HCA Healthcare Reports First Quarter 2022 Results

health news

Revises 2022 Guidance

NASHVILLE, Tenn.–(BUSINESS WIRE)–HCA Healthcare, Inc. (NYSE: HCA) today announced financial and operating results for the first quarter ended March 31, 2022.

Key first quarter metrics (all percentage changes compare 1Q 2022 to 1Q 2021 unless otherwise noted):

  • Revenues totaled $14.945 billion
  • Net income attributable to HCA Healthcare, Inc. totaled $1.273 billion, or $4.14 per diluted share
  • Adjusted EBITDA totaled $2.944 billion
  • Cash flows from operating activities totaled $1.345 billion
  • Same facility admissions increased 2.1 percent and same facility equivalent admissions increased 5.0 percent

“As always, our colleagues and physicians continued to show-up and deliver on our promise to provide high quality care to our patients,” said Sam Hazen, Chief Executive Officer of HCA Healthcare. “I want to thank them for their commitment and hard work as we hopefully exit the COVID-19 pandemic. In the first quarter, we had a number of positive volume and revenue indicators. Unfortunately, they were offset by higher than expected inflationary pressures on labor costs.”

Revenues in the first quarter of 2022 increased to $14.945 billion, compared to $13.977 billion in the first quarter of 2021. Net income attributable to HCA Healthcare, Inc. totaled $1.273 billion, or $4.14 per diluted share, compared to $1.423 billion, or $4.14 per diluted share, in the first quarter of 2021. Results for the first quarter of 2022 included gains on sales of facilities of $10 million, or $0.02 per diluted share. In March 2022, the state of Texas received approval from the Centers for Medicare and Medicaid Services to implement its proposed directed payment program effective for the current program year that began September 1, 2021. Revenues for the first quarter of 2022 include approximately $244 million related to this program for the period September through December 2021. Other operating expenses include approximately $90 million from provider tax assessments related to the same period in 2021.

For the first quarter of 2022, Adjusted EBITDA totaled $2.944 billion, compared to $3.052 billion in the first quarter of 2021. Adjusted EBITDA is a non-GAAP financial measure. A table providing supplemental information on Adjusted EBITDA and reconciling net income attributable to HCA Healthcare, Inc. to Adjusted EBITDA is included in this release.

Same facility admissions increased 2.1 percent and same facility equivalent admissions increased 5.0 percent in the first quarter of 2022, compared to the prior year period. Same facility emergency room visits increased 14.6 percent in the first quarter of 2022, compared to the prior year period. Same facility inpatient surgeries increased 0.8 percent while same facility outpatient surgeries increased 6.8 percent in the first quarter of 2022 compared to the same period of 2021. Same facility revenue per equivalent admission increased 2.7 percent in the first quarter of 2022, compared to the first quarter of 2021.

Balance Sheet and Cash Flows from Operations

As of March 31, 2022, HCA Healthcare, Inc.’s balance sheet reflected cash and cash equivalents of $2.371 billion, total debt of $37.696 billion, and total assets of $52.208 billion. During the first quarter of 2022, capital expenditures totaled $861 million, excluding acquisitions. Cash flows provided by operating activities in the first quarter totaled $1.345 billion, compared to $1.988 billion in the first quarter of 2021.

During the first quarter of 2022, the Company repurchased 8.375 million shares of its common stock at a cost of $2.101 billion. The Company had $6.485 billion remaining under its repurchase authorization as of March 31, 2022. As of March 31, 2022, the Company had $6.435 billion of availability under its credit facilities.

Dividend

HCA today announced that its Board of Directors declared a quarterly cash dividend of $0.56 per share on the Company’s common stock. The dividend will be paid on June 30, 2022 to stockholders of record at the close of business on June 16, 2022.

The declaration and payment of any future dividend will be subject to the discretion of the Board of Directors and will depend on a variety of factors, including the Company’s financial condition and results of operations and contractual restrictions. Future dividends are expected to be funded by cash balances and future cash flows from operations.

2022 Revised Guidance

The 2022 guidance ranges for the year have been revised from our fourth quarter release as follows:

 
Previous 2022 Guidance Range
as of January 27, 2022
2022 Guidance Range
as of April 22, 2022
Revenues $60.0 to $62.0 billion $59.5 to $61.5 billion
Net Income Attributable to HCA Healthcare, Inc. $5.550 to $5.835 billion $4.950 to $5.340 billion
Adjusted EBITDA $12.55 to $13.05 billion $11.8 to $12.4 billion
EPS (diluted) $18.40 to $19.20 per diluted share $16.40 to $17.60 per diluted share

The Company’s 2022 guidance contains a number of assumptions, including, among others, the Company’s current expectations regarding the impact of the COVID-19 pandemic and related government legislation, labor cost and inflation and excludes the impact of items such as, but not limited to, gains or losses on sales of facilities, losses on retirement of debt, legal claims costs and impairment of long-lived assets.

