Total Revenue [USD, Millions]

Cost of Goods Sold (COGS) [USD, Millions]

SG&A [USD, Millions]

R&D [USD, Millions]

D&A [USD, Millions]

Interest Expense [USD, Millions]

Operating Income (EBIT) [USD, Millions]

Net Income [USD, Millions]

EPS - Basic [USD, Per Share]

EPS - Diluted [USD, Per Share]

b06dfc9d8377b633c238bc4ed74dd2c21c745cec0e86e18217c893b93dd00751

National Group

Atlantic Group

American Group

Corporate and Other

- Medicare

- Managed Medicare

- Medicaid

- Managed Medicaid

- Managed care and insurers

- International (managed care and insurers)

- Uninsured

- Other

Total Revenue

712295463bd28a1bdab5c91c80ed57d931c13ae8595d130cb2613623ae3d5f07

10656786d7204e06c5be5c8529c257d96330891f90e009c9b8b9b1756c7e65ea

Adjustments for Non-Cash Items

Stock-Based Compensation

Changes in Working Capital

Capital Expenditures (CapEx)

Proceeds from / Repayments of Debt

Share Repurchases

Dividend Payments

Net Change in Cash

3137907d16c3a89f67b3f1c853a6ed40df0bbd149f8c53256b10746c9bce98e0

| Metric [USD Billion] | Q1 2023 | Q2 2023 | Q3 2023 | Q4 2023 | Q1 2024 | Q2 2024 | Q3 2024 | Q4 2024 |
|----------------------|---------|---------|---------|---------|---------|---------|---------|---------|
| National Group       | **4.616**  **[0000950170-23-015314_hca-20230331.htm:13]**  | **4.372**  **[0000950170-23-037237_hca-20230630.htm:13]**  | **4.352**  **[0000950170-23-055641_hca-20230930.htm:13]**  | N/A     | **4.795**  **[0000950170-24-052195_hca-20240331.htm:12]**  | **4.817**  **[0000950170-24-087322_hca-20240630.htm:12]**  | **4.891**  **[0000950170-24-119581_hca-20240930.htm:12]**  | N/A     |
| Atlantic Group       | **5.109**  **[0000950170-23-015314_hca-20230331.htm:13]**  | **5.038**  **[0000950170-23-037237_hca-20230630.htm:13]**  | **5.470**  **[0000950170-23-055641_hca-20230930.htm:13]**  | N/A     | **5.677**  **[0000950170-24-052195_hca-20240331.htm:12]**  | **5.719**  **[0000950170-24-087322_hca-20240630.htm:12]**  | **5.578**  **[0000950170-24-119581_hca-20240930.htm:12]**  | N/A     |
| American Group       | **5.199**  **[0000950170-23-015314_hca-20230331.htm:13]**  | **5.536**  **[0000950170-23-037237_hca-20230630.htm:13]**  | **5.491**  **[0000950170-23-055641_hca-20230930.htm:13]**  | N/A     | **5.914**  **[0000950170-24-052195_hca-20240331.htm:12]**  | **5.978**  **[0000950170-24-087322_hca-20240630.htm:12]**  | **6.019**  **[0000950170-24-119581_hca-20240930.htm:12]**  | N/A     |
| Corporate and Other  | **0.667**  **[0000950170-23-015314_hca-20230331.htm:13]**  | **0.915**  **[0000950170-23-037237_hca-20230630.htm:13]**  | **0.900**  **[0000950170-23-055641_hca-20230930.htm:13]**  | N/A     | **0.953**  **[0000950170-24-052195_hca-20240331.htm:12]**  | **0.978**  **[0000950170-24-087322_hca-20240630.htm:12]**  | **0.999**  **[0000950170-24-119581_hca-20240930.htm:12]**  | N/A     |
| **Total Revenue**    | **15.591**  **[0000950170-23-015314_hca-20230331.htm:13]**  | **15.861**  **[0000950170-23-037237_hca-20230630.htm:13]**  | **16.213**  **[0000950170-23-055641_hca-20230930.htm:13]**  | N/A     | **17.339**  **[0000950170-24-052195_hca-20240331.htm:12]**  | **17.492**  **[0000950170-24-087322_hca-20240630.htm:12]**  | **17.487**  **[0000950170-24-119581_hca-20240930.htm:12]**  | N/A     |

748db3256d6feb3541883aee19761a0ed6b81d7eea02901c07b88130f3cbbebb

| Metric [Unit: $ Million] | Q4 2022 | Q1 2023 | Q2 2023 | Q3 2023 | Q4 2023 | Q1 2024 | Q2 2024 | Q3 2024 |
|--------------------------|---------|---------|---------|---------|---------|---------|---------|---------|
| Medicare                 | N/A     | N/A     | **2,567**  **[0000950170-23-037237_hca-20230630.htm:20]**  | **2,560**  **[0000950170-23-055641_hca-20230930.htm:20]**  | N/A     | N/A     | **2,621**  **[0000950170-24-087322_hca-20240630.htm:6]**  | **2,584**  **[0000950170-24-119581_hca-20240930.htm:6]**  |
| Managed Medicare         | N/A     | N/A     | **2,541**  **[0000950170-23-037237_hca-20230630.htm:20]**  | **2,535**  **[0000950170-23-055641_hca-20230930.htm:20]**  | N/A     | N/A     | **2,913**  **[0000950170-24-087322_hca-20240630.htm:6]**  | **2,949**  **[0000950170-24-119581_hca-20240930.htm:6]**  |
| Medicaid                 | N/A     | N/A     | **742**  **[0000950170-23-037237_hca-20230630.htm:20]**    | **1,001**  **[0000950170-23-055641_hca-20230930.htm:20]**  | N/A     | N/A     | **1,108**  **[0000950170-24-087322_hca-20240630.htm:6]**  | **1,208**  **[0000950170-24-119581_hca-20240930.htm:6]**  |
| Managed Medicaid         | N/A     | N/A     | **894**  **[0000950170-23-037237_hca-20230630.htm:20]**    | **1,039**  **[0000950170-23-055641_hca-20230930.htm:20]**  | N/A     | N/A     | **1,033**  **[0000950170-24-087322_hca-20240630.htm:6]**  | **1,031**  **[0000950170-24-119581_hca-20240930.htm:6]**  |
| Managed care and insurers| N/A     | N/A     | **7,830**  **[0000950170-23-037237_hca-20230630.htm:20]**  | **7,687**  **[0000950170-23-055641_hca-20230930.htm:20]**  | N/A     | N/A     | **8,549**  **[0000950170-24-087322_hca-20240630.htm:6]**  | **8,497**  **[0000950170-24-119581_hca-20240930.htm:6]**  |
| International (managed care and insurers) | N/A | N/A | **377**  **[0000950170-23-037237_hca-20230630.htm:20]**  | **375**  **[0000950170-23-055641_hca-20230930.htm:20]**  | N/A | N/A | **416**  **[0000950170-24-087322_hca-20240630.htm:6]**  | **424**  **[0000950170-24-119581_hca-20240930.htm:6]**  |
| Other                    | N/A     | N/A     | **910**  **[0000950170-23-037237_hca-20230630.htm:20]**    | **1,016**  **[0000950170-23-055641_hca-20230930.htm:20]**  | N/A     | N/A     | **852**  **[0000950170-24-087322_hca-20240630.htm:6]**    | **794**  **[0000950170-24-119581_hca-20240930.htm:6]**  |
| Total Revenue            | **15,497**  **[0001193125-23-016833_d268135dex991.htm:1]**  | **15,591**  **[0000950170-23-015314_hca-20230331.htm:13]**  | **15,861**  **[0000950170-23-037237_hca-20230630.htm:20]**  | **16,213**  **[0000950170-23-055641_hca-20230930.htm:20]**  | **17,303**  **[0001193125-24-018748_d734797dex991.htm:0]**  | **17,339**  **[0000950170-24-052195_hca-20240331.htm:12]**  | **17,492**  **[0000950170-24-087322_hca-20240630.htm:6]**  | **17,487**  **[0000950170-24-119581_hca-20240930.htm:6]**  |

303b5fd631d63c226df56b72f1c4f67adba84214b70a2bf1333cef3eb1450c96

HCA Healthcare, Inc. is a leading healthcare provider that operates hospitals and related healthcare entities across the United States and England **[0000950170-24-052195_hca-20240331.htm:4]** **[0000950170-24-119581_hca-20240930.htm:4]**. The company owns and manages a network of 188 hospitals, 125 freestanding surgery centers, and 23 freestanding endoscopy centers, offering a wide range of outpatient and ancillary services **[0000950170-24-052195_hca-20240331.htm:4]** **[0000950170-24-119581_hca-20240930.htm:4]**. HCA's facilities include general acute care hospitals, behavioral hospitals, and various outpatient facilities, providing comprehensive medical services such as surgery, emergency care, and diagnostics **[0000950170-24-016524_hca-20231231.htm:3]**. The company is structured into three geographic groups: the American, Atlantic, and National Groups, each contributing to its diversified service line approach **[0000950170-24-016524_hca-20231231.htm:178]** **[HCA_3400966_0]**.

