 12,952 13,252 Net debt issuance costs (236 ) (239 ) Total debt (average life of 8.9 years, rates averaging 5.0%) 31,004 33,722 Less amounts due within one year 209 145 $ 30,795 $ 33,577 |
Leases (Tables)
Leases (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Leases [Abstract] | |
Schedule of lease-related assets and liabilities | The following table presents our lease-related assets and liabilities at December 31, 2020 and 2019 (dollars in millions): Balance Sheet Classification 2020 2019 Assets: Operating leases Right-of-use operating lease assets $ 2,024 $ 1,834 Finance leases Property and equipment 553 520 Total lease assets $ 2,577 $ 2,354 Liabilities: Current: Operating leases Other accrued expenses $ 379 $ 350 Finance leases Long-term debt due within one year 128 87 Noncurrent: Operating leases Right-of-use operating lease obligations 1,673 1,499 Finance leases Long-term debt 494 470 Total lease liabilities $ 2,674 $ 2,406 Weighted-average remaining term: Operating leases 10.4 years 10.8 years Finance leases 11.5 years 12.0 years Weighted-average discount rate: Operating leases 4.8 % 5.3 % Finance leases 5.4 % 6.0 % |
Schedule of lease expense for finance and operating leases | The following table presents certain information related to lease expense for finance and operating leases for the years ended December 31, 2020 and 2019 (dollars in millions): 2020 2019 Finance lease expense: Depreciation and amortization $ 106 $ 93 Interest 31 32 Operating leases( 1 ) 447 389 Short-term lease expense( 1 322 316 Variable lease expense( 1 154 150 $ 1,060 $ 980 ( 1 ) Expenses are included in “other operating expenses” in our consolidated income statements. |
Schedule of supplemental cash flow information | The following table presents supplemental cash flow information for the years ended December 31, 2020 and 2019 (dollars in millions): 2020 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 445 $ 404 Operating cash flows for finance leases 31 32 Financing cash flows for finance leases 86 79 |
Schedule of undiscounted cash flows to the finance lease liabilities and operating lease liabilities recorded on balance sheet | The following table reconciles the undiscounted minimum lease payment amounts to the operating and finance lease liabilities recorded on the balance sheet at December 31, 2020 and 2019 (dollars in millions): 2020 2019 Operating Finance Operating Finance Year 1 $ 431 $ 155 $ 411 $ 110 Year 2 366 125 350 105 Year 3 307 81 285 99 Year 4 255 82 228 58 Year 5 207 51 182 60 Thereafter 1,136 353 1,074 368 Total minimum lease payments 2,702 847 2,530 800 Less: amount of lease payments representing interest (650 ) (225 ) (681 ) (243 ) Present value of future minimum lease payments 2,052 622 1,849 557 Less: current lease obligations (379 ) (128 ) (350 ) (87 ) Long-term lease obligations $ 1,673 $ 494 $ 1,499 $ 470 |
Segment and Geographic Inform_2
Segment and Geographic Information (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
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, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions): For the Years Ended December 31, 2020 2019 2018 Revenues: National Group $ 25,694 $ 25,913 $ 22,581 American Group 23,593 23,173 21,959 Corporate and other 2,246 2,250 2,137 $ 51,533 $ 51,336 $ 46,677 Equity in earnings of affiliates: National Group $ (28 ) $ (2 ) $ (4 ) American Group (42 ) (44 ) (40 ) Corporate and other 16 3 15 $ (54 ) $ (43 ) $ (29 ) Adjusted segment EBITDA: National Group $ 5,532 $ 5,634 $ 4,980 American Group 5,333 4,904 4,593 Corporate and other (828 ) (681 ) (624 ) $ 10,037 $ 9,857 $ 8,949 Depreciation and amortization: National Group $ 1,216 $ 1,161 $ 946 American Group 1,164 1,117 1,027 Corporate and other 341 318 305 $ 2,721 $ 2,596 $ 2,278 For the Years Ended December 31, 2020 2019 2018 Adjusted segment EBITDA $ 10,037 $ 9,857 $ 8,949 Depreciation and amortization 2,721 2,596 2,278 Interest expense 1,584 1,824 1,755 Losses (gains) on sales of facilities 7 (18 ) (428 ) Losses on retirement of debt 295 211 9 Income before income taxes $ 5,430 $ 5,244 $ 5,335 December 31, 2020 2019 2018 Assets: National Group $ 18,913 $ 18,290 $ 14,839 American Group 20,760 20,608 19,122 Corporate and other 7,817 6,160 5,246 $ 47,490 $ 45,058 $ 39,207 National American Corporate Total Goodwill and other intangible assets: Balance at December 31, 2017 $ 1,474 $ 5,265 $ 655 $ 7,394 Acquisitions 132 504 — 636 Foreign currency translation, amortization and other (9 ) (40 ) (28 ) (77 ) Balance at December 31, 2018 1,597 5,729 627 7,953 Acquisitions 155 39 138 332 Foreign currency translation, amortization and other (13 ) (3 ) — (16 ) Balance at December 31, 2019 1,739 5,765 765 8,269 Acquisitions 38 27 279 344 Foreign currency translation, amortization and other (2 ) (17 ) (16 ) (35 ) Balance at December 31, 2020 $ 1,775 $ 5,775 $ 1,028 $ 8,578 |
Other Comprehensive Loss (Table
Other Comprehensive Loss (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Equity [Abstract] | |
Components of Accumulated Other Comprehensive Loss | The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized for-Sale Foreign Defined Change Total Balances at December 31, 2017 $ 7 $ (149 ) $ (168 ) $ 32 $ (278 ) Unrealized losses on available-for-sale income tax benefit (5 ) — — — (5 ) Foreign currency translation adjustments, net of $8 income tax benefit — (63 ) — — (63 ) Defined benefit plans, net of $10 of income taxes — — 34 — 34 Change in fair value of derivative instruments, net of $5 of income taxes — — — 18 18 Expense (income) reclassified into operations from other comprehensive income, net of $5 income tax benefit and $2 of income taxes, respectively — — 16 (8 ) 8 Reclassification of stranded tax effects 1 (71 ) (30 ) 5 (95 ) Balances at December 31, 2018 3 (283 ) (148 ) 47 (381 ) Unrealized gains on available-for-sale income taxes 11 — — — 11 Foreign currency translation adjustments, net of $5 of income taxes — — — — — Defined benefit plans, net of $14 income tax benefit — — (49 ) — (49 ) Change in fair value of derivative instruments, net of $13 income tax benefit — — — (37 ) (37 ) Expense (income) reclassified into operations from other comprehensive income, net of $3 income tax benefit and $3 of income taxes, respectively — — 10 (14 ) (4 ) Balances at December 31, 2019 14 (283 ) (187 ) (4 ) (460 ) Unrealized gains on available-for-sale income taxes 11 — — — 11 Foreign currency translation adjustments, net of $6 of income taxes — 12 — — 12 Defined benefit plans, net of $16 income tax benefit — — (55 ) — (55 ) Change in fair value of derivative instruments, net of $15 income tax benefit — — — (51 ) (51 ) Expense reclassified into operations from other comprehensive income, net of $6 and $5 income tax benefits, respectively — — 22 19 41 Balances at December 31, 2020 $ 25 $ (271 ) $ (220 ) $ (36 ) $ (502 ) |
