HCA(HCA) - 2025 Q3 - Earnings Call Transcript

Financial Data and Key Metrics Changes - The company reported a 42% growth in diluted earnings per share as adjusted compared to the previous year [5] - Revenue increased by 9.6%, driven by broad-based volume growth, improved payer mix, and additional revenue from Medicaid supplemental programs [5][11] - Adjusted EBITDA margin improved due to strong performance in labor and supplies management [13][15] - Cash flow from operations was $4.4 billion, with $1.3 billion in capital expenditures and $2.5 billion in share repurchases [16] Business Line Data and Key Metrics Changes - Same-facility equivalent admissions increased by 2.4% year-over-year [11] - Same-facility inpatient surgical volume grew by 1.4%, while outpatient surgical volume increased by 1.1% [11] - Same-facility visits rose by 1.3%, with commercial and Medicare visits combined increasing by 4.1% [11][12] - Medicaid and self-pay visits both declined compared to the prior year [11] Market Data and Key Metrics Changes - The company experienced solid demand across its markets for healthcare services, expecting volumes to remain within a long-term growth range of 2 to 3% [8] - The respiratory season started slowly, impacting year-over-year growth rates in admissions and visits [11] Company Strategy and Development Direction - The company is focused on enhancing care for patients by increasing access, investing in digital tools, and training staff [7] - The management team has been restructured to improve enterprise capabilities and operational performance [9] - The company is advocating for the extension of enhanced premium tax credits for health insurance coverage [7][8] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in sustaining high levels of performance, citing strong cash flow and a robust balance sheet [9] - The company anticipates stable operating costs and solid demand for healthcare services in the upcoming year [8] - Preliminary views for 2026 are cautious due to the fluid nature of federal policy [8][9] Other Important Information - The company raised its full-year guidance, expecting revenues between $75 billion and $76.5 billion and adjusted EBITDA between $15.25 billion and $15.65 billion [17] - The net benefit from Medicaid state supplemental payments is expected to be $250 million to $350 million favorable for the full year 2025 compared to 2024 [17][18] Q&A Session Summary Question: Can you remind us what states are still pending for grandfathered programs? - Management mentioned Florida, Georgia, and Virginia as states with pending applications, but they do not expect approvals during the current shutdown [21][23] Question: Are you seeing early scheduling for elective surgeries? - Management noted that it is too early to size the potential impact of upcoming enrollment periods and special enrollment provisions [27][28] Question: Can you provide a bridge from Q3 into Q4 guidance? - Management indicated that hurricane impacts and declines in state supplemental payments will affect Q4 growth rates, which are expected to be in the high single-digits range [34] Question: How much of the supplemental payment benefit is included in guidance for Tennessee and Texas? - Tennessee was the largest driver of net benefit in Q3, while Texas had a minor impact due to late approval [38] Question: What is the outlook for professional fees and their impact on EBITDA? - Professional fees increased by 11% year-over-year, primarily related to anesthesia and radiology [84] Question: How is the company managing capacity for incremental volumes? - Management stated there are no significant capacity constraints and that they have improved staffing to meet expected demand [90][91] Question: How should we think about the hurricane-impacted facilities' recovery? - Management expects to recover approximately $100 million of the $250 million headwind from hurricanes in 2025 [97] Question: What gives you confidence in achieving long-term volume growth? - Management highlighted 18 consecutive quarters of volume growth and the addition of more outpatient facilities as key factors [101]