1. **American Group** - Operates hospitals and healthcare facilities in various states, providing a broad spectrum of medical services and contributing significantly to the company's revenue.
2. **Atlantic Group** - Manages healthcare facilities across different regions, offering extensive inpatient and outpatient services, including emergency and diagnostic care.
3. **National Group** - Comprises hospitals and related entities, delivering a wide range of healthcare services and supporting the company's balanced revenue mix.
4. **General Acute Care Hospitals** - Provides comprehensive medical and surgical services, including intensive care, cardiac care, and emergency services.
5. **Behavioral Hospitals** - Offers specialized care for mental health and behavioral disorders.
6. **Outpatient Facilities** - Includes ambulatory surgery centers, emergency care facilities, urgent care facilities, and diagnostic centers, enhancing community healthcare networks.

ab0f4ae2f27c0fc661437ed09d512c12662e435e98299c02018cc70898a467bc

1. **Given the significant impact of recent hurricanes on HCA's operations, including the closure of HCA Florida Largo Hospital and ongoing issues at HCA Mission Hospital, how do you plan to mitigate the financial and operational risks associated with natural disasters, and has this influenced your long-term capital allocation strategy?**

2. **With Medicaid adjusted admissions declining by 8.5% due to redeterminations, and considering Medicaid accounts for 17%-18% of your adjusted admissions, what specific strategies are you implementing to offset this volume decline and potential revenue impact?**

3. **Despite your investments in AI and technology, which are still in early stages and not yet yielding material results, can you provide more details on the expected timeline for these initiatives to significantly enhance operational efficiency and how you plan to measure their success?**

4. **As wage rates have stabilized in the 2.5% to 3.5% range but labor costs remain a challenge, what additional measures are you taking to optimize labor expenses and improve your wage and compensation expense ratio?**

5. **In light of pressures on Medicare Advantage plan rates and margins, how are you addressing potential reimbursement challenges in your contracts with MA plans, and what changes do you anticipate in your contracting strategy to ensure sustainable revenue growth?**

2e0e82cb30d3ce7607443683e28908363029b458a2f575a46b1f7c601ce399f1

6c41c1200549236dff52e3a169649ed01c4438073f01fc18329511e968401f0c

23794d91c53ae875c8e247d72561e35d9d06ee07c70c9e0dbcc977a6d161504a

### Q3 2024 Earnings Call
- **Issued Period**: Q3 2024
- **Guided Period**: FY 2024 and preliminary comments on FY 2025
- **Guidance**:
  - **Volume Growth**: 3% to 4% for 2025  **[HCA_3404029_2]** .
  - **Earnings Growth**: Near or slightly above the upper end of long-term target ranges for diluted earnings per share and adjusted EBITDA for 2025  **[HCA_3404029_2]** .
  - **Capital Expenditures**: Approximately $5 billion for 2024  **[HCA_3404029_4]** .
  - **Impact of Hurricanes**: Additional expenses and loss of revenue of $200 million to $300 million or $0.60 to $0.90 per diluted share during Q4 2024  **[HCA_3404029_3]** .
  - **Revenue Growth**: 7.9% over the prior year  **[HCA_3404029_3]** .
  - **Adjusted EBITDA Margin**: Improved by 90 basis points over the prior year  **[HCA_3404029_3]** .
  - **Labor Costs**: Improved by 160 basis points from the prior year  **[HCA_3404029_3]** .
  - **Cash Net Revenue per Adjusted Admission**: Growth of 2% to 3% for 2025  **[HCA_3404029_7]** .

### Q2 2024 Earnings Call
- **Issued Period**: Q2 2024
- **Guided Period**: FY 2024
- **Guidance**:
  - **Revenues**: $69.75 billion to $71.75 billion  **[HCA_3393944_0]** .
  - **Net Income Attributable to HCA Healthcare**: $5.675 billion to $5.975 billion  **[HCA_3393944_0]** .
  - **Adjusted EBITDA**: $13.75 billion to $14.25 billion  **[HCA_3393944_0]** .
  - **Diluted Earnings Per Share**: $21.60 to $22.80 per share  **[HCA_3393944_0]** .
  - **Share Repurchases**: Estimated to be around $6 billion in 2024  **[HCA_3393944_0]** .

### Q1 2024 Earnings Call
- **Issued Period**: Q1 2024
- **Guided Period**: FY 2024
- **Guidance**:
  - The documents do not provide specific details on the exact metrics included in HCA's guidance for Q1 2024. It is mentioned that HCA reaffirmed their full-year 2024 guidance ranges during the earnings call  **[HCA_3381143_2]** .

### Q4 2023 Earnings Call
- **Issued Period**: Q4 2023
- **Guided Period**: FY 2024
- **Guidance**:
  - **Revenues**: $67.75 billion to $70.25 billion  **[HCA_3371141_4]** .
  - **Net Income Attributable to HCA Healthcare**: $5.2 billion to $5.6 billion  **[HCA_3371141_4]** .
  - **Adjusted EBITDA**: $12.85 billion to $13.55 billion  **[HCA_3371141_4]** .
  - **Diluted Earnings Per Share**: $19.70 to $21.20  **[HCA_3371141_4]** .
  - **Capital Spending**: $5.1 billion to $5.3 billion  **[HCA_3371141_4]** .
  - **Cash Flow from Operations**: $9.5 billion to $10 billion  **[HCA_3371141_4]** .
  - **Depreciation**: About $3.2 billion  **[HCA_3371141_4]** .
  - **Interest Expense**: Around $2 billion  **[HCA_3371141_4]** .
  - **Fully Diluted Shares**: Around 264 million for the year  **[HCA_3371141_4]** .

