Cover Page
Cover Page - shares | 9 Months Ended | |
Sep. 30, 2023 | Oct. 23, 2023 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Sep. 30, 2023 | |
Document Fiscal Year Focus | 2023 | |
Document Fiscal Period Focus | Q3 | |
Trading Symbol | HCA | |
Entity Registrant Name | HCA Healthcare, Inc. | |
Entity Central Index Key | 0000860730 | |
Current Fiscal Year End Date | --12-31 | |
Entity Current Reporting Status | Yes | |
Entity Filer Category | Large Accelerated Filer | |
Entity Shell Company | false | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Common Stock, Shares Outstanding | 267,660,800 | |
Entity Interactive Data Current | Yes | |
Securities Act File Number | 1-11239 | |
Entity Incorporation, State or Country Code | DE | |
Entity Tax Identification Number | 27-3865930 | |
Entity Address, Address Line One | One Park Plaza | |
Entity Address, City or Town | Nashville | |
Entity Address, State or Province | TN | |
Entity Address, Postal Zip Code | 37203 | |
City Area Code | 615 | |
Local Phone Number | 344-9551 | |
Document Quarterly Report | true | |
Document Transition Report | false | |
Title of 12(b) Security | Voting common stock, $.01 par value | |
Security Exchange Name | NYSE |
Condensed Consolidated Income S
Condensed Consolidated Income Statements (Unaudited) - USD ($) shares in Thousands, $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2023 | Sep. 30, 2022 | Sep. 30, 2023 | Sep. 30, 2022 | |
Income Statement [Abstract] | ||||
Revenues | $ 16,213 | $ 14,971 | $ 47,665 | $ 44,736 |
Salaries and benefits | 7,556 | 6,899 | 21,917 | 20,630 |
Supplies | 2,417 | 2,320 | 7,318 | 6,942 |
Other operating expenses | 3,379 | 2,860 | 9,316 | 8,305 |
Equity in (earnings) losses of affiliates | (19) | (10) | 6 | (29) |
Depreciation and amortization | 769 | 749 | 2,288 | 2,219 |
Interest expense | 483 | 446 | 1,447 | 1,288 |
Losses (gains) on sales of facilities | (2) | 3 | 12 | 25 |
Losses on retirement of debt | 0 | 0 | 0 | 78 |
Total expenses including equity in earnings of affiliates | 14,583 | 13,267 | 42,304 | 39,458 |
Income before income taxes | 1,630 | 1,704 | 5,361 | 5,278 |
Provision for income taxes | 355 | 360 | 1,131 | 1,090 |
Net income | 1,275 | 1,344 | 4,230 | 4,188 |
Net income attributable to noncontrolling interests | 196 | 210 | 595 | 626 |
Net income attributable to HCA Healthcare, Inc. | $ 1,079 | $ 1,134 | $ 3,635 | $ 3,562 |
Per share data: | ||||
Basic earnings | $ 3.98 | $ 3.97 | $ 13.26 | $ 12.13 |
Diluted earnings | $ 3.91 | $ 3.91 | $ 13.07 | $ 11.97 |
Shares used in earnings per share calculations (in millions): | ||||
Basic | 271,173 | 285,958 | 274,171 | 293,583 |
Diluted | 275,424 | 289,852 | 278,173 | 297,702 |
Condensed Consolidated Comprehe
Condensed Consolidated Comprehensive Income Statements (Unaudited) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2023 | Sep. 30, 2022 | Sep. 30, 2023 | Sep. 30, 2022 | |
Statement of Comprehensive Income [Abstract] | ||||
Net income | $ 1,275 | $ 1,344 | $ 4,230 | $ 4,188 |
Other comprehensive loss before taxes: | ||||
Foreign currency translation | (35) | (76) | 3 | (181) |
Unrealized losses on available-for-sale securities | (7) | (16) | (5) | (58) |
Losses included in other operating expenses | 0 | 0 | 0 | 1 |
Total Unrealized losses on available-for-sale securities | (7) | (16) | (5) | (57) |
Defined benefit plans | 0 | 0 | 0 | 0 |
Pension costs included in salaries and benefits | 1 | 2 | 1 | 7 |
Total defined benefit plans | 1 | 2 | 1 | 7 |
Change in fair value of derivative financial instruments | 0 | 1 | 0 | 6 |
Interest costs included in interest expense | 0 | 0 | 0 | 4 |
Total change in fair value of derivative financial instruments | 0 | 1 | 0 | 10 |
Other comprehensive loss before taxes | (41) | (89) | (1) | (221) |
Income tax benefits related to other comprehensive loss items | (6) | (12) | 0 | (33) |
Other comprehensive loss | (35) | (77) | (1) | (188) |
Comprehensive income | 1,240 | 1,267 | 4,229 | 4,000 |
Comprehensive income attributable to noncontrolling interests | 196 | 210 | 595 | 626 |
Comprehensive income attributable to HCA Healthcare, Inc. | $ 1,044 | $ 1,057 | $ 3,634 | $ 3,374 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Millions | Sep. 30, 2023 | Dec. 31, 2022 |
Current assets: | ||
Cash and cash equivalents | $ 891 | $ 908 |
Accounts receivable | 9,182 | 8,891 |
Inventories | 2,030 | 2,068 |
Other | 2,191 | 1,776 |
Total current assets | 14,294 | 13,643 |
Property and equipment, at cost | 57,772 | 54,757 |
Accumulated depreciation | (30,655) | (29,182) |
Property and equipment, net | 27,117 | 25,575 |
Investments of insurance subsidiaries | 382 | 381 |
Investments in and advances to affiliates | 739 | 823 |
Goodwill and other intangible assets | 9,778 | 9,653 |
