HCA - Earnings call transcript Q4 2024

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Operator

Thank you for standing by. My name is Janine, and I will be your conference operator for today. At this time, I would like to welcome everyone to the HCA Healthcare Fourth Quarter 2024 Earnings Call. [Operator Instructions] I will now turn the call over to Frank Morgan, Vice President of Investor Relations. Please go ahead.

Frank Morgan

to today's welcome and morning, everyone call. on Good our Hazen; and me this Mike Sam is morning With CFO, CEO, Marks. Sam prepared and questions. remarks some and then Mike we will will provide take

call remind over forward-looking any that uncertainties are is reference such current Sam, reconciling call and call non-GAAP and management's supplemental statements the on that, numerous I'll turn to included turn may recorded should call today's we call, I let is table This Before being me on expectations, everyone which the of information based adjusted net other a income over that contain may to today's risks, factors in and More morning's from today's now With information our be filings. On replay to release. results available might that measure. actual factors providing A in today. measures those Inc. are Sam. release differ will these press materially as morning's listed forward-looking is and the various on attributable this call EBITDA expressed EBITDA, to cause adjusted statements later financial and a in Healthcare, today. HCA be SEC

Samuel Hazen

in favorable you, to as with order with this continued a good The to good These and finished the good point and for health were company company Demand year. starting stable, opportunities. we the enter see strong, year Thank morning were the remains fundamentals right. strong All operations that XXXX. Frank, fundamentals quarters and business everybody. consistent investment previous represent services care

impacted and months experienced facilities a West in ago. major hurricanes few in Georgia, we Carolina, number by done a X job of fantastic have teams the Our Florida that were a North remediating

in Florida resumed facilities recovery these where and West operations Largo All including community's Hospital Hospital normal division in of quarter. our in the the Mission efforts continue, Nashville,

decade long-term growth of another for the end has half this we As company. the XXXX, been first period of

HCA delivered believe and health made patient colleagues across increased system way shareholders. local stronger key high-quality us greater we the our performance accomplishments and efficiency consistently value happen. position financial for with the operational indicators, capability have our a well who our These this We results. and to the seen of national have improvements We produces for innovation grateful better yields outcomes, of combining drives networks future. I'm

share, While and gratified with finally, They shareholders our company. opportunities stakeholders. We career will financial These fourth adjusted, training our our per in in also estimate of growth generate we In in increase outcomes by believe effects to our the well this quarter, capabilities. for allow further favorable our as investing to returns. Diluted in deliver strength results earnings effectively to X.X% included And increased X creating hurricanes. maintain creates the to to these cash major as us the quarter the enhance strength accomplishments, balance value year. also clinical compared and capital people prior to of allocating the financial while pursuit our to we the the flow position, networks expand significant capacity further with investments position for access, teams lastly, improve sheet a was this improve cardiac well Operating service X.X%, cases, grew costs increased our Emergency to surgery obstetrics, our admissions had were earnings and continued On be were while visits This categories from acuity to the mix provided increased room solid on and rehab, we with strong and equated per mix X.X%. across Outpatient and up $X.XX to to remained volumes admissions basis, in equivalent markets. Revenue service same-facilities in our costs managed was strong. impact share. revenue be line line lost X.X%. in down payer inpatient due call. the continued revenue we and estimation growth surgeries strong and service by X%. payer expectations. again, X%. procedure Inpatient line. And most mix, approximately growth previous and Demand, our approximately

our preliminary prior guidance call. XXXX see to outlook earnings aligns for on Before that, the with our Mike the details. provided I close, we And turn will I'll for you that call with

Mike Marks

guidance. and will Thank morning, and you, Sam, discuss good additional comments the our year I then quarter everyone. on provide and XXXX

producing Regarding our the of the the teams the of fourth and results and quarter, we responding excellence challenges which are still demonstrates pleased solid quarter, results. to with

noted, top the line estimates the line $XXX in impact, we was any adverse that receive reviewed These good the approximately growth. the with quarter do had recoveries we for XXXX hurricane expectations. the not volume estimate information impact include may in future. Considering quarter. the Sam in our per or As share, insurance Sam million diluted fourth $X.XX company hurricane

X.X% trends Our the the to equivalent compared quarter to our our year, both strong year quarter. quarter year, with impacted by in volume with a adversely of depressed prior fourth hurricane fourth impact admissions over XXXX. care in increased prior the and was all remained X.X% respiratory season with Same-facility line net up per the revenue admissions mix Consistent compared in managed the expectations. XXXX, quarter of payer same-facility

the in the While adjusted decline Hospital is the North our Carolina declined on to the hurricanes compared and the division, related adjusted which impact in a quarter. unfavorable point performed Tampa of quarter, on prior impact Largo margin margin well year our quarter. in XXX basis XX operations EBITDA basis primarily had EBITDA the to points This