e1ea9c9e6da3f39f45693458280a7c1856b1f18b805a7dc9bd768cf8efc2ca90

| Name                  | Position                                           | Start Date  | Short Bio                                                                                                                                                                                                                                                                                                                                 |
|-----------------------|----------------------------------------------------|-------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Samuel N. Hazen       | Chief Executive Officer                            | Jan 2019    | Samuel N. Hazen has served as the CEO of HCA Healthcare since January 2019. He was appointed as a director in September 2018. Prior to becoming CEO, he served as President and COO from November 2016 through December 2018. He has been with HCA for 40 years, holding various leadership roles  **[0000950170-24-016524_hca-20231231.htm:54]** **[0001193125-24-069180_d874659ddef14a.htm:31]** .                                      |
| Erol R. Akdamar       | President of the American Group                     | Jan 2023    | Erol R. Akdamar is the President of the American Group at HCA Healthcare, a position he has held since January 1, 2023. He previously served as President of the North Texas Division from October 2013 to December 2022  **[0000950170-24-016524_hca-20231231.htm:54]** **[0000950170-23-003234_hca-20221231.htm:52]** .                                                                                                          |
| Jennifer L. Berres    | Senior Vice President and Chief Human Resources Officer | Nov 2019    | Jennifer L. Berres serves as the Senior Vice President and Chief Human Resources Officer at HCA. She was appointed to this position effective November 1, 2019. Ms. Berres joined HCA in 1993 and has held various roles, including Vice President of Human Resources from April 2013 through October 2019  **[0000950170-24-016524_hca-20231231.htm:54]** .                                |
| Phillip G. Billington | Senior Vice President of Internal Audit Services    | Jan 2019    | Phillip G. Billington is the Senior Vice President of Internal Audit Services at HCA. He was appointed to this position effective January 1, 2019. Prior to this role, he served as Vice President of Corporate Internal Audit from June 2005 to December 2018  **[0000950170-24-016524_hca-20231231.htm:54]** .                                                                         |
| Jeff E. Cohen         | Senior Vice President — Government Relations        | Oct 2019    | Jeff E. Cohen serves as Senior Vice President — Government Relations at HCA. He was appointed to this position effective October 1, 2019. Before joining HCA, Mr. Cohen spent 20 years with the Federation of American Hospitals, where he most recently held the position of Executive Vice President of Public Affairs  **[0000950170-24-016524_hca-20231231.htm:54]** **[0000950170-23-003234_hca-20221231.htm:52]** .              |
| Michael S. Cuffe, M.D.| Executive Vice President and Chief Clinical Officer | Jan 2022    | Michael S. Cuffe, M.D. serves as the Executive Vice President and Chief Clinical Officer at HCA Healthcare, a position he has held since January 1, 2022. Prior to this role, he was the President of the Physician Services Group from October 2011 through December 2021  **[0000950170-24-016524_hca-20231231.htm:55]** **[0000950170-23-003234_hca-20221231.htm:53]** .                                                            |
| Jon M. Foster         | Executive Vice President and Chief Operating Officer| Jan 2023    | Jon M. Foster is the Executive Vice President and Chief Operating Officer at HCA Healthcare, a position he has held since January 1, 2023. Prior to this role, he served as President of the American Group from January 2013 to December 2022  **[0000950170-24-016524_hca-20231231.htm:55]** **[0000950170-23-003234_hca-20221231.htm:53]** .                                                                                     |
| Richard A. Hammett    | President — Atlantic Group                          | Jan 2023    | Richard A. Hammett was appointed as President — Atlantic Group effective January 1, 2023. He previously served as President of the North Florida Division from June 2020 to December 2022  **[0000950170-24-016524_hca-20231231.htm:55]** **[0000950170-23-003234_hca-20221231.htm:53]** .                                                                                                                                         |
| Michael A. Marks      | Executive Vice President and Chief Financial Officer| May 2024    | Michael A. Marks serves as the Executive Vice President and Chief Financial Officer at HCA Healthcare. He was appointed to this position effective May 1, 2024  **[0001193125-24-046248_d798449d8ka.htm:1]** . Prior to this role, he served as Senior Vice President of Finance from January 1, 2023  **[0000950170-24-016524_hca-20231231.htm:55]** .                                                                            |
| Michael R. McAlevey   | Senior Vice President and Chief Legal Officer       | Jan 2022    | Michael R. McAlevey serves as the Senior Vice President and Chief Legal Officer at HCA. He was appointed to this position in January 2022. Before joining HCA, Mr. McAlevey held senior legal and executive roles at General Electric  **[0000950170-24-016524_hca-20231231.htm:55]** **[0000950170-23-003234_hca-20221231.htm:53]** .                                                                                               |
| Timothy M. McManus    | President — National Group                          | Jan 2023    | Timothy M. McManus serves as President — National Group at HCA Healthcare. He was appointed to this position effective January 1, 2023. Prior to this role, Mr. McManus served as President of the Capital Division from August 2016 to December 2022  **[0000950170-24-016524_hca-20231231.htm:55]** **[0000950170-23-003234_hca-20221231.htm:53]** .                                                                              |
| Sammie S. Mosier      | Senior Vice President and Chief Nurse Executive     | Dec 2021    | Sammie S. Mosier serves as Senior Vice President and Chief Nurse Executive at HCA. She was appointed to this position effective December 1, 2021. Dr. Mosier joined HCA in 1996 as a medical-surgical bedside nurse and has held progressive leadership roles  **[0000950170-24-016524_hca-20231231.htm:56]** .                                                                           |
| Deborah M. Reiner     | Senior Vice President — Marketing and Communications| Oct 2017    | Deborah M. Reiner serves as Senior Vice President — Marketing and Communications at HCA. She was appointed to this position in October 2017. Prior to that, she served as Vice President of Marketing and Customer Relationship Management from August 2017 to October 2017  **[0000950170-24-016524_hca-20231231.htm:56]** **[0000950170-23-003234_hca-20221231.htm:54]** .                                                          |
| William B. Rutherford | Executive Vice President and Chief Financial Officer| Jan 2014    | William B. Rutherford serves as the Executive Vice President and Chief Financial Officer at HCA Healthcare. He has held this position since January 2014. Prior to this role, Mr. Rutherford served as Chief Operating Officer of the Company’s Clinical and Physician Services Group  **[0000950170-24-016524_hca-20231231.htm:56]** .                                                   |
| Joseph A. Sowell, III | Senior Vice President and Chief Development Officer | Dec 2009    | Joseph A. Sowell, III serves as Senior Vice President and Chief Development Officer at HCA. He was appointed to this position in December 2009. Before joining HCA, Mr. Sowell was a partner at the law firm of Waller Lansden Dortch & Davis  **[0000950170-24-016524_hca-20231231.htm:56]** **[0000950170-23-003234_hca-20221231.htm:54]** .                                                                                      |
| Kathryn A. Torres     | Senior Vice President — Payer Contracting and Alignment | Jul 2016    | Kathryn A. Torres serves as Senior Vice President — Payer Contracting and Alignment at HCA. She was appointed to this position in July 2016. Ms. Torres joined HCA in 1993 and has served in various capacities  **[0000950170-24-016524_hca-20231231.htm:56]** **[0000950170-23-003234_hca-20221231.htm:54]** .                                                                                                                     |
| Chad J. Wasserman     | Senior Vice President and Chief Information Officer | Feb 2024    | Chad J. Wasserman serves as the Senior Vice President and Chief Information Officer at HCA Healthcare, effective February 1, 2024. Prior to this role, he was the Senior Vice President and Chief Operating Officer of the Information Technology Group since July 2023  **[0000950170-24-016524_hca-20231231.htm:56]** .                                                                 |
| Kathleen M. Whalen    | Senior Vice President and Chief Ethics and Compliance Officer | Jan 2019    | Kathleen M. Whalen serves as the Senior Vice President and Chief Ethics and Compliance Officer at HCA. She was appointed to this position effective January 1, 2019. Prior to that, she served as Vice President of Ethics and Compliance  **[0000950170-24-016524_hca-20231231.htm:56]** **[0000950170-23-003234_hca-20221231.htm:54]** .                                                                                           |
| Christopher F. Wyatt  | Senior Vice President and Controller; Principal Accounting Officer | Apr 2016    | Christopher F. Wyatt was appointed as Senior Vice President and Controller at HCA in April 2016. He will succeed William B. Rutherford as the Principal Accounting Officer effective May 1, 2024  **[0000950170-24-016524_hca-20231231.htm:57]** **[0001193125-24-125204_d823649d8k.htm:1]** . Prior to his current role, Mr. Wyatt served as Vice President and Chief Financial Officer for IT&S  **[0000950170-24-016524_hca-20231231.htm:57]** **[0000950170-23-003234_hca-20221231.htm:55]** .                             |

a73b4fa38dfed3298634a17949f362dd18e1207f1e5b538daf1784dfed7b362a

| Program Details           | Program 1               | Program 2               |
|---------------------------|-------------------------|-------------------------|
| Approval Date             | January 2023  **[0000950170-24-119581_hca-20240930.htm:11]**         | January 2024  **[0000950170-24-119581_hca-20240930.htm:11]** **[0000950170-24-119581_hca-20240930.htm:40]**      |
| End Date/Duration         | Completed Q1 2024  **[0000950170-24-119581_hca-20240930.htm:11]**    | Ongoing as of 2024-09-30  **[0000950170-24-119581_hca-20240930.htm:11]** **[0000950170-24-119581_hca-20240930.htm:40]**  |
| Total Additional Amount   | **$3 billion**  **[0000950170-24-119581_hca-20240930.htm:11]**       | **$6 billion**  **[0000950170-24-119581_hca-20240930.htm:11]** **[0000950170-24-119581_hca-20240930.htm:40]**    |
| Remaining Authorization   | **$0**  **[0000950170-24-119581_hca-20240930.htm:11]**               | **$2.433 billion**  **[0000950170-24-119581_hca-20240930.htm:11]** **[0000950170-24-119581_hca-20240930.htm:40]**  |
| Details                   | Completed  **[0000950170-24-119581_hca-20240930.htm:11]**            | Active  **[0000950170-24-119581_hca-20240930.htm:11]** **[0000950170-24-119581_hca-20240930.htm:40]**            |