Right-of-use operating lease assets | 2,079 | 2,065 |
Other | 200 | 298 |
Total assets | 54,589 | 52,438 |
Current liabilities: | ||
Accounts payable | 4,139 | 4,239 |
Accrued salaries | 1,912 | 1,712 |
Other accrued expenses | 3,803 | 3,581 |
Long-term debt due within one year | 2,553 | 370 |
Total current liabilities | 12,407 | 9,902 |
Long-term debt, less debt issuance costs and discounts of $341 and $301 | 36,793 | 37,714 |
Professional liability risks | 1,590 | 1,528 |
Right-of-use operating lease obligations | 1,776 | 1,752 |
Income taxes and other liabilities | 1,666 | 1,615 |
Stockholders' equity (deficit): | ||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 268,967,300 shares - 2023 and 277,378,300 shares - 2022 | 3 | 3 |
Accumulated other comprehensive loss | (491) | (490) |
Retained deficit | (1,989) | (2,280) |
Stockholders' deficit attributable to HCA Healthcare, Inc. | (2,477) | (2,767) |
Noncontrolling interests | 2,834 | 2,694 |
Total stockholders' equity | 357 | (73) |
Total liabilities and stockholders' equity | $ 54,589 | $ 52,438 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions | Sep. 30, 2023 | Dec. 31, 2022 |
Statement of Financial Position [Abstract] | ||
Debt issuance costs | $ 341 | $ 301 |
Common stock, par value | $ 0.01 | $ 0.01 |
Common stock, shares authorized | 1,800,000,000 | 1,800,000,000 |
Common stock, shares outstanding | 268,967,300 | 277,378,300 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Stockholders' Equity (DEFICIT) (Unaudited) - USD ($) $ in Millions | Total | Common Stock [Member] | Capital in Excess of Par Value [Member] | Accumulated Other Comprehensive Loss [Member] | Retained Deficit [Member] | Equity Attributable to Noncontrolling Interests [Member] |
Balances at Dec. 31, 2021 | $ 1,489 | $ 3 | $ 0 | $ (404) | $ (532) | $ 2,422 |
Balance, shares at Dec. 31, 2021 | 305,477,000 | |||||
Comprehensive income (loss) | 1,422 | (43) | 1,273 | 192 | ||
Repurchase of common stock | (2,101) | (2,101) | ||||
Repurchase of common stock, shares | (8,375,000) | |||||
Share-based benefit plans | (57) | (57) | ||||
Share-based benefit plans, shares | 1,879,000 | |||||
Cash dividends declared | (171) | (171) | ||||
Distributions | (171) | (171) | ||||
Other | 3 | (1) | 4 | |||
Balance at Mar. 31, 2022 | 414 | $ 3 | 0 | (447) | (1,589) | 2,447 |
Balance, shares at Mar. 31, 2022 | 298,981,000 | |||||
Balances at Dec. 31, 2021 | 1,489 | $ 3 | 0 | (404) | (532) | 2,422 |
Balance, shares at Dec. 31, 2021 | 305,477,000 | |||||
Comprehensive income (loss) | 4,000 | |||||
Balance at Sep. 30, 2022 | (778) | $ 3 | 0 | (592) | (2,781) | 2,592 |
Balance, shares at Sep. 30, 2022 | 283,904,000 | |||||
Balances at Mar. 31, 2022 | 414 | $ 3 | 0 | (447) | (1,589) | 2,447 |
Balance, shares at Mar. 31, 2022 | 298,981,000 | |||||
Comprehensive income (loss) | 1,311 | (68) | 1,155 | 224 | ||
Repurchase of common stock | (2,682) | (111) | (2,571) | |||
Repurchase of common stock, shares | (12,230,000) | |||||
Share-based benefit plans | 118 | 118 | ||||
Share-based benefit plans, shares | 253,000 | |||||
Cash dividends declared | (163) | (163) | ||||
Distributions | (162) | (162) | ||||
Other | 22 | (7) | 29 | |||
Balance at Jun. 30, 2022 | (1,142) | $ 3 | 0 | (515) | (3,168) | 2,538 |
Balance, shares at Jun. 30, 2022 | 287,004,000 | |||||
Comprehensive income (loss) | 1,267 | (77) | 1,134 | 210 | ||
Repurchase of common stock | (698) | (113) | (585) | |||
Repurchase of common stock, shares | (3,361,000) | |||||
Share-based benefit plans | 116 | 116 | ||||
Share-based benefit plans, shares | 261,000 | |||||
Cash dividends declared | (162) | (162) | ||||
Distributions | (217) | (217) | ||||
Other | 58 | (3) | 61 | |||
Balance at Sep. 30, 2022 | (778) | $ 3 | 0 | (592) | (2,781) | 2,592 |
Balance, shares at Sep. 30, 2022 | 283,904,000 | |||||
Comprehensive income (loss) | 2,748 | 102 | 2,081 | 565 | ||
Repurchase of common stock | (1,519) | (40) | (1,479) | |||
Repurchase of common stock, shares | (6,781,000) | |||||
Share-based benefit plans | 105 | 48 | 57 | |||
Share-based benefit plans, shares | 255,000 | |||||
Cash dividends declared | (159) | (159) | ||||
Distributions | (475) | (475) | ||||
Other | 5 | (8) | 1 | 12 | ||
Balance at Dec. 31, 2022 | (73) | $ 3 | 0 | (490) | (2,280) | 2,694 |
Balance, shares at Dec. 31, 2022 | 277,378,000 | |||||
Comprehensive income (loss) | 1,563 | 20 | 1,363 | 180 | ||
Repurchase of common stock | (849) | (849) | ||||
Repurchase of common stock, shares | (3,340,000) | |||||
Share-based benefit plans | (87) | (87) | ||||
Share-based benefit plans, shares | 1,902,000 | |||||
Cash dividends declared | (168) | (168) | ||||
Distributions | (187) | (187) | ||||
Other | 33 | (7) | 40 | |||
Balance at Mar. 31, 2023 | 232 | $ 3 | 0 | (470) | (2,028) | 2,727 |
