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HCA Healthcare Continues to Execute Well

By Brian Feroldi - May 1, 2019 at 10:14AM

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The hospital conglomerate continues to drive strong top-line growth and margin expansion.

HCA Healthcare (HCA -1.38%), an operator of 185 hospitals and approximately 2,000 sites of care, reported its first-quarter results on Tuesday.

Revenue and adjusted EBITDA continued to grow at a brisk pace thanks to rising admissions and acquisitions. The story wasn't as pretty on the bottom line, but that is mostly due to tough year-over-year comparisons. The generally upbeat results allowed management to favorably tweak its guidance for the remainder of the year. 

HCA Healthcare first-quarter results: The raw numbers


Q1 2019

Q1 2018

Year-Over-Year Change


$12.52 billion

$11.42 billion


Adjusted EBITDA

$2.54  billion

$2.12  billion


Net income

$1.04 billion

$1.14  million


Earnings per share




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

Exterior of a hospital emergency room entrance

Image source: Getty Images.

What happened with HCA Healthcare this quarter?

  • The year-ago period had a $405 million gain on sales related to the divestiture of its facilities in Oklahoma. That translated into a $0.85-per-share boost and more than explains the year-over-year decline in EPS. On an adjusted basis, EPS grew 27%.
  • Same-facility equivalent admissions increased 1.8% during the quarter. Same-facility revenue per equivalent admission grew 4.4%.
  • Operating expenses as a percentage of revenue declined by 180 basis points year over year to 79.8%. The leverage helped to drive the double-digit gain in adjusted EBITDA.
  • Management spent $278 million to buy back 2.1 million shares. HCA still has the green light to repurchase up to $2 billion more in future quarters. Shares outstanding are down 2.5% over the last year thanks to the company's substantial stock repurchase program.
  • HCA completed its purchase of Mission Health for $1.5 billion. Mission Health owns seven hospitals in North Carolina.
  • The company recently became the majority owner of Galen College of Nursing, one of the largest educators of nurses in the U.S. The terms of the deal were not disclosed.

What management had to say

On the call with investors, CEO Samuel Hazen stated that the company continues to execute well: "We have now grown our same-facilities and patient admissions in 20 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 high-quality convenient patient care in an HCA Healthcare facility."

Looking forward

The strong start to the year allowed management to favorably tweak its guidance for 2019:


Previous Guidance Updated Guidance
Revenue $50.5 billion to $51.5 billion $50.5 billion to $51.5 billion
Adjusted EBITDA $9.35 billion to $9.75 billion $9.45 billion to $9.85 billion
EPS $9.60 to $10.20 $9.80 to $10.40

Data source: HCA Healthcare.

Hazen ended his prepared remarks on the conference call with investors by talking up the potential of the Galen College of Nursing transaction:

We are excited about the pending deal. HCA Healthcare has been investing heavily in nursing over the past few years, so our nurses can be successful and provide to the best possible patient care. This investment creates new opportunities for Galen to expand programs into more of our markets.

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