a99149f89f62e4d13fafbd016d2a51663d25cdebc64b456fecd9640977bcef07

### New Metrics in Q3 2024:
- Volume Growth: 3% to 4% for 2025.  **[HCA_3404029_2]**   
- Earnings Growth: Near or slightly above the upper end of long-term target ranges for diluted earnings per share and adjusted EBITDA for 2025.  **[HCA_3404029_2]**   
- Capital Expenditures: Approximately $5 billion for 2024.  **[HCA_3404029_4]**   
- Impact of Hurricanes: Additional expenses and loss of revenue of $200 million to $300 million or $0.60 to $0.90 per diluted share during Q4 2024.  **[HCA_3404029_3]**   
- Revenue Growth: 7.9% over the prior year.  **[HCA_3404029_3]**   
- Adjusted EBITDA Margin: Improved by 90 basis points over the prior year.  **[HCA_3404029_3]**   
- Labor Costs: Improved by 160 basis points from the prior year.  **[HCA_3404029_3]**   
- Cash Net Revenue per Adjusted Admission: Growth of 2% to 3% for 2025.  **[HCA_3404029_7]**   

acfe4af463a0a9c707a424f1cc1cc0999de98395392b8a1c9550801ed0231a12

- **Strong inpatient surgical growth driven by high-margin specialties**: HCA experienced solid inpatient surgical growth, particularly in **neurosciences**, **orthopedics**, general surgery, and vascular procedures. This broad-based growth indicates robust demand for HCA's services in high-margin areas.  **[HCA_3413240_18]**
- **Effective labor management leading to reduced costs**: HCA reduced contract labor expenses by **8%** compared to the prior year, with contract labor as a percentage of salaries, wages, and benefits down to **4.5%** in the quarter. This reflects successful efforts in improving retention, reducing turnover, and enhancing workforce development, resulting in more stable labor costs.  **[HCA_3413240_21]**
- **Continued expansion through network development and strategic acquisitions**: HCA is maintaining its **$5.1 billion** capital expenditure plan for 2025, focusing on network development and expanding clinical capabilities. The upcoming acquisition of a hospital in **Manchester, New Hampshire**, expected to close in Q1 2025, will strengthen their network in that region, indicating confidence in future growth.  **[HCA_3413240_22]** **[HCA_3413240_17]**

d3b30ba0a622a8090d955d4ef49036829224d4cf620363a22b1dd836503df2fa

- **Decline in Outpatient Surgery Volumes:** The company's outpatient surgery case volumes decreased by **1%** in the fourth quarter of 2024 compared to the prior year.  **[HCA_3413240_20]**  This decline was attributed to decreases in Medicaid and uninsured categories  **[HCA_3413240_18]** , which could signal ongoing pressures in outpatient services and potential revenue challenges in this segment.
- **Potential Headwinds from Medicaid Supplemental Payments:** The company's 2025 guidance anticipates that the net effect of Medicaid supplemental payment programs could range from being flat to a **$250 million headwind** compared to 2024.  **[HCA_3413240_2]**  This is due to onetime payments received in a few states in 2024 that may not recur, potentially impacting the company's earnings.
- **Uncertainty Surrounding Site-Neutral Payment Policies:** The possibility of site-neutral payment policies being implemented poses a risk to the company's hospital outpatient reimbursement rates.  **[HCA_3413240_14]**  While HCA has not attempted to size the potential impact due to lack of specific proposals, such policies could have a "more notable impact" on HCA if outpatient surgical procedures are included  **[HCA_3413240_14]** , potentially affecting revenue and margins.

9273dc1d282da4e6324df232c60312023564b1861c022f2a06b903800de2cd4d

1. **Medicaid Supplemental Payments Guidance**  
   **Q:** What's the outlook for Medicaid supplemental payments in 2025?  
   **A:** Management expects the net effect of supplemental payment programs in 2025 to range between **flat compared to 2024 up to a $250 million headwind**, influenced by uncertainties related to the new Tennessee program.  **[HCA_3413240_4]** 

2. **Managed Care Contracting and Denials**  
   **Q:** How are managed care contracts and denial rates for '25 and '26?  
   **A:** HCA is **80% contracted for 2025** and **60% for 2026**, achieving rates at the top of their pricing targets. Denial rates are not materially impacting the company, thanks to improved capabilities in managing denials and underpayments.  **[HCA_3413240_6]** 

3. **Professional Fees Impact**  
   **Q:** What's the impact of professional fees on 2025 expenses?  
   **A:** Professional fee cost pressures are expected to **moderate further in 2025** but will remain above normal inflationary trends, particularly in radiology. Management has bent the cost curve on professional fees in 2024 and anticipates continued progress.  **[HCA_3413240_11]** 

4. **Operational Initiatives and Growth**  
   **Q:** Which internal initiatives are prioritized this year?  
   **A:** HCA is focusing on case management, inpatient throughput, ER optimization, operating room efficiency, and leveraging technology like **AI** to drive improvements. These efforts aim to enhance patient satisfaction, reduce turnover, and support continued growth.  **[HCA_3413240_7]** 

5. **Hurricane Impact on EBITDA**  
   **Q:** How do hurricanes affect EBITDA guidance for 2025?  
   **A:** The reopening of Largo Hospital is expected to increase EBITDA in 2025, offset by a decline in the North Carolina division due to lingering hurricane effects. The **net impact is expected to offset**, providing no tailwind to 2025 guidance.  **[HCA_3413240_10]** 

6. **Site Neutral Payment Proposals**  
   **Q:** What's management's view on site neutral payment proposals?  
   **A:** HCA opposes cuts to Medicare hospital outpatient reimbursement, arguing hospitals shouldn't be paid the same rates as ASCs due to operational differences. The impact is unclear without specific policy details, but HCA sees no need to alter their outpatient strategy.  **[HCA_3413240_14]** 

7. **Medicare Two-Midnight Rule Impact**  
   **Q:** How did the Two-Midnight Rule affect admissions in 2024?  
   **A:** The shift from observation to inpatient status due to the Medicare Advantage Two-Midnight Rule added approximately **50 basis points to admission growth in 2024**, a benefit not expected to repeat in 2025.  **[HCA_3413240_9]** 

8. **Health Care Exchanges Enrollment**  
   **Q:** How does exchange enrollment affect payer mix and outlook?  
   **A:** Exchange enrollment grew about **13–15%** for 2025, with exchanges now representing **7.5%** of equivalent admissions and **9%** of revenues. Management is advocating for the continuation of enhanced subsidies set to expire, emphasizing their positive community impact.  **[HCA_3413240_8]** 

9. **Labor Costs and Wage Inflation**  
   **Q:** What's the outlook for labor costs and wage inflation?  
   **A:** Contract labor decreased to **4.5% of SWD** in Q4 2024. Wage inflation is stable, and 2025 guidance assumes a steady operating environment with rational wage trends. Management expects overall wage inflation to be stable.  **[HCA_3413240_21]** 

10. **Tariff Proposal Impact**  
    **Q:** Any expected impact from Trump's tariff proposals?  
    **A:** It's too early to estimate impacts without policy specifics. HCA is monitoring announcements and employs strategies like fixed-price contracts and supply chain diversification to mitigate potential effects.  **[HCA_3413240_15]** 

11. **CapEx Guidance and Allocation**  
    **Q:** Is there any shift in CapEx allocation due to hurricanes?  
    **A:** CapEx guidance for 2025 is around **$5.1 billion**, with no significant shift due to hurricanes. The typical **50-50 split** between maintenance and growth CapEx remains in place.  **[HCA_3413240_22]** 

12. **ASC Performance and Strategy**  
    **Q:** How did ASCs perform, and what's the growth strategy?  
    **A:** ASC revenues grew **5–6%** in the quarter, with case volumes down **1%**. HCA continues to integrate ASCs into their network, operating **124 surgery centers** and additional GI centers, focusing on network optimization.  **[HCA_3413240_20]** 

13. **M&A Outlook and Strategy**  
    **Q:** What's the outlook for M&A activity in 2025?  
    **A:** HCA focuses on organic growth through capital spending and network development. A new hospital acquisition in Manchester, New Hampshire, is expected to close in Q1, but **no material M&A** is anticipated.  **[HCA_3413240_17]** 

14. **California Wildfires Impact**  
    **Q:** Did California wildfires affect operations?  
    **A:** There was **no impact** on Southern California hospitals from the wildfires. One facility in Ventura County was on high alert but remained unaffected.  **[HCA_3413240_12]** 

