HCA Healthcare (HCA) 30 Jan 242023 Q4 Earnings call transcript

Welcome to the HCA Healthcare Fourth Quarter 2023 Earnings Conference Call. Today's call is being recorded. At this time, for opening remarks and introductions, I would like to turn the call over to Vice President of Investor Relations, Mr. Frank Morgan. Please go ahead, sir.

to today's welcome and morning, everyone call. on Good our Hazen; and me this Bill Sam is morning With CFO, CEO, Rutherford. Sam prepared and questions. remarks, some and then Bill we will will provide take everyone to statements forward-looking are based expectations. let over contain current that call management's the today's call turn me I'll remind that on should any Sam, that factors today. expressed and Numerous actual to be risks, other uncertainties differ might results cause may materially from those filings. in are on listed these in our forward-looking various release press information SEC More factors and statements today's and

call, reference supplemental measure. reconciling may be will as recorded adjusted Healthcare EBITDA, morning's today's included such today. this financial later On available Inc. and non-GAAP which we in being HCA and release. A adjusted a measures net attributable EBITDA is information to This replay a is is income morning's providing table on call

turn With over that, I'll now to Sam. it

and we to lines. across than for All portfolio quarter, the This of everybody, fourth drove the Good facilities with cost dimensions solid the services for growth, of better trends most thank quarter. right. XXXX performance markets financial We improved service expected our and across call. experienced in demand you diversified strong In finished business. coupled morning joining our

were Diluted XX% our excluding $X.XX gains prior year. and sales share, which a over represented on increase

and We have are results well encouraged by momentum believe we operational us the XXXX. these created should for position

XXXX. Day, Investor sales year. as HCA for of on to power our year retirement Healthcare display staying and at per earnings almost Diluted the the the share, again debt XX% on mentioned throughout recent excluding compared As and grew losses was gains

serve to making can big whatever our our the and impressively mission. again, thought, believe we the people for following: again, past it. stakeholders. being adjust they work refer outcomes disciplined allocation and this hard delivered can for have they helping and to for company ourselves year, small company. Often Once management our do [ they the a are; them in our them owning first, And on communities new positive us we execution, think and challenges people. of As thank our as and we their these timely; proved our to resource I in accomplish demonstrated face third, I patients, other so traits ] everything pride want I realities, a next, team, do

volume X%. procedures equivalent admissions the Same-facility X% Most Admissions in volumes year-over-year. growth X%. volumes and X%, domestic the cardiac admissions the outpatient approximately other the surgery up strong fourth admissions were grew also. including across grew had in rehab were divisions Inpatient company quarter. increased Equivalent categories, in emergency room quarter. All had solid and our of visits quarter growth metrics

levels the Medicaid couple in Additionally, facilities programs produce quarter states payer same on certain quarter. will mix helped in and of These improved provide Bill with XX% a enhancements more his along comments. growth revenue revenue in of factors, acuity the year-over-year. detail supplemental in

results, third we utilization. by further labor saw contract quarter. the reductions year We executed on in on key agenda. metrics employee our as well In prior leverage year. on sequentially quarter Operating the as revenue we the more the compared compared as the when were in produced to increased across to But operating the generate solid margins improved company the progress solid people over engagement and to able quarter, even turnover evidenced trends impressively stable we

a we human comprehensive As plan. have detailed in have the implemented resources we past,

further into as to progress on we make We expect move it XXXX.

includes and remain for training, investments in plan a which clinical workforce top Nursing development Galen with advancement. Our priority College of both centers in organizational and expansions significant will our

rate growth. the we in the of quarter, With respect to hospital-based physician costs slowed

venture, our in in the with loss fourth quarter, our Valesco, pertains physician expectations. it staffing line reduced more operating to we joint As the

in our and which core achieve we year Day, Investor in our our we from at to to business. take designed indicated potential As long-term expect see growth company strength significantly plans, this the we our invest strength to

revolve around investments X These distinct opportunities.

one that we while XXXX, to our market capacity. in first supporting markets facilities, also have capital The will includes we projects that of expect continued growth increase the to $X demand network efforts to our workforce online services new billion share. expansion and In come over scheduled meet increase

acquired Additionally, facilities we should a of our hospitals complement integrate number to networks. expect outpatient that newly and

the The embedded our robust to advance see across in and company digital agenda second designed a operations. value includes opportunity capabilities the we unlock

program performing as is unlock together tools, more believe are believe to technological we company. initiative, this operational evolving and investing efficiencies management program enhance value. inside case drive revenue operational high We we functions our better. there and innovation As capabilities, integrating including improve our we With our care this resiliency overall are potential today, and quality, through further our with transformation cycle will financial management

