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Group 1: HCA Healthcare, Inc. - HCA Healthcare, Inc. exceeded consensus earnings estimates by 10.66% last quarter, with expected earnings of $21.37 per share on revenue of $69.35 billion for the current fiscal year [1] Group 2: Tenet Healthcare (THC) - Tenet Healthcare's shares have increased by 7.1% over the past month, reaching a new 52-week high of $151, and have gained 92.3% since the beginning of the year [2] - Tenet has consistently outperformed earnings estimates, reporting EPS of $2.31 against a consensus estimate of $1.89 in its last earnings report [3] - For the current fiscal year, Tenet is projected to have earnings of $8.87 per share on revenues of $20.25 billion, reflecting a 27.08% increase in EPS but a -1.46% decrease in revenues [4] - The following fiscal year, Tenet is expected to earn $8.81 per share on $21.12 billion in revenues, indicating a year-over-year change of -0.75% in EPS and a 4.32% increase in revenues [4] - Tenet has a Value Score of A, a Growth Score of C, and a Momentum Score of A, resulting in a VGM Score of A [7] - The stock trades at 16.4X current fiscal year EPS estimates, slightly above the peer industry average of 16.2X, and has a trailing cash flow multiple of 9X compared to the peer group's average of 10.3X [8] - Tenet holds a Zacks Rank of 1 (Strong Buy) due to rising earnings estimates, indicating potential for further gains [9] Group 3: Industry Comparison - The Medical - Hospital industry is performing well, with HCA Healthcare also holding a Zacks Rank of 1 (Strong Buy) and strong value and growth scores [10] - HCA shares have gained 1% over the past month, trading at a forward P/E of 16.09X and a P/CF of 11X, indicating a favorable position within the industry [11]

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Core Insights - Tenet Healthcare's stock has reached a two-decade high due to strong earnings growth and an improved revenue outlook [1] - The company reported second-quarter adjusted EPS of $2.31 and net operating revenue of $5.1 billion, both exceeding forecasts [1] - Tenet's full-year operating revenue guidance has been raised to between $20.6 billion and $21.0 billion [1] Financial Performance - Adjusted EBITDA increased by $102 million to $945 million [1] - Net operating revenue for the ambulatory segment rose by 21.1% to $1.14 billion, driven by higher patient services spending [1] - Hospital segment revenue decreased by 4.3% to $3.96 billion, attributed to a reduction in facilities, despite an increase in admissions [1] Market Reaction - Shares of Tenet rose nearly 5% in a single day, contributing to a year-to-date increase of over 90% [1] - The stock is currently at levels last seen in 2002 [1] - Tenet is the second hospital provider this week to report strong numbers, following HCA Healthcare [1]

HCA Healthcare reported second-quarter adjusted EPS of $5.50, which beat the Zacks Consensus Estimate by 10.7%. The bottom line improved 28.2% year over year. Revenues amounted to $17.5 billion, which improved 10.3% year over year. The top line outpaced the consensus mark by 2.2%. Same-facility equivalent admissions increased 5.2% year over year while same-facility admissions grew 5.8% year over year. Same-facility revenue per equivalent admission rose 4.4% year over year. Same-facility inpatient surgeries ...