Adjusted EBITDA is a non-GAAP financial measure. A table reconciling forecasted net income attributable to HCA Healthcare, Inc. to forecasted Adjusted EBITDA is included in this release.

The Company’s guidance is based on current plans and expectations and is subject to a number of known and unknown uncertainties and risks, including those set forth below in the Company’s “Forward-Looking Statements.”

Earnings Conference Call

HCA Healthcare will host a conference call for investors at 9:00 a.m. Central Daylight Time today. All interested investors are invited to access a live audio broadcast of the call via webcast. The broadcast also will be available on a replay basis beginning this afternoon. The webcast can be accessed through the Company’s Investor Relations web page at https://investor.hcahealthcare.com/events-and-presentations/default.aspx.

About the Company

As of March 31, 2022, HCA operated 182 hospitals and approximately 2,300 ambulatory sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics, in 20 states and the United Kingdom.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of the federal securities laws, which involve risks and uncertainties. Forward-looking statements include the Company’s financial guidance for the year ending December 31, 2022, as well as other statements that do not relate solely to historical or current facts. Forward-looking statements can be identified by the use of words like “may,” “believe,” “will,” “expect,” “project,” “estimate,” “anticipate,” “plan,” “initiative” or “continue.” These forward-looking statements are based on our current plans and expectations and are subject to a number of known and unknown uncertainties and risks, many of which are beyond our control, which could significantly affect current plans and expectations and our future financial position and results of operations. These factors include, but are not limited to, (1) developments related to COVID-19, including, without limitation, the length and severity of the pandemic and the spread of virus strains with new epidemiological characteristics; the volume of canceled or rescheduled procedures and the volume of COVID-19 patients cared for across our health systems; measures we are taking to respond to the COVID-19 pandemic; the impact and terms of government and administrative regulation and stimulus and relief measures (including the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act, the Paycheck Protection Program and Health Care Enhancement Act, the Consolidated Appropriations Act, 2021, the American Rescue Plan Act of 2021 (“ARPA”) and other enacted and potential future legislation) and whether various stimulus and relief programs continue or new similar programs are enacted in the future; changes in revenues due to declining patient volumes, changes in payer mix and deteriorating macroeconomic conditions (including increases in uninsured and underinsured patients); potential increased expenses related to labor, supply chain or other expenditures; workforce disruptions, including the impact of any current or future vaccine mandates; supply shortages and disruptions; and the timing, availability and adoption of effective medical treatments and vaccines (including boosters), (2) the impact of our substantial indebtedness and the ability to refinance such indebtedness on acceptable terms, as well as risks associated with disruptions in the financial markets and the business of financial institutions as the result of the COVID-19 pandemic which could impact us from a financial perspective, (3) the impact of current and future federal and state health reform initiatives and possible changes to other federal, state or local laws and regulations affecting the health care industry, including but not limited to, the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the “Affordable Care Act”), and the effects of additional changes to the Affordable Care Act, its implementation, or interpretation (including through executive orders and court challenges), and proposals to expand coverage of federally-funded insurance programs as an alternative to private insurance or establish a single-payer system (such reforms often referred to as “Medicare for All”), and also including any such laws or governmental regulations which are adopted in response to the COVID-19 pandemic, (4) the effects related to the implementation of sequestration spending reductions required under the Budget Control Act of 2011, related legislation extending these reductions and those required under the Pay-As-You-Go Act of 2010 (“PAYGO Act”) as a result of the federal budget deficit impact of the ARPA, and the potential for future deficit reduction legislation that may alter these spending reductions, which include cuts to Medicare payments, or create additional spending reductions, (5) increases in the amount and risk of collectability of uninsured accounts and deductibles and copayment amounts for insured accounts, (6) the ability to achieve operating and financial targets, and attain expected levels of patient volumes and control the costs of providing services, (7) possible changes in Medicare, Medicaid and other state programs, including Medicaid supplemental payment programs or Medicaid waiver programs, that may impact reimbursements to health care providers and insurers and the size of the uninsured or underinsured population, (8) increases in wages and the ability to attract and retain qualified management and personnel, including affiliated physicians, nurses and medical and technical support personnel, (9) the highly competitive nature of the health care business, (10) changes in service mix, revenue mix and surgical volumes, including potential declines in the population covered under third-party payer agreements, the ability to enter into and renew third-party payer provider agreements on acceptable terms and the impact of consumer-driven health plans and physician utilization trends and practices, (11) the efforts of health insurers, health care providers, large employer groups and others to contain health care costs, (12) the outcome of our continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures, (13) the availability and terms of capital to fund the expansion of our business and improvements to our existing facilities, (14) changes in accounting practices, (15) changes in general economic conditions nationally and regionally in our markets, including inflation and economic and business conditions (and the impact thereof on the economy, financial markets and banking industry) resulting from the COVID-19 pandemic, (16) the emergence of and effects related to other pandemics, epidemics and infectious diseases, (17) future divestitures which may result in charges and possible impairments of long-lived assets, (18) changes in business strategy or development plans, (19) delays in receiving payments for services provided, (20) the outcome of pending and any future tax audits, disputes and litigation associated with our tax positions, (21) potential adverse impact of known and unknown government investigations, litigation and other claims that may be made against us, (22) the impact of potential cybersecurity incidents or security breaches, (23) our ongoing ability to demonstrate meaningful use of certified electronic health record (“EHR”) technology and the impact of interoperability requirements, (24) the impact of natural disasters, such as hurricanes and floods, or similar events beyond our control, (25) changes in U.S. federal, state, or foreign tax laws including interpretive guidance that may be issued by taxing authorities or other standard setting bodies, and (26) other risk factors described in our annual report on Form 10-K for the year ended December 31, 2021 and our other filings with the Securities and Exchange Commission. Many of the factors that will determine our future results are beyond our ability to control or predict. In light of the significant uncertainties inherent in the forward-looking statements contained herein, readers should not place undue reliance on forward-looking statements, which reflect management’s views only as of the date hereof. We undertake no obligation to revise or update any forward-looking statements, or to make any other forward-looking statements, whether as a result of new information, future events or otherwise.