to to pertains the capital of balance cash The while production opportunity use flexibility we sheet people our billion. spending around invest plan over In to our program and our in increase also to XXXX, $X enhance third billion heavily $X and repurchase strong to area business share flow have shareholders. position and allocating capital to to our we our

better continue for play also creating other We for will stakeholders. believe to winning produce to this plan for patients our allowing strategic deliver value organization, services us more while

our the to constant need the they leveraging our Let to whenever principles: X Healthcare organization and with performance. improve they high-quality partnering of distinct deliver giving services, elements of me deserve what outcomes HCA our close patients in with consists this, physicians

with us relentlessly different as enterprise-level these with on term what capabilities that to such address on delivering in navigate operating provider values the cycles, we coupled from pandemic. to focus HCA comes adapt COVID changes challenges helped support execution. industry detailed the This is approach and way. and has philosophy That systems Our local economic the disciplined teams management core value-added our oriented

of advantage designed I'm of in even growth take of plan look us. proud and the we we front we HCA our over to have future, Healthcare. the the the build proud strengths next-generation more opportunities of As years to people. our I am developed have upon

We and value our the discuss with growth years the to the ahead to in more XXXX and turn to call will in results detail our and guidance. positive Bill, drive deliver will move into sustained for stakeholders. outcomes with greater he and purpose confidence a I'll quarter's agenda in with that, With renewed XXXX ability

good our Okay. performance discuss I will and Great. Sam, year guidance. on Thank the you, and provide morning, our and quarter additional everyone. some then comments XXXX for

track that Day We over formula our balanced performance Investor a operational of time. long of at of generating disciplined allocation highlighted recent with value a strong combining record has capital and our

continuation provided many quarter of formula. XXXX Sam results our Our indicators of this in his our for fourth for XXXX a comments. and guidance reflect

me take let some for So year the results review of a moment XXXX. our to full

We have growth. top strong line

care facility XXXX. our for with X% X.X% same over grew Emergency consolidated index on and Revenue on strong and X.X% Equivalent basis. X.X% grew managed full same-facility full growing room a For trends basis admissions grew up X.X%. year increasing the X.X%. per prior on grew acuity mix X.X% for growing basis. business to We X.X% and were admission the admissions other the same-facility admissions a cases year, equivalent a This facility year. case revenue year contributed same surgical maintained and our payer total with mix improved

a percentage in line to Contract as basis XX% X.X% management improved Salaries, points and of couple fourth quarter. year. on basis year We for strength labor prior XX consolidated of strong with of costs. revenue operating the equated wages top SWB compared a to declined and benefits the

a costs as improved percentage of Our the the managing XX basis for to do points supply continue teams which a full year. great job revenue

with force pressures through saw As the hospital-based Sam and and mentioned was are fourth in physician improvement we professional our expectations. have sequential in improvement we throughout of year, third quarter. managing rate mentioned, But saw on in growth we which venture, we Valesco costs. in joint the the our also an an both fees line

adjusted of to are of through growth our this an what in working for and and basis solid the EBITDA XXXX. our on line this in on XX.X% a expectations margins in plans we believe We pressures we industry-wide result basis consolidated of X.X% range area. are produced confident year The with is full as-reported of continue

performance very the team, management So operational year. as the we a are during pleased with

results year. expense management solid Adjusted under compared quarter grew discuss as the quarter. EBITDA XX% the growth just me the This in quarter. is prior primarily our and the revenue fourth Let during due to in briefly strong to

new In program. business supplemental ] of and addition to [ core increase Carolina North trends, This the adjustments adjusted to our strong we a within EBITDA program related favorable recognized Texas certain approximately the payment includes programs. million year-over-year our $XXX

the sum an recognized program program experience our on began basis. this whereas Florida based the Additionally, on with quarter to accruing lump date, annual in previously, we had we program the

with joint the in less divested this well EBITDA $XX Our half roughly adjusted recently resulted the in facilities venture. entities acquired in as year from decline quarter, about the Valesco million as of prior

operational quarter the additional And was of with the of year. summary, divested benefit the new impact programs supplemental In and and from strongest the the facility. performance

to year-over-year very were we able are produce. with We pleased the growth

capital capital in let a of to next, XXXX. speak So allocation me deployed We allocation. balanced

dividends For of paid from growth. year line under in compared the the which shares our billion $X.X $XXX during billion year. billion just in were with to approximately cash or approximately our was prior We $X.X the flow and the outstanding expectations. for of million Capital XX% full year, $X.X expenditures purchased year, operations above just billion was $X.X our

Our the debt range to Xx. adjusted X remains near guidance of to low end stated our leverage EBITDA of

for we And me speak guidance XXXX going positioned we a are to let that, well our moment. So with believe XXXX. into