per supply quarter, hurricanes. half of reflects quarter the the X.X% including our drove repair adjusted grew of impact impact the share expenses revenue Additional as increase fourth to year operating the year the hurricanes, of the the quarter the Hospital, expenses X.X% of which Largo in hurricanes. quarter, in the the grew to reflecting a in EBITDA Diluted other over these costs related and increase. Adjusted prior compared prior for earnings as also percent

of pipeline highlight XX.X% EBITDA estimate X.X%. hurricanes X.X% and by prior briefly XXXX with improvement admissions additional year impacted the in Adjusted posted strong revenue share the year. point million results me share. adjusted over EBITDA We basis year. year X.X% a for that XX adversely growing of growth admission had Let full per margin the for XXXX. our per over and equivalent and prior equivalent full increased or lost earnings from expenses $XXX revenue diluted $X.XX X% We increased year, per diluted We

the $XXX benefit onetime due Our payments from to an net unfavorable a net $XXX payment million year, year $XXX lowest net $XXX is Medicaid benefit the and incremental settlement, the year the the million benefit full the operating This incremental from approximately in of programs payments higher-than-expected was increase very supplemental prior million to expected, quarter pleased incremental with the company year. being largely in million program and in fourth hurricane consider of impact, few When are states. XXXX. we the incremental performance payer net benefit the million, we program core with we $XXX supplemental

Moving to capital allocation.

strategy quarter and operating in prior operations in to dividends for $XXX the over XXXX year. for $X and work XX% was $XXX the $XX.X and $X.X represents Capital billion deploy teams. in a long-term $X.X capital the great paid billion $X.X of the million increase continue in quarter indicative We We for billion of in billion Cash year. and the flow million quarter cash outstanding balanced repurchases our operating allocating year, from the by value year. paid billion And of $X.XX billion flow our creation. This for during administrative we in expenditures the in quarter the for shares totaled and year. an

a end of the to low adjusted at we leverage sheet balance believe we and our positioned remains from EBITDA debt well perspective. Our range, guidance stated are

we fits our ratio current as use As no our transactions to profile or this and lowering from anticipated extraordinary result, of a Xx targeted leverage range our X.XX are company, events. leverage to X new believe We a X.XXx. assuming our significant to

guidance for let that, with moment. a our me to speak So XXXX

morning, we year As noted our guidance we follows: $XX.X XXXX between providing as billion to billion. $XX.X guidance in expect full revenues and range are this

net $X.XX $X.XX income Healthcare HCA billion attributable between range to We to and billion. expect

EBITDA and adjusted $XX.X expect range We to billion. $XX.X billion between

between and range diluted We share $XX.XX. expect $XX.XX per earnings to

to $X $X.X capital expect billion. billion approximately We be spending to

assumes X%. per X% net equivalent guidance Our and and between revenue X% admission and X% growth in admissions a between equivalent

not XXXX, the this hurricanes of Carolina expected our at adjusted tailwind Regarding a market Carolina from expect division of in the are effects increase in the Largo, produce EBITDA to the Hurricane to reopening in XXXX XXXX. will assumptions have effects as lingering Helene guidance much XXXX. a The a we in and decline us throughout for increase on year-over-year Largo for earnings current and our North year-over-year of are offset expected decline the of in North and

Regarding Medicaid supplemental programs. payment

of treat to payment of to complex, said program Tennessee net do supplemental to when The is variable the current our we past, in the Medicaid of XXXX. states and guidance effect XXXX programs payments in cost on Medicaid flat our cover these As are not our a in in being all million considered received patients. supplemental range. programs aggregate impact onetime driven we've assumptions, a new headwind, fully contemplate in timing Based these by this $XXX to range payment few from programs,

from consistent operations be billion cash flow from and to XXXX $XX.XX to billion. margins with to year full range expect We $XX.XX

to a $XX Board XXXX, anticipate authorized our significant market our and noted completing repurchase new share in has As release and in program, billion other Directors conditions a morning, subject factors. this of we portion

quarterly our with $X.XX in over dividend Frank increase And an share. questions. I for declared Board to to from turn that, our addition, per will the call In $X.XX

Frank Morgan

a may [Operator Mike. give like you, now ask to Thank those Instructions] Janine, to instructions who you would question.

Operator

of Instructions] [Operator line Deutsche Pito Bank. comes from from first the Chickering Our question

Pito Chickering

a you where you that been XXXX I sort we are On it -- came to sort ] payments? to time I of [ Medicaid guess on XXXX sort bit. bridge (sic) little were understand where and of of make And were quarter, this sure that what's you around guidance in the in end the little in then has ] us last did [ is XXXX can high low of we XXXX number for and on just [ XXXX From bit you question where just you (sic) sort now. year? fourth end Medicaid XXXX, (sic) bridge ], XXXX a of into bouncing for where will change? guided that in for million $XXX quarter guess, that I on be we the it Was want third supplemental, on

Mike Marks

Mike. Pito, this is Yes.