Balance, shares at Mar. 31, 2023 | 275,940,000 | |||||
Balances at Dec. 31, 2022 | (73) | $ 3 | 0 | (490) | (2,280) | 2,694 |
Balance, shares at Dec. 31, 2022 | 277,378,000 | |||||
Comprehensive income (loss) | $ 4,229 | |||||
Repurchase of common stock, shares | (10,818,000) | |||||
Balance at Sep. 30, 2023 | $ 357 | $ 3 | 0 | (491) | (1,989) | 2,834 |
Balance, shares at Sep. 30, 2023 | 268,967,000 | |||||
Balances at Mar. 31, 2023 | 232 | $ 3 | 0 | (470) | (2,028) | 2,727 |
Balance, shares at Mar. 31, 2023 | 275,940,000 | |||||
Comprehensive income (loss) | 1,426 | 14 | 1,193 | 219 | ||
Repurchase of common stock | (924) | (924) | ||||
Repurchase of common stock, shares | (3,311,000) | |||||
Share-based benefit plans | 72 | 72 | ||||
Share-based benefit plans, shares | 303,000 | |||||
Cash dividends declared | (165) | (165) | ||||
Distributions | (155) | (155) | ||||
Other | (25) | 2 | (27) | |||
Balance at Jun. 30, 2023 | 461 | $ 3 | 0 | (456) | (1,850) | 2,764 |
Balance, shares at Jun. 30, 2023 | 272,932,000 | |||||
Comprehensive income (loss) | 1,240 | (35) | 1,079 | 196 | ||
Repurchase of common stock | (1,151) | (86) | (1,065) | |||
Repurchase of common stock, shares | (4,167,000) | |||||
Share-based benefit plans | 101 | 86 | 15 | |||
Share-based benefit plans, shares | 202,000 | |||||
Cash dividends declared | (164) | (164) | ||||
Distributions | (155) | (155) | ||||
Other | 25 | (4) | 29 | |||
Balance at Sep. 30, 2023 | $ 357 | $ 3 | $ 0 | $ (491) | $ (1,989) | $ 2,834 |
Balance, shares at Sep. 30, 2023 | 268,967,000 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Stockholders' Equity (DEFICIT) (Parenthetical) (Unaudited) - $ / shares | 3 Months Ended | ||||||
Sep. 30, 2023 | Jun. 30, 2023 | Mar. 31, 2023 | Dec. 31, 2022 | Sep. 30, 2022 | Jun. 30, 2022 | Mar. 31, 2022 | |
Statement of Stockholders' Equity [Abstract] | |||||||
Cash dividends declared, per share | $ 0.6 | $ 0.6 | $ 0.6 | $ 0.56 | $ 0.56 | $ 0.56 | $ 0.56 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Millions | 9 Months Ended | |
Sep. 30, 2023 | Sep. 30, 2022 | |
Cash flows from operating activities: | ||
Net income | $ 4,230 | $ 4,188 |
Increase (decrease) in cash from operating assets and liabilities: | ||
Accounts receivable | (168) | (487) |
Inventories and other assets | (274) | 53 |
Accounts payable and accrued expenses | 211 | (644) |
Depreciation and amortization | 2,288 | 2,219 |
Income taxes | 61 | 159 |
Losses on sales of facilities | 12 | 25 |
Losses on retirement of debt | 0 | 78 |
Amortization of debt issuance costs and discounts | 26 | 22 |
Share-based compensation | 205 | 258 |
Other | 166 | 124 |
Net cash provided by operating activities | 6,757 | 5,995 |
Cash flows from investing activities: | ||
Purchase of property and equipment | (3,585) | (3,072) |
Acquisition of hospitals and health care entities | (281) | (176) |
Sales of hospitals and health care entities | 183 | 652 |
Change in investments | (30) | 10 |
Other | (7) | (10) |
Net cash used in investing activities | (3,720) | (2,596) |
Cash flows from financing activities: | ||
Issuance of long-term debt | 3,220 | 5,976 |
Net change in revolving credit facilities | (1,420) | (230) |
Repayment of long-term debt | (691) | (2,774) |
Distributions to noncontrolling interests | (497) | (550) |
Payment of debt issuance costs | (31) | (53) |
Payment of dividends | (501) | (497) |
Repurchase of common stock | (2,901) | (5,481) |
Other | (234) | (209) |
Net cash used in financing activities | (3,055) | (3,818) |
Effect of exchange rate changes on cash and cash equivalents | 1 | (33) |
Change in cash and cash equivalents | (17) | (452) |
Cash and cash equivalents at beginning of period | 908 | 1,451 |
Cash and cash equivalents at end of period | 891 | 999 |
Interest payments | 1,460 | 1,329 |
Income tax payments, net | $ 1,070 | $ 931 |
Pay vs Performance Disclosure
Pay vs Performance Disclosure - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2023 | Sep. 30, 2022 | Sep. 30, 2023 | Sep. 30, 2022 | |
Pay vs Performance Disclosure | ||||
Net Income (Loss) | $ 1,079 | $ 1,134 | $ 3,635 | $ 3,562 |
Insider Trading Arrangements
Insider Trading Arrangements | 3 Months Ended | 9 Months Ended |
Sep. 30, 2023 | Sep. 30, 2023 | |
Trading Arrangements, by Individual | ||
Material Terms of Trading Arrangement | (c) During the three months ended September 30, 2023 , no director or officer (as defined in Rule 16a-1(f) of the Exchange Act) of the Company adopted or terminated a “Rule 10b5-1 trading arrangement” or “non-Rule 10b5-1 trading arrangement,” as each term is defined in Item 408(a) of Regulation S-K. | |
Rule 10b5-1 Arrangement Adopted | false | |
Non-Rule 10b5-1 Arrangement Adopted | false | |
Rule 10b5-1 Arrangement Terminated | false | |