XXXX are As year we providing noted guidance our release in morning, this as full follows.

billion to revenues range expect We $XX.XX and between billion. $XX.XX

billion net range We Healthcare $X.X $X.X to billion. HCA income attributable and expect to between

diluted expect We $X.X range $XX.XX and $XX.XX finally, between and spending and per $XX.XX expect billion $X.X to capital expect billion $XX.XX. and billion between And EBITDA we range between share billion. adjusted to to range earnings

provide me let guidance. commentary on So our additional a little

payer First, note the the me of we quarter million $XXX XXXX. first in reported settlement let

in X%. growth and a assumes per X% revenue and between X% between equivalent admission guidance Our and equivalent admissions X%

reads state complex the want amounts we app timing these programs that receive. programs. most and to that highlight Regarding impact I and mobile have are supplemental [ ]

in variability results during the this impact timing of So the programs these of recognizing some year. of the

and But we we between some For these year. could we supplemental XXXX, program we headwinds based on of $XXX in the current anticipating all programs of range expect from for $XXX new Nevada. million aggregate this impact million believe the assumptions, are modest benefit when and a

$X.X to our operations and trends around billion expect between and historical expense projected be billion. to range from $X.X interest cash Depreciation is full billion. We flow margins $X year about within billion to and $XX be to be estimated

diluted the for around to fully are our be year. shares $XXX million Finally, expected

remaining million Also noted be authorization. share $XXX a in This new $X on Board of to prior authorized in our has our will Directors our program. release this the addition billion morning, repurchase approximately

addition, In in our per declared to Board from quarterly $X.XX our $X.XX dividend increase [ ] an share.

With that, over me back Sam. turn call to the let

All right. Thank Bill. you,

results the with company has the his be press Bill's you I the tremendous with to company, mission throughout during in As that as embraced Bill he will the as company mentorship many Rutherford the XX in to culture. had remembered after HCA with with company decided by and positively communication company with has and impacted tenure. leadership, colleagues work retire years in our CFO, my release, saw impressive a the and his the XX Bill our the financially way our years is legacy career indicated people

the you've your much everything so congratulations you and for senior Board thank And and on retirement, Bill, in for very of done behalf the on organization. the

CFO. President team know ] HCA replace is were our Group I Group for talent has next has He Senior for company ] to the and We many the of been executive. legacy an Heart XX with for and the He of have having He the [ he's appreciates last Mike Operations in various the to for years. National I'm our pride the him. talent and and And Group eager to Mike on get Marks knows deep we're for of at exceptional financial He how build understands and had Financial for in creating years, culture. then accrued be which inside XX HCA, is National been few fortunate and get most Vice going [ to a you our and years. to as really he's ourselves organization. meet roles execute results. Bill's the then CFO to capabilities role

Mike, And so congratulations.

questions. into So with that, will we go

and Sam, you, Thank thank Bill. you,

ask to please give to so instructions question. many to As might a like limit we the queue, reminder, question. now may possible give as as would yourself question Greg, you to those a who an in ask X opportunity a

[Operator Instructions].

Okay. It looks from A.J. like UBS. Rice our first the line of question comes with

to there's Bill, congratulations ask obviously wishes just different about Mike. out on. because what's chatter I want about Best some going retirement there volumes to and the on

a had coming bit utilization going I actually any we've whether in talked pent-up seeing you I wonder status. maybe updated people population review. getting post-pandemic And little think specifically are seeing the to what around time chatter [ from see you well what you you're have well. said in that just plans wonder what category if to fourth OxteBase for there's saw back review then sicker aggressive there? management, the that There's I ] return you a guys post-COVID seasonality. about expected you that time maybe as thoughts could into as also to demand doctors. us to last about of a quarter, you ] utilization see the now Do on [ in whether on more that's about described, some easing normal tell health a

A.J., Well, X see, is Sam. let's I there. this have questions about

Let this emphasize had with seasonality normal indicated them. of most trends respect will third to the for in last areas of categories XXXX, to half half the some latter estimation the our me if the we they our of XXXX you year in of And into well quarter quarter. sort from from that natural in we areas standpoint, fourth see and we year business. our tell seasonality our that had with returned surgical our we as have see the continued of I seasonality thought can as most outpatient latter the other I part, of

really we and believe was we How that, that had a material demand, can't pent-up don't policies influenced by new and impact. determine it

the and we've our and quick our push to our Investor So our that partnerships ] mentioned think been patient part business then our what's continue quality we some strategy the latter grow. the health business development, to and demand from utilization allow parcel optimistic certain really us are and and agenda at procedures our least thinking the our physicians was we at part that on of judging care around from coming as I payers. markets. always policies said, our optimistically standpoint, execution we to around with way there's We with early like in effect judge through year. our about policies. and of changes too for those in [ and safety There's our Day to going happening is mean the It's I of XXXX that's where

