Tenet Health(THC) - 2025 Q3 - Earnings Call Transcript

Financial Data and Key Metrics Changes - In Q3 2025, net operating revenues were $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 [4][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 [6][14] - Free cash flow for 2025 is now expected to be in the range of $2.275 to $2.525 billion, with free cash flow after non-controlling interest projected at $1.495 to $1.695 billion, an increase of $250 million at the midpoint from previous guidance [7][16] Business Line Data and Key Metrics Changes - USPI's adjusted EBITDA grew 12% year-over-year to $492 million, with same-facility revenues increasing by 8.3% and total joint replacements in ASCs growing by 11% [4][11] - The hospital segment's adjusted EBITDA increased 13% to $607 million, with same-store hospital admissions up 1.4% and revenue per adjusted admission rising 5.9% [5][12] Market Data and Key Metrics Changes - The exchange business represented 8.4% of total admissions and 7% of total consolidated revenues in Q3, with a slight increase in total as a percent of admissions from Q2 [24][68] - The company noted healthy patient demand supporting same-store volume growth and a stable operating environment for 2026 [8][9] Company Strategy and Development Direction - The company is focusing on higher acuity services, which has led to improved margins and strong earnings growth [9][10] - There is a robust M&A and de novo activity, with 11 centers acquired and two new centers opened in Q3, emphasizing high-acuity procedures [5][6] - Capital expenditures for 2025 are expected to be between $875 million and $975 million, reflecting a $150 million increase at the midpoint over prior expectations [6][16] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the business's performance, citing strong same-store revenue growth, high patient acuity, and effective cost controls [11][14] - There is uncertainty regarding enhanced premium tax subsidies and their impact on reimbursement and enrollment in exchanges for 2026, but management remains optimistic about patient demand [8][9] 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 [12][54] - The leverage ratio as of September 30 was 2.3 times EBITDA, indicating strong operational performance and financial discipline [13][14] Q&A Session Summary Question: Q4 guidance and utilization expectations - Management has not built in expectations for higher utilization due to exchange subsidies expiring, but they are prepared for typical demand increases in Q4 [19][20] Question: CapEx inputs and allocation - The increased CapEx is focused on clinical program infrastructure and growth strategies, particularly in high-acuity services [25][26] Question: Free cash flow sustainability - The company highlighted improved cash collections and operational efficiencies as key drivers for sustainable free cash flow [28][29] Question: ASC volumes and service line performance - Growth in ASC volumes was driven by higher acuity services, with healthy GI recovery noted in Q3 [46][48] Question: Contribution from DPP in provider taxes - The company recorded approximately $346 million in supplemental Medicaid programs in Q3, with $148 million being out-of-period [52][54] Question: M&A environment for ASCs - The company remains a partner of choice in the ASC market, focusing on high-end specialties and multi-specialty centers [64][66] Question: Impact of CMS WISER model - The company is prepared for changes in pre-authorization requirements and is confident in managing operational adjustments [69][70] 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 [73][74]