Non-Rule 10b5-1 Arrangement Terminated | false |
Basis of Presentation and Signi
Basis of Presentation and Significant Accounting Policies | 9 Months Ended |
Sep. 30, 2023 | |
Accounting Policies [Abstract] | |
Basis of Presentation and Significant Accounting Policies | NOTE 1 — BASIS OF PR ESENTATION AND SIGNIFICANT ACCOUNTING POLICIES Reporting Entity HCA Healthcare, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At September 30, 2023 , these affiliates owned and operated 183 hospitals, 126 freestanding surgery centers, 22 freestanding endoscopy centers and provided extensive outpatient and ancillary services. HCA Healthcare, Inc.’s facilities are located in 20 states and England. The terms “Company,” “HCA,” “we,” “our” or “us,” as used herein and unless otherwise stated or indicated by context, refer to HCA Healthcare, Inc. and its affiliates. The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA and the term “employees” refers to employees of affiliates of HCA. Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and footnotes required by generally accepted accounting principles for complete consolidated financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation have been included and are of a normal and recurring nature. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $ 80 million and $ 74 million for the quarters ended September 30, 2023 and 2022 , respectively, and $ 227 million and $ 228 million for the nine months ended September 30, 2023 and 2022, respectively. Operating results for the quarter and nine months ended September 30, 2023 are not necessarily indicative of the results that may be expected for the year ending December 31, 2023. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K for the year ended December 31, 2022. Revenues Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges . Our performance obligations for outpatient services are generally satisfied over a period of less than one day . The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges), and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals. NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (continued) Revenues (continued) Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured and other discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Patients treated at our hospitals for non-elective care, who have income at or below 400 % of the federal poverty level, are eligible for charity care. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters and nine months ended September 30, 2023 and 2022 are summarized in the following table (dollars in millions): Quarter 2023 Ratio 2022 Ratio Medicare $ 2,560 15.8 % $ 2,569 17.2 % Managed Medicare 2,535 15.6 2,229 14.9 Medicaid 1,001 6.2 797 5.3 Managed Medicaid 1,039 6.4 939 6.3 Managed care and insurers 7,687 47.4 7,184 47.9 International (managed care and insurers) 375 2.3 311 2.1 Other 1,016 6.3 942 6.3 Revenues $ 16,213 100.0 % $ 14,971 100.0 % Nine Months 2023 Ratio 2022 Ratio Medicare $ 7,865 16.5 % $ 7,790 17.4 % Managed Medicare 7,635 16.0 6,813 15.2 Medicaid 2,478 5.2 1,987 4.4 Managed Medicaid 2,846 6.0 3,003 6.7 Managed care and insurers 23,140 48.5 21,480 48.1 International (managed care and insurers) 1,127 2.4 992 2.2 Other 2,574 5.4 2,671 6.0 Revenues $ 47,665 100.0 % $ 44,736 100.0 % To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters and nine months ended September 30, 2023 and 2022 follows (dollars in millions): Quarter Nine Months 2023 2022 2023 2022 Patient care costs (salaries and benefits, supplies, other $ 14,121 $ 12,828 $ 40,839 $ 38,096 Cost-to-charges ratio (patient care costs as percentage of gross 10.9 % 11.2 % 10.6 % 11.2 % Total uncompensated care $ 9,042 $ 8,050 $ 25,516 $ 23,512 Multiply by the cost-to-charges ratio 10.9 % 11.2 % 10.6 % 11.2 % Estimated cost of total uncompensated care $ 975 $ 901 $ 2,705 $ 2,633 NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (continued) Revenues (continued) The total uncompensated care amounts include charity care of $ 3.531 billion and $ 3.206 billion, respectively, and the related estimated costs of charity care were $ 382 million and $ 359 million, respectively, for the quarters ended September 30, 2023 and 2022. The total uncompensated care amounts include charity care of $ 10.684 billion and $ 10.281 billion, respectively, and the related estimated costs of charity care were $ 1.133 billion and $ 1.151 billion, respectively, for the nine months ended September 30, 2023 and 2022 . Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Acquisitions and Dispositions
Acquisitions and Dispositions | 9 Months Ended |
Sep. 30, 2023 | |
Business Combinations [Abstract] | |