Okay. Thank you.

comes of Bank. Chickering question next Pito Our with Deutsche from the line

over Thanks years. Good with is taking Bill working guys. my real questions. a for morning, you the And pleasure

that. So thank you very much all for

again And versus the 'XX, bridge 'XX? for payments, [ were dollars? a on also actually were guess, how supplemental unpack ] much so OpEx 'XX, and taxes On lot supplemental the I what of can the PIMS you there. ] payment 'XX [ in side, absolute 'XX 'XX

you me that now. let I right this way, give detail Pito, put can't all it Yes.

view talked supplemental Medicaid we've part of revenue overall just is we As -- really payments about portfolio. our

with we're think XX I now. to payment right or states up supplemental XX programs

As I have comments, complexity, my level of those. mentioned in realize multiple of a to the when timing it programs that each affect attributes the of

for settlement had we began anticipated. In of program the Carolina it. Florida the quarter, I benefit accruing did in the We North new that we and mentioned, was recognize as Texas, accounts

well the things can mention programs, But core during supplemental we a payments operations When affected will just So per were quarter-by-quarter as maybe of you believe But the quarter. growth strong. will look added what breakdown. I unit strong revenue our a be fourth were the quarter. revenue supplemental We as payment the at those give the to offline that remains growth. business us main with we core

Okay.

Lake comes next Our Justin with Research. question from of the Wolfe line

off Mike. And congrats adding the to to and the I'll and help by my for all start you'll missed Bill over be years, thanks

ramping give some and benefits about the Medicare And question, a specifically talk around in the been Advantage I as strong. impact being started into We've of you was Medicare of have Can you what's the specifically, Medicare specifically any on growth the was to going on A.J.'s One, [ role. on think trends Can just think been up color then in to -- And question quarter? Median the really about you in X ] reference in did be? we tried XXXX? volume this? growth and for things. think My touch us you you there see early impact revenue Medicare might quarter. what hearing commercial strong couple I you XXXX And talked

that. thanks I as know volume, topic. the Justin, Medicare with that's for Yes, been I the start

seen roughly traditional for what We a some this we've which admissions, growth quarter, up pretty throughout the in Advantage fee-for-service. we from is combination seen have [ Medicare year. XX% in our Medicare And probably which conversion consistent of were the think ]

some all bit that our to on break for utilization, in it's So us there. and its a of down maybe hard gains volume of entirety

of our consistent and Advantage been terms year well. as between year In the very Medicare Medicare revenue has through per

over our through believe no ultimately, we've as we that. benefit believe, some And yet, through as be go moderate time we be benefit we modest So really could but we But results [ us. rule, think could quarter Sam we a didn't in of judge the us alluded, be midnight to impact fourth see period When to it's got material any I that it's the the amount. We implemented, to positive ] go seen think for about this early time, 'XX, there too rule. of some X over patients. it's going for change step impact know we

Capital Ben go next Instructions]. the from question ahead. line And Markets. Hendrix Ben, our RBC of comes with [Operator

much very and and you Mike. Bill congratulations Thank to

think of that comment up you wanted follow you're expect. spending your about to billion capital allocating your think acuity. And about year? to how mix And about capabilities you idea as an we $X into wanted inpatient should of how that the I get on and do just we thinking Just the look XXXX higher -- through into guidance? your the on impact where evolving case

This is Sam.

bit been connected over I you have outpatient XXXX [ consistent than will I large technology. in few a have capital and of a come tell We our in We ] And a do few online, other new starting markets. inpatient, facilities quite pretty project will that our little hospitals and had have outpatient and 'XX somewhat in with are we 'XX. think between we're we'll online that. we more come XXXX, with XXXX have a will the new years do to be allocation markets pipeline some and development to in, invest in consistent that

our So I consistently. at so as ER of remember think and I capacity is beds coming in forth if 'XX, when the and volume the then it's we correctly, about on look 'XX, same growing

also So in they it's not our expectations clinical strong market, to allowed our created we're pretty exist approach capital. It's has demand practice yielded that returns. to again, disproportionately the the allowed to we responded the their of the that medicine. consistent us really any in business. for that need the one oriented It's that to and physicians way our or meet allocation of And category capacity in technology think,

That's outpatient an our prior expand stepping occupancy in of generally standpoint further we then we're fast-growing on to it, we snapshot up but the it inpatient much And pretty the in side a because from opportunities networks the years. So have to side. communities. allocation consistent it's have growing these

the Gary, TD line go question Thank Great. Cowen. comes of from our And ahead. next with please Taylor Gary you.