our for the you it's about net incremental if programs, the think million. payment XXXX, $XXX year benefit So about from full supplemental

the I quarter As in in noted of benefit the was comments, X quarters year. net the my fourth lowest incremental

from the $XXX second quarter was You recall our second highest that of 'XX million. benefit at may quarter the

that kind came in, and onetime payments few how to that's And related we largely a a came really driver programs states more in it's our that couple of was a of so expected. spread little state out. The than favorably in

variability net So noting the about landed. complexity start then a And I $XXX and to wide my our will estimation guidance, estimating range Tennessee between you that's the million effect parts, projecting various of we a noted inclusive headwind. supplemental consider XXXX the where of are and when the programs, the that program. as and in range of thinking payment XXXX, pretty all we moving flat upwards we new related is of to to programs as That

So and that's that's for of it 'XX. year through of our kind the the went how projections basis

Pito Chickering

give quarterly I million? in with in it's the actually $XXX it's guess, saying $XXX $XXX that XQ. is that all, are versus for I not rest just actually, lowest the you seems a Mike $XXX XQ you us million XXXX, of high million, XQ guess, quarter. because and highest just benefit can million just The So

how whole through on color flows the of that year? any So sort

Mike Marks

QX, a and at I Well, the flow that's I give the quarter will mean, think the obviously, best can would through high then little first the take bit and as I quarter the lowest. watermark. terms million be can be Pito, year. you in higher $XXX And the I you of fourth mean, third

Operator

next comes from Our from the question Rice UBS. line A.J. of

Albert Rice

Did MCOs. are strong. 'XX? care, anything because those I MA were denial in new pricing in 'XX, there -- quarter you or was terms publicity It managed rates, wonder so or sounds same-store seeing for rather, lines? admissions along you the the your much at different of utilization in you're Anything where around like review,

Mike Marks

So is A.J., this Mike.

terms I our 'XX, We're our XX% of in contracted still XX% and contracted terms in our 'XX. of XX% 'XX, we top of range it's on In for -- contracting, contracted for for pricing. estimates, targets think are

denial up think a and our I would over managing are I of this denials of the capabilities, of for about the lot beefing As the seeing couple or process. X say growth only impact underpayment years through quarter we point. being activity, of a company but fourth the but denials a underpayments, effort really last put X when not we we and year material clearly in in think not about 'XX, full at lot

Operator

Our next Leerink Partners. of the comes Whit Mayo from question from line

Benjamin Mayo

just maybe some length end length forefront discharge while, the the like to of I moving a initiatives on been I with post-acute? of bottlenecks optimization throughput, be stay, wanted you might hear of Anything feel that. be you the mix, about around case guys Anything around may back to for have this internal that stay talking a management? ER and that year. seeing all lot

Mike Marks

to year. with. continues our for even the really So mentioned yes, a case strengthen. We Investor couple conference And us the last been throughput strong initiative has continues in management, work of inpatient it and over years last Day

and think into discharge case take good especially stock length focused within today, year important. solid, post-acute care we the performance payers. a infrastructure for on Medicare been year where the continues kind with we and our XXXX. stay I improving forecasting our about forward even I in of XXXX, stay might number that But of placement we length and we're work of of as going of management initiatives Advantage it's have when Specifically, into say another the our head I management if process. And And has are

Samuel Hazen

let Mike. add me Yes, that, and to

add about So we have facilities. of company. you are initiatives to a development And our the when network initiatives, progressing I mean, number continue we think that across

that more got You'll than the facilities last at this end year. year we of did we've see

to as market is itself and share. What key markets expand showcasing our data well to incremental encouraging seeing in as initiative. capital allowing is market reach in particular opportunities really continued of we're our and itself of some So networks. acquisitions some share us in lends the That's growing that sort our

tremendous to addition operational inside to initiative into meet we'll the case an Mike with throughput community see of of as success allowing as our supply us the and reach emergency needs growth, that's to And of operational channel again had In our improvements satisfaction management was that in of we're with patient room networks talking emergency the ER use plan those yielded that well. improvements, about, we've effective improvement that we the and a XXXX, and operating ability productively rooms. We're carrying way. And our from again, investments push more to the the beds revitalization result room our success that of as making, elements bed program then program. the extend

our labor room beneficial then I'm our as accomplishments the to operating elements And other is well of and emergency efficiency that also We our patients. of our this say turnaround to that's with an time, will as physician have company. lot proud important past our mirrors our to staffing, as very patients. And OR And partners year, we've of that This really efforts agenda I finally, improve. initiative continues we progress a a be seen going surgeons it and the involves our think room. optimization to

employee and meet us more and has nursing all-time is Our colleagues at necessary demand. especially of really facilities the to a really capacity improve having broadly turnover company. high an and and across for all inside of capabilities to That reduce the the the our workforce competent allowed with continuity staffing, engagement

what to beneficial of that for position the I number call are So company a the really success. we our organization, to responsive have plays and winning communities

forward, our initiatives. about As we've we push longer-term talked

we clinically We're signs AI our longer-term organization, how of on improve geared think technology technology. facilities, well. success of already and are operationally our our initiatives We're early aspects as inside can using seeing of administratively, toward journey. Our and with

very AI know potential processes better that we our that's speak management of even I exists agenda. And see for and provider, the within care others exciting So a as but health to of us greater of efficiencies, quality, a drive better business. lot a

And so things continue. those

the And flow another cash between the the back earlier. is sheet programs We'll to year. $X.X our I ability somewhere shareholder the through even that got company. balance initiative then Mike and more and for important we've billion to $X to invest billion capital use allocation value investing heavily deliver We're our business. think in this alluded

we to value our employees, and for these all value, our our So for combined, patients, value of create believe, for shareholders. value

Operator

Hendrix the RBC next of Our line question Capital Ben comes from from Markets.