15. **Denial Rates and MA Utilization**  
    **Q:** Are there changes in denial rates or utilization review?  
    **A:** HCA has not seen material growth in denials, due to efforts in managing denial and underpayment processes. Denials are not a material impact at this point.  **[HCA_3413240_6]** 

16. **Executive Orders Impact on Labor**  
    **Q:** Could executive orders on foreign workers affect labor?  
    **A:** HCA is monitoring potential impacts but currently doesn't hire undocumented workers. Any effects would be on supply and demand for labor in certain skill mixes.  **[HCA_3413240_15]** 

17. **Outpatient Surgical Volumes**  
    **Q:** What's affecting outpatient surgical volumes?  
    **A:** Outpatient surgical volumes are down, mainly due to declines in Medicaid and uninsured categories. Commercial and exchange volumes were up over **1%**, and revenue growth and profitability within outpatient surgery were up for the quarter and year.  **[HCA_3413240_18]** 

18. **Supplemental Payments and Tennessee Program**  
    **Q:** What's the status of the new Tennessee program?  
    **A:** HCA has been notified of approval for a partial year covering July to December 2024. The 2025 calendar year program has not been approved yet, and management awaits decisions from the new administration.  **[HCA_3413240_13]** 

61b05967dc8af61e355250f7c2da4c65ff2b5deb8e1efacbebf7923e28308336

c2ff74407cddfc53906eaa28241191620b8954a263c2d0d8fda2b92e085661b1

In Q4 '24, HCA saw robust inpatient surgical growth in high-margin specialties while contract labor decreased 8% YOY (4.5% of SWB). Outpatient surgery volumes dipped 1%. Potential Medicaid supplemental shortfall could cost up to $250M in 2025.

335db1af5bea443eba13d4d0385a41ef8cc8eba6698e8a20d87fdd7409b284c3

**Annual guidance for FY 2025:**
- **Growth in Equivalent Admissions**: 3% to 4%  **[HCA_3413240_3]**  (no change from prior guidance of 3% to 4%  **[HCA_3404029_2]** )  
- **Net Revenue per Equivalent Admission**: 2% to 3%  **[HCA_3413240_3]**  (no change from prior guidance of 2% to 3%  **[HCA_3404029_7]** )  
- **Revenues**: $72.8B to $75.8B  **[HCA_3413240_3]**  (no prior guidance)  
- **Net Income Attributable to HCA Healthcare**: $5.85B to $6.29B  **[HCA_3413240_3]**  (no prior guidance)  
- **Adjusted EBITDA**: $14.3B to $15.1B  **[HCA_3413240_3]**  (no prior guidance)  
- **Diluted Earnings Per Share (EPS)**: $24.05 to $25.85  **[HCA_3413240_3]**  (no prior guidance)  
- **Capital Spending (CapEx)**: $5B to $5.2B  **[HCA_3413240_3]**  (no prior guidance)  
- **Full-Year Margins**: Expected to be consistent with 2024  **[HCA_3413240_3]**  (no prior guidance)  
- **Cash Flow from Operations**: $10.75B to $11.25B  **[HCA_3413240_3]**  (no prior guidance)  

8e1a3e215fe434d894d89309ba9c549775bc6adcc9ac533f0f23ffa9257a1715

| Name            | Start Date | End Date | Reason for Change |
|-----------------|------------|----------|-------------------|
| Ernst & Young LLP | 1994  **[0000950170-24-016524_hca-20231231.htm:154]**  | Present  | Current auditor   |

a68f819cd46064347b4ebd5dfe9fb80410eae185847da8cc7cfd2c34c8558c7b

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| Year  | Amount Due [Billions] | Debt Type                  | Interest Rate [%] | % of Total Debt                                                                 |
|-------|-----------------------|----------------------------|-------------------|---------------------------------------------------------------------------------|
| 2024  | 4.682                | Short-term debt            | N/A               | 10.9% = (4.682 / 42.965) * 100 **[0000950170-24-119581_hca-20240930.htm:10]**                                         |
| 2031  | 1.750                | Senior unsecured notes     | 5.450             | 4.1% = (1.750 / 42.965) * 100 **[0000950170-24-119581_hca-20240930.htm:10]**                                         |
| 2034  | 2.550                | Senior unsecured notes     | 5.450 - 5.600     | 5.9% = (2.550 / 42.965) * 100 **[0000950170-24-119581_hca-20240930.htm:10]**                                         |
| 2054  | 2.500                | Senior unsecured notes     | 5.950 - 6.000     | 5.8% = (2.500 / 42.965) * 100 **[0000950170-24-119581_hca-20240930.htm:10]**                                         |
| 2064  | 0.700                | Senior unsecured notes     | 6.100             | 1.6% = (0.700 / 42.965) * 100 **[0000950170-24-119581_hca-20240930.htm:10]**                                         |
| Other | 30.783               | Remaining long-term debt   | 4.3 - 6.3         | 71.7% = (30.783 / 42.965) * 100 **[0000950170-24-119581_hca-20240930.htm:10]** **[0000950170-24-119581_hca-20240930.htm:30]**                               |

30fd60981bf02e4d8149d217294592b2667ee58266717b9ec5029472ffa564ac

1. **Volume Growth Outlook**  
   **Q:** What are the current volume trends and future expectations?  
   **A:** HCA experienced strong volume growth with inpatient admissions up over **5%**.  **[HCA_3381143_3]**  Every division saw inpatient growth, with 56 hospitals growing greater than **10%**.  **[HCA_3381143_3]**  While comparisons will be tougher in the second half, they expect demand to remain strong and sustain growth, even if not at the current levels.  **[HCA_3381143_3]** 

2. **Operating Expenses**  
   **Q:** What's driving OpEx pressure and future expectations?  
   **A:** Primary factors impacting operating expenses are increased professional fees and higher provider taxes related to supplemental payment programs.  **[HCA_3381143_5]**  Professional fees began pressuring expenses in the second quarter last year, and while they are moderating sequentially, they still affect year-over-year comparisons.  **[HCA_3381143_5]**  OpEx as a percentage of revenue has been consistent over the past three quarters, and HCA expects this trend to continue.  **[HCA_3381143_5]** 

3. **Labor Costs and Contract Labor**  
   **Q:** Can you update on labor costs and contract labor trends?  
   **A:** Core labor trends are in line with expectations, with wage inflation around **2.5% to 3%**.  **[HCA_3381143_14]**  Contract labor costs are down **20%** year-over-year, and HCA believes there's still more room for reduction.  **[HCA_3381143_7]**  Initiatives on recruitment, retention, and enhanced care models have improved staffing supply, allowing them to accommodate strong demand.  **[HCA_3381143_9]** 

4. **Medicaid Redetermination Impact**  
   **Q:** How is Medicaid redetermination affecting volumes and payer mix?  
   **A:** Medicaid redeterminations have led to a slight negative impact on volumes, particularly in outpatient surgery.  **[HCA_3381143_3]**  However, many patients transitioning off Medicaid are moving to employer-sponsored plans or health insurance exchanges, with exchange volume up nearly **50%**.  **[HCA_3381143_8]**  This shift contributes positively to the payer mix.  **[HCA_3381143_8]** 

5. **Guidance and Volume Expectations**  
   **Q:** Are you adjusting guidance based on strong Q1 volumes?  
   **A:** HCA reaffirmed their guidance, noting that ranges are wide enough to accommodate various outcomes.  **[HCA_3381143_12]**  While pleased with strong volume trends, they anticipate year-over-year comparisons will become more challenging in the second half due to strong prior-year volumes.  **[HCA_3381143_12]**  They prefer not to adjust guidance quarterly unless material circumstances warrant it.  **[HCA_3381143_12]** 

6. **Medicaid Supplemental Payments**  
   **Q:** What's the outlook on Medicaid supplemental payments and DSH?  
   **A:** HCA expects a modest headwind in revenue from Medicaid supplemental payment programs in 2024 versus 2023 due to settlements realized in 2023 that won't recur.  **[HCA_3381143_10]**  The ratios of associated operating expenses remain relatively consistent.  **[HCA_3381143_10]**  The recent CMS final rule is viewed positively, potentially leading to changes in how providers receive payments.  **[HCA_3381143_13]** 