Acquisitions and Dispositions | NOTE 2 — ACQUISITIONS AND DISPOSITIONS During the nine months ended September 30, 2023 , we paid $ 83 million to acquire a hospital facility in Texas. During the nine months ended September 30, 2023 and 2022 , we paid $ 198 million and $ 176 million, respectively, to acquire nonhospital health care entities. Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values. During the nine months ended September 30, 2023 , we received proceeds of $ 162 million for the sale of two hospital facilities in Louisiana. During the nine months ended September 30, 2023 and 2022 , we received proceeds of $ 21 million and $ 38 million, respectively, related to sales of real estate and other health care entity investments. We recognized pretax losses of $ 12 million and $ 25 million, respectively, for these transactions. We also received net proceeds of $ 614 million on September 30, 2022 related to the sale of a controlling interest in a subsidiary of our group purchasing organization, which was effective October 1, 2022. |
Income Taxes
Income Taxes | 9 Months Ended |
Sep. 30, 2023 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | NOTE 3 — INCOME TAXES Our provisions for income taxes for the quarters ended September 30, 2023 and 2022 were $ 355 million and $ 360 million, respectively, and the effective tax rates were 24.8 % and 24.1 %, respectively. Our provisions for income taxes for the nine months ended September 30, 2023 and 2022 were $ 1.131 billion and $ 1.090 billion, respectively, and the effective tax rates were 23.7 % and 23.4 %, respectively. Our provisions for income taxes included tax benefits related to settlements of employee equity awards of $ 89 million and $ 70 million for the nine months ended September 30, 2023 and 2022, respectively. Our gross unrecognized tax benefits were $ 653 million, excluding accrued interest of $ 168 million, as of September 30, 2023 ($ 639 million and $ 129 million, respectively, as of December 31, 2022). Unrecognized tax benefits of $ 326 million ($ 278 million as of December 31, 2022) would affect the effective rate, if recognized. At September 30, 2023 , the Internal Revenue Service was conducting examinations of the Company’s 2016, 2017 and 2018 federal income tax returns and the 2019 returns of certain affiliates. We are also subject to examination by state, local and foreign taxing authorities. Depending on the resolution of any tax disputes, the completion of examinations by taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change. |
Earnings Per Share
Earnings Per Share | 9 Months Ended |
Sep. 30, 2023 | |
Earnings Per Share [Abstract] | |
Earnings Per Share | NOTE 4 — EARNINGS PER SHARE We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards, computed using the treasury stock method. NOTE 4 — EARNINGS PER SHARE (continued) The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2023 and 2022 (dollars and shares in millions, except per share amounts): Quarter Nine Months 2023 2022 2023 2022 Net income attributable to HCA Healthcare, Inc. $ 1,079 $ 1,134 $ 3,635 $ 3,562 Weighted average common shares outstanding 271.173 285.958 274.171 293.583 Effect of dilutive incremental shares 4.251 3.894 4.002 4.119 Shares used for diluted earnings per share 275.424 289.852 278.173 297.702 Earnings per share: Basic earnings $ 3.98 $ 3.97 $ 13.26 $ 12.13 Diluted earnings $ 3.91 $ 3.91 $ 13.07 $ 11.97 |
Investments of Insurance Subsid
Investments of Insurance Subsidiaries | 9 Months Ended |
Sep. 30, 2023 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments of Insurance Subsidiaries | NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES A summary of our insurance subsidiaries’ investments at September 30, 2023 and December 31, 2022 follows (dollars in millions): September 30, 2023 Unrealized Amortized Gains Losses Fair Debt securities $ 404 $ — $ ( 43 ) $ 361 Money market funds and other 124 — — 124 $ 528 $ — $ ( 43 ) 485 Amounts classified as current assets ( 103 ) Investment carrying value $ 382 December 31, 2022 Unrealized Amortized Gains Losses Fair Debt securities $ 415 $ — $ ( 38 ) $ 377 Money market funds and other 96 — — 96 $ 511 $ — $ ( 38 ) 473 Amounts classified as current assets ( 92 ) Investment carrying value $ 381 At September 30, 2023 and December 31, 2022, the investments in debt securities of our insurance subsidiaries were classified as “available-for-sale.” Changes in unrealized gains and losses that are not credit-related are recorded as adjustments to other comprehensive income (loss). NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES (continued) Scheduled maturities of investments in debt securities at September 30, 2023 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 13 $ 13 Due after one year through five years 148 139 Due after five years through ten years 165 140 Due after ten years 78 69 $ 404 $ 361 The average expected maturity of the investments in debt securities at September 30, 2023 was 5.2 years, compared to the average scheduled maturity of 8.7 years. Expected and scheduled maturities may differ because the issuers of certain securities have the right to call, prepay or otherwise redeem such obligations prior to their scheduled maturity date. |