Benjamin Hendrix

it's for After another enrollment state going your And the to that growth, how you your Texas? to opinion, or under strong thoughts year of in with get lobbyists regard? thoughts impact fate mix new the you administration and how the enrollment you've exchange In then on just fared how enhanced and wanted whatever commercial and broadly efforts any progressing Florida see any made subsidies on of guys.

Samuel Hazen

enrollments continue right. this seeing XX up think XX%, of think, Thanks, we're All inside over to around a HCA to the XX% particular Ben. strengthen. And Clearly, at growth somewhere the states. consistent number it's million so juncture it's across exchanges We I 'XX.

access So positive we families. believe. outcome It for improves creates that's to greater It It's a outcomes. care. a positive,

to that So their have Trump and a opportunity affordability, really positive all family. for believe, administration, we backdrop, they and they politically, their for and think have an a themselves have ensure for families coverage, presents for positive that opportunity as -- is achieve to outcomes the the sustain of we and

is exchanges. the that with the end they the backdrop we what's pathway expire believe, don't going. Trump very find is continue So juncture within the positive current a satisfaction see are All work we community think enrollment have And administration the to we benefit, a growth, particular any with of into a at been to positive. backdrop forward next of opportunities the at to insights due this we of this where know year. We is to

within very to to serve. partner outcome for coalition achieve to support that We the that agenda we we other advocacy with different sense work robust to here makes think a organizations, our communities the have

anything it's process active but in early as the too on are you call we to So for that, expect. us would

Mike Marks

question And about X.X% Ben, of represents payer of terms in our about now admissions XXXX our mix and health your and X% exchanges it in revenues. care landed, where equivalent of

Operator

next from Our of the Hynes question line comes Mizuho Securities. Ann from

Ann Hynes

I earnings to the do think much Medicare you continue will in Rule. that about for And you impact that on emissions inpatient Two-Midnight do Can stat XXXX? you gave to what had Medicare want last gap? How us I ask benefit? it stat you a time, think observation That you call, great. Medicare a that just be fee think think the detailed remind And of over you that be difference traditional service. versus the between Advantage is? can do would in close

Mike Marks

This Mike. is

So points status, over observation the of the consistent Rule, of say XX to year Advantage inpatient equivalent from basis at the that, Medicare if would I overall I growth. impact, in admission for that X pretty of full approximately the we our kind that's Two-Midnight was to XXXX, remained terms look movement the with it estimate quarters. consistent

that I going go -- it's to more see as you'll think be So movement much you XXXX. into don't

of program. I we you'll Advantage see think point, working change we've at traditional, to this to we're I a is associated processes really in than don't through to comparison 'XX. seen on that on so Advantage higher changes. focused denial Medicare percentage volume approximately traditional material appeal the note trends opt-in mix Medicare I revenue suspect collecting this as that the see the we're Advantage right Medicare. with don't and kind a this the head that year far that to observation At would and observation going material of But total As to as of Medicare the XX%

Operator

from question the from Our line Andrew comes of Mok next Barclays.

Andrew Mok

out guidance. on any quarter of spike us EBITDA of the the and performance the impacts quarter had recovery functions the understand in explicit in help Hoping including in you around throughout pace and the same-store that volumes Mission Hospital what could XXXX, hurricane

Mike Marks

comparison I same-facility experience, growth prior a fourth year fourth of of I'm we not division, and to speaking depressed fourth a With which related little Let me to compared quarter thing North tougher it overall, mentioned I Andrew, to season 'XX, equivalent admission admission in to is might overall, we just did had was think as quarter, in talk and again respiratory fourth overall, We about quarter of bit of 'XX. 'XX quarter volumes this the X% strong first did but mention about overall, experience growth. just Carolina a quarter.

room season growth had Our that hurricanes growth visits in respiratory admission the as this about prior to on on October well the X-point Overall, a company, as a primarily for depressed on an impact a estimate drag is and but whole to X-point emergency about drag same-facility quarter. prior had year. year volume growth same-facility

you month volume points October, Our basis state recovery mentioned between look a clearly was good and recovered. effects as in somewhere of XX at in estimates are And drag Florida, that kind quarter directly the if the related to attributable. I'd some the of saw they hurricanes of of in December. lingering there XX then rest of on and we November that's also and the

quarter. So of of in on tale that's tape a the kind volume the

Andrew Mok

any there in EBITDA was hurricanes And the guidance? assumption for explicit

Mike Marks

Yes.