Accrued Expenses (Tables)
Accrued Expenses (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Text Block [Abstract] | |
Summary of Other Accrued Expenses | A summary of other accrued expenses at December 31 follows (dollars in millions): 2020 2019 Professional liability risks $ 477 $ 457 Defined contribution benefit plan 547 528 Right-of-use operating lease 379 350 Taxes other than income 343 325 Interest 315 368 Government stimulus refund liability 83 — Other 1,096 904 $ 3,240 $ 2,932 |
Accounting Policies - Additiona
Accounting Policies - Additional Information (Detail) $ in Thousands | 1 Months Ended | 3 Months Ended | 12 Months Ended | ||
Nov. 30, 2017 | Dec. 31, 2020USD ($)ClaimStateSurgery_CenterEndoscopy_CenterHospital | Dec. 31, 2020USD ($)ClaimStateSurgery_CenterEndoscopy_CenterHospital | Dec. 31, 2019USD ($)Claim | Dec. 31, 2018USD ($) | |
Summary Of Significant Accounting Policies [Line Items] | |||||
Number of owned and operated hospitals | Hospital | 185 | 185 | |||
Number of freestanding surgery centers | Surgery_Center | 121 | 121 | |||
Number of freestanding endoscopy centers | Endoscopy_Center | 21 | 21 | |||
Number of facilities locations | State | 20 | 20 | |||
General and administrative expense | $ 416,000 | $ 370,000 | $ 344,000 | ||
Adjustments to estimated reimbursement filed during respective year | 70,000 | 51,000 | 29,000 | ||
Adjustments to estimated reimbursement filed during previous years | (5,000) | 13,000 | 51,000 | ||
Estimated implicit price concessions recorded as reductions to revenues and accounts receivable | 6,108,000 | 6,953,000 | |||
Charity care amount | 13,763,000 | 13,260,000 | 8,611,000 | ||
Estimated costs of charity care | 1,652 | 1,591 | $ 1,068,000 | ||
Outstanding checks unpresented for payment | $ 495,000 | $ 495,000 | $ 486,000 | ||
Days revenues in accounts receivable | 45 days | 50 days | 51 days | ||
Depreciation expense | $ 2,693,000 | $ 2,579,000 | $ 2,262,000 | ||
Goodwill impairments | 0 | 0 | 0 | ||
Goodwill acquired during period | 279,000 | 332,000 | |||
Intangible assets decreased | 26,000 | 12,000 | |||
Gross carrying amount of intangible assets | 249,000 | 184,000 | |||
Accumulated amortization of intangible assets | 149,000 | 149,000 | 123,000 | ||
Gross carrying amount of indefinite-lived intangible assets | 269,000 | 269,000 | 269,000 | ||
Deferred loan costs | 411,000 | 411,000 | 413,000 | ||
Deferred loan costs, accumulated amortization | 175,000 | 175,000 | 174,000 | ||
Amortization of debt issuance costs | 30,000 | 30,000 | 31,000 | ||
Reserves for professional liability risks | 1,963,000 | 1,963,000 | 1,827,000 | ||
Current portion of professional liability risks reserves | $ 477,000 | 477,000 | 457,000 | ||
Provisions for losses related to professional liability risks | 435,000 | 497,000 | 447,000 | ||
Decrease in provision for professional liability risks | $ 112,000 | $ 50,000 | 70,000 | ||
Reserves for professional liability risks cover individual claims | Claim | 2,300 | 2,300 | 2,300 | ||
Net payments of professional and general liability claims | $ 292,000 | $ 408,000 | |||
Self-insured retention amount per occurrence | 15,000 | ||||
Maximum amount losses per occurrence | $ 50,000 | ||||
Reinsurance for professional liability risks retention minimum level of amount per occurrence | 25,000 | ||||
Reinsurance for professional liability risks retention level of amount per occurrence | 35,000 | ||||
Amounts receivable under reinsurance contracts recorded in other assets | $ 31,000 | 31,000 | 37,000 | ||
Amounts receivable under reinsurance contracts recorded in other current assets | 8,000 | 8,000 | 9,000 | ||
Government stimulus refund liability | 83,000 | 83,000 | |||
Increase decrease in accounts receivable | $ 329,000 | ||||
Percentage increase in fourth quarter revenues per day | 5.70% | ||||
CARES Act Provider Relief Fund [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Accelerated Medicare payments received | $ 4,400,000 | ||||
General and targeted distributions recived | 1,800,000 | ||||
Deferred social security taxes | 688,000 | 688,000 | |||
Employee retention payroll tax credits | 60,000 | ||||
Repayments of provider relief funds | 6,100,000 | ||||
Government stimulus refund liability | $ 83,000 | 83,000 | |||
Foreign Currency Translation And Other [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Goodwill increase (decrease) | $ 9,000 | $ 4,000 | |||
Insurance Subsidiary [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Insurance subsidiary ownership percentage | 100.00% | ||||
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 | ||||
Maximum [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Percentage of income of federal poverty level eligible for charity care | 400.00% | ||||
Finite lived intangible asset useful life | 10 years | ||||
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 | ||||
Maximum [Member] | Building and Improvements [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Estimated useful lives in years | 40 years | ||||
Maximum [Member] | Equipment [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Estimated useful lives in years | 10 years | ||||
Minimum [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Finite lived intangible asset useful life | 3 years | ||||
Minimum [Member] | Building and Improvements [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Estimated useful lives in years | 10 years | ||||
Minimum [Member] | Equipment [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Estimated useful lives in years | 4 years |
Accounting Policies - Schedule
Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 51,533 | $ 51,336 | $ 46,677 |
Revenues ratio from third party payers | 100.00% | 100.00% | 100.00% |
Medicare [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 10,420 | $ 10,798 | $ 9,831 |
Revenues from third party payers, Ratio | 20.20% | 21.00% | 21.10% |
Managed Medicare [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 6,997 | $ 6,452 | $ 5,497 |
Revenues from third party payers, Ratio | 13.60% | 12.60% | 11.80% |
Medicaid [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 1,965 | $ 1,572 | $ 1,358 |