understood question. by and Bill, make just to and real Bill congrats clarification, sure the I my I One said what want way. I'll to then ask

I then net come line sort DBP to share more bit to just the brings outlook 'XX. was overall, You're walking the in the thought, what originally I down sure you just expecting that what And sequentially little down to question $XXX hoping in us that think to of you're for maybe a to was off. $XXX Valesco you [ I stemming ] million breakeven I said, losses about my through real want you'd Medicaid which that operational means had think you I talked about operating with And correct. how EBITDA quarter. pulled million. And you make dollars that

], overall, Yes, those with Gary, we anywhere $XXX for potentially we headwind the largely in $XXX year, programs million, we to I'll don't to comments Bill. million be Thanks are aggregate an then to respecting Florida expect that you this between a comments. and all correct is DPP my that. when start the received beginning impact due had this accrual settlements and reoccur to [

mostly programs. So what's multiple that's our driving across that

last quarter. came million sized in so Valesco, we expectations, which quarter, think with line it $XX just On our as mentioned, we a under or

to further continue we on As HCA. that into multiple venture improvement joint integrating work including initiatives,

expect see forward. improvement going continued We to

about amount for obviously year, recorded we months same year we Next full will the this year Valesco had I versus with XX in think the XXXX. equate months X year, but this

diligently So we we're and continued over will working improvement, time do there be efforts. those towards believe

Thank our Jefferies. Tanquilut from question Brian you. line the next comes And with of

congrats it the further maybe my thinking spending labor career to level? obviously are Maybe HCA. nursing about the I how to outlook. viewing Bill, ask question inflation way at to both a Or are reduce broader another at and opportunity further a wage you up on at you How very on the successful on follow to is, bit Gary's. expanding Valesco? guess

the inflationary Well, we experienced. period I through think very we've proven managed during that well teams have the

to we that forward, be to And is XXXX. I of execute And then back there's think wage X% improvement which in throughout labor to normal into continued going expect of we have going X.X% -- move inflation to trends, we achieved. plans kind contract generally forward.

professional to figure in but our into teams integrate to adjustments initiatives the out that Valesco, with only have number programs. on working a to continue we operations, fees those of further On

of growth. to, we fees professional seen the I've sequential talked a Our have decline rate in

it to initiatives, we at through revenue as programs. working we're looking are hard enhancements, sequential encouraged declines And a bit So 'XX, those to be those continue. adjustments go whether [ or ] we some multiple into expect internalize offices that program we're of would with

our And with Ann you. Hynes Thank next Mizuho. question from comes

congratulate to I conservative assumptions rule is managed also midnight I for the follow-ups on given [ just pricing the just and ] very states when X%, Medicaid the which a X% on couple care growth little to you his have Bill looks XXXX, X want of which in health exchange strong. retirement. the a at redeterminations, look yield and are up

So benefit do in from X the X midnight detail if impact potentially be your could you Medicaid would embed from some or percent rule per you can us a any guidance, of to between just kind then of more maybe shift secondly, or of you, the give our about And commercial? rule how it great. revenue differential midnight maybe a kind emissions maybe

Bill. is this Yes,

throughout guidance HICS on Medicaid say from and material in our trend sponsors. migrated that's modest clarify, We there's underneath still redetermination to me believe into X% would early. And material our tell is ] that Medicaid not continues we other obviously, mentioned regarding clinician have it our aggregated have employer I We'll as factored revenue you, believe see patients fact, a that then that. first is to seen it. some X% into don't benefit Let [ yet. would I I earlier, there's XXXX. material, categories we've how I don't

if us we as expected. the midnight On should early positive it earlier, for it's is It in really implemented rule, that X said be progression. as

well. have, how have it time say, But that a for see we'll I patients I'd will well. factored number to over plays as just think our for we adjustment material And that into 'XX positive don't as be out.

Our part of go that various see range first we'll year. both the for of and out those outcomes of as the we plays guidance, programs, I how think, on through accommodates

[Operator Leerink Instructions]. from And comes Whit Mayo with our next question Partners.