year-over-year as go EBITDA to XXXX. that hurricane from really we at comments, if a the to if you year-over-year expect offset hurricane the is if increase think assumption and that to North Largo XXXX -- Andrew, are back Carolina division the Largo, North are in The reopening let's into we this the of decline of Carolina current increase for and are market expected Largo contemplates have throughout not the tailwind for a Hospital, us effects will about expected is that you decline much in produce lingering guidance start this, in the think in our do a and you impact Largo adjusted way with of about guiding So my XXXX.

way So impact hurricanes into and XXXX. about their to think the the that's

Operator

from of line Our Joanna Bank America. of the next question comes Gajuk from

Joanna Gajuk

QX line. other from things, the OpEx the So related so the impact somewhat on of on to on guess, I hurricane cost side I the the in the thanks for quarter question, color guess in the

want ask fees. professional to I So about

into about recently, highlighted continue time, you fees for most quite talking been professional the higher-than-expected to this but some 'XX. You've

you guidance? can We maybe asking next about So group doctors you what in What of assume that heard you're seeing your the or talk for there? do higher fees. radiologists are

is OpEx what line size line? that also your can you help seeing? And you're in us that So also, maybe other

Mike Marks

that's professional you it. So so of size about expenses would are how fees XX% other operating

in As hospital-based these through our calls, from last to we have through subsidy noted, curve as of have several business. address pressure professional year, on fees, gone due And component the diligently operating teams we've to mentioned 'XX, to moved continued as physician group the efforts. we've we've the work our really the we've as bent the cost

So guidance as like the say XXXX, into I about would think I it this.

segment, business moved the cost it's looking into how And Valesco. When physician costs going the segments given through especially that's we year. Maybe But that in a of would about medicine to higher be the clearly, normal with have flow work than integration has on expect physician cost more in bit you you're moderate and the HCA a We this double-click at trends. the the done pressures just next 'XX. acquisition and fully emergency to our room categories, hospital further think the inflationary challenges related really see still hospital-based that to significant radiology.

and in into As our gone to of be portion through 'XX. did it radiology, we that we our that do focused impact is in a continue have see mind addressing teams as lower radiology, relates we to management that we've focused I'll radiology XXXX. But keep and is our much hospital-based physician material pressure a not this, teams expect subsidies. physician expect operating our efforts on teams both it and finish to between just with XXXX,

Operator

of comes from line question Matthew KeyBanc. the next Gillmor from Our

Matthew Gillmor

And any got or at impact of level but difference? there's the consolidated I to on call just in big a to see I a want couple you've California to enough wildfires. area, commentary make if facilities is any it L.A. not know the the there real out

Samuel Hazen

Ventura hurricanes protect and to was, alert, on and We the you to some its through no will, can County. due hospitals facilities impact Fire no at result just Ventura making tactics high our particular proximity our have County to that the some in sure our and Fire, Ventura fires. Sam. we had in produced with hospital reach there's further. into we a did evolve Southern We plan notice, mitigation of it Palisades is of so protect been the we did California, to on there in have sense one and But protect County. continue think patients the it colleagues if And community, iterating, and whatsoever our in our we asset. location California in Kenneth do the the even issues that advance like that our that I as smoke there so forth. And issue was in This on on fires valley was have facility but that the not we're that The In fire Riverside, speak, we're there.

a knows, side So canyon on Thousand Oaks. everybody of we're the our with event, were in but facility horrible as other we fortunate. That's the

Operator

from from Jefferies. question the line comes next Our Brian Tanquilut of

Meghan Holtz

is This on Meghan Brian. Holtz for

quick nonrecurring about including seasonality any then just that items considering? or EBITDA, we think are question And a As the should be there clarifying payments. supplemental some moving pieces, we QX on

approved the to Tennessee referred new it program. that Does You recently? mean was

Mike Marks

Let me handle the second X first.

So of year. in Tennessee the notified we program, partial a approval of been have

X And is year July new, XXXX see has calendar then program in which we program, The in an calendar December of And they effect, not year 'XX. approval 'XX. cover approved. that of that a 'XX to beginning so transitioning are been we through have would, -- XX

And addressing new be will so that. the administration

that. is So follow our stick would that's the trends, status just normal of historical seasonal the new with Tennessee our program. We guidance don't to give so and we advice quarter-by-quarter

year 'XX the So guidance XXXX. for is full of the

Operator

line next of Lake Justin Research. from Our from Wolfe question the comes

Anna Barsanti

strategy so, It's footprint? the of size sort revenue growth in surrounding same-store neutral you your alter And Justin. where ASC guys Have quarter? that us ASC if at you does all Anna also the outpatient impact the attempted on potential was to can site for your payments? of And tell