7. **Occupancy Levels and Capacity**  
   **Q:** Are high occupancy levels affecting operating leverage?  
   **A:** Occupancy levels are near all-time highs  **[HCA_3381143_9]** , but HCA believes there's still room for operating leverage through fixed cost absorption.  **[HCA_3381143_9]**  They are investing in additional inpatient bed capacity, expecting to grow capacity by about **2%** this year.  **[HCA_3381143_16]**  Initiatives in case management and staffing supply have improved capacity management without compromising leverage.  **[HCA_3381143_9]** 

8. **Capital Expenditures**  
   **Q:** What's the plan for CapEx and capacity expansion?  
   **A:** CapEx is expected to be around **$5.2 billion** for the year.  **[HCA_3381143_16]**  Investments include a new hospital in San Antonio opening later this year and major projects across campuses.  **[HCA_3381143_16]**  HCA is also investing in emergency room capacity and outpatient surgery platforms.  **[HCA_3381143_16]** 

9. **Commercial Outpatient Surgeries**  
   **Q:** How did commercial outpatient surgeries perform?  
   **A:** Commercial outpatient surgeries were generally flat but performed better than the overall aggregate.  **[HCA_3381143_17]**  Calendar effects impacted outpatient surgery volumes, with softness in Medicaid volumes.  **[HCA_3381143_9]**  HCA doesn't see any structural issues and continues to invest in the outpatient surgery platform.  **[HCA_3381143_17]** 

10. **Emergency Room Volumes**  
    **Q:** What's happening with emergency room volumes?  
    **A:** Emergency room visits were up **7%**, with commercial ER visits up **20%** year-over-year.  **[HCA_3381143_9]**  Medicaid ER visits were down **10%**, likely due to redeterminations.  **[HCA_3381143_9]**  Improved service levels and investments in ER capacity have led to better patient satisfaction and processing times.  **[HCA_3381143_9]** 

11. **Valesco Performance**  
    **Q:** How is Valesco performing relative to expectations?  
    **A:** Valesco operations are expected to generate the same amount as in 2023, but over four quarters instead of three, resulting in sequential improvement.  **[HCA_3381143_7]**  Valesco is providing a modest benefit, and HCA is starting to see encouraging signs.  **[HCA_3381143_4]** 

12. **Galen Nursing School**  
    **Q:** How is the integration of Galen nursing graduates progressing?  
    **A:** HCA is integrating Galen campuses into the organization, aiming to retain graduates within the company.  **[HCA_3381143_17]**  They plan to have about **30 campuses** by 2027 with **30,000 students**, graduating **7,000 to 8,000** per year.  **[HCA_3381143_17]**  It's early, but they're encouraged by the progress.  **[HCA_3381143_17]** 

082134b4e482870b3329929b0f1b9c6e9b59e104d3509aa4c7a964c8c48c69fb

- **Decline in outpatient surgery volumes:** Outpatient surgeries declined **2%** in the quarter, attributed mainly to calendar effects and a considerable decline in Medicaid volume due to the redetermination process.  **[HCA_3381143_1]** ,  **[HCA_3381143_17]**
- **Increasing operating expenses and uncertain timing of supplemental payments:** Operating expenses, such as state supplemental payment expenses and professional fees, continued to grow, with sequential increases and variability in timing, potentially impacting margins.  **[HCA_3381143_11]** ,  **[HCA_3381143_13]**
- **Occupancy at all-time high may limit further operating leverage:** Occupancy levels are at an **all-time high**, suggesting limited room for additional operating leverage through occupancy gains, potentially peaking operating leverage on labor and other operating expenses.  **[HCA_3381143_9]**

5587a4c4c8ccbde358834952bd98dc38a85a89ebfb2ec2baba8ba3e564177045

- **Medicaid volumes decreased by 10%** due to redeterminations, which may continue to impact patient volumes negatively.  **[HCA_3393944_0]**
- **Uncertainty over the expiration of enhanced ACA exchange subsidies at the end of 2025** could lead to a loss of exchange patients, affecting future revenues.  **[HCA_3393944_0]**
- **Medicaid reimbursements, even with supplemental payments, remain below the cost of care**, potentially pressuring margins as Medicaid patient mix increases.  **[HCA_3393944_0]**

38402e7479518f00bfbe3348a1adbb3edb1c754e08bd56a36e00a88b7150621f

- **HCA Healthcare is experiencing strong volume growth**, with same-facility surgical volumes increasing both inpatient (**up 2%**) and outpatient (**up 2.5%**) in 2023, and expects these trends to continue into 2024, supported by investments in new programs and facilities.  **[HCA_3371141_15]**
- **Medicare Advantage admissions grew approximately 10%** in the quarter, consistent throughout the year, reflecting market share gains and an aging population, which is expected to positively impact revenue growth.  **[HCA_3371141_8]**
- **HCA is implementing effective expense management initiatives**, including a financial resiliency program and technology investments, leading to improved efficiencies and performance, enhancing their cost structure and operational excellence.  **[HCA_3371141_13]**

ef99a2dcfdafad3e0488feae6f606d80861b971225eca39820b13b819d777f1b

- **HCA is investing in AI and technology, leading to improvements in administrative functions, operational management, and clinical outcomes, with early promising results and expectations for incremental improvements in 2025 and beyond.**  **[HCA_3404029_13]**
- **HCA has advanced commercial contracts, including major signings with Kaiser in Denver and Blue Cross of Tennessee in Chattanooga, resulting in broad payer participation and access, contributing to growth.**  **[HCA_3404029_18]**
- **Despite challenges such as hurricane impacts, HCA anticipates earnings growth near or slightly above the upper end of their long-term target ranges, indicating strong financial performance ahead.**  **[HCA_3404029_11]**

1d42c77dea7617cb0e9589586555d3cf1e04d097b63a2e5e719bd3eb0e4f4c76

- **Significant impact from recent hurricanes:** HCA expects **significant repair expenses and lost revenue** due to Hurricane Helene affecting HCA Mission Hospital and Hurricane Milton affecting HCA Florida Largo Hospital. They anticipate ongoing effects into 2025, which could negatively impact financial performance.  **[HCA_3404029_1]** **[HCA_3404029_11]**
- **Artificial intelligence investments not yet material:** While HCA is making investments in AI and technology, they acknowledge that these are **not material yet** and benefits are expected to be more significant in **2025 and 2026** onwards. This suggests a delay in realizing returns on these investments.  **[HCA_3404029_13]**
- **Rising uninsured patient volumes and stable bad debt costs:** HCA reports a **7% increase in uninsured volume growth** for equivalent admissions due to Medicaid redeterminations. While they state that bad debt costs remain stable, the rise in uninsured patients could pressure margins if this trend continues.  **[HCA_3404029_20]**

102348564f39bcbfe9c180aa97ddbb3782198afaa216cccccb8d2c4fb10437cf

1. **Medicaid Supplemental Payments**  
   **Q:** How are Medicaid supplemental payments impacting earnings, and is Tennessee included in estimates?  
   **A:** Mike Marks explained that they recognized a year-over-year earnings increase of approximately **$125 million** related to Medicaid supplemental payment programs, primarily from new programs in Nevada and Florida.  **[HCA_3393944_0]**  They do not anticipate financial impact from Tennessee in 2024.  **[HCA_3393944_0]**  They now expect a **$100–$200 million tailwind** from these programs in 2024, mostly occurring in the first half.  **[HCA_3393944_0]** 

2. **Exchange Volume Growth**  
   **Q:** What is the trend in public exchange volumes year-over-year, and how is it affecting results?  
   **A:** Managed care volumes, including exchanges, were up **12.5%** in the quarter.  **[HCA_3393944_0]**  Excluding exchanges, managed care volumes increased just under **5%**.  **[HCA_3393944_0]**  Healthcare exchange volumes surged **46%** over the prior year.  **[HCA_3393944_0]**  Exchange patients represent about **7%** of admissions and **9%** of revenues, with margins below commercial but above Medicare.  **[HCA_3393944_0]** 

3. **Labor Cost Improvements**  
   **Q:** Is the sequential decline in labor costs due to contract labor reductions, and can you provide details?  
   **A:** Contract labor costs decreased **25.7%** from the prior year and represented **4.8%** of total labor costs  **[HCA_3393944_0]** , down from **6.8%** last year and nearly **10%** at the height of COVID.  **[HCA_3393944_0]**  Wage inflation remained stable at **2.5–3%**.  **[HCA_3393944_0]** 

