Overall, good on our our markets everyone. progress CHS' you, we solid priorities. Tim, ongoing see strategic demand to and pleased in and continued were Thank morning,
the revenues fourth growth billion, net representing On same-store a XXXX, was quarter, revenue growth driven X.X% basis. net in admission. admissions consolidated were a a operating $X.X X.X% X.X% net and basis, on For over primarily a per year-over-year increase up quarter of adjusted revenue of X.X% in adjusted by fourth the
for volumes markets and and reflecting the in Inpatient fourth the strong capital investments. targeted and both in quarter our demand books, outpatient increased the Medicare commercial
admission commercial negotiated quarters. growth in fee-for-service our of per to where net mix similar versus the our continued rates states business that However, and to Medicare growth, are previous the revenue adjusted disproportionate affect from Advantage lower, with
representing of margin Adjusted EBITDA for XX.X%. the fourth quarter $XXX million, a was
During benefited Program, approximately the Hospital which the the Mississippi of EBITDA related Access of from we quarter, to million half $XX periods. in approximately recognition from prior increased
we reserves We hospital While estimate medical this benefit our factored increasing fourth adjustment claims appropriate the activity in guidance, believe the into experience this during was for a recognized this our was and effectively on offset not amount quarter. which industry. was self-insurance by malpractice, as based recent change across
our full up pleased labor year hourly quarter bringing to wage year-over-year, rate we X% costs. approximately for versus for on Average full year with X%. expectation was Overall, our performance the the approximately increase were X%
in We growth X%. of rate XXXX hourly similar expect average in approximately
patient workforce, noted, our modest $XX we seasonally in in million contract a drive quarter helped utilization in $XX strategies material significant which recruitment that labor labor our and have allowing sequentially. expense, retention year higher see stabilize help prior increase for an at reductions fourth demand. As decline to million cover over contract a approximate represented to Tim us decline Recall the typically
net the quarter paid approximately the specialist the related former for quarter. previously generally of gross but revenue contract elevated the during levels, the against fees to consistent up that million our expenses we those X% of revenue in-sourced, subsidy at from estimate Meanwhile, comparing the with versus medical When benefited by APP. APP payments net physicians remained historical approximately $X versus to results third physicians,
in We in-sourcing expect opportunities we to the our anesthesia. efforts, further of particularly continues there to in pressure, quarters area the scale look be believe as but coming
We did were to operations from primarily in-sourcing million last the quarter for year from of billing discussed not expected see in quarter XXXX ago improvement upgrades that the the period. related flows physician Cash receivable, with accounts delays compared $X clinical system the temporary million our we sequentially and in fourth $XX initiative.
first Additionally, the $XX Medicaid Mississippi the and versus AR The in the acceleration affected in further flows was of $XX slowdown from relative million from of quarter efforts approximately program expanded fee-for-service quarter cash funding $XX Advantage in we we've XXXX. supplemental that significant finished receiving refinancing Medicare million. begun payments payments of of performance of Medicaid Note the program, expect to resulting and interest our for approximately the payers the where million. from by state receiving for growth approximately of Mississippi payments improvement
to the of guidance for our with full quarter the $XXX expenditures million. million Capital $XXX year $XXX million, consistent million, $XXX were bringing total to
extinguishment resulted X% quarter. of completed extinguish completion $XXX to from million amount of our of In proceeds senior capturing a notes $XX the December, approximately debt, of of early gain Using discount of private million and from $X the Bravera debt XXXX. divestiture XX.XXX% notes $XXX a due principal which billion the pretax in and offering to XXXX of due redeem million during offering, our we secured by other from of
Net quarter. improved debt capacity We million needs the year-end of relative remain meet borrowing EBITDA under X.XXx to to was our and positioned improved third going with to well operations, $XXX ABL. trailing slightly adjusted our forward at
apart anticipate or markets one billion for remarks, the for redeploy. are we close proceeds. transaction, within Carolina transactions the more the these substantial handful We providing from company additional his that divestitures in could more noted Tim in than opportunities year, of could further of currently total North calendar a evaluating As across capital $X to that
disruption no we our expected. X. throughout workflows launched up shared further closing a of and platform patient Project facilities are XX pause process, Empower, modernization initiative October implementations after as and standing year-end insight And our new XXXX. in our services visibility at seeing during we will improved the After care, with enterprise begin
of the our the include adjusted $XX.X cash to for and the approximately of from in deductibility midpoint from of X%. outlook a guidance approximately flow a We $XXX to $X.XXX million EBITDA the operations anticipate benefit completed and does When of and or for impact major we include to outlook growth interest of transactions of on the the $XXX X% XXXX, net our represents revenue million. billion of normalizing rollback that does our represents refund debt of income revenue and a previously to billion XXXX. Moving Note impact initial refinancing billion, year-over-year EBITDA purposes midpoint billion growth excludes $XX.X for $X.XXX the net adjusted the that any acquisitions, any of not XXX(j)limitation on potential divestitures discussed. tax have future not of tax divestitures
of $XX Empower. Additionally, our cash approximately Project includes $XX cash flow million to related million guidance to outflow
and modernization the out XXXX, the wind tailwind year-end workflow rolls As to throughout investments and cash into markets will by will a ERP down XXXX. become these flow
the we EBITDA are and would to like XXXX to adjusted several XXXX relative I'll takes provide that XXXX. guidance context and There highlight. for puts
relief since What APP transaction fees spike would medical higher results patient malpractice headwinds as as expected at primary the year as headwinds had we as high quarterly the have for additional anticipated that we At in XXXX, adjusted prior time had $XXX outsized medical growth a from in we then, our improvement growth was XXXX in Advantage, time, we growth X% you did offset benefits the of of funds calls moderate were increase they and in and that EBITDA the we Specifically, in specialist were that we we this expense and million today. discussed contract see labor to medical the our midyear margin would approximately midpoint. not to reduction the initial anticipated to leading from specialist and able which set last guidance started through Medicare as face volumes. pandemic reductions fees, program,
of benefit the the Looking these efforts as from ability as control quarters. results to in further forward our on a factors, high at X factors the Medicaid tailwinds have while visibility deliver to into past Mississippi we have operating funding these additional reductions program. in cost confidence have X XXXX, much updates we expanded Based provided better recently a from well look Tim? over years, we coming of degree year's providing year, on weeks through the first the and labor, contract time, the capital we same into anticipate full the projects growth guidance from in and savings