Thanks. And Bill. congrats to

time I might be think retired. this you've the second

to I'm this So new forth focus, it internally the as bringing that you're a is question maybe expense really, you organization. that strategic imaginative new guys But any my challenge sticks. anything, I initiatives creative have elevated or year more curious on hope Sam,

sophisticated case here. Day, Well, which includes it's at that financial our management resiliency our initiative, our program There's Investor cycle it. components integration highlight presented Mike will Marks our revenue got to more different of I and

initiative sure free right get appropriate. setting the management make case and up is line capacity Our the where time into our in to that right patients

And so the success that. for past early-stage with we year, had

mix length down case stay of Our was modestly up. was and our

good case forth. fronts. it's when respect important nurse our start initiative. more multiple to to That management and the staffing us So It put you for effectively acute us with on so allows to X a is more our together, allocate patients

We initiative as teams our process on we to more will benchmarking. invest continue structure in to technology, better in more that bring and

The second highlight thing would our initiative. respect I is benchmarking with we're internal to calling what

are fixed incredible getting with organization, compare both have those costs. more side to of a to finding opportunities costs. it's we how or what how we We the to our cost on improve structure, leadership, and into our categories cost respect we we're leverage areas we variable on technology distribute process organize to those opportunities deeply under in use processes and automation variable whether how Mike's lot benchmarking allocate more and And to rethink our and facilities improvement,

I'm products the about there. excited So

was transparency mentioned the a have edits think for [ in the to the improve our fourth due ] to company. to some we efficiencies, is quarter I so our my the of with part I quarter had improve and what from quarter successful I've clinical of to very As my we outcomes experiences in And of forth. around the efforts that commentary, that, these third all not and with patients fourth leverage the operating transition we quarter respect seen our from the leverage best operating call and to third clearance

X our We're run. success transformation modest are improved really those short had longer-run business. care those across programs respect dimensions banking So outcomes things in we there our And long-term the Obviously, our effort technology giving agenda would some different I on with highlight. of us to and value.

So a of highlights, couple those Whit. are just

things carry think for that is for tell to health opportunities it's will mentioned, I forward so us all happen. act we'll and that they stakeholders. are And mindset to on teams better the do of of disciplined. next, essential the for on 'XX that X a to discipline carry And make you, initiatives then and and 'XX our how an culturally that we ingredient system that our find from and forth. they I into our year And something to And teams creates that into I'm as we pretty embrace how proud success. ways

with Bank the Thanks, from Whit. question of And comes line Kevin Fischbeck of America. our next

your I -- Great. to Bill for the And -- talk help more 'XX. guys you X% get guess growth want in from because I'll XXXX for X% a years. just faster expectation the over looking add about I to little know it's my you guys you're about for thanks volume wanted color to

wanted better coming understand I growth where So just is that extra from. to

that think there's And average? So you'd for on where procedures service any there opportunity in the lines perspective payer if payer a mix volumes color big above there's type you snap anything have 'XX? to of expect that or back? to from think you still a Is room one

can Kevin, add in. start, let Sam me and then

'XX. So experience off we've our we're going seen throughout

program our demand markets. comments, said capital services for very earlier we are programs our in our there initiatives We paying the strong we and off. in was think thought As

adjusted admissions year this were X.X%. Our

strong next we're lives our access we X% X% guidance I a strong And be that employments a exchanges in health across us to expectation X% development and enrollment We favorable continues wells. to for continue But to us. continued states. the economic contracted believe be higher indicators We right to think than may our remaining demand. reading adjusted and our strong on see You're for in X% historical. that saw year, admissions really little our caused to insurance

I is based into with experience. expectations our for those of kind play and our all So factors current 'XX think go on of

And next from line our Baxter Wells the Fargo. comes question Stephen with of

there's in to Congrats there growth how well. a you'll quarter, first XXXX, little half go And some or of are then surgical comparisons we down could especially talk coming a the bit line overall hoping whether I in half outpatient? in Bill tougher the about versus against service by the guess, you thinking slowed I up notable about as the growth I as you was have bit maybe of the any the little surgical or takes that puts year. inpatient through the guess, year. growth of back

in our the quarter. trends We migration, a And more were few were quarter our slower surgical programs, a that generally X%, we push months in in overall, this even about to we well process surgery X our nothing our outpatient improving morning. days will ambulatory pursuits. a the emergency XXXX. processes our previous hospital X.X% surgery. challenges patients and activity for our We will, XXXX. room structural fourth in help same certain think to the if and and for the complex volume us had are our the number we outpatient and in markets. both we talking solid volume activity We've inpatient offerings. total, physicians at settings heavily as and surgical with for But level, our suggest in will our volume centers, to value-add as be of that we a up acquisitions our continue in with that the to earlier a as there's saw for ambulatory outpatient we allocated that will we and our were on did with in into a think have little more inpatient our made have created continue improve so we we really calendar, going growth And just into of continue the centers slight change year, a consistent side revitalization in the outpatient was outpatient some up with as that operating they opened were be program and had acute suite year, the we do program, not invest as are to surgeries have the year-to-date, way setting. you So that invest or surgeries open strong though than surgery December surgery And difficult supporting our as

the how So that's surgical we're judging space.

lines of physician believe service underneath and and responding growing we again, If and and our reflective volumes for the look needs expansion robust our that's ways new overall think, development, in patient and grow you mid-single are at in to our our are needs to cardiac that, underneath digits into program we continue productive very actually cardiac cardiac again organization.

