Executive Summary

Solid Q1 2025 with 4.0% Y/Y revenue growth to $1.497B and adjusted EBITDA up 2.5% to $98M; admissions rose 7.6% Y/Y, while adjusted admissions grew 2.7% . Results excluded any 2025 New Mexico DPP benefit pending CMS approval, a known timing headwind .
Versus Wall Street: revenue was essentially in-line ($1,497.2M actual vs $1,497.6M consensus); on S&P “Primary EPS,” the quarter was a slight miss (0.19 actual vs 0.21 consensus), though management reported diluted EPS of $0.29 (different basis) . Consensus figures from S&P Global shown with asterisks below.
Guidance reaffirmed across all metrics (revenue $6.2–$6.45B, adj. EBITDA $575–$615M, EPS $1.73–$2.01, etc.), signaling confidence in volume durability and operational execution despite payer-denial headwinds and DPP timing .
Near-term catalysts: CMS approval and recognition timing for New Mexico 2025 DPP, ambulatory M&A updates (NextCare integration, further pipeline), and continued supply chain savings; S&P rating upgrade to B+ underscores balance sheet progress .

What Went Well and What Went Wrong

What Went Well

Admissions strength and execution: “Strong underlying volumes and a heightened flu season drove a 7.6% increase in admissions…Adjusted admissions grew 2.7%” (CEO) .
Cost discipline: Supply costs down 60 bps Y/Y as a % of revenue; professional fees growth moderated to 6% vs 13% last year (CFO/CEO) .
Ambulatory growth integration: 18 NextCare urgent care clinics acquired Jan 1 are being integrated, expected to drive downstream volumes in Tulsa and Albuquerque (CEO/CFO) .

What Went Wrong

Payer denials and slower payments: Elevated denials vs Q1’24 and slower clean-claim payments created a Y/Y headwind; management expects a lap in H2 2025 (CFO) .
Outpatient surgeries and calendar effects: Outpatient surgeries declined 2.3% Y/Y and total surgeries −0.7% with ~1.5% Y/Y volume impact from leap year timing (CFO) .
Cash flow seasonality and DPP timing: Q1 operating cash flow was an outflow ($25M used) due to typical Q1 timing and no 2025 New Mexico DPP recognition pre-approval, shifting intra-year cadence (CFO) .

Financial Results

Headline P&L and Non-GAAP

Metric	Q1 2024	Q3 2024	Q4 2024	Q1 2025
Total revenue ($USD Millions)	$1,439.0	$1,449.8	$1,606.3	$1,497.2
Net income attributable to ARDT ($USD Millions)	$27.0	$26.3	$114.2	$41.4
Diluted EPS ($)	$0.21	$0.19	$0.81	$0.29
Adjusted EBITDA ($USD Millions)	$95.8	$97.8	$182.6	$98.2

Notes: Q4 2024 benefited from retroactive New Mexico DPP recognition ($94M revenue, $65M adjusted EBITDA) .

Vs. S&P Global Consensus (Q1 2025)

Metric	Consensus	Actual
Revenue ($USD)	$1,497,589,350*	$1,497,234,000
Primary EPS ($)	$0.2061*	$0.1921*
Primary EPS – # of estimates	8*	—
Revenue – # of estimates	9*	—

Values marked with * retrieved from S&P Global.

Company also reported diluted EPS of $0.29 (not directly comparable to S&P “Primary EPS”) .

Operating KPIs (Q1 2025 vs Q1 2024)

KPI	Q1 2024	Q1 2025	Y/Y
Admissions	38,469	41,389	+7.6%
Adjusted admissions	82,313	84,536	+2.7%
Inpatient surgeries	8,946	9,250	+3.4%
Outpatient surgeries	22,223	21,712	−2.3%
Total surgeries	31,169	30,962	−0.7%
ER visits	157,582	161,249	+2.3%
Patient days	179,126	196,214	+9.5%
ALOS (days)	4.66	4.74	+1.7%
NPSR per adjusted admission ($)	17,204	17,402	+1.2%

Non-GAAP drivers: Q1’25 adjusted EBITDA reflected add-backs including net cybersecurity insurance recoveries (−$19.7M), equity-based comp ($9.3M), Epic implementation costs, and other items .