Revenues from third party payers, Ratio | 3.80% | 3.10% | 2.90% |
Managed Medicaid [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 2,621 | $ 2,450 | $ 2,403 |
Revenues from third party payers, Ratio | 5.10% | 4.80% | 5.10% |
Managed Care and Other Insurers [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 26,535 | $ 26,544 | $ 24,467 |
Revenues from third party payers, Ratio | 51.50% | 51.60% | 52.40% |
International (Managed Care and Other Insurers) [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 1,120 | $ 1,162 | $ 1,156 |
Revenues from third party payers, Ratio | 2.20% | 2.30% | 2.50% |
Product and Service, Other [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 1,875 | $ 2,358 | $ 1,965 |
Other, Ratio | 3.60% | 4.60% | 4.20% |
Accounting Policies - Schedul_2
Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Accounting Policies [Abstract] | |||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | $ 44,271 | $ 44,118 | $ 40,035 |
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) | 12.00% | 12.00% | 12.40% |
Total uncompensated care | $ 29,029 | $ 31,105 | $ 26,757 |
Multiply by the cost-to-charges ratio | 12.00% | 12.00% | 12.40% |
Estimated cost of total uncompensated care | $ 3,483 | $ 3,733 | $ 3,318 |
Share-Based Compensation - Addi
Share-Based Compensation - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Weighted Average Fair Value of Stock Options Granted | $ 35.98 | $ 38.21 | $ 28.90 |
Total Intrinsic Value of Stock Options | $ 328 | $ 153 | $ 456 |
Unrecognized Compensation Cost Related to Nonvested Awards | $ 53 | ||
Employee Stock Purchase Plan ("ESPP") [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Common stock were reserved for issuance | 5,865,000 | ||
Compensation expense | $ 13 | 12 | 10 |
Stock Appreciation Rights (SARs) [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Shares Available for Future Grants | 20,274,000 | ||
Restricted Stock Units and Performance Stock Units [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs, Vested, value | $ 349 | $ 346 | $ 413 |
Unrecognized Compensation Cost Related to Nonvested Awards | $ 330 |
Share-Based Compensation - Sche
Share-Based Compensation - Schedule of Fair Value of Each Stock Option Award is Estimated on Grant Date, Using Option Valuation Models (Detail) | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Disclosure of Compensation Related Costs, Share-based Payments [Abstract] | |||
Risk-free interest rate | 1.44% | 2.50% | 2.62% |
Expected volatility | 27.00% | 27.00% | 29.00% |
Expected life, in years | 6 years 1 month 24 days | 6 years 2 months 4 days | 6 years 1 month 24 days |
Expected dividend yield | 1.19% | 1.16% | 1.37% |
Share-Based Compensation - Sc_2
Share-Based Compensation - Schedule of Stock Option Activity (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Stock Options outstanding, Weighted Average Exercise Price, Beginning Balance | $ 71.79 | $ 61.49 | $ 43.47 |
Granted, Weighted Average Exercise Price | 144.47 | 138.31 | 101.96 |
Exercised, Weighted Average Exercise Price | 44.07 | 44.45 | 27.86 |
Cancelled, Weighted Average Exercise Price | 111.69 | 93.26 | 68.43 |
Stock Options outstanding, Weighted Average Exercise Price, Ending Balance | 91.53 | $ 71.79 | $ 61.49 |
Options exercisable, Weighted Average Exercise Price | $ 71.25 | ||
Options outstanding, Weighted Average Remaining Contractual Term | 6 years | ||
Options exercisable, Weighted Average Remaining Contractual Term | 4 years 9 months 18 days | ||
Options outstanding, Aggregate Intrinsic Value | $ 631 | ||
Options exercisable, Aggregate Intrinsic Value | $ 502 | ||
Time Based Stock Options and SARs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Stock Options Outstanding, Beginning Balance | 9,050 | 9,360 | 11,156 |
Granted, Stock Options | 1,120 | 1,349 | 2,342 |
Exercised, Stock Options | (2,159) | (1,137) | (3,917) |
Cancelled, Stock Options | (175) | (522) | (221) |
Stock Options Outstanding, Ending Balance | 7,836 | 9,050 | 9,360 |
Stock Options Exercisable, Ending Balance | 4,562 | ||
Performance Stock Options and SARs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Stock Options Outstanding, Beginning Balance | 2,144 | 2,667 | 4,586 |
Exercised, Stock Options | (1,325) | (523) | (1,774) |
Cancelled, Stock Options | (145) | ||
Stock Options Outstanding, Ending Balance | 819 | 2,144 | 2,667 |
Stock Options Exercisable, Ending Balance | 819 | ||
Total Stock Options and Stock SARs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Stock Options Outstanding, Beginning Balance | 11,194 | 12,027 | 15,742 |
Granted, Stock Options | 1,120 | 1,349 | 2,342 |
Exercised, Stock Options | (3,484) | (1,660) | (5,691) |
Cancelled, Stock Options | (175) | (522) | (366) |
Stock Options Outstanding, Ending Balance | 8,655 | 11,194 | 12,027 |
Stock Options Exercisable, Ending Balance | 5,381 |
Share-Based Compensation - Sc_3
Share-Based Compensation - Schedule of Restricted Stock Units Activity (Detail) - $ / shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Restricted Stock Units and Performance Stock Units [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs Outstanding, Beginning Balance | 5,655 | 6,545 | 7,254 |
RSUs and PSUs, Granted | 1,856 | 1,769 | 2,725 |
Performance adjustment | 206 | 227 | 1,250 |
RSUs and PSUs, Vested | (2,394) | (2,467) | (4,123) |
RSUs and PSUs, Cancelled | (255) | (419) | (561) |
RSUs and PSUs Outstanding, Ending Balance | 5,068 | 5,655 | 6,545 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Beginning balance | $ 105.23 | $ 86.32 | $ 72.05 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Granted | 144.17 | 138.45 | 101.85 |
Performance adjustment | 81.89 | 69.94 | 69.27 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Vested | 88.63 | 75.97 | 67.33 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Cancelled | 124.50 | 103.27 | 78.82 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Ending balance | $ 125.40 | $ 105.23 | $ 86.32 |
Restricted Stock Units and Performance Stock Units [Member] | Time Based Stock Options and SARs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs Outstanding, Beginning Balance | 2,620 | 3,123 | 3,465 |
RSUs and PSUs, Granted | 1,048 | 973 | 1,464 |
RSUs and PSUs, Vested | (1,030) | (1,216) | (1,487) |
RSUs and PSUs, Cancelled | (162) | (260) | (319) |
RSUs and PSUs Outstanding, Ending Balance | 2,476 | 2,620 | 3,123 |
