HCA Healthcare (NYSE:HCA) has been on a roll. The hospital stock has nearly doubled over the last three years. And while HCA's shares haven't moved much so far in 2020, all the stock needed was the right catalyst.

Investors received such a catalyst with HCA's fourth-quarter update. The company announced its Q4 results before the market opened on Tuesday. Here are the highlights from HCA's latest quarter.

Male healthcare provider in white coat standing next to female healthcare provider in scrubs, both smiling.

Image source: Getty Images.

By the numbers

HCA announced Q4 revenue of $13.5 billion, a 10% increase from the $12.3 billion reported in the same quarter of the previous year. This result was also slightly higher than the analysts' average revenue estimate of $13.37 billion.

The hospital operator reported adjusted earnings before interest, taxes, depreciation, and amortization (EBITDA) of $2.74 billion. This was up 9% from HCA's adjusted EBITDA of $2.5 billion in the fourth quarter of 2018.

HCA posted net income in the fourth quarter of $1.07 billion, or $3.09 per share, based on generally accepted accounting principles (GAAP). This reflected improvement from HCA's net income of $1.06 billion, or $3.01 per share, recorded in the prior-year period. It also met the consensus Wall Street earnings estimate.

The company ended the fourth quarter with cash, cash equivalents, and short-term investments of $621 million. This was an increase from HCA's cash position of $559 million as of Dec. 31, 2019.

Behind the numbers

For hospitals, the most important driver of revenue is the number of admissions. HCA said that its same-facility admissions increased 4.7% year over year. Its same-facility emergency room visits jumped 6.7%. 

HCA also reported that its same-facility inpatient surgeries rose by 2.1% from the prior-year period. Same-facility outpatient surgeries increased by 1.8% year over year. In addition, the company's same-facility revenue per equivalent admission rose 1.1% from the fourth quarter of 2018.

While these metrics were key to HCA's revenue growth in Q4, the company's spending increases weighed on earnings growth. Salaries and benefits increased by 11.3% year over year to $6.1 billion. Supply expenses jumped 11.5% to $2.2 billion. Other operating expenses rose 8.1% to $2.5 billion. In addition, HCA's depreciation and amortization expenses increased by 19.4% year over year to $694 million.

Looking ahead

HCA anticipates that revenue will fall between $53.5 billion and $55.5 billion in full-year 2020. The midpoint of the range represents a year-over-year increase of 6.2%. The company also projected 2020 earnings per share of between $11.30 and $12.10. The midpoint of this range reflects year-over-year growth of 16.2%.

Probably the biggest question mark for HCA -- and for healthcare stocks in general -- is what will happen with the upcoming U.S. elections. Several leading presidential candidates favor major changes to the U.S. healthcare system that would dramatically affect HCA. There could be significant volatility in store as the presidential race continues over the next 10 months. 

This article represents the opinion of the writer, who may disagree with the “official” recommendation position of a Motley Fool premium advisory service. We’re motley! Questioning an investing thesis -- even one of our own -- helps us all think critically about investing and make decisions that help us become smarter, happier, and richer.