HCA Healthcare (HCA 0.83%), a healthcare conglomerate that owns and operates hospitals in the U.S. and U.K., reported its fourth-quarter and full-year results on Tuesday.

Sales continued marching forward at a moderate pace thanks to steady gains in patient admissions and higher revenue per admission. A non-recurring tax benefit allowed net income to more than double, though growth in adjusted profits largely matched the gains in revenue. 

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HCA Healthcare fourth-quarter results: The raw numbers


Q4 2018

Q4 2017

YOY Change


$12.27 billion

$11.56 billion


Adjusted EBITDA

$2.51 billion

$2.36 billion


Net income

$1.06 billion

$474 million


Earnings per share




Data source: HCA Healthcare. EBITDA = earnings before interest, taxes, depreciation, and amortization.

What happened with HCA Healthcare this quarter?

  • Same-facility equivalent admissions increased by 1.9%. Revenue per equivalent admission grew by 4.4% thanks to favorable payer mix and pricing.
  • Changes in the company's tax rate explain the huge jump in net income and earnings per share. Last year, HCA recorded a $301 million increase in its tax bill. This quarter featured a tax benefit of $236 million, or $0.67 per share.
  • Operating expenses declined 10 basis points year over year to 79.6% of revenue.
  • Stock buybacks totaled $335 million, or 2.5 million shares. 
  • A new $2 billion share buyback program has been authorized.
  • HCA increased its dividend to $0.40 per share. That represents a 14% jump.

Zooming out to the full year, here's a review of the headline numbers from 2018:

  • Revenue grew 7% to $46.68 billion.
  • Adjusted EBITDA rose 9% to $8.95 billion
  • Net income jumped 70% to $3.8 billion.
  • EPS soared 79% to $10.66 per share.
  • The company spent $1.53 billion to buy back 14 million shares of its common stock.

These figures all came in at the high end or above management's guidance range.

What management had to say

On the call with investors, new CEO Samuel Hazen stated that he was happy with the company's performance during the year:

2018 was another strong year for HCA Healthcare. We have now grown our same facility inpatient admissions in 19 consecutive quarters. The strategic investments in our business to expand our networks and improve our clinical capabilities are making it easier for patients to get higher-quality, convenient patient care in an HCA facility. We have in excess of $3.5 billion of capital spending in the pipeline that should come online over the next 2 years. These investments will create additional inpatient and outpatient capacity within our local healthcare systems.

Management also said it expects to close on its recent acquisition of Mission Health by the end of January.

Looking forward

Management expects that 2019 will be another year of revenue growth for the company. However, a range of factors will make the year-over-year diluted EPS comparisons more challenging. As a result, management is expecting a modest decline in reported net income.


2019 Guidance 2018 Actual Implied Change
Revenue $50.5 billion to $51.5 billion $46.7 billion 9.2%
Adjusted EBITDA $9.35 billion to $9.75 billion $8.95 billion 6.7%
EPS $9.60 to $10.20 $10.66 (7%)

Data source: HCA Healthcare.

On a more positive note, management stated that if you strip away all of the one-time adjustment factors, then growth in earnings per share would be approximately 8% in 2019.

Hazen closed out his remarks by reaffirming his belief that the company remains well-positioned for long-term success: "We believe the fundamentals in our markets are strong with growing demand for healthcare services. This, coupled with the continual improvement and the competitive positioning of our local healthcare systems, gives us confidence as we move into 2019."

Check out the latest HCA Healthcare earnings call transcript.