Restricted Stock Units and Performance Stock Units [Member] | Performance Based Stock Options and RSUs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs Outstanding, Beginning Balance | 227 | ||
RSUs and PSUs, Vested | (136) | ||
RSUs and PSUs, Cancelled | (91) | ||
Performance Shares PSUs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs Outstanding, Beginning Balance | 3,035 | 3,422 | 3,562 |
RSUs and PSUs, Granted | 808 | 796 | 1,261 |
Performance adjustment | 206 | 227 | 1,250 |
RSUs and PSUs, Vested | (1,364) | (1,251) | (2,500) |
RSUs and PSUs, Cancelled | (93) | (159) | (151) |
RSUs and PSUs Outstanding, Ending Balance | 2,592 | 3,035 | 3,422 |
Acquisitions and Dispositions -
Acquisitions and Dispositions - Additional Information (Detail) $ in Millions | 12 Months Ended | ||
Dec. 31, 2020USD ($)Hospital | Dec. 31, 2019USD ($)Hospital | Dec. 31, 2018USD ($)Hospital | |
Business Acquisition [Line Items] | |||
Number of hospitals purchased | Hospital | 1 | 7 | 2 |
Proceeds from sale of business | $ 68 | $ 61 | $ 808 |
Real Estate and Other Investments [Member] | |||
Business Acquisition [Line Items] | |||
Pretax gain (loss) before tax | 75 | ||
Pretax gain (loss) after tax | 59 | ||
Proceeds from sale of business | 50 | ||
Discontinued Operations, Disposed of by Sale [Member] | Oklahoma [Member] | |||
Business Acquisition [Line Items] | |||
Pretax gain (loss) before tax | 353 | ||
Pretax gain (loss) after tax | 265 | ||
Proceeds from sale of business | $ 758 | ||
Number of hospitals sold | Hospital | 2 | ||
Discontinued Operations, Disposed of by Sale [Member] | Louisiana [Member] | |||
Business Acquisition [Line Items] | |||
Pretax gain (loss) before tax | 18 | ||
Pretax gain (loss) after tax | 13 | ||
Proceeds from sale of business | $ 61 | ||
Number of hospitals sold | Hospital | 1 | ||
Discontinued Operations, Disposed of by Sale [Member] | Mississippi [Member] | |||
Business Acquisition [Line Items] | |||
Pretax gain (loss) before tax | (7) | ||
Pretax gain (loss) after tax | (9) | ||
Proceeds from sale of business | $ 68 | ||
Number of hospitals sold | Hospital | 1 | ||
Hospitals [Member] | |||
Business Acquisition [Line Items] | |||
Aggregate purchase price | $ 1,384 | $ 792 | |
Nonhospital Health Care [Member] | |||
Business Acquisition [Line Items] | |||
Aggregate purchase price | 298 | 461 | |
Other [Member] | |||
Business Acquisition [Line Items] | |||
Goodwill | $ 279 | $ 332 | $ 636 |
Hospital and other nonhospital health care entities [Member] | |||
Business Acquisition [Line Items] | |||
Aggregate purchase price | $ 568 |
Income Taxes - Schedule of Prov
Income Taxes - Schedule of Provision for Income Taxes (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Income Tax Disclosure [Abstract] | |||
Current, Federal | $ 1,021 | $ 670 | $ 759 |
Current, State | 126 | 134 | 149 |
Current, Foreign | 5 | 17 | 23 |
Deferred, Federal | (73) | 254 | 9 |
Deferred, State | (39) | 29 | 13 |
Deferred, Foreign | 3 | (5) | (7) |
Provision for income taxes | $ 1,043 | $ 1,099 | $ 946 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Millions | 12 Months Ended | |||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | Dec. 31, 2017 | |
Income Tax Contingency [Line Items] | ||||
Provisional amount related to remeasurement of deferred tax assets and liabilities, recorded as a component of provision for income taxes | $ 67 | |||
Effective tax rate | 21.00% | 21.00% | 21.00% | 35.00% |
Reduction to provision for income taxes for tax credits | $ (28) | |||
Provision for tax benefits related to settlement of employee awards | $ 92 | $ 65 | 124 | |
Foreign pretax income | 9 | 50 | $ 86 | |
State net operating loss carryforwards | 56 | |||
Federal net operating loss carryforwards | 127 | |||
Liability for unrecognized tax benefits | 508 | 550 | ||
Unrecognized tax benefits, accrued interest | 73 | 62 | ||
Unrecognized tax benefits that would impact effective tax rate | 157 | 160 | ||
Deferred tax assets, reductions | $ 34 | $ 34 | ||
State and Local Jurisdiction [Member] | Minimum [Member] | ||||
Income Tax Contingency [Line Items] | ||||
Net operating loss carryforwards, expiration date | 2023 | |||
State and Local Jurisdiction [Member] | Maximum [Member] | ||||
Income Tax Contingency [Line Items] | ||||
Net operating loss carryforwards, expiration date | 2039 |
Income Taxes - Schedule of Reco
Income Taxes - Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate (Detail) | 12 Months Ended | |||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | Dec. 31, 2017 | |
Income Tax Disclosure [Abstract] | ||||
Federal statutory rate | 21.00% | 21.00% | 21.00% | 35.00% |
State income taxes, net of federal tax benefit | 1.90% | 2.70% | 2.90% | |
Change in liability for uncertain tax positions | (0.20%) | 0.40% | (0.10%) | |
Tax benefit from settlements of employee equity awards | (1.80%) | (1.30%) | (2.40%) | |
Impact of Tax Act on deferred tax balances | (1.60%) | |||
Other items, net | 0.80% | 1.10% | 0.20% | |
Effective income tax rate on income attributable to HCA Healthcare, Inc. | 21.70% | 23.90% | 20.00% | |
Income attributable to noncontrolling interests from consolidated partnerships | (2.50%) | (2.90%) | (2.30%) | |
Effective income tax rate on income before income taxes | 19.20% | 21.00% | 17.70% |
Income Taxes - Schedule of Defe
Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Millions | Dec. 31, 2020 | Dec. 31, 2019 |
Income Tax Disclosure [Abstract] | ||
Depreciation and fixed asset basis differences, Assets | $ 0 | $ 0 |
Allowances for professional liability and other risks, Assets | 407 | 376 |
Accounts receivable, Assets | 283 | 307 |
Compensation, Assets | 487 | 292 |
Right-of-use lease obligations | 416 | 369 |
Other, Assets | 485 | 461 |
Deferred tax assets | 2,078 | 1,805 |
Depreciation and fixed asset basis differences, Liabilities | 678 | 601 |
Allowances for professional liability and other risks, Liabilities | 0 | 0 |
Accounts receivable, Liabilities | 0 | 0 |
Compensation, Liabilities | 0 | 0 |
Right-of-use lease assets and obligations | 409 | 366 |
Other, Liabilities | 606 | 538 |
Deferred tax liabilities | $ 1,693 | $ 1,505 |
Income Taxes - Schedule of Acti
Income Taxes - Schedule of Activity Related to Unrecognized Tax Benefits (Detail) - USD ($) $ in Millions | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Income Tax Disclosure [Abstract] | ||
Beginning Balance | $ 522 | $ 390 |
Additions (reductions) based on tax positions related to the current year | (3) | 29 |
Additions for tax positions of prior years | 13 | 119 |
Reductions for tax positions of prior years | (30) | (3) |