Financial Data and Key Metrics - Q2 2024 net operating revenues were $5.1 billion, with consolidated adjusted EBITDA of $945 million, representing a 12% YoY growth [8] - Adjusted EBITDA margin was 18.5% in Q2 2024 [8] - USPI adjusted EBITDA grew 21% YoY to $447 million in Q2 2024 [8] - Same-facility revenues grew 7.1% YoY in Q2 2024 [8] - Hospital segment adjusted EBITDA grew 5.3% YoY, with margins up 120 basis points to 12.6% [15] - Same-hospital inpatient admissions increased 5.2%, and revenue per adjusted admission grew 5.7% in Q2 2024 [15] - Free cash flow in Q2 2024 was $602 million, with $2.9 billion in cash on hand as of June 30, 2024 [44] Business Line Performance - USPI added 11 new centers in Q2 2024, including a partnership with Florida Orthopedic Institute [9] - USPI has nearly 25 centers in syndication stages or under construction [9] - Orthopedic volumes were strong, with total joint replacements in ASCs up 23% YoY [35] - Urology and GI procedures also showed ongoing growth [35] - Hospital segment adjusted EBITDA was $498 million in Q2 2024, with same-store hospital admissions growing 5.2% [36] Market Performance - The company is expanding its network, including a new hospital in Westover Hills near San Antonio, which will focus on procedural services [10] - The new hospital is in a geography growing at six times the national average [10] - USPI's same-facility system-wide revenues grew 7.1% YoY, with net revenue per case up 6.8% [42] Strategic Direction and Industry Competition - The company is prioritizing capital investments to grow USPI through M&A and hospital growth opportunities [21] - Investments are being made in higher acuity service offerings and AI-enabled technologies to enhance clinical and administrative efficiency [39] - The company has retired $2.1 billion of debt in 2024, focusing on deleveraging the balance sheet [39] - A new $1.5 billion share repurchase program has been authorized [13] Management Commentary on Operating Environment and Future Outlook - Management highlighted strong same-store revenues, high patient acuity, favorable payer mix, and effective cost controls as drivers of Q2 performance [14] - The company raised its full-year 2024 adjusted EBITDA guidance to $3.825 billion to $3.975 billion, an increase of $300 million [37] - USPI's 2024 adjusted EBITDA is expected to be $1.75 billion to $1.81 billion, a $100 million increase over prior expectations [19] - Q3 2024 consolidated adjusted EBITDA is expected to be $900 million to $950 million [20] Other Important Information - The company received a $30 million favorable adjustment from additional Medicaid supplemental revenues in Texas [16] - Contract labor expense was 2.6% of salary, wages, and benefits (SWB) in Q2 2024, down from 4.3% in Q2 2023 [43] - The company repurchased 2 million shares for $270 million in Q2 2024 [44] Q&A Session Summary Question: ASC revenue per case and surgical case volume drivers [23] - The increase in net revenue per case is driven by higher acuity and mix, particularly in orthopedics, cardiac, urology, and robotics [51] Question: Supplemental payment programs and opportunities [26] - Six hospital markets currently participate in supplemental programs, with potential for expansion in other states [53] - Michigan recently enhanced its HRA program, improving reimbursement rates [53] Question: Hospital segment performance and capacity expansion [29] - Q2 performance was strong due to strong volumes, capacity expansion, and effective cost control [29] - Capacity expansion is selective, focusing on markets lagging in COVID recovery [57] Question: Volume outlook for hospitals and USPI [65] - Inpatient admissions are expected to grow 3% to 4% in 2024, driven by a favorable utilization environment [95] - USPI volume guidance was adjusted due to strong comps from the previous year, but revenue per case remains strong [94] Question: Exchange-based coverage and margins [96] - Exchange-based coverage accounts for 6.5% of hospital revenues, with margins comparable to commercial payers [96][97] Question: ASC volume growth and service line trends [106] - Urology is in early stages of growth, with potential for multi-year tailwinds as robotic procedures move to ASCs [106] - Ophthalmology is strong, while pain procedures are being diversified to include higher acuity services [106][108] Question: USPI facility mix and hospital partnerships [110] - USPI has a disciplined integration process for new acquisitions, with 30% to 40% of centers in partnership with external hospitals [113] Question: Managed care pricing and contract negotiations [124] - Contract negotiations have normalized, with discussions focused on catching up to inflationary pressures [124] Question: Inpatient surgical growth vs. outpatient surgical decline [127] - Inpatient surgical growth is driven by acuity, while outpatient surgical decline is influenced by the shift to freestanding ASCs [128] Question: Hospital capacity and margin impact [137] - New capacity additions are margin accretive, with early phases potentially using contract labor before transitioning to permanent staff [148] Question: Occupancy levels and capacity utilization [150] - The company is focused on improving capacity utilization, with a measured approach to service line participation [140][141]

The reported revenue compares to the Zacks Consensus Estimate of $4.98 billion, representing a surprise of +2.49%. The company delivered an EPS surprise of +22.22%, with the consensus EPS estimate being $1.89. As these metrics influence top- and bottom-line performance, comparing them to the year-ago numbers and what analysts estimated helps investors project a stock's price performance more accurately. Net Operating revenues: $5.10 billion versus the three-analyst average estimate of $4.96 billion. The rep ...