Assets and Liabilities Measured
Assets and Liabilities Measured at Fair Value | 9 Months Ended |
Sep. 30, 2023 | |
Fair Value Disclosures [Abstract] | |
Assets and Liabilities Measured at Fair Value | NOTE 6 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”), emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy). Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. The investments of our insurance subsidiaries are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. The following tables summarize our assets measured at fair value on a recurring basis as of September 30, 2023 and December 31, 2022, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): September 30, 2023 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Investments of insurance subsidiaries: Debt securities $ 361 $ — $ 361 $ — Money market funds and other 124 124 — — Investments of insurance subsidiaries 485 124 361 — Less amounts classified as current assets ( 103 ) ( 103 ) — — $ 382 $ 21 $ 361 $ — NOTE 6 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued) December 31, 2022 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Investments of insurance subsidiaries: Debt securities $ 377 $ — $ 377 $ — Money market funds and other 96 96 — — Investments of insurance subsidiaries 473 96 377 — Less amounts classified as current assets ( 92 ) ( 92 ) — — $ 381 $ 4 $ 377 $ — The estimated fair value of our long-term debt was $ 36.120 billion and $ 35.555 billion at September 30, 2023 and December 31, 2022, respectively, compared to carrying amounts, excluding debt issuance costs and discounts, aggregating $ 39.687 billion and $ 38.385 billion, respectively. The estimates of fair value are generally based on Level 2 inputs, including quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities. |
Long-Term Debt
Long-Term Debt | 9 Months Ended |
Sep. 30, 2023 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | NOTE 7 — LONG-TERM DEBT A summary of long-term debt at September 30, 2023 and December 31, 2022, including related interest rates at September 30, 2023, follows (dollars in millions): September 30, December 31, Senior secured asset-based revolving credit facility (effective interest rate of 6.7 %) $ 1,480 $ 2,900 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 6.8 %) 1,331 1,880 Other senior secured debt (effective interest rate of 4.0 %) 974 953 Senior secured debt 3,785 5,733 Senior unsecured notes (effective interest rate of 5.0 %) 35,902 32,652 Debt issuance costs and discounts ( 341 ) ( 301 ) Total debt (average life of 9.6 years, rates averaging 5.1 %) 39,346 38,084 Less amounts due within one year 2,553 370 $ 36,793 $ 37,714 During January 2023, the availability under our senior secured revolving credit facility was increased by $ 1.500 billion to total $ 3.500 billion, the senior secured term loan B facility was fully retired and certain administrative updates were made to our credit agreements. During May 2023, we issued $ 3.250 billion aggregate principal amount of senior notes comprised of (i) $ 1.000 billion aggregate principal amount of 5.200 % senior notes due 2028, (ii) $ 1.250 billion aggregate principal amount of 5.500 % senior notes due 2033 and (iii) $ 1.000 billion aggregate principal amount of 5.900 % senior notes due 2053 . We used the net proceeds to repay borrowings under our asset-based revolving credit facility. |
Contingencies
Contingencies | 9 Months Ended |
Sep. 30, 2023 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | NOTE 8 — CONTINGENCIES We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us which may not be covered by insurance. We are also subject to claims by various taxing authorities for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations, financial position or liquidity. Health care companies are routinely subject to investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam , or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our results of operations, financial position or liquidity. Texas operates a state Medicaid program pursuant to a waiver from the Centers for Medicare & Medicaid Services under Section 1115 of the Social Security Act (the “Program”). The Program includes uncompensated-care pools; payments from these pools are intended to defray the uncompensated costs of services provided by our and other hospitals to Medicaid eligible or