Settlements | (22) | 0 |
Lapse of applicable statutes of limitations | (11) | (13) |
Ending Balance | $ 469 | $ 522 |
Earnings Per Share - Additional
Earnings Per Share - Additional information (Detail) - shares | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Earnings Per Share [Abstract] | |||
Common stock repurchased | 3,287,000 | 7,949,000 | 14,070,000 |
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 | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Earnings Per Share [Abstract] | |||
Net income attributable to HCA Healthcare, Inc. | $ 3,754 | $ 3,505 | $ 3,787 |
Weighted average common shares outstanding | 338,274 | 341,210 | 347,297 |
Effect of dilutive incremental shares | 5,331 | 7,016 | 8,006 |
Shares used for diluted earnings per share | 343,605 | 348,226 | 355,303 |
Basic earnings per share | $ 11.10 | $ 10.27 | $ 10.90 |
Diluted earnings per share | $ 10.93 | $ 10.07 | $ 10.66 |
Investments of Insurance Subs_3
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions | Dec. 31, 2020 | Dec. 31, 2019 |
Debt Securities, Available-for-sale [Line Items] | ||
Amounts classified as current assets | $ (116) | $ (147) |
Investment carrying value | 388 | 315 |
Amortized Cost | 472 | 444 |
Unrealized Amounts, Gains | 32 | 18 |
Fair Value | 504 | 462 |
Money Market Funds and Other [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 88 | 85 |
Fair Value | 88 | 85 |
Debt Securities [Member] | States and Municipalities [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 384 | 359 |
Unrealized Amounts, Gains | 32 | 18 |
Fair Value | $ 416 | $ 377 |
Investments of Insurance Subs_4
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions | Dec. 31, 2020USD ($) |
Investments, Debt and Equity Securities [Abstract] | |
Due in one year or less, Amortized Cost | $ 4 |
Due after one year through five years, Amortized Cost | 147 |
Due after five years through ten years, Amortized Cost | 157 |
Due after ten years, Amortized Cost | 76 |
Amortized Cost, Total | 384 |
Due in one year or less, Fair Value | 4 |
Due after one year through five years, Fair Value | 156 |
Due after five years through ten years, Fair Value | 174 |
Due after ten years, Fair Value | 82 |
Fair Value, Total | $ 416 |
Investments of Insurance Subs_5
Investments of Insurance Subsidiaries - Additional Information (Detail) | 12 Months Ended |
Dec. 31, 2020 | |
Investments, Debt and Equity Securities [Abstract] | |
Available for sale securities expected maturity of debt securities | 5 years 2 months 12 days |
Available for sale securities average scheduled maturity | 9 years 4 months 24 days |
Financial Instruments - Schedul
Financial Instruments - Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges (Detail) - Pay-Fixed Interest Rate Swaps [Member] $ in Millions | 12 Months Ended |
Dec. 31, 2020USD ($) | |
Maturity Date, 2021 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 2,000 |
Fair Value | $ (27) |
Maturity Date | 2021-12 |
Maturity Date, 2022 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 500 |
Fair Value | $ (19) |
Maturity Date | 2022-12 |
Financial Instruments - Additio
Financial Instruments - Additional Information (Detail) $ in Millions | 12 Months Ended |
Dec. 31, 2020USD ($) | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Estimated amount reclassified from other comprehensive income and reduce interest expense | $ 37 |
Estimated termination value | $ 46 |
Financial Instruments - Effect
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Derivative Instruments, Gain (Loss) [Line Items] | |||
Amount of Loss Recognized in OCI on Derivatives, Net of Tax | $ 51 | $ 37 | $ (18) |
Interest Rate Swaps [Member] | |||
Derivative Instruments, Gain (Loss) [Line Items] | |||
Amount of Loss Recognized in OCI on Derivatives, Net of Tax | 51 | ||
Interest Rate Swaps [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | |||
Derivative Instruments, Gain (Loss) [Line Items] | |||
Interest rate swaps | $ 24 |
Assets and Liabilities Measur_3
Assets and Liabilities Measured at Fair Value - Schedule of Assets Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Millions | Dec. 31, 2020 | Dec. 31, 2019 |
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | $ 504 | $ 462 |
Less amounts classified as current assets | (116) | (147) |
Investments of insurance subsidiaries, noncurrent | 388 | 315 |
Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Derivative Asset | 3 | |
Derivative Liability | 46 | 7 |
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 | 88 | 85 |
Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Securities, Available-for-sale Securities | 416 | 377 |
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 | 88 | 85 |
Less amounts classified as current assets | (87) | (83) |
Investments of insurance subsidiaries, noncurrent | 1 | 2 |
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 | 88 | 85 |
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 | 416 | 377 |
Less amounts classified as current assets | (29) | (64) |
Investments of insurance subsidiaries, noncurrent | 387 | 313 |
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 Asset | 3 | |
Derivative Liability | 46 | 7 |
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 | $ 416 | $ 377 |
Assets and Liabilities Measur_4
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions | Dec. 31, 2020 | Dec. 31, 2019 |
Fair Value Disclosures [Abstract] | ||
Estimated fair value of long-term debt | $ 35,814 | $ 37,026 |
Carrying amounts of long-term debt | $ 31,240 | $ 33,961 |
Long-Term Debt - Schedule of Lo
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($) $ in Millions | Dec. 31, 2020 | Dec. 31, 2019 |
Debt Instrument [Line Items] | ||
Senior secured debt | $ 18,288 | $ 20,709 |
Net debt issuance costs | (236) | (239) |
Total debt (average life of 8.9 years, rates averaging 5.0%) | 31,004 | 33,722 |
Less amounts due within one year | 209 | 145 |
Long-term debt | 30,795 | 33,577 |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 2,480 | |
Senior Secured Term Loan Facilities [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 3,671 | 3,725 |
Senior Secured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 13,850 | 13,850 |
Other Senior Secured Debt [Member] | ||
Debt Instrument [Line Items] | ||
Other senior secured debt | 767 | 654 |
Senior Unsecured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior unsecured notes | $ 12,952 | $ 13,252 |
Long-Term Debt - Schedule of _2
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) | 12 Months Ended |
