Financial Data and Key Metrics Changes - In Q3 2025, the company reported net operating revenues of $5.3 billion, with consolidated adjusted EBITDA growing 12% year-over-year to $1.1 billion, resulting in an adjusted EBITDA margin of 20.8%, a 170 basis points improvement from the previous year [5][11] - The company raised its full-year 2025 adjusted EBITDA guidance to a range of $4.47 to $4.57 billion, reflecting an increase of $445 million, or 11% at the midpoint from initial guidance [7][15] - Free cash flow for Q3 was $778 million, totaling $2.16 billion year-to-date, which is a 22% increase over the same period last year [14] Business Line Data and Key Metrics Changes - The USPI segment generated $492 million in adjusted EBITDA, representing a 12% year-over-year growth, with same-facility revenues increasing by 8.3% [5][11] - The hospital segment's adjusted EBITDA grew 13% to $607 million, with same-store hospital admissions up 1.4% and revenue per adjusted admission increasing by 5.9% [6][12] Market Data and Key Metrics Changes - The company reported that exchange admissions accounted for 8.4% of total admissions and 7% of total consolidated revenues in Q3, indicating a slight increase from Q2 [24][77] - The company noted that the exchange business at USPI has less exposure compared to the hospital segment, with exchange patients exhibiting consumption patterns similar to Medicaid [22][72] Company Strategy and Development Direction - The company is focusing on higher acuity services, which has led to improved margins and strong earnings growth over the past few years [9] - The strategy includes continued investment in M&A and de novo development, with a robust pipeline for future growth [6][9] - The company plans to invest $875 to $975 million in capital expenditures in 2025, a $150 million increase at the midpoint over prior expectations [7][15] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the business's performance, citing healthy patient demand and stable operating conditions for 2026 [8][9] - There is uncertainty regarding enhanced premium tax subsidies and their impact on reimbursement and enrollment in exchanges, but management is optimistic about a potential compromise [8][21] - The company is committed to maintaining a deleveraged balance sheet and generating strong free cash flow [14][15] Other Important Information - The company recognized a $38 million pre-tax impact for Medicaid supplemental revenues related to prior years in Q3 2025, totaling $148 million year-to-date [13][59] - The company has no significant debt maturities until 2027 and reported $2.98 billion in cash on hand as of September 30, 2025 [14] Q&A Session Summary Question: Q4 guidance and utilization expectations - Management has not built in expectations for higher utilization due to exchange subsidies expiration and is confident in USPI's capacity to handle typical demand [19][21] Question: CapEx inputs and allocation - The increased CapEx is focused on clinical program infrastructure and high-acuity service offerings, with specific investments in cardiac care and surgical programs [26][28] Question: Free cash flow sustainability - Management highlighted improved cash collections and operational efficiencies as key drivers for sustainable free cash flow generation [30][32] Question: USPI Q4 guidance and growth expectations - The implied Q4 guidance reflects typical seasonal growth patterns, with no significant changes in business demand anticipated [35][36] Question: Labor environment and inflationary pressures - The labor environment remains strong, with no significant changes expected, and the company is managing inflationary pressures effectively [39][41] Question: Contribution from Conifer and enrollment services - Conifer is performing well, and the company is preparing to utilize its capabilities for potential enrollment needs if exchange subsidies expire [45][47] Question: Service line performance in Q3 - Growth in USPI was driven by higher acuity services, with some lower-than-expected volumes in respiratory and infectious disease areas noted on the hospital side [51][53] Question: DPP contribution and estimates for the year - The company recorded approximately $346 million in supplemental Medicaid programs in Q3, with $148 million being out-of-period [59][60] Question: Capital allocation and buyback strategy - The company remains focused on M&A and de novo strategies while being active in share repurchases, adjusting based on market conditions [62][64] Question: Expense management opportunities for 2026 - The company is exploring various opportunities for cost savings and efficiency improvements, including labor and supply management [66][68] Question: Impact of the WISER model on USPI - The company is preparing for potential changes in pre-authorization requirements under the WISER model, with a capable revenue cycle function in place [80][81] Question: Inpatient-only list removal impact - The potential removal of the inpatient-only list could benefit the USPI segment, but quantification of the impact is still under discussion [85][86]