uninsured individuals. Separately, we and other hospitals provide charity care services in several communities in the state. In 2018, the Civil Division of the U.S. Department of Justice and the U.S. Attorney’s Office for the Southern District of Texas requested information about whether the Program, as operated in Harris County, complied with the laws and regulations applicable to provider related donations, and the Company cooperated with that request. On May 21, 2019, a qui tam lawsuit asserting violations of the FCA and the Texas Medicaid Fraud Prevention Act related to the Program, as operated in Harris County, was unsealed by the U.S. District Court for the Southern District of Texas. Both the federal and state governments declined to intervene in the qui tam lawsuit. The Company believes that our participation is and has been consistent with the requirements of the Program and is vigorously defending against the lawsuit being pursued by the relator. We cannot predict what effect, if any, the qui tam lawsuit could have on the Company. |
Share Repurchase Transactions a
Share Repurchase Transactions and Accumulated Other Comprehensive Loss | 9 Months Ended |
Sep. 30, 2023 | |
Federal Home Loan Banks [Abstract] | |
Share Repurchases Transactions and Accumulated Other Comprehensive Loss | NOTE 9 — SHARE REPURCHASE TRANSACTIONS AND ACCUMULATED OTHER COMPREHENSIVE LOSS During January 2023 and 2022, our Board of Directors authorized share repurchase programs for up to $ 3 billion and $ 8 billion, respectively, of our outstanding common stock. During the nine months ended September 30, 2023, we repurchased 10.818 million shares of our common stock at an average price of $ 268.18 per share through market purchases pursuant to the January 2022 authorization (which was completed during the second quarter of 2023) and the January 2023 authorization. At September 30, 2023 , we had $ 1.685 billion of repurchase authorization available under the January 2023 authorization. The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized Foreign Defined Total Balances at December 31, 2022 $ ( 30 ) $ ( 373 ) $ ( 87 ) $ ( 490 ) Unrealized losses on available-for-sale securities, net of $ 1 income ( 4 ) ( 4 ) Foreign currency translation adjustments, net of $ 1 of income 2 2 Expense reclassified into operations from other 1 1 Balances at September 30, 2023 $ ( 34 ) $ ( 371 ) $ ( 86 ) $ ( 491 ) |
Segment and Geographic Informat
Segment and Geographic Information | 9 Months Ended |
Sep. 30, 2023 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | NOTE 10 — SEGMENT AND GEOGRAPHIC INFORMATION Effective January 1, 2023, we reorganized our operations from two geographically organized groups into three geographically organized groups: the National, American and Atlantic Groups. The National Group includes 57 hospitals located in Alaska, California, Idaho, Indiana, Kentucky, Nevada, New Hampshire, North Carolina, Tennessee, Utah and Virginia, the American Group includes 57 hospitals located in Colorado, central Kansas, Louisiana and Texas, and the Atlantic Group includes 62 hospitals located in Florida, Georgia, northern Kansas, Missouri and South Carolina. The seven hospitals we operate in England remain in the Corporate and other group. Prior periods presented have been restated according to the new organizational structure. Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, gains and losses on sales of facilities, losses on retirement of debt, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2023 and 2022 are summarized in the following table (dollars in millions): Quarter Nine Months 2023 2022 2023 2022 Revenues: National Group $ 4,352 $ 4,092 $ 13,340 $ 12,382 Atlantic Group 5,470 4,951 15,617 14,337 American Group 5,491 5,117 16,226 15,528 Corporate and other 900 811 2,482 2,489 $ 16,213 $ 14,971 $ 47,665 $ 44,736 Equity in (earnings) losses of affiliates: National Group $ — $ — $ ( 2 ) $ ( 1 ) Atlantic Group — ( 1 ) ( 2 ) ( 2 ) American Group ( 13 ) ( 13 ) ( 35 ) ( 31 ) Corporate and other ( 6 ) 4 45 5 $ ( 19 ) $ ( 10 ) $ 6 $ ( 29 ) Adjusted segment EBITDA: National Group $ 799 $ 780 $ 2,826 $ 2,602 Atlantic Group 1,158 1,014 3,219 2,833 American Group 1,210 1,178 3,662 3,832 Corporate and other ( 287 ) ( 70 ) ( 599 ) ( 379 ) $ 2,880 $ 2,902 $ 9,108 $ 8,888 Depreciation and amortization: National Group $ 206 $ 207 $ 621 $ 598 Atlantic Group 249 231 735 686 American Group 244 236 719 701 Corporate and other 70 75 213 234 $ 769 $ 749 $ 2,288 $ 2,219 Adjusted segment EBITDA $ 2,880 $ 2,902 $ 9,108 $ 8,888 Depreciation and amortization 769 749 2,288 2,219 Interest expense 483 446 1,447 1,288 Losses (gains) on sales of facilities ( 2 ) 3 12 25 Losses on retirement of debt — — — 78 Income before income taxes $ 1,630 $ 1,704 $ 5,361 $ 5,278 |