Dec. 31, 2020 | |
Debt Instrument [Line Items] | |
Total debt average term | 8 years 10 months 24 days |
Total debt average rate | 5.00% |
Senior Secured Term Loan Facilities [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 2.80% |
Senior Secured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 5.10% |
Other Senior Secured Debt [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 4.70% |
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 ($) | 1 Months Ended | 12 Months Ended | |||
Mar. 31, 2020 | Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | Feb. 29, 2020 | |
Debt Instrument [Line Items] | |||||
Pretax loss on retirement of debt | $ 295,000,000 | $ 211,000,000 | $ 9,000,000 | ||
Capital leases and other secured debt | 767,000,000 | ||||
Maturity of long-term debt in 2022 | 233,000,000 | ||||
Maturity of long-term debt in 2023 | 2,799,000,000 | ||||
Maturity of long-term debt in 2024 | 3,163,000,000 | ||||
Maturity of long-term debt in 2025 | $ 5,872,000,000 | ||||
Minimum [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, maturities range | 2022 | ||||
Maximum [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, maturities range | 2025 | ||||
Interest Rate Swaps [Member] | |||||
Debt Instrument [Line Items] | |||||
Notional amount, total | $ 2,500,000,000 | ||||
Federal Fund Rate [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument basis spread | 0.50% | ||||
Asset-Based Revolving Credit Facility Maturing on June 28, 2022 [Member] | |||||
Debt Instrument [Line Items] | |||||
Maximum borrowing capacity | $ 3,750,000,000 | ||||
Debt instrument maturity date | Jun. 28, 2022 | ||||
Percentage of senior secured credit facility over eligible accounts receivable | 85.00% | ||||
Line of credit outstanding | $ 0 | ||||
Senior Secured Revolving Credit Facility Maturing On June 28, 2022 [Member] | |||||
Debt Instrument [Line Items] | |||||
Maximum borrowing capacity | $ 2,000,000,000 | ||||
Debt instrument maturity date | Jun. 28, 2022 | ||||
Line of credit outstanding | $ 0 | ||||
Senior Secured Term Loan A-6 Facility Maturing On July 16, 2024 [Member] | |||||
Debt Instrument [Line Items] | |||||
Maximum borrowing capacity | $ 1,078,000,000 | ||||
Debt instrument maturity date | Jul. 16, 2024 | ||||
Senior Secured Term Loan B-12 Facility Maturing On March 13, 2025 [Member] | |||||
Debt Instrument [Line Items] | |||||
Maximum borrowing capacity | $ 1,459,000,000 | ||||
Debt instrument maturity date | Mar. 13, 2025 | ||||
Senior Secured Term Loan B-13 Facility Maturing On March 18, 2026 [Member] | |||||
Debt Instrument [Line Items] | |||||
Maximum borrowing capacity | $ 1,134,000,000 | ||||
Debt instrument maturity date | Mar. 18, 2026 | ||||
Senior Secured Revolving Credit Facility Maturing On March 19, 2021 | |||||
Debt Instrument [Line Items] | |||||
Maximum borrowing capacity | $ 2,000,000,000 | ||||
Debt instrument maturity date | Mar. 18, 2021 | ||||
Line of credit outstanding | $ 0 | ||||
Senior Unsecured Note Maturities Ranging 2021 to 2033 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 12,091,000,000 | ||||
Senior Unsecured Note Maturities Ranging 2021 to 2033 [Member] | Minimum [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, maturities range | 2023 | ||||
Senior Unsecured Note Maturities Ranging 2021 to 2033 [Member] | Maximum [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, maturities range | 2033 | ||||
Senior Unsecured Note Maturity Year 2025 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 125,000,000 | ||||
Senior Unsecured Note Maturities Ranging 2023 to 2095 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 736,000,000 | ||||
Senior Unsecured Note Maturities Ranging 2023 to 2095 [Member] | Minimum [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, maturities range | 2023 | ||||
Senior Unsecured Note Maturities Ranging 2023 to 2095 [Member] | Maximum [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, maturities range | 2095 | ||||
Secured Debt [Member] | |||||
Debt Instrument [Line Items] | |||||
Pretax loss on retirement of debt | $ 295,000,000 | ||||
6.25% Senior Notes Due 2021 [Member] | |||||
Debt Instrument [Line Items] | |||||
Early Repayment of Senior Debt | $ 1,000,000,000 | ||||
Debt Instrument, Redemption Price, Percentage | 6.25% | ||||
7.50% Senior Notes Due 2022 [Member] | |||||
Debt Instrument [Line Items] | |||||
Early Repayment of Senior Debt | $ 2,000,000,000 | ||||
Debt Instrument, Redemption Price, Percentage | 7.50% | ||||
Senior Notes [Member] | Senior Secured Notes Due 2023 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 1,250,000,000 | ||||
Debt instrument, stated interest | 4.75% | ||||
Senior Notes [Member] | Senior Secured Notes Due 2024 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 2,000,000,000 | ||||
Debt instrument, stated interest | 5.00% | ||||
Senior Notes [Member] | Senior Secured Notes Due 2025 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 1,400,000,000 | ||||
Debt instrument, stated interest | 5.25% | ||||
Senior Notes [Member] | Senior Secured Notes Due 2026 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 1,500,000,000 | ||||
Debt instrument, stated interest | 5.25% | ||||
Senior Notes [Member] | Senior Secured Notes Due 2027 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 1,200,000,000 | ||||
Debt instrument, stated interest | 4.50% | ||||
Senior Notes [Member] | Senior Secured Notes Due 2029 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 2,000,000,000 | ||||
Debt instrument, stated interest | 4.125% | ||||
Senior Notes [Member] | Senior Secured Notes Due 2047 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 1,500,000,000 | ||||
Debt instrument, stated interest | 5.50% | ||||
Senior Notes [Member] | Senior Secured Notes Due 2049 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 2,000,000,000 | ||||
Debt instrument, stated interest | 5.25% | ||||
Senior Notes [Member] | 5.13% Senior Notes Due 2039 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 1,000,000,000 | ||||
Senior Unsecured Notes [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 2,700,000,000 | ||||
Debt instrument, stated interest | 3.50% | ||||
Senior Secured Three Six Four Day Term Loan Facility [Member] | |||||
Debt Instrument [Line Items] | |||||
Maximum borrowing capacity | $ 2,000,000,000 |
Leases - Schedule Of Lease-Rela
Leases - Schedule Of Lease-Related Assets And Liabilities (Detail) - USD ($) $ in Millions | Dec. 31, 2020 | Dec. 31, 2019 |