Excellent.

from me, Our question next comes with Citigroup. next Jason, our excuse or -- Jason Cassorla caller the line of go please ahead.

Bill. on Best professional the of retirement, just environment. up I to your in follow fee wanted luck

that was on like or it embedded if growth, professional fees physician for of at versus in in comments, Bill, correctly. is maybe within I some Valesco any heard your 'XX? costs guidance? would for way that Valesco, would spend $XXX it? 'XX your professional there then sounds or to generate fee million headwind look And But what other growth great. deceleration be Is expectation noted the so a Or there next EBITDA color that $XXX negative million You fair year

Yes.

and in, Let thanks,. me add

I obviously, we little next year. million think month XX had 'XX, But about We're in both lower. $XXX Valesco a is versus in full years. months X months

of improvement we a during we orders kind through a the run So see year. rate as go

said, On the in pro a of we, seen as growth. we rate decline fees, have sequential

where We have to holding is X% that versus multiple guidance fee XX% XX% to in underway. been our this growth to next it's year perhaps to professional closer year, initiatives XX%. Embedded

bend looking line. [ the begin step we're to initiatives and for be confident trend that our So we are have in we ], to a able to and June activities

comes with go from next our please Fidel And Thanks. question Stephens. Great. Scott, ahead. Scott

where the the debate to And are would your congrats pent-up seniors be population. is to then my thinking echo the you the in Bill. curious on terms data And just whole based of I'll demand in think recovery trends utilization how Medicare question and my on about all analysis broader you're point the in of we [ pre-pandemic in be recovery this baseline, that point. process sort that out quite now to sort and you But interested at this at bit liquidity returning to 'XX. of levels some, like think may ] in played of relative was there inning felt a certainly

This at beyond trend don't XXXX, I a it composite is this view Sam. this a It's But interesting, have time I'm here. of in looking is period. line just Medicare.

admissions Medicare grew both Medicare X.X%. and It's Advantage. has it So our Medicare

X.X%. grew XXXX XXXX You X%. grew out throw XXXX XXXX and and X.X% grew

out Number our on taking ] acceleration there the two, Yes. Obviously, mix trend? there's aging boomers is we market there, think in [ we're So share. number one. bag

So on XXXX, you to at and is difficult overall in admissions, 'XX. in markets. really utilization X.X% that same 'XX, judge X.X% around for in patterns 'XX the at in us. combination Again, look payer There's X.X% X.X% When growth class. population our adjusted

function, slight for beneficiaries we boomers of and but a baby a of So program, the market believe, aging acceleration, a moving us growth in in number population share gains.

some whether judge for underneath structural that us data utilization, to that's have. that, it's discern So hard we not there's impossible in us or almost with for change to

Scott. with you, question line Sarah next Thank Fitzgerald. the Great. of comes from And our James Cantor

Congratulations on the retirement.

the that as be mechanics there rule midyear pull payers that impact And What retaining that it can fully when from said of exiting switch. stage board? X it you then to flipping benefit are the your anything ramped? in would Sam the midnight guys claims the implementation? HCA year. ramps And on delay is of assuming some [ is through ] Or and You forward? Are talking getting XXXX? staff? do denials opposed that to it the a Is

mean, the ]. rule in goes January in I Well, effect [

the impact change think the may time. over ramp a It's notable I for payers. So

on and operating it does, administration equally see them And we as plans we're there. So of year. making those sure the it's working very throughout closely described if should it on the

on payers. the but change And a so working it, it's pretty for we're big closely

might way And be see we go year. so through hope to that be as begin we benefit administrative and gets some as the implemented work But differences it we'll very able our quickly, some there to through XXXX. through

C. Wilkes from Sanford comes question next our And Lance with Bernstein. Sarah. Thanks,

a supply quarters seeing? First, you like the talked labor Bill that about the at have in Mike. about turned Congratulations bit to hospitals. ago, a and couple I you're talk been both that demand past, away little of Can

you how and particular If still might of just could hiring that any kind note areas that. or And there areas be that are bottlenecks? then more pipelines of plentiful if there's are

words, question. Sam is have and finished don't acceptance rate. the throughout referred average where you the navigation is we we XXXX. roughly, coming more went In able as us were the we That such. in we that the our centers we that first XX% transfer our part seen through high the for maybe of in than in patients half the exact who year other the improved We're through were take what below weren't to patients XXXX. to This little the Thank We patient better the of again. year in of the roughly here at XX% centers year, mid- But transfer year. to from other did and second to program have a still I

about inflow, we So will. good if feel the you

capital that's to where improve. centers. navigation all think We we will are continue that open and generates is to coming 'XX We can't still these that patients through in not transfer we capacity of situations get as in at times have programs and where these and our better continue situations online available, what our are coming hiring the receive as

been they for in receive help in environment able what trading resource my just do. capabilities into support to system. we through with as and commentary, a and push be the intentional to great improved. that efforts good have very I capacity will us think has turnover, hopefully people that trying our patients successful so to the be We've available more mentioned in also want Our they create can overall our that 'XX And and get leadership,

