HCA Healthcare, Inc. (NYSE: HCA)

HCA Healthcare delivered strong financial results in the first quarter of 2025, with revenues increasing 5.7% year-over-year to $18.32 billion. This growth was driven by higher patient volumes across most metrics, with same facility admissions up 2.6% and same facility equivalent admissions up 2.8% compared to the first quarter of 2024. The company also benefited from a 2.9% increase in same facility revenue per equivalent admission, which reached $18,047 in Q1 2025.

Net income attributable to HCA Healthcare increased slightly to $1.61 billion from $1.59 billion in the prior year period. When adjusting for the $201 million gain on sales of facilities recorded in Q1 2024, adjusted net income grew by approximately 12.0% year-over-year. Diluted earnings per share increased 8.8% to $6.45, compared to $5.93 in Q1 2024, and adjusted diluted EPS increased by a more substantial 20.3% from $5.36 to $6.45.

Adjusted EBITDA for the quarter totaled $3.73 billion, representing an 11.3% increase from $3.35 billion in the prior year period. The company's Adjusted EBITDA margin expanded by 110 basis points to 20.4%, indicating improved operational efficiency. This margin improvement was achieved despite ongoing cost pressures, as HCA continues to manage its expense structure effectively while maintaining high-quality patient care.

HCA Healthcare's operational performance in Q1 2025 showed positive trends across most key volume metrics. Same facility admissions increased 2.6% year-over-year to 568,265, while same facility equivalent admissions grew 2.8% to 987,645. These increases reflect growing demand for healthcare services within HCA's network of 192 hospitals and approximately 2,500 ambulatory sites of care across 20 states and the United Kingdom.

Emergency room visits were particularly strong, with same facility ER visits increasing 4.0% to 2,486,489 compared to the prior year period. This growth indicates potential increased acuity and demand for acute care services. Surgical volumes were mixed, with same facility inpatient surgeries showing a slight increase of 0.2% while outpatient surgeries declined 2.1%. The decline in outpatient surgeries may reflect shifting care patterns or potential competitive pressures in certain markets.

Revenue per equivalent admission at same facilities increased 2.9% to $18,047, demonstrating the company's ability to capture appropriate reimbursement for services provided. This increase was driven by a combination of favorable payer mix, acuity levels, and pricing adjustments. The company's occupancy rate rose to 76.9% from 75.2% in the prior year period, reflecting increased utilization of inpatient capacity. HCA's average length of stay decreased slightly to 4.922 days from 4.959 days, suggesting improvements in care efficiency while managing patient throughput effectively.

HCA Healthcare continued to see favorable volume trends in the first quarter of 2025, with growth in most key metrics. Inpatient services showed solid growth, with same facility admissions increasing 2.6% year-over-year. This growth, combined with a 2.4% increase in inpatient revenue per admission, indicates both higher volumes and improved pricing/acuity mix. Inpatient surgeries showed modest growth of 0.2% at same facilities, suggesting stable demand for complex surgical procedures.

Outpatient services presented a mixed picture, with strong growth in emergency room visits (+4.0%) offset by a 2.1% decline in outpatient surgeries. The decrease in outpatient surgeries could reflect some procedural migration to non-hospital settings or potential scheduling constraints. Despite this decline, outpatient revenues continued to grow as a percentage of total patient revenues, reaching 37.3% in Q1 2025, up from 36.9% in Q1 2024.

The overall growth in same facility equivalent admissions of 2.8% demonstrates HCA's ability to expand service utilization across its network. This growth, combined with the 2.9% increase in revenue per equivalent admission, drove the company's strong financial performance for the quarter. Management highlighted the "solid fundamentals" in the business that continued from previous quarters, noting an encouraging outlook based on growing demand for healthcare services and strategic investments across HCA's networks to better serve communities.

HCA Healthcare's balance sheet remained strong at the end of Q1 2025, with total assets of $59.80 billion, a slight increase from $59.51 billion at the end of 2024. Cash and cash equivalents stood at $1.06 billion, down from $1.93 billion at the end of Q4 2024, primarily due to significant share repurchases during the quarter. Total debt increased slightly to $44.58 billion from $43.03 billion at the end of 2024, reflecting some refinancing activity during the quarter.

Operating cash flow totaled $1.65 billion for the first quarter, representing a 33.1% decrease from $2.47 billion in Q1 2024. This decline was primarily due to changes in working capital, including increases in accounts receivable and decreases in accounts payable and accrued expenses. Capital expenditures for the quarter were $991 million, down 11.4% from $1.12 billion in the prior year period, reflecting disciplined capital allocation.

The company continued its significant share repurchase activity, buying back 7.76 million shares at a cost of $2.51 billion during Q1 2025, more than double the $1.18 billion spent on share repurchases in Q1 2024. Additionally, HCA paid $180 million in dividends during the quarter and announced a quarterly cash dividend of $0.72 per share, payable on June 30, 2025. As of March 31, 2025, the company had $8.26 billion remaining under its share repurchase authorization and $7.77 billion of availability under its credit facility, providing substantial financial flexibility for future capital allocation decisions.

HCA Healthcare has reaffirmed its full-year 2025 guidance, demonstrating confidence in its operational trajectory following the strong first-quarter results. The company continues to expect revenues between $72.8 billion and $75.8 billion, net income attributable to HCA Healthcare of $5.85 billion to $6.29 billion, and earnings per diluted share of $24.05 to $25.85. Adjusted EBITDA is projected to be between $14.3 billion and $15.1 billion for the full year.

The guidance is based on several key assumptions, including continued volume growth coupled with an anticipated mostly stable operating environment. Management also factored in the ongoing impacts of the two major hurricanes that occurred in 2024 (Hurricanes Milton and Helene), potential healthcare policy developments, and macroeconomic conditions including inflation and the impact of trade policies such as tariffs.

CEO Sam Hazen's commentary reflects optimism about the remainder of 2025, citing encouraging performance, growing demand for healthcare services, and the strategic investments the company has made across its networks. This positive outlook suggests that HCA expects the favorable volume trends observed in Q1 to continue throughout the year, supporting its financial targets. The reaffirmation of guidance after a strong first quarter also indicates potential for outperformance if current trends persist.