Assets: | ||
Operating leases | $ 2,024 | $ 1,834 |
Finance leases | 553 | 520 |
Total lease assets | 2,577 | 2,354 |
Liabilities | ||
Operating leases | 379 | 350 |
Finance leases | 128 | 87 |
Operating leases | 1,673 | 1,499 |
Finance leases | 494 | 470 |
Total lease liabilities | $ 2,674 | $ 2,406 |
Weighted-average remaining term: | ||
Operating leases | 10 years 4 months 24 days | 10 years 9 months 18 days |
Finance leases | 11 years 6 months | 12 years |
Weighted-average discount rate: | ||
Operating leases | 4.80% | 5.30% |
Finance leases | 5.40% | 6.00% |
Leases - Schedule Of Lease Expe
Leases - Schedule Of Lease Expense For Finance And Operating Leases (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | ||
Finance lease expense: | |||
Depreciation and amortization | $ 106 | $ 93 | |
Interest | 31 | 32 | |
Operating leases | [1] | 447 | 389 |
Short-term lease expense | [1] | 322 | 316 |
Variable lease expense | [1] | 154 | 150 |
Total lease expense | $ 1,060 | $ 980 | |
[1] | Expenses are included in “other operating expenses” in our consolidated income statements. |
Leases - Schedule Of Supplement
Leases - Schedule Of Supplemental Cash Flow Information (Detail) - USD ($) $ in Millions | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Cash Paid For Amounts Included In Measurement Of Lease Liabilities [Abstract] | ||
Operating cash flows for operating leases | $ 445 | $ 404 |
Operating cash flows for finance leases | 31 | 32 |
Financing cash flows for finance leases | $ 86 | $ 79 |
Leases - Schedule of undiscount
Leases - Schedule of undiscounted cash flows to the finance lease liabilities and operating lease liabilities (Detail) - USD ($) $ in Millions | Dec. 31, 2020 | Dec. 31, 2019 |
Operating Lease Liabilities, Payments Due [Abstract] | ||
Year 1 | $ 431 | $ 411 |
Year 2 | 366 | 350 |
Year 3 | 307 | 285 |
Year 4 | 255 | 228 |
Year 5 | 207 | 182 |
Thereafter | 1,136 | 1,074 |
Total minimum lease payments | 2,702 | 2,530 |
Less: amount of lease payments representing interest | (650) | (681) |
Present value of future minimum lease payments | 2,052 | 1,849 |
Less: current obligations under leases | (379) | (350) |
Long-term lease obligations | 1,673 | 1,499 |
Finance Lease Liabilities, Payments, Due [Abstract] | ||
Year 1 | 155 | 110 |
Year 2 | 125 | 105 |
Year 3 | 81 | 99 |
Year 4 | 82 | 58 |
Year 5 | 51 | 60 |
Thereafter | 353 | 368 |
Total minimum lease payments | 847 | 800 |
Less: amount of lease payments representing interest | (225) | (243) |
Present value of future minimum lease payments | 622 | 557 |
Less: current obligations under leases | (128) | (87) |
Long-term lease obligations | $ 494 | $ 470 |
Capital Stock - Additional Info
Capital Stock - Additional Information (Detail) | 12 Months Ended | ||||||
Dec. 31, 2020USD ($)$ / sharesDirectorsshares | Dec. 31, 2019$ / sharesshares | Dec. 31, 2018$ / sharesshares | Feb. 01, 2021USD ($) | Jan. 31, 2020USD ($) | Jan. 31, 2019USD ($) | Oct. 31, 2017USD ($) | |
Capital Structure [Line Items] | |||||||
Common stock, shares authorized | shares | 1,800,000,000 | 1,800,000,000 | |||||
Repurchase of common stock, shares | shares | 3,287,000 | 7,949,000 | 14,070,000 | ||||
Repurchase price of common stock, per share | $ / shares | $ 134.18 | $ 129.71 | $ 108.74 | ||||
Share repurchase program authorized amount | $ 6,000,000,000 | $ 6,000,000,000 | $ 6,000,000,000 | ||||
Share repurchase program, remaining authorized repurchase amount | $ 2,800,000,000 | $ 2,000,000,000 | $ 2,000,000,000 | $ 2,000,000,000 | |||
Subsequent Event [Member] | |||||||
Capital Structure [Line Items] | |||||||
Share repurchase program authorized amount | $ 8,800,000,000 | ||||||
Share repurchase program, remaining authorized repurchase amount | 2,800,000,000 | ||||||
Stock repurchase program additional authorized amount | $ 6,000,000,000 | ||||||
Minimum [Member] | |||||||
Capital Structure [Line Items] | |||||||
Number of directors as per the amended and restated by-laws | Directors | 3 |
Employee Benefit Plans - Additi
Employee Benefit Plans - Additional Information (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Defined Contribution Benefit Plans [Member] | |||
Pension Plans, Postretirement and Other Employee Benefits [Line Items] | |||
Percentage of employer contribution to match participant contribution in defined contribution plan, net | 100.00% | ||
Cost of defined benefit plans | $ 552 | $ 532 | $ 499 |
Defined benefit plan cost | 8 | 11 | 9 |
Defined benefit plan obligation | $ 96 | 63 | |
Defined Contribution Benefit Plans [Member] | Minimum [Member] | |||
Pension Plans, Postretirement and Other Employee Benefits [Line Items] | |||
Percentage of employer contribution to match participant contribution in defined contribution plan | 3.00% | ||
Defined Contribution Benefit Plans [Member] | Maximum [Member] | |||
Pension Plans, Postretirement and Other Employee Benefits [Line Items] | |||
Percentage of employer contribution to match participant contribution in defined contribution plan | 9.00% | ||
Restoration Plan [Member] | |||
Pension Plans, Postretirement and Other Employee Benefits [Line Items] | |||
Number of hours of service required to qualify for the plan | 1,000 or more hours | ||
Noncontributory and nonqualified plan, benefit expense | $ 35 | 44 | 22 |
Noncontributory and nonqualified plan, accrued benefits liabilities | 242 | 227 | |
Supplemental Executive Retirement Plan [Member] | |||
Pension Plans, Postretirement and Other Employee Benefits [Line Items] | |||
Defined benefit plan cost | 24 | 19 | $ 26 |
Defined benefit plan obligation | $ 204 | $ 192 |
Segment and Geographic Inform_3
Segment and Geographic Information - Additional Information (Detail) | 12 Months Ended |
Dec. 31, 2020Hospital | |
Segment Reporting Information [Line Items] | |
Number of geographically organized groups | 2 |
Number of owned and operated hospitals | 185 |
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 | 82 |
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 | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Segment Reporting Information [Line Items] | |||
Revenues | $ 51,533 | $ 51,336 | $ 46,677 |
Equity in earnings of affiliates | (54) | (43) | (29) |
Adjusted segment EBITDA | 10,037 | 9,857 | 8,949 |
Depreciation and amortization | 2,721 | 2,596 | 2,278 |
Interest expense | 1,584 | 1,824 | 1,755 |
Losses (gains) on sales of facilities | 7 | (18) | (428) |
Losses on retirement of debt | 295 | 211 | 9 |
Income before income taxes | 5,430 | 5,244 | 5,335 |