Guidance Changes

Metric	Period	Previous Guidance (as of Q4 2024)	Current Guidance (Q1 2025)	Change
Total revenue	FY 2025	$6,200–$6,450M	$6,200–$6,450M	Maintained
Net income attributable to ARDT	FY 2025	$245–$285M	$245–$285M	Maintained
Adjusted EBITDA	FY 2025	$575–$615M	$575–$615M	Maintained
Rent expense to REITs	FY 2025	$164M	$164M	Maintained
Diluted EPS	FY 2025	$1.73–$2.01	$1.73–$2.01	Maintained
Adjusted admissions growth	FY 2025	2.0%–3.0%	2.0%–3.0%	Maintained
NPSR per adjusted admission growth	FY 2025	2.1%–4.4%	2.1%–4.4%	Maintained
Capital expenditures	FY 2025	$215–$235M	$215–$235M	Maintained

Earnings Call Themes & Trends

Topic	Previous Mentions (Q3 2024, Q4 2024)	Current Period (Q1 2025)	Trend
AI/technology initiatives	OR block optimization and NLP call center; early clinical tech (BioButton) aiding outcomes/LOS	Focus remains on operational tech platform (Epic single instance); AI not a focal update this quarter	Steady deployment; emphasis shifts to throughput/transfer ops
Supply chain and cost	Supply expense −70 bps Y/Y in Q3; contract labor normalization	Supply cost −60 bps Y/Y; contract labor 3.8% of S&B; continued pipeline of savings (CEO/CFO)	Positive, ongoing savings
Payer denials/MA	Elevated denials but not accelerating in Q3	Higher Y/Y denials and slower payments; expect lap in H2’25 (CFO)	Persistent headwind; stabilization expected late-year
Ambulatory expansion	Urgent care build-out as downstream funnel; M&A pipeline active	NextCare 18 urgent cares integrated; pipeline building; hiring CDO	Expanding; execution in-flight
DPP programs	NM submission pending CMS; DPPs durable across states	No NM 2025 recognition in Q1; approval expected; guidance embeds full-year OK & NM impact	Timing item, durable long-term
Tariffs/macro	Limited commentary	Minimal 2025 EBITDA exposure estimated “mid-single-digit millions”; fixed pricing via GPO; monitoring	Manageable
Transfer centers/throughput	Growing transfer acceptance rates, LOS improvements	Regionalized transfer centers + Epic visibility driving inpatient volumes	Structural volume lever
Exchange volumes	Exchange rev 3.6% in 2024; small base	Q1 admissions +40% from exchanges; mid-single-digit % of revenue	Growth on small base

Management Commentary

“Ardent delivered solid first quarter 2025 results...Strong underlying volumes and a heightened flu season drove a 7.6% increase in admissions. Adjusted admissions grew 2.7%...” (CEO Marty Bonick) .
“Adjusted EBITDA increased 2.5%… Supply cost as a percent of revenue declined 60 basis points year-over-year… we see an opportunity to improve margins by 100 to 200 basis points over the next 3 to 4 years” (CEO/CFO) .
“We ended the first quarter with total cash of $495 million… total available liquidity was $790 million… lease-adjusted net leverage was 3x” (CFO Alfred Lumsdaine) .
“We are reaffirming our full-year 2025 financial guidance” (CEO/CFO) .
“S&P upgraded our credit rating to B+ from B reflecting our improved net leverage and cash flow profile” (CFO) .

Q&A Highlights

Seasonality and sequential EBITDA: Q1 sequential EBITDA softness viewed as normal (reset of deductibles/co-pays, payroll tax timing); flu volumes are lower acuity and not a tailwind to margins (CFO) .
Payer denials and cash: Elevated denials vs Q1’24 and slower payments on clean claims impacted cash; denials not worse vs H2’24; expect lap in H2’25 (CFO) .
Operating levers: Regionalized transfer centers plus Epic-enabled capacity visibility are increasing placed transfers and inpatient surgeries; leap year timing reduced Y/Y surgical volume by ~1.5% (CEO/CFO) .
Exchange growth: Admissions from exchanges +40% Y/Y; exchanges now mid-single digits % of revenue, closer to Medicare rates than commercial (CFO) .
DPP timing: Expect NM 2025 DPP approval; quarterly recognition follows approval date and can be cumulative in-quarters (CFO) .
Site neutrality exposure: Limited expected impact given smaller ambulatory footprint; potential impact < ~$10M under broad scenarios (CEO) .

Estimates Context

For Q1 2025, S&P Global consensus Revenue was $1,497,589,350*, essentially in-line with reported $1,497,234,000 . S&P “Primary EPS” consensus was $0.2061* vs Primary EPS actual of $0.1921*, a slight miss on that basis. Management reported diluted EPS of $0.29, which is not directly comparable to S&P “Primary EPS” . Values retrieved from S&P Global.
Estimate revisions: Reaffirmed full-year guidance and commentary on DPP timing suggest quarterly estimate mix may shift to later quarters upon CMS approval, without changing full-year outlook .