All references to “Company” and “HCA Healthcare” as used throughout this release refer to HCA Healthcare, Inc. and its affiliates.

HCA Healthcare, Inc.
Condensed Consolidated Comprehensive Income Statements
First Quarter
Unaudited
(Dollars in millions, except per share amounts)
 
 
 

2022

2021

Amount Ratio Amount Ratio
 
Revenues

$

14,945

100.0

%

$

13,977

100.0

%
Salaries and benefits

 

6,939

 

46.4

 

 

6,301

 

45.1

 

Supplies

 

2,321

 

15.5

 

 

2,224

 

15.9

 

Other operating expenses

 

2,752

 

18.5

 

 

2,421

 

17.4

 

Equity in earnings of affiliates

 

(11

)

(0.1

)

 

(21

)

(0.2

)

Depreciation and amortization

 

732

 

5.0

 

 

697

 

5.0

 

Interest expense

 

408

 

2.7

 

 

384

 

2.7

 

Gains on sales of facilities

 

(10

)

(0.1

)

 

(2

)

 

 

 

13,131

 

87.9

 

 

12,004

 

85.9

 

 
Income before income taxes

 

1,814

 

12.1

 

 

1,973

 

14.1

 

 
Provision for income taxes

 

349

 

2.3

 

 

393

 

2.8

 

 
Net income

 

1,465

 

9.8

 

 

1,580

 

11.3

 

 
Net income attributable to noncontrolling interests

 

192

 

1.3

 

 

157

 

1.1

 

 
Net income attributable to HCA Healthcare, Inc.

$

1,273

 

8.5

 

$

1,423

 

10.2

 

 
Diluted earnings per share

$

4.14

 

$

4.14

 

 
Shares used in computing diluted earnings per share (millions)

 

307.374

 

 

343.321

 

 
Comprehensive income attributable to HCA Healthcare, Inc.

$

1,230

 

$

1,434

 

 
HCA Healthcare, Inc.
Condensed Consolidated Balance Sheets
Unaudited
(Dollars in millions)
 
 
 

March 31,

December 31,

2022

2021

 
ASSETS
Current assets:
Cash and cash equivalents

$

2,371

 

$

1,451

 

Accounts receivable

 

8,520

 

 

8,095

 

Inventories

 

2,003

 

 

1,986

 

Other

 

2,112

 

 

2,010

 

 

15,006

 

 

13,542

 

 
Property and equipment, at cost

 

52,042

 

 

51,350

 

Accumulated depreciation

 

(27,814

)

 

(27,287

)

 

24,228

 

 

24,063

 

 
Investments of insurance subsidiaries

 

408

 

 

438

 

Investments in and advances to affiliates

 

441

 

 

448

 

Goodwill and other intangible assets

 

9,525

 

 

9,540

 

Right-of-use operating lease assets

 