Great. Thanks, the Raskin next Lance. our of Nephron with question And line from comes Josh Research.

trend him maybe a just has a well. CapEx retirement, have increase guidance? for the where speak bit to congrats this of And if point little as down sort go list? to to there's for incremental on Bill, or Mark continue trended? that you mix you you Could and been and how curious on are project are more returns the to getting the guidance multiyear a in to CapEx the outpatient, in congratulate the I'm improving is on again, lower returns actually as coming returns

Josh, Bill. start returns. on this the is I'll

returns. remain the returns very Our upper solid. teens in mean, I we're

growth validate backs have that to some disciplined do to we actually our and see growth a we to evaluate of projects the me, growth. to look in deploy assumptions. reflection of opportunities We process capital these the we continue of is the spending very And the a capital where

on with those. we're So pleased returns very the

mentioned online. similar. the They do Sam inpatient to mostly returns earlier time, the returns on. We good and quick have do coming Q&A, generally mix varies as but when newer it between come out in outpatient, from think facilities time they very some have I and

about, we've capital pleased the in component talked the program the think formula, as we're overall growth an I to It's So interview. with our and with. returns we're important pleased

only short that our for have of longer the tends to facilities. And navigate but value they our need to and our system to capital that they're facilities And to hospital system to critically in as we're a if get a into the generate offerings. efficient patient acute Yes. more invest assets, our the platform real returns. long-lived hospitals, this, thing able overall say, they system. further respect alluded returns, sort care allocation the with sense those health are cycle the would care outpatient them be hospital-centric important can cycle We health outpatient we I outpatient Bill And we the and on side, in are a then to

So we at to manners. look both in it have

on our additional pre-pandemic think over level of Bill's the inpatient returns, pretty in it the even where was XX% which I is strong low a have point, had have high added. occupancy to we've with hospital up beds we strong a we pattern side occupancy returns, that

for So Day system that positive by all is with enterprise complemented we we produces Investor the at outpatient facilities hospital that integrated really a highlighted think our the for company. the network model manner and in you working is returns the

comes line Cal of the with our question JPMorgan. final Thanks, Sternick And Great. Josh. from

congratulations my Bill to as I'll add well.

So X follow-ups.

guide, that's a sounds like First, really redeterminations. the yet. but It slight not to XXXX benefit on the material

could after Is XXXX? to material something to does better it think clarify upside wanted this be you Just annualized redeterminations is if more the you're XXXX the anticipating? Or completed. in than are develop

my was then question the quarter other And itself. on

that saw case. consistently COVID you the in and quarter past? called seen whether levels Can that acuity you've the with out talk So per inpatient COVID the about you payers higher in developed one of costs the what

Yes. This is Bill.

Let me redetermination. with start the Medicaid

do, modest we XXXX. think some characteristic I right in you're benefit see is

late into be to or that XX% able benefit employer-sponsored decently redeterminations guidance up We're either XX% We individuals some haven't being potentially reasons. off that closely. reapplied were there. tracking to HICS XXXX. to some a on see those those to Medicaid the very outcomes our of but We're We started material roughly in Medicaid show on there's some for allows range number of with adjusted so We're some those coverage, for to seem that. large effects seeing in be were seeing technical of because redetermined yet, of

So we've manage been able to that. through

is And into the HICS XXXX. stage. conversion I go through to continue as some we be year. through think judge that or this material there with don't we But And potentially, modest employer-sponsored, at will as benefit go that the

late honest the be very admissions. and I really our In factor COVID total on of don't data any to COVID, of we it's [ our have ] roughly acuity, ]. are stable very, past total, in really overall stable missions you, [ hasn't over been results Regarding our operating material us X% has been year. haven't for think a I with but got really

like over Great. does that our it the Thanks, to would session. all. is for question-and-answer to Frank And turn conclude floor now yours. I Frank, remarks. closing

can day. thanks your might and you of we wonderful a to additional for have the Have you questions everyone answer in the if call. this over help the on you be for any Thank Hope have. afternoon week, Sure. week joining and we'll good us Great. a and today, balance

gentlemen, today's call. you And ladies all that Thank may does for disconnect. conclude and now and you joining,