Tenet Healthcare (THC) came out with quarterly earnings of $2.31 per share, beating the Zacks Consensus Estimate of $1.89 per share. This compares to earnings of $1.44 per share a year ago. These figures are adjusted for non-recurring items. This quarterly report represents an earnings surprise of 22.22%. A quarter ago, it was expected that this hospital operator would post earnings of $1.45 per share when it actually produced earnings of $3.22, delivering a surprise of 122.07%. Over the last four quarters, ...

[Financial Highlights and Corporate Developments](index=1&type=section&id=Financial%20Highlights%20and%20Corporate%20Developments) [Second Quarter 2024 Performance Summary](index=1&type=section&id=Second%20Quarter%202024%20Performance%20Summary) The company reported strong Q2 2024 results, exceeding expectations with significant growth in Adjusted EBITDA and net income Q2 & Six Months 2024 vs 2023 Performance | ($ in millions, except per share) | Three Months Ended June 30, 2024 | Three Months Ended June 30, 2023 | Six Months Ended June 30, 2024 | Six Months Ended June 30, 2023 | | :--- | :--- | :--- | :--- | :--- | | Net operating revenues | $5,103 | $5,082 | $10,471 | $10,103 | | Net income available to Tenet common shareholders | $259 | $123 | $2,410 | $266 | | Net income per diluted share | $2.64 | $1.15 | $24.22 | $2.47 | | Adjusted EBITDA | $945 | $843 | $1,969 | $1,675 | | Adjusted diluted earnings per share | $2.31 | $1.44 | $5.53 | $2.87 | - Consolidated Adjusted EBITDA for Q2 2024 was **$945 million**, a **12.1% increase** over Q2 2023, driven by strong same-hospital admission growth, ambulatory net revenue per case growth, favorable payer mix, and improved contract labor costs[35](index=35&type=chunk)[63](index=63&type=chunk) - The company recognized a **$30 million favorable pre-tax impact** in Q2 2024 from additional Medicaid supplemental revenues in Texas related to prior years[13](index=13&type=chunk)[45](index=45&type=chunk) [Balance Sheet, Cash Flow, and Capital Allocation](index=3&type=section&id=Balance%20Sheet%2C%20Cash%20Flow%2C%20and%20Capital%20Allocation) The company improved its financial health with increased free cash flow, reduced leverage, and a new share repurchase program - The Board of Directors authorized a new **$1.5 billion share repurchase program**[28](index=28&type=chunk)[37](index=37&type=chunk) - The company completed its previous **$1 billion share repurchase program** by repurchasing 4,801,461 shares for $548 million in the first six months of 2024[66](index=66&type=chunk) - **Free cash flow** for the first six months of 2024 was **$948 million**, compared to $680 million for the same period in 2023[30](index=30&type=chunk)[101](index=101&type=chunk) - The ratio of **net debt to Adjusted EBITDA improved to 2.61x** at June 30, 2024, down from 2.79x at March 31, 2024, and 3.89x at December 31, 2023[67](index=67&type=chunk) [Segment Performance](index=4&type=section&id=Segment%20Performance) [Ambulatory Care Segment](index=4&type=section&id=Ambulatory%20Care%20Segment) The Ambulatory Care segment delivered strong Q2 2024 growth in revenue and Adjusted EBITDA, driven by higher acuity and acquisitions Ambulatory Segment Q2 & Six Months 2024 Performance ($ in millions) | Metric | Q2 2024 | Q2 2023 | Six Months 2024 | Six Months 2023 | | :--- | :--- | :--- | :--- | :--- | | Net operating revenues | $1,141 | $942 | $2,136 | $1,847 | | Same-facility surgical cases | 0.2% | 6.6% | 0.0% | 7.2% | | Adjusted EBITDA | $447 | $370 | $841 | $710 | | Adjusted EBITDA margin | 39.2% | 39.3% | 39.4% | 38.4% | - Q2 2024 net operating revenues **increased 21.1% YoY**, driven by strong net revenue per case growth, facility acquisitions, and new service lines[70](index=70&type=chunk) - Surgical business same-facility system-wide net revenue per case **increased 6.8%** in