Mike Marks

I'll cut would sense stating Medicare we a of We're programmatically for let's use And site-neutral, just start that could to full surgery, rate outpatient makes it capabilities on same So against pay with but our operates hospital nor service the that of reimbursement, obvious. use basis that the you implementations think a do that with XX/X on program of physicians, hospital. all and equipment. staff

If centers a complex to Friday the does to Monday rate seem for operate who our do of through lot you'll example, X sense X make those same that, and for not of surgery idea less paying to compare the to much generally us. work,

you our outpatient expect materially clinics. them impacted, being In the reimbursement. these those government debates hospital notable closely, other are been seen like As health would have policy estimate and through discussions information as it how more relates be various a would and structure you've give a for tracking. end we've Medicare clinic past, HCA. cuts that as not facilities. continue care site sure a we there's right hospital-based procedures seen We At of to X that end to visits do, physician bill a the and yet proposals, going sizing around On proposals this, considered we'll now, we impact. In the would But proposals us potential I'm around have not certain given being surgical bit impact, enough potential range physician would HCA draft infusion be considered range, would we that range that outpatient to procedures of impact seen neutral. monitor the to the a be lot of for outpatient to of

Samuel Hazen

cause believe per any And to of see opportunities will I and it out around us again, more policy system or we networks. finding health that rethink integrate our to don't and We se extend strategy development strategy. the into the outpatient patient, site-neutral convenient building larger then are our us facility Mike, reach is our network and that networks particular more into new fully to efficient make parcel hospital-centric for our force part communities, the

see Medicare implemented. as result one to So changes I any were if don't site-neutral provision of that a a be to

Mike Marks

about the in prior around question growth growth right to at your to And X% year. over revenues, X% it's ASC

Operator

line Scott Stephens. from Our comes the of next from Fidel question

Scott Fidel

that. if clearly done you be you've understanding net and of the around workers policy and and very recent he's from at out to orders it any I wanted And et already proposals tossing economic there or on been of to then preliminary also tariff but a that type immigrants, could rate still relates any think stick from analysis Trump's some brisk the effect cetera. curious if impact was foreign executive And side. as early, just, it's

either Just labor curious if have or effect you may think the on of any environment. those demand an

Mike Marks

contracted being of which closely have Like we of work On announcements like including years, China. note sourcing. kind tariff new including the of team tariffs, years, on health and and many suppliers organization the countries from derisking on price targeted, are supplies and for being the our administration, Many last working tariffs XX% working are you, and contracting, from mapping our rate exclusions many away for been especially a would items. I actions about really have of firm for been we mitigation over tariffs monitoring implemented, chain on our their the XXXX, supply assessments with supply on care-related pricing. risk potential of has lot that fixed strategies purchasing chains diversifying tariff

going relates to estimates need and the details of it, can tariff produce information we impact. policies additional we're sizing specific As we that noted, to kind before more it of need as of these on

don't On those items, the are. other all workers. tracking you as hire We related undocumented carefully we're of

can would labor we at this on point. special demand are, the give insight we're more mixes in you it like no tracking skill impact be so those that or you but supply for and And note

Operator

next Our Cantor from line Sarah James of question from comes the Fitzgerald.

Sarah James

to X.X% to to X%. on just the the again clarify admissions bridge X% going from the equivalent I want

EBITDA leap volumes. then it procedures on a of be on expanded from bps Mission explicitly And other if concerned going subsidies we're Largo sounds any calculating and sort away. like consumers but you're XX implied you're So year. that forward assuming nonrepeated not from of may each pull about I'm offset implying And sure

Or So that just I'd just XQ led exiting conservative? love is to be that then the back to saw there conservatism mean? rest anything you know specific the to that. And it, that of going you is

Mike Marks

in guidance more 'XX growth. through to X% our X% 'XX. that bit we fourth on that noted, about then think and admissions quarter little we're at call ran a September it, higher so equivalent I year-to-date, a And than was as And growth. line when projecting growth X% So volume, you for X% a with in

question, a as season in little flu impact bit I did we quarter an see fourth -- of noted and fourth season, with quarter earlier of related in on bit a respiratory Although, hurricanes. depressed sorry, drag to

the I XX%. call of health is in and growth As XXXX. things. growth One -- I we XX% bridge care volume had exchange in exchanges. big I couple volume in probably XX%, We be big had enrollment X XXXX, into the growth And note big mean, just our XXXX, 'XX, a would it, might volume in

we're in our at in it, As into care on states growth health XXXX XX%, we XXXX. look XX%, exchanges, for enrollment seeing, the enrollment call XX%

And 'XX do drivers saw one mentioned Two-Midnight expect in growth admission the benefit than we care in health Rule repeats had to will related pullback of 'XX. Advantage we the that I That's be an so in there. I volume of that in big we to 'XX. don't the Medicare less think there 'XX earlier exchanges that related

And so Medicaid that was and this be other redetermination the thing the would year. then process -- down