2,138

 

 

2,113

 

Other

 

462

 

 

598

 

 

$

52,208

 

$

50,742

 

 
 
 
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Accounts payable

$

4,010

 

$

4,111

 

Accrued salaries

 

1,865

 

 

1,912

 

Other accrued expenses

 

3,157

 

 

3,322

 

Long-term debt due within one year

 

1,486

 

 

237

 

 

10,518

 

 

9,582

 

 
Long-term debt, less debt issuance costs and discounts of $323 and $248

 

36,210

 

 

34,342

 

Professional liability risks

 

1,508

 

 

1,514

 

Right-of-use operating lease obligations

 

1,790

 

 

1,755

 

Income taxes and other liabilities

 

1,768

 

 

2,060

 

 
Stockholders’ equity:
Stockholders’ deficit attributable to HCA Healthcare, Inc.

 

(2,033

)

 

(933

)

Noncontrolling interests

 

2,447

 

 

2,422

 

 

414

 

 

1,489

 

$

52,208

 

$

50,742

 

HCA Healthcare, Inc.
Condensed Consolidated Statements of Cash Flows
First Quarter
Unaudited
(Dollars in millions)
 
 
 

2022

2021

 

 
Cash flows from operating activities:
Net income

$

1,465

 

$

1,580

 

Adjustments to reconcile net income to net cash provided by operating activities:
Decrease in cash from operating assets and liabilities:
Accounts receivable

 

(427

)

 

(371

)

Inventories and other assets

 

(121

)

 

(85

)

Accounts payable and accrued expenses

 

(771

)

 

(371

)

Depreciation and amortization

 

732

 

 

697

 

Income taxes

 

346

 

 

406

 

Gains on sales of facilities

 

(10

)

 

(2

)

Amortization of debt issuance costs and discounts

 

7

 

 

8

 

Share-based compensation

 

86

 

 

97

 

Other

 

38

 

 

29

 

 
Net cash provided by operating activities

 

1,345

 

 

1,988

 

 
 
Cash flows from investing activities:
Purchase of property and equipment

 

(861

)

 

(654

)

Acquisition of hospitals and health care entities

 

(2

)

 

(22

)

Sales of hospitals and health care entities

 

14

 

 

20

 

Change in investments

 

10

 

 

(2

)

Other

 

(6

)

 

9

 

 
Net cash used in investing activities

 

(845

)

 

(649

)

 
 
Cash flows from financing activities:
Issuances of long-term debt

 

5,966

 

 

 

Net change in revolving credit facilities

 

(2,780

)

 

80

 

Repayment of long-term debt

 

(66

)

 

(47

)

Distributions to noncontrolling interests

 

(171

)

 

(234

)

Payment of debt issuance costs

 

(49

)

 

 

Payment of dividends

 

(177

)

 

(169

)

Repurchase of common stock

 

(2,101

)

 

(1,527

)

Other

 

(197

)

 

(207

)

 
Net cash provided by (used in) financing activities

 

425

 

 

(2,104

)

 
Effect of exchange rate changes on cash and cash equivalents

 

(5

)

 

2

 

 
Change in cash and cash equivalents

 

920

 

 

(763

)

Cash and cash equivalents at beginning of period

 

1,451

 

 

1,793

 

 
 
Cash and cash equivalents at end of period

$

2,371

 

$

1,030

 

 
 
Interest payments

$

408

 

$

375

 

Income tax payments (refunds), net

$

3

 

$

(13

)

HCA Healthcare, Inc.
Operating Statistics
 
 
 
First Quarter

 

2022

 

2021

 
Operations:
Number of Hospitals

 

182

 

186

Number of Freestanding Outpatient Surgery Centers*

 

124

 

121

Licensed Beds at End of Period

 

48,892

 

49,561

Weighted Average Beds in Service

 

41,818

 

42,363

 
Reported:
Admissions

 

506,956

 

506,380

% Change

 

0.1%

Equivalent Admissions

 

859,290

 

832,489

% Change

 

3.2%

Revenue per Equivalent Admission

$

17,392

$

16,789

% Change

 

3.6%

Inpatient Revenue per Admission

$

17,694

$

17,090

% Change

 

3.5%

 
Patient Days

 

2,681,718

 

2,671,041

% Change

 

0.4%

Equivalent Patient Days

 

4,545,512

 

4,391,191

% Change

 

3.5%

 
Inpatient Surgery Cases

 

126,880

 

127,590

% Change

 

-0.6%

Outpatient Surgery Cases

 

247,421

 

231,228

% Change

 

7.0%

 
Emergency Room Visits

 

2,056,389

 