Assets | 47,490 | 45,058 | 39,207 |
Goodwill and other intangible assets, Beginning Balance | 8,269 | 7,953 | 7,394 |
Goodwill and other intangible assets, Acquisitions | 344 | 332 | 636 |
Goodwill and other intangible assets, Foreign currency translation and other | (16) | (77) | |
Goodwill and other intangible assets, Foreign currency translation, amortization and other | (35) | ||
Goodwill and other intangible assets, Ending Balance | 8,578 | 8,269 | 7,953 |
National Group [Member] | |||
Segment Reporting Information [Line Items] | |||
Revenues | 25,694 | 25,913 | 22,581 |
Equity in earnings of affiliates | (28) | (2) | (4) |
Adjusted segment EBITDA | 5,532 | 5,634 | 4,980 |
Depreciation and amortization | 1,216 | 1,161 | 946 |
Assets | 18,913 | 18,290 | 14,839 |
Goodwill and other intangible assets, Beginning Balance | 1,739 | 1,597 | 1,474 |
Goodwill and other intangible assets, Acquisitions | 38 | 155 | 132 |
Goodwill and other intangible assets, Foreign currency translation and other | (13) | (9) | |
Goodwill and other intangible assets, Foreign currency translation, amortization and other | (2) | ||
Goodwill and other intangible assets, Ending Balance | 1,775 | 1,739 | 1,597 |
American Group [Member] | |||
Segment Reporting Information [Line Items] | |||
Revenues | 23,593 | 23,173 | 21,959 |
Equity in earnings of affiliates | (42) | (44) | (40) |
Adjusted segment EBITDA | 5,333 | 4,904 | 4,593 |
Depreciation and amortization | 1,164 | 1,117 | 1,027 |
Assets | 20,760 | 20,608 | 19,122 |
Goodwill and other intangible assets, Beginning Balance | 5,765 | 5,729 | 5,265 |
Goodwill and other intangible assets, Acquisitions | 27 | 39 | 504 |
Goodwill and other intangible assets, Foreign currency translation and other | (3) | (40) | |
Goodwill and other intangible assets, Foreign currency translation, amortization and other | (17) | ||
Goodwill and other intangible assets, Ending Balance | 5,775 | 5,765 | 5,729 |
Corporate and Other [Member] | |||
Segment Reporting Information [Line Items] | |||
Revenues | 2,246 | 2,250 | 2,137 |
Equity in earnings of affiliates | 16 | 3 | 15 |
Adjusted segment EBITDA | (828) | (681) | (624) |
Depreciation and amortization | 341 | 318 | 305 |
Assets | 7,817 | 6,160 | 5,246 |
Goodwill and other intangible assets, Beginning Balance | 765 | 627 | 655 |
Goodwill and other intangible assets, Acquisitions | 279 | 138 | |
Goodwill and other intangible assets, Foreign currency translation and other | (28) | ||
Goodwill and other intangible assets, Foreign currency translation, amortization and other | (16) | ||
Goodwill and other intangible assets, Ending Balance | $ 1,028 | $ 765 | $ 627 |
Other Comprehensive Loss - Comp
Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Equity [Abstract] | |||
Unrealized gains on available-for-sale securities, beginning balances | $ 14 | $ 3 | $ 7 |
Unrealized gains (losses) on available-for-sale securities | 11 | 11 | (5) |
Reclassification of stranded tax effects, unrealized gains (losses) on available-for-sale securities | 1 | ||
Unrealized gains on available-for-sale securities, ending balances | 25 | 14 | 3 |
Foreign currency translation adjustments, beginning balances | (283) | (283) | (149) |
Foreign currency translation adjustments | 12 | (63) | |
Reclassification of stranded tax effects, foreign currency translation adjustments | (71) | ||
Foreign currency translation adjustments, ending balances | (271) | (283) | (283) |
Defined benefit plans, beginning balances | (187) | (148) | (168) |
Defined benefit plans | (55) | (49) | 34 |
Defined benefit plans, (income) expense reclassified into operations from other comprehensive income | 22 | 10 | 16 |
Reclassification of stranded tax effects, defined benefit plans | (30) | ||
Defined benefit plans, ending balances | (220) | (187) | (148) |
Change in fair value of derivative instruments, beginning balances | (4) | 47 | 32 |
Change in fair value of derivative instruments | (51) | (37) | 18 |
Change in fair value of derivatives instruments, (income) expense reclassified into operations from other comprehensive income | 19 | (14) | (8) |
Reclassification of stranded tax effects, change in fair value of derivative instruments | 5 | ||
Change in fair value of derivative instruments, ending balances | (36) | (4) | 47 |
Accumulated other comprehensive income (loss), net of tax, beginning balances | (460) | (381) | (278) |
Unrealized gains (losses) on available-for-sale securities, net of income taxes | 11 | 11 | (5) |
Foreign currency translation adjustments | 12 | (63) | |
Defined benefit plans | (55) | (49) | 34 |
Change in fair value of derivative instruments, net of income tax benefit | (51) | (37) | 18 |
Expense (income) reclassified into operations from other comprehensive income, Total | 41 | (4) | 8 |
Reclassification of stranded tax effects, total | (95) | ||
Accumulated other comprehensive income (loss), net of tax, ending balances | $ (502) | $ (460) | $ (381) |
Other Comprehensive Loss - Co_2
Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Equity [Abstract] | |||
Unrealized gains (losses) on available-for-sale securities, tax benefit | $ 2 | ||
Unrealized gains (losses) on available-for-sale securities, tax expense | $ 3 | $ 4 | |
Foreign currency translation adjustments, income tax benefit | 8 | ||
Foreign currency translation adjustments, income tax expense | 6 | 5 | |
Defined benefit plans, income tax benefit | 16 | 14 | |
Defined benefit plans, income tax expense | 10 | ||
Change in fair value of derivative instruments, income tax benefit | 15 | 13 | |
Change in fair value of derivative instruments, income tax expense | 5 | ||
Defined benefit plans, benefit reclassified into operations from other comprehensive income | 6 | 3 | 5 |
Interest expense on derivative instruments, benefit reclassified into operations from other comprehensive income | $ 5 | ||
Interest benefit on derivative instruments, expense reclassified into operations from other comprehensive income | $ 3 | $ 2 |
Accrued Expenses - Summary of O
Accrued Expenses - Summary of Other Accrued Expenses (Detail) - USD ($) $ in Millions | Dec. 31, 2020 | Dec. 31, 2019 |
Payables and Accruals [Abstract] | ||
Professional liability risks | $ 477 | $ 457 |
Defined contribution benefit plan | 547 | 528 |
Right-of-use operating lease | 379 | 350 |
Taxes other than income | 343 | 325 |
Interest | 315 | 368 |
Government stimulus refund liability | 83 | |
Other | 1,096 | 904 |
Other accrued expenses | $ 3,240 | $ 2,932 |