4. **EBITDA Guidance Increase**  
   **Q:** What's driving the increase in EBITDA guidance for the back half of the year?  
   **A:** The company is pleased with year-to-date performance, with strong demand and improved margins.  **[HCA_3393944_0]**  Volume and payer mix were better than expected, and labor costs improved due to declines in contract labor.  **[HCA_3393944_0]**  They now anticipate a **$100–$200 million tailwind** from Medicaid supplemental payments in 2024, mostly in the first half.  **[HCA_3393944_0]** 

5. **Volume Sustainability**  
   **Q:** How sustainable is the elevated utilization trend you're experiencing?  
   **A:** Sam Hazen expects volume trends to continue throughout 2024.  **[HCA_3393944_0]**  The company's growth is supported by strong market characteristics, effective network strategies, significant capital investments, and increased coverage which elevates demand.  **[HCA_3393944_0]**  Broad-based growth has been seen across all payer classes and services.  **[HCA_3393944_0]** 

6. **Patient Acuity Trends**  
   **Q:** What's driving the strength in patient acuity?  
   **A:** The company's strategy to offer comprehensive services—including enhancements in trauma, transplant, and neonatal care—has naturally lifted patient acuity.  **[HCA_3393944_0]**  Investments in complex services and network capabilities contribute to this trend.  **[HCA_3393944_0]**  The two-midnight rule is slightly dilutive to case mix, but overall acuity has increased.  **[HCA_3393944_0]** 

7. **Exchange Subsidies Risk**  
   **Q:** What is the potential impact if enhanced exchange subsidies expire in 2025?  
   **A:** Sam Hazen stated it's too early to predict policy changes.  **[HCA_3393944_0]**  The company is studying potential impacts but currently lacks precise details on subsidy expirations.  **[HCA_3393944_0]**  They will share information once they have a better understanding.  **[HCA_3393944_0]** 

8. **Capital Allocation and CapEx**  
   **Q:** Are there changes to CapEx plans, and how will excess cash flow be used?  
   **A:** The company maintains its CapEx outlook at **$5.1–$5.3 billion** for 2024.  **[HCA_3393944_0]**  They expect to spend about **$6 billion** on share repurchases in 2024, subject to market conditions.  **[HCA_3393944_0]**  Excess free cash flow from improved results will primarily go toward share repurchases.  **[HCA_3393944_0]** 

9. **Margin Outlook**  
   **Q:** Is current margin performance sustainable into next year?  
   **A:** Sam Hazen indicated that the first six months reflect solid operational performance without unusual events.  **[HCA_3393944_0]**  No material factors are expected to negatively impact margins moving forward.  **[HCA_3393944_0]** 

10. **Outpatient Surgery Volumes**  
    **Q:** Outpatient surgeries were down 2%; can you elaborate on the trends?  
    **A:** The decline is primarily in Medicaid and uninsured categories.  **[HCA_3393944_0]**  Despite lower volumes, revenue growth and profitability in the outpatient surgery segment increased.  **[HCA_3393944_0]**  The company anticipates potential improvement if patients shifting from Medicaid to exchanges adjust their service utilization patterns.  **[HCA_3393944_0]** 

87277c9e8ac3b1866610893c9679c510c4eca41e0491fb0fc8fbf6a9c0a1f1ab

- **HCA anticipates headwinds of $100 million to $200 million** in Medicaid supplemental payment programs in 2024 due to non-recurring settlements received in 2023.  **[HCA_3371141_10]**
- The company experienced **slower surgical growth in the fourth quarter**, potentially indicating a deceleration in surgical volumes.  **[HCA_3371141_15]**
- Increasing admissions of **Medicare Advantage patients grew roughly 10%**, which could pressure margins due to lower reimbursement rates compared to commercial insurance.  **[HCA_3371141_8]**

1290a8440076a27c98d29419ee6c0aaa33548fef311e54b413b084fe7df13096

1. **2024 Volume Expectations**  
   **Q:** What's driving higher volume growth in 2024?  
   **A:** HCA anticipates adjusted admissions to grow by **3% to 4%** in 2024, exceeding the historical **2% to 3%** range. This increase is driven by strong demand, successful capital initiatives, favorable economic indicators, and robust enrollment in health insurance exchanges across their states. Access to contracted lives remains strong, supporting this optimistic outlook.  **[HCA_3371141_14]** 

2. **Labor Cost Outlook**  
   **Q:** How will labor costs and wage inflation trend?  
   **A:** HCA expects wage inflation to normalize to **2.5% to 3%** going forward. There's continued opportunity to reduce contract labor expenses, with plans in place for 2024. Professional fees are targeted to decrease, aiming for growth of **8% to 10%** next year compared to **15% to 20%** this year, through multiple initiatives including revenue enhancements and program adjustments.  **[HCA_3371141_11]** **[HCA_3371141_16]** 

3. **Managed Care Pricing and Medicaid Redeterminations**  
   **Q:** Is guidance factoring benefits from the 2-midnight rule or Medicaid shifts?  
   **A:** The 2024 guidance includes a **2% to 3%** aggregated revenue per adjusted admission increase but doesn't materially factor in benefits from the 2-midnight rule or Medicaid redeterminations. While there's potential for modest benefits as patients migrate from Medicaid to health insurance exchanges or employer-sponsored coverage, it's too early to assess significant impacts.  **[HCA_3371141_12]** **[HCA_3371141_18]** 

4. **Capital Expenditure Plans**  
   **Q:** How is capital being allocated, and what are returns?  
   **A:** HCA plans to invest **$5 billion** in capital in 2024, maintaining consistent allocation between inpatient, outpatient, and technology investments. Returns remain solid, in the upper teens percentage. Outpatient facilities offer quick returns, while hospital investments provide long-term value, enhancing the overall network and meeting demand in fast-growing communities.  **[HCA_3371141_9]** **[HCA_3371141_20]** 

5. **Medicare Advantage Trends and 2-Midnight Rule**  
   **Q:** What are Medicare trends and the 2-midnight rule impact?  
   **A:** Medicare Advantage admissions grew roughly **10%** in the quarter, consistent with trends throughout the year, due to conversions from traditional Medicare and utilization gains. The 2-midnight rule is expected to benefit patients and could provide modest positive results over time, but it's too early to quantify its impact for 2024.  **[HCA_3371141_8]** 

6. **Professional Fees Management**  
   **Q:** How will professional fee growth be managed in 2024?  
   **A:** HCA aims to reduce professional fee growth to **8% to 10%** in 2024 from **15% to 20%** this year. This will be achieved through initiatives such as integrating operations, adjusting programs, and internalizing certain services, with a focus on bending the trend line of expense growth.  **[HCA_3371141_16]** 

7. **Supplemental Payment Headwinds**  
   **Q:** What's the outlook for supplemental payments in 2024?  
   **A:** Supplemental payments are expected to be a headwind of **$100 million to $200 million** in 2024. This is largely due to non-recurring settlements received in 2023 and the impact of beginning accruals for new programs, such as in Florida. These factors contribute to the anticipated decrease in supplemental payment income.  **[HCA_3371141_10]** 

8. **Demand Trends in Senior Population**  
   **Q:** Is pent-up senior demand still impacting volumes?  
   **A:** Medicare admissions have shown slight acceleration, growing from **2.6%** in 2019 to **4%** in 2023. This growth is attributed to aging demographics, population increases in HCA's markets, and market share gains. It's challenging to determine if there's a structural change in utilization patterns.  **[HCA_3371141_17]** 

9. **Surgical Growth Outlook**  
   **Q:** How is surgical volume expected to trend?  
   **A:** HCA expects consistent surgical volume growth in 2024. In 2023, inpatient surgeries increased by **2%** and outpatient surgeries by **2.5%**, despite a slower fourth quarter due to calendar effects. Ongoing investments in ambulatory surgery centers and complex program offerings are anticipated to support this growth. Cardiac volumes are particularly strong, growing in the **mid-single digits**.  **[HCA_3371141_15]** 

10. **Labor Supply and Capacity Constraints**  
    **Q:** Are there still labor-related capacity issues?  
    **A:** HCA's patient acceptance rate has improved to approximately **90%**, meaning about **10%** of referred patients couldn't be admitted due to capacity constraints. While still below 2019 levels, improvements are expected in 2024 as hiring continues and new capital projects come online. Efforts to enhance staff retention and create a supportive work environment are ongoing.  **[HCA_3371141_19]** 