I flattens next out think year. it

guide we're what X% landed balance X% demand in, 'XX. 'XX. forecasting X% services in our think to care above rational A where we the about is in health to we and for as we XXXX X% all still strong still growth long-term of be feels of to to So compared think

Operator

the from comes question Perse Sachs. next Jamie from Goldman of Our line

Jamie Perse

portfolio thinking the you I to or And aggressiveness overall, existing a had in on show M&A, markets. XXXX. you're have seeing how going what in markets could in you transactions on wanted about Just the guys couple of smaller just of including adding scale to guys the new just deal activity, you're front market recently. terms

Samuel Hazen

be primary central have bed add going very productive proven we development and as capital growth to return successful a measures to be facilities, supply, to outpatient So is elements I'll and very standpoint. through strategies mentioned. we in it, Those add we network organic capacity call have are our our capital from and, where spending proven be to

and mentioned, forth. continue, to have significant you've think, so existing added, our as to XXXX. will surgical have, networks We juncture. facilities We've complemented our We any can, into facilities particular and I bought businesses. that And rural point this networks. hospital don't we at items We with necessarily to outpatient when

that. But Hampshire expecting out we will do fairly think, Hampshire. a have anticipating to round about to point, a and shift our and that we material. in are go new New investments give inorganic excited acquisition close system to to growth However, network overall That particular more this wait are organic broader we're market it, most development. our southern in see call We're to us going Manchester, of Hampshire and not add hospital but more towards, I'll we have the just anything New opportunities productive, develop, network. first at New and We'll if the starts quarter and

Operator

of Our TD next the Ryan question from comes Cowen. Langston line from

Ryan Langston

quarters. Same-store Can I of the strong inpatient a you that? us give down, outpatient And pretty driving was surgical just last on procedures surgical think of in looked was couple that the growth the quarter. maybe sense again, types

still your uninsured case. You've I'm categories. that's it Maybe was the wondering just the said that Medicaid but mostly in commentary, missed in and I if

Samuel Hazen

Sam. this is So

a saw I that very We fairly cycles move solid we general On array saw vascular. strong we side, have. of service less see have with saw in and risk orthopedics. offerings the solid But diversified to neurosciences. the growth our Again, quarter, strong we broad-based. also then We surgery through think allows inpatient and us did programs the

the side. So it's broad-based inpatient really on

On side, down largely by it's again, which declines, the Medicaid XX%. outpatient were driven

and commercial Self-pay X%. exchange was volumes little up down. Our were a over

and and we profitability surgery mix, those because payer and why outpatient more added cases. within year, types that's category up growth that's quarter revenue So was again growth that for the the of indicated and for to mix capacity the our our our in of the

not we're we underneath the activity company about when in So hood. the surgery look outpatient concerned the

Operator

Our next Steve line of from Baxter comes question from Fargo. the Wells

Stephen Baxter

the understand broadly, trying in of bit Medicaid looks some benefit a $XXX expectations than third better. you in larger the supplemental in of like quarter, the came moving And the but I think, quarter [indiscernible] the to discussed at what met call. is maybe now, the end a quarter basis that it mean, I million on provided. guidance hurricanes, I little Just previously full you range parts think, the year you on

think of moving to I way square are quarter? that's people look to it, to that's think how trying misinterpretation about and parts or what the at right whether those a the

Mike Marks

you would we've through as as impact of moving I Sure, this is Mike. be hurricane The think mentioned, the way fourth the first, would noted. parts the as kind quarter, frame here,

the the is EBITDA I that think benefits, about year couple net other fourth about you're that benefit to quarter In component. And might a very payments a fourth things lowest terms think growth then one, quarter earnings of 'XX the would when way was of be of payment thinking for of I mention having strong. XXXX good adjusted growth of description quarter our supplement or of supplemental the our the fourth portion in kind

year related our the is and 'XX. to think was of about was keep you in growth this to last somewhat to little in it So this just of a to that X% is at quarter fourth depressed the quarter in a respiratory of admission mind, versus akin comparison year-to-date year. tougher more if season, X% thing bit And second then September the

rate, some our are guidance think I that might consistent midpoint those that believe at as thoughts. well. you we mention if the a So as kind of launching it's do we about growth look range from of XXXX point

So good we're and of company given felt was quarter with quarter. XXXX, the the like the a pleased with fourth was in everything it quarter dealing

Stephen Baxter

payment guidance of the clarify, XXXX the fourth recognized now? And the in in is XXXX Tennessee quarter or just to the that portion

Mike Marks

'XX. not fourth recognized event. will was It Yes, it be quarter of 'XX a in

Operator

Our Nephron Research. Joshua question comes from of next Raskin

Joshua Raskin

X% but more you you versus volume about? you markets specifically any speak rate got there bit the that broadly, acute I'm on growth a to that significant quarter? revenue opportunity. yet? the specifics there Maybe the Could then little more And about where care more interested, ASC not maybe think performance you've in X% inpatient to ASC on talked side underneath the share are And how