1,841,778

% Change

 

11.7%

 
Outpatient Revenues as a Percentage of Patient Revenues

 

37.4%

 

35.8%

 
Average Length of Stay (days)

 

5.290

 

5.275

 
Occupancy (weighted average beds in service)

 

71.3%

 

70.1%

 
Same Facility:
Admissions

 

503,068

 

492,940

% Change

 

2.1%

Equivalent Admissions

 

849,682

 

808,915

% Change

 

5.0%

Revenue per Equivalent Admission

$

17,367

$

16,916

% Change

 

2.7%

Inpatient Revenue per Admission

$

17,727

$

17,172

% Change

 

3.2%

 
Inpatient Surgery Cases

 

125,995

 

125,024

% Change

 

0.8%

Outpatient Surgery Cases

 

240,718

 

225,439

% Change

 

6.8%

 
Emergency Room Visits

 

2,034,692

 

1,775,884

% Change

 

14.6%

 
 
* Excludes freestanding endoscopy centers (21 centers at both March 31, 2022 and March 31, 2021).
HCA Healthcare, Inc.
Supplemental Non-GAAP Disclosures
Operating Results Summary
(Dollars in millions, except per share amounts)
 
 
 
First Quarter

 

2022

 

 

2021

 

 
Revenues

$

14,945

 

$

13,977

 

 
Net income attributable to HCA Healthcare, Inc.

$

1,273

 

$

1,423

 

Gains on sales of facilities (net of tax)

 

(8

)

 

(1

)

Net income attributable to HCA Healthcare, Inc., excluding gains on sales of facilities (a)

 

1,265

 

 

1,422

 

Depreciation and amortization

 

732

 

 

697

 

Interest expense

 

408

 

 

384

 

Provision for income taxes

 

347

 

 

392

 

Net income attributable to noncontrolling interests

 

192

 

 

157

 

 
Adjusted EBITDA (a)

$

2,944

 

$

3,052

 

 
Adjusted EBITDA margin (a)

 

19.7

%

 

21.8

%

 
Diluted earnings per share:
Net income attributable to HCA Healthcare, Inc.

$

4.14

 

$

4.14

 

Gains on sales of facilities

 

(0.02

)

 

 

Net income attributable to HCA Healthcare, Inc., excluding gains on sales of facilities (a)

$

4.12

 

$

4.14

 

 
Shares used in computing diluted earnings per share (millions)

 

307.374

 

 

343.321

 

 

 
(a) Net income attributable to HCA Healthcare, Inc., excluding gains on sales of facilities, and Adjusted EBITDA should not be considered as measures of financial performance under generally accepted accounting principles (“GAAP”). We believe net income attributable to HCA Healthcare, Inc., excluding gains on sales of facilities, and Adjusted EBITDA are important measures that supplement discussions and analysis of our results of operations. We believe it is useful to investors to provide disclosures of our results of operations on the same basis used by management. Management relies upon net income attributable to HCA Healthcare, Inc., excluding gains on sales of facilities, and Adjusted EBITDA as the primary measures to review and assess operating performance of its health care facilities and their management teams.
Management and investors review both the overall performance (including net income attributable to HCA Healthcare, Inc., excluding gains on sales of facilities, and GAAP net income attributable to HCA Healthcare, Inc.) and operating performance (Adjusted EBITDA) of our health care facilities. Adjusted EBITDA and the Adjusted EBITDA margin (Adjusted EBITDA divided by revenues) are utilized by management and investors to compare our current operating results with the corresponding periods during the previous year and to compare our operating results with other companies in the health care industry. It is reasonable to expect that gains on sales of facilities will occur in future periods, but the amounts recognized can vary significantly from period to period, do not directly relate to the ongoing operations of our health care facilities and complicate period comparisons of our results of operations and operations comparisons with other health care companies.
Net income attributable to HCA Healthcare, Inc., excluding gains on sales of facilities, and Adjusted EBITDA are not measures of financial performance under GAAP, and should not be considered as alternatives to net income attributable to HCA Healthcare, Inc. as a measure of operating performance or cash flows from operating, investing and financing activities as a measure of liquidity. Because net income attributable to HCA Healthcare, Inc., excluding gains on sales of facilities, and Adjusted EBITDA are not measurements determined in accordance with GAAP and are susceptible to varying calculations, net income attributable to HCA Healthcare, Inc., excluding gains on sales of facilities, and Adjusted EBITDA, as presented, may not be comparable to other similarly titled measures presented by other companies.

Contacts

INVESTOR CONTACT:

Frank Morgan

615-344-2688

MEDIA CONTACT:
Harlow Sumerford

615-344-1851

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