11. **Expense Management Initiatives**  
    **Q:** Any new strategic focus on expense reduction?  
    **A:** HCA is enhancing financial resiliency through sophisticated revenue cycle integration and internal benchmarking efforts. Initiatives like the case management program have reduced length of stay and modestly increased case mix, contributing to operating leverage and efficiency. These programs aim to find better ways to serve stakeholders while managing costs effectively.  **[HCA_3371141_13]** 

12. **Valesco Operating Improvements**  
    **Q:** How are Valesco's operating losses being addressed?  
    **A:** Valesco's performance aligned with expectations, with operating losses around **$150 million** annually for both 2023 and 2024, considering the transition from 9 months to a full year. HCA anticipates continued improvements through integrating the joint venture and implementing operational enhancements, expecting run-rate improvements as the year progresses.  **[HCA_3371141_10]** **[HCA_3371141_16]** 

13. **COVID Impact on Operations**  
    **Q:** How is COVID affecting patient acuity and costs?  
    **A:** COVID admissions have remained stable at approximately **2%** of total admissions, with acuity levels consistent over the past year. COVID has not been a material factor in HCA's overall operating results recently.  **[HCA_3371141_21]** 

14. **Capital Expenditure Returns**  
    **Q:** Are returns on capital investments changing?  
    **A:** Returns on capital expenditures continue to be strong, in the upper teens percentage. Outpatient facilities provide efficient and quick returns, while hospital investments yield long-term value. The integrated network model combining outpatient and inpatient facilities supports positive enterprise returns and aligns with HCA's growth strategy.  **[HCA_3371141_20]** 

3b785925ecc6b58263cb53c43d8f51f5216de47415ed8a8faf6e843bae352be7

- **HCA experienced broad-based volume growth across the company**, with inpatient admissions increasing in every division. **56 hospitals grew more than 10%**, representing almost one-third of their portfolio, and another quarter grew more than 5%. This is described as **the best portfolio performance** the CEO has seen in his experience.  **[HCA_3381143_3]**
- **Commercial emergency room visits increased by 20% year-over-year**, indicating strong demand in higher-margin segments and an improved payer mix. Patient satisfaction and service levels in emergency rooms have also **improved markedly**, contributing to overall growth.  **[HCA_3381143_9]**
- **Occupancy levels are at an all-time high**, and HCA has made **solid improvements in recruitment and retention**, enhancing staffing capacity to meet increased demand efficiently. Despite higher acuity, **length of stay decreased**, allowing for more admissions and demonstrating effective capacity management.  **[HCA_3381143_9]**

7258581c54f0457e111a31d1dbd72785689324f946e4017fedee4b01104247a4

1. **2025 Outlook and Hurricane Impact**  
   **Q:** Is the 2025 guidance accounting for hurricane impacts?  
   **A:** Management confirmed that their 2025 outlook accounts for the ongoing effects of the hurricanes, primarily in North Carolina, with the Tampa facility expected to be operational by the end of 2024. They anticipate being near or slightly above the upper end of their long-term growth range. More details will be provided in January.  **[HCA_3404029_5]** ,  **[HCA_3404029_11]** 

2. **Pricing Assumptions for 2025**  
   **Q:** What are the pricing expectations for 2025?  
   **A:** They project a cash net revenue per adjusted admission growth of **2% to 3%** in 2025. Commercial payer contracting is progressing well, with mid-single-digit updates and **80%** completion for 2025 contracts.  **[HCA_3404029_7]** ,  **[HCA_3404029_8]** 

3. **Volume Trends and Payer Mix**  
   **Q:** How are volume trends and payer mix expected to change?  
   **A:** Exchange enrollment growth is expected to moderate to **8% to 10%** in 2025, down from over **30%** this year. Medicaid volumes are anticipated to flatten as the redetermination process concludes, leading to a generally stable payer mix moving from 2024 to 2025.  **[HCA_3404029_10]** ,  **[HCA_3404029_14]** ,  **[HCA_3404029_23]** 

4. **Labor and OpEx Assumptions**  
   **Q:** What are the labor and OpEx expectations for next year?  
   **A:** They anticipate a stable operating environment for 2025, with wage inflation remaining in the **2.5% to 3.5%** range, consistent with 2024 trends. Other cost assumptions are expected to be stable and in line with 2024.  **[HCA_3404029_8]** ,  **[HCA_3404029_20]** 

5. **Claim Denial Activity and Two-Midnight Rule**  
   **Q:** What is the impact of claim denials and the two-midnight rule?  
   **A:** Denials were not a material impact in the third quarter. Medicare Advantage admissions increased by **11%**, with approximately **2%** attributed to the two-midnight rule. They continue to see modest reductions in prior authorization denials but are still facing significant denials from a few large Medicare Advantage payers.  **[HCA_3404029_6]** 

6. **Medicare Advantage Contracting Environment**  
   **Q:** How is contracting with Medicare Advantage plans progressing?  
   **A:** They are largely contracted across major Medicare Advantage payers and have secured renewals in 2024, maintaining consistency with past agreements. They continue to work through challenges with payer partners but remain committed to being contracted.  **[HCA_3404029_15]** 

7. **Capital Allocation and Leverage Strategy**  
   **Q:** How are hurricanes affecting capital allocation and leverage?  
   **A:** Despite the hurricanes, they do not plan to alter their long-term capital allocation strategy. Facilities have recovered from past storms and are performing at higher levels. Leverage is at the low end of their target range, and any changes to financial policies will be announced on the first-quarter call.  **[HCA_3404029_11]** ,  **[HCA_3404029_16]** 

8. **AI and Technology Investments**  
   **Q:** What progress is being made with AI and technology investments?  
   **A:** They are early in their digital agenda but see promising results, particularly in scheduling, workforce allocation, and revenue cycle management. While not yet material, these initiatives are expected to yield incremental improvements in **2025**, **2026**, and beyond.  **[HCA_3404029_13]** 

9. **Resiliency Program and Cost Savings**  
   **Q:** How is the resiliency program contributing to savings?  
   **A:** The program is on track, contributing to a **1.5%** reduction in length of stay and margin improvements in labor. These efforts are helping fund investments in technology and innovation while supporting margins.  **[HCA_3404029_21]** 

10. **Outpatient Surgery Trends**  
    **Q:** What is driving the decline in outpatient surgery volumes?  
    **A:** Declines are focused almost entirely on Medicaid and uninsured patients. Despite lower volumes, revenue per surgical case increased by **7%** due to acuity growth and payer mix improvement, leading to higher profitability. They do not anticipate significant changes in this trend next year.  **[HCA_3404029_17]** 

11. **Bad Debt Impacts from Medicaid Redetermination**  
    **Q:** How is Medicaid redetermination affecting bad debt?  
    **A:** Uninsured volume growth was **7.2%**, but bad debt and uninsured costs remain stable. They do not anticipate significant changes moving into next year.  **[HCA_3404029_10]** ,  **[HCA_3404029_20]** 

12. **Valesco Update**  
    **Q:** What is the status of the Valesco integration?  
    **A:** The integration is on plan and slightly ahead, though not material to the company. Long-term objectives include improving clinical outcomes, efficiency, and leveraging the group to support technology and growth agendas, turning it into a strategic asset.  **[HCA_3404029_22]** 

13. **Value-Based Care and Quality Metrics**  
    **Q:** What impact do quality metrics have on revenue?  
    **A:** Quality incentives in commercial contracts are incremental and not material to revenue escalators. However, improving quality outcomes is core to their operations, aiding in attracting physicians and patients.  **[HCA_3404029_18]** ,  **[HCA_3404029_19]** 

14. **Insurance Recoveries and CapEx Changes**  
    **Q:** Any updates on insurance recoveries and CapEx guidance?  
    **A:** They anticipate insurance recoveries related to the hurricanes but cannot estimate timing or amounts yet. The change in CapEx guidance is due to the timing of capital projects, with no implications on investment opportunities.  **[HCA_3404029_12]** 

15. **Professional Fees and Stability**  
    **Q:** Will professional fees remain stable in 2025?  
    **A:** While it's early to provide detailed guidance, they are pleased with efforts to manage professional fees, which have shown decreasing growth rates throughout 2024, contributing to a stable operating environment for next year.  **[HCA_3404029_20]** ,  **[HCA_3404029_21]** 

a1d0e0d9007fc54590cd72201414480c24d931ba7097660744914a0b231a42b5

HCA Healthcare Inc (HCA)

Financials