Mike Marks

network. don't volumes of In a of now. our our the that to surgery was go continue quarter. the quarter. be numbers. X% -- if you part part have it of They're center network optimization and part overall start The Sam, beyond my a comment, the good net centers at surgery kind And X% ambulatory will development down previous know We I in up with work XXX an we markets in that in it 'XX revenue and I to our the of important network about were as as the we case work. So X% into will We're serve. be mentioned feel through let's

Samuel Hazen

the of reasons per average care That's outpatient canvassing markets do hospital. average, and thinking the XX about, clinics, an that We've ASCs, Well, we that hospitals have. sort surgery we of a talked don't average. facilities a vis-à-vis facilities, number hospital. roughly we of sort company the of have across forth for an about variety I'm number centers of number And here sitting have urgent just have per including few and on of so

In markets some we aggressively in where in out in outpatient markets our build of it and Georgia, ability because have no more to certificate can quickly North strategy, some to they CON, execute have like our the same a limits there's We some Virginia in markets in Carolina. where much restrictive move need network. and

those per of outpatient over we're differences dynamics. Where destiny, will, including hospital. network, ASCs fairly a we own consistent large you sort some have control because our with if have of you So

XX that's a to also. don't you physician, part even centers like market So and to have I'm larger in point incrementally our if continue network. XX in centers. about ambulatory feel to Those include GI our or we're Mike probably surgery outpatient of space. grow we really struggling We particular will, another that number, where of we this XXX out talked

through limitation the administrative to process. that think as we I have mostly for and expect, is regulatory, us through way that, you our would So work

Operator

Lance Bernstein. is Sanford of question from Wilkes next Our

Lance Wilkes

Could Medicaid exposure the be what if margin on what's on there. nurse essential and level staff you these what and margin wage you total get little to are inflation. And kind a what's background 'XX. days? commentary particular, of in little And little and those and on could in like In in to would talk making? then about just guidance give that supplemental implied been without pace support in a an those the labor of Obviously, 'XX labor you've programs? is hirings the appropriate bit the progress programs the talking the on a Maybe

Mike Marks

Yes.

Let's cover labor first.

moved making the continues use is labor, It I labor down think labor prior a looking good been X% to improve. contract way we've at quarter measure year. our the contract progress of kind to or premium and of so to or for

good and of lot terms development, on the improving years and was both as in X.X%, of hiring. of it workforce teams our a a targeted the down labor to SWD the of percentage retention really lot that X.X% reducing of represents, think, coming turnover I out the good seen of including last a contract over Our couple really in the quarter. have pandemic rates done, we've work work And

to in with nursing workforce in talked across continuing [indiscernible] the really increases about really work And that We've we're a is add in robust. markets. We're Galen, and medicine academic nurses where our large to key we schools of plan and our other plan a have see we're -- Our we continuing go development enrollment in out robust hirer markets. nurses. past graduate

So progressed and I think overall, well. really the labor agenda has gone

inflation inflation wages stable guidance, is into the wage our I quarter, think really In rational. terms think being steady margin overall XXXX, operating of a contemplates, we wage guidance contemplate you what stable. fourth and environment if in And including really as our was about wages were stable, head

industry labor. On I'll hospitals total and of America. of you this. care effects These around wide in cost payment a programs just programs HCA but still the When including not to important public of the spot on take they're supplemental Medicaid we're important, covering and not-for-profit the Medicaid, short are Medicaid. on across of mention range So and the just good Medicaid, reimbursement, we're

leave I'll Medicaid. where for margins that's So on

Frank Morgan

We're of X for at the time Janine, maybe hour. the right top more.

Operator

from comes question JPMorgan. Ben next Rossi of from line the Our

Benjamin Rossi

me squeezing X. for Thanks in last here for X

about CapEx at $X.X So billion. guide your XXXX

maintenance you've I between and weighted growth to growth CapEx think XX-XX this historically, CapEx.

this fair XXXX? term is consideration or hurricane shift still there prioritization for any the in with in XX-XX Just the a recovery, near is

Samuel Hazen

community hurricane I plant physical weren't changing It a is our North think fair was that's destruction. The The number. not around spending. Carolina dynamics really in destruction. capital

community hospitals his on we Our was as commentary. higher a it. repair in experience whole mentioned were dealt that with didn't costs, we levels so In Mike than mostly the that, where as Largo, mostly

high-quality and our making and the sure necessary is have capabilities care. spending geared development. to It's toward So it's really clinical consistent our environment we network capital deliver the toward geared

So that continue. will

Frank Morgan

Janine. Okay,

Operator

back I That to turn closing Frank Morgan now for our to call like concludes the session. Q&A over remarks. would

Frank Morgan

can thanks Janine, you. good joining We weekend. additional hope questions. thanks for answer call. your have help for today, this everyone a Thank and you the we any We're around afternoon if to

Operator

That today. concludes for our conference call

may disconnect. You now

HCA Healthcare (HCA) 24 Jan 252024 Q4 Earnings call transcript