Q2 2024, driven by higher acuity case mix and favorable payer mix[41](index=41&type=chunk) - As of June 30, 2024, USPI had interests in **520 ambulatory surgery centers** (377 consolidated) and **24 surgical hospitals** (7 consolidated) in 38 states[69](index=69&type=chunk) [Hospital Operations and Services Segment](index=5&type=section&id=Hospital%20Operations%20and%20Services%20Segment) The Hospital segment's revenue declined due to divestitures, but same-hospital performance and Adjusted EBITDA remained strong Hospital Segment Q2 & Six Months 2024 Performance ($ in millions) | Metric | Q2 2024 | Q2 2023 | Six Months 2024 | Six Months 2023 | | :--- | :--- | :--- | :--- | :--- | | Net operating revenues | $3,962 | $4,140 | $8,335 | $8,256 | | Same-hospital admissions | 5.2% | 3.0% | 4.7% | 3.6% | | Adjusted EBITDA | $498 | $473 | $1,128 | $965 | | Adjusted EBITDA margin | 12.6% | 11.4% | 13.5% | 11.7% | - The **4.3% decline** in Q2 2024 net operating revenues was primarily due to the impact of hospital divestitures in Q1 2024[73](index=73&type=chunk) - Same-hospital net patient service revenue per adjusted admission **increased 5.7% year-over-year** for Q2 2024, driven by improved pricing yield, favorable payer mix, and a focus on higher acuity services[44](index=44&type=chunk) [2024 Financial Outlook](index=6&type=section&id=2024%20Financial%20Outlook) [Consolidated Outlook](index=6&type=section&id=Consolidated%20Outlook) The company raised its full-year 2024 outlook for Adjusted EBITDA and Free Cash Flow, reflecting strong year-to-date performance FY 2024 and Q3 2024 Consolidated Outlook ($ in millions, except per share) | Metric | FY 2024 Outlook | Q3 2024 Outlook | | :--- | :--- | :--- | | Net operating revenues | $20,600 to $21,000 | $5,000 to $5,100 | | Adjusted EBITDA | $3,825 to $3,975 | $900 to $950 | | Adjusted diluted EPS | $10.41 to $11.12 | $2.16 to $2.58 | | Free cash flow | $1,100 to $1,350 | N/A | - The FY 2024 Adjusted EBITDA Outlook was **increased by $300 million**, and the Free Cash Flow outlook was **increased by $150 million**[63](index=63&type=chunk) [Segment Outlook](index=7&type=section&id=Segment%20Outlook) The company provided a detailed full-year 2024 outlook for its Ambulatory and Hospital segments, projecting continued growth FY 2024 Ambulatory Segment Outlook | Metric | FY 2024 Outlook | | :--- | :--- | | Net operating revenues | $4,325M to $4,475M | | Adjusted EBITDA | $1,750M to $1,810M | | Surgical cases volumes | Up 1.0% to 2.0% | | Net revenues per surgical case | Up 4.5% to 5.5% | FY 2024 Hospital Segment Outlook | Metric | FY 2024 Outlook | | :--- | :--- | | Net operating revenues | $16,275M to $16,525M | | Adjusted EBITDA | $2,075M to $2,165M | | Inpatient admissions | Up 3.0% to 4.0% | | Adjusted admissions | Up 1.0% to 3.0% | [Financial Statements](index=12&type=section&id=Financial%20Statements) [Consolidated Statements of Operations](index=12&type=section&id=Consolidated%20Statements%20of%20Operations) The statements show 3.6% revenue growth and a significant increase in net income for the first six months, driven by facility sales Consolidated Statement of Operations - Six Months Ended June 30 ($ in millions) | Line Item | 2024 | 2023 | | :--- | :--- | :--- | | Net operating revenues | $10,471 | $10,103 | | Operating income | $4,046 | $1,207 | | Net gains on sales of facilities | ($2,558) | ($13) | | Income before income taxes | $3,671 | $753 | | Net income | $2,811 | $589 | | Net income available to common shareholders | $2,410 | $266 | | Diluted EPS | $24.22 | $2.47 | Consolidated Statement of Operations - Three Months Ended June 30 ($ in millions) | Line Item | 2024 | 2023 | | :--- | :--- | :--- | | Net operating revenues | $5,103 | $5,082 | | Operating income | $761 | $604 | | Income before income taxes | $587 | $373 | | Net income | $477 | $293 | | Net income available to common shareholders | $259 | $123 | | Diluted EPS | $2.64 | $1.15 | [Consolidated Balance Sheets](index=14&type=section&id=Consolidated%20Balance%20Sheets) The balance sheet as of June 30, 2024, shows increased cash, reduced long-term debt, and a significant rise in total equity Consolidated Balance Sheet Summary ($ in millions) | Line Item | June 30, 2024 | Dec 31, 2023 | | :--- | :--- | :--- | | **Assets** | | | | Cash and cash equivalents | $2,880 | $1,228 | | Total current assets | $7,955 | $7,167 | | Total assets | $29,265 | $28,312 | | **Liabilities & Equity** | | | | Total current liabilities | $5,493 | $4,760 | | Long-term debt, net | $12,769 | $14,882 | | Total liabilities | $21,396 | $22,804 | | Total equity | $5,056 | $3,117 | | Total liabilities and equity | $29,265 | $28,312 | [Consolidated Statements of Cash Flows](index=15&type=section&id=Consolidated%20Statements%20of%20Cash%20Flows) Net cash from operations increased, while significant proceeds from facility sales drove positive investing cash flow for the first half of 2024 Consolidated Statement of Cash Flows - Six Months Ended June 30 ($ in millions) | Line Item | 2024 | 2023 | | :--- | :--- | :--- | | Net cash provided by operating activities | $1,333 | $1,047 | | Net cash provided by (used in) investing activities | $3,134 | ($467) | | *Proceeds from sales of facilities* | *$4,048* | *$16* | | *Purchases of property and equipment* | *($385)* | *($367)* | | Net cash used in financing activities | ($2,815) | ($504) | | *Repayments of borrowings* | *($2,179)* | *($1,437)* | | *Repurchases of common stock* | *($548)* | *($90)* | | Net increase in cash and cash equivalents | $1,652 | $76 | [Segment Reporting](index=16&type=section&id=Segment%20Reporting) This section details the financial performance of the Ambulatory Care and Hospital Operations segments for the first six months of 2024 Segment Financial Data - Six Months Ended June 30, 2024 vs 2023 ($ in millions) | Metric | Segment | 2024 | 2023 | | :--- | :--- | :--- | :--- | | **Net operating revenues** | Ambulatory Care | $2,136 | $1,847 | | | Hospital Operations | $8,335 | $8,256 | | | **Total** | **$10,471** | **$10,103** | | **Adjusted EBITDA** | Ambulatory Care | $841 | $710 | | | Hospital Operations | $1,128 | $965 | | | **Total** | **$1,969** | **$1,675** | | **Adjusted EBITDA margins** | Ambulatory Care | 39.4% | 38.4% | | | Hospital Operations | 13.5% | 11.7% | | | **Total** | **18.8%** | **16.6%** | [Non-GAAP Reconciliations and Disclosures](index=10&type=section&id=Non-GAAP%20Reconciliations%20and%20Disclosures) [Definitions of Non-GAAP Measures](index=10&type=section&id=Definitions%20of%20Non-GAAP%20Measures) The company defines non-GAAP measures like Adjusted EBITDA and Free Cash Flow, which management uses to track performance - The company uses non-GAAP measures to track financial and operating performance, compare against peers, and for management incentive compensation[82](index=82&type=chunk) - Key non-GAAP measures are defined, including: - **Adjusted EBITDA:** Net income adjusted for items like interest, taxes, D&A, NCI, gains/losses on sales, and litigation costs - **Adjusted Net Income:** Net income adjusted for items like gains/losses on sales, litigation costs, and their associated tax and NCI impacts - **Free Cash Flow:** Net cash from operating activities less purchases of property and equipment[82](index=82&type=chunk) - Investors are encouraged to use GAAP measures when evaluating financial performance as non-GAAP measures exclude many items and may not be comparable to other companies' metrics[17](index=17&type=chunk) [Reconciliation of Net Income to Adjusted Net Income](index=17&type=section&id=Reconciliation%20of%20Net%20Income%20to%20Adjusted%20Net%20Income) This table reconciles GAAP Net Income to Adjusted Net Income, primarily excluding a $2.56 billion net gain on sales of facilities Reconciliation to Adjusted Net Income ($ in millions) | Line Item | Six Months 2024 | Six Months 2023 | | :--- | :--- | :--- | | Net income available to common shareholders | $2,410 | $266 | | Net gains on sales of facilities | $2,558 | $13 | | Tax and NCI impact of adjustments | ($625) | $7 | | Other adjustments | ($93) | ($79) | | **Adjusted net income available to common shareholders** | **$550** | **$308** | [Reconciliation of Net Income to Adjusted EBITDA](index=18&type=section&id=Reconciliation%20of%20Net%20Income%20to%20Adjusted%20EBITDA) This section reconciles GAAP Net Income to Adjusted EBITDA by adding back items like interest, taxes, depreciation, and facility sale gains Reconciliation to Adjusted EBITDA ($ in millions) | Line Item | Six Months 2024 | Six Months 2023 | | :--- | :--- | :--- | | Net income available to common shareholders | $2,410 | $266 | | Add: NCI | $401 | $323 | | Add: Income tax expense | $860 | $164 | | Add: Interest expense | $421 | $447 | | Add: Depreciation & amortization | $416 | $430 | | Less: Net gains on sales of facilities | ($2,558) | ($13) | | Other adjustments | $13 | $58 | | **Adjusted EBITDA** | **$1,969** | **$1,675** | [Reconciliation of Cash Flow to Free Cash Flow](index=19&type=section&id=Reconciliation%20of%20Cash%20Flow%20to%20Free%20Cash%20Flow) This reconciliation details the calculation of Free Cash Flow from operating cash flow, showing $948 million for the first half of 2024 Reconciliation to Free Cash Flow - YTD June 30 ($ in millions) | Line Item | 2024 | 2023 | | :--- | :--- | :--- | | Net cash provided by operating activities | $1,333 | $1,047 | | Purchases of property and equipment | ($385) | ($367) | | **Free cash flow** | **$948** | **$680** | | Payments for restructuring, etc. | $64 | $78 | | **Adjusted free cash flow** | **$1,012** | **$758** | [Outlook Reconciliations](index=20&type=section&id=Outlook%20Reconciliations) These tables provide reconciliations for the company's 2024 financial outlook, bridging projected GAAP and non-GAAP measures FY 2024 Outlook Reconciliation: Net Income to Adjusted EBITDA ($ in millions) | Line Item | Low | High | | :--- | :--- | :--- | | Net income available to common shareholders | $2,825 | $2,930 | | Adjustments (Taxes, Interest, D&A, etc.) | ($2,558) | ($2,558) | | Less: Net gains on sales of facilities | $2,558 | $2,558 | | Other adjustments | $735 | $845 | | **Adjusted EBITDA** | **$3,825** | **$3,975** | FY 2024 Outlook Reconciliation: Net Income to Adjusted Net Income ($ in millions) | Line Item | Low | High | | :--- | :--- | :--- | | Net income available to common shareholders | $2,825 | $2,930 | | Less: Net gains on sales of facilities | ($2,558) | ($2,558) | | Other adjustments & tax impact | $753 | $718 | | **Adjusted net income available to common shareholders** | **$1,020** | **$1,090** | FY 2024 Outlook Reconciliation: Operating Cash to Adjusted Free Cash Flow ($ in millions) | Line Item | Low | High | | :--- | :--- | :--- | | Net cash provided by operating activities | $1,900 | $2,250 | | Purchases of property and equipment | ($800) | ($900) | | **Free cash flow** | **$1,100** | **$1,350** | | Payments for restructuring, etc. | $125 | $75 | | **Adjusted free cash flow** | **$1,225** | **$1,425** |

The sole determinant of the Zacks rating is a company's changing earnings picture. The Zacks Consensus Estimate -- the consensus of EPS estimates from the sell-side analysts covering the stock -- for the current and following years is tracked by the system. As such, the Zacks rating upgrade for Tenet is essentially a positive comment on its earnings outlook that could have a favorable impact on its stock price. The change in a company's future earnings potential, as reflected in earnings estimate revisions, ...