Basis of Presentation and Sig_2
Basis of Presentation and Significant Accounting Policies (Policies) | 9 Months Ended |
Sep. 30, 2023 | |
Accounting Policies [Abstract] | |
Basis of Presentation | Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and footnotes required by generally accepted accounting principles for complete consolidated financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation have been included and are of a normal and recurring nature. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $ 80 million and $ 74 million for the quarters ended September 30, 2023 and 2022 , respectively, and $ 227 million and $ 228 million for the nine months ended September 30, 2023 and 2022, respectively. Operating results for the quarter and nine months ended September 30, 2023 are not necessarily indicative of the results that may be expected for the year ending December 31, 2023. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K for the year ended December 31, 2022. |
Revenues | Revenues Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges . Our performance obligations for outpatient services are generally satisfied over a period of less than one day . The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges), and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals. Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured and other discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Patients treated at our hospitals for non-elective care, who have income at or below 400 % of the federal poverty level, are eligible for charity care. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters and nine months ended September 30, 2023 and 2022 are summarized in the following table (dollars in millions): Quarter 2023 Ratio 2022 Ratio Medicare $ 2,560 15.8 % $ 2,569 17.2 % Managed Medicare 2,535 15.6 2,229 14.9 Medicaid 1,001 6.2 797 5.3 Managed Medicaid 1,039 6.4 939 6.3 Managed care and insurers 7,687 47.4 7,184 47.9 International (managed care and insurers) 375 2.3 311 2.1 Other 1,016 6.3 942 6.3 Revenues $ 16,213 100.0 % $ 14,971 100.0 % Nine Months 2023 Ratio 2022 Ratio Medicare $ 7,865 16.5 % $ 7,790 17.4 % Managed Medicare 7,635 16.0 6,813 15.2 Medicaid 2,478 5.2 1,987 4.4 Managed Medicaid 2,846 6.0 3,003 6.7 Managed care and insurers 23,140 48.5 21,480 48.1 International (managed care and insurers) 1,127 2.4 992 2.2 Other 2,574 5.4 2,671 6.0 Revenues $ 47,665 100.0 % $ 44,736 100.0 % To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters and nine months ended September 30, 2023 and 2022 follows (dollars in millions): Quarter Nine Months 2023 2022 2023 2022 Patient care costs (salaries and benefits, supplies, other $ 14,121 $ 12,828 $ 40,839 $ 38,096 Cost-to-charges ratio (patient care costs as percentage of gross 10.9 % 11.2 % 10.6 % 11.2 % Total uncompensated care $ 9,042 $ 8,050 $ 25,516 $ 23,512 Multiply by the cost-to-charges ratio 10.9 % 11.2 % 10.6 % 11.2 % Estimated cost of total uncompensated care $ 975 $ 901 $ 2,705 $ 2,633 NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (continued) Revenues (continued) The total uncompensated care amounts include charity care of $ 3.531 billion and $ 3.206 billion, respectively, and the related estimated costs of charity care were $ 382 million and $ 359 million, respectively, for the quarters ended September 30, 2023 and 2022. The total uncompensated care amounts include charity care of $ 10.684 billion and $ 10.281 billion, respectively, and the related estimated costs of charity care were $ 1.133 billion and $ 1.151 billion, respectively, for the nine months ended September 30, 2023 and 2022 . |
Reclassifications | Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Earnings Per Share | We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards, computed using the treasury stock method. |
Fair Value Measurements and Disclosures | Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”), emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy). Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. |
Investment Securities | The investments of our insurance subsidiaries are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. |
Basis of Presentation and Sig_3
Basis of Presentation and Significant Accounting Policies (Tables) | 9 Months Ended |
Sep. 30, 2023 | |
Accounting Policies [Abstract] | |
Schedule of Revenues from Third Party Payers, Uninsured and Other Payers | Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters and nine months ended September 30, 2023 and 2022 are summarized in the following table (dollars in millions): Quarter 2023 Ratio 2022 Ratio Medicare $ 2,560 15.8 % $ 2,569 17.2 % Managed Medicare 2,535 15.6 2,229 14.9 Medicaid 1,001 6.2 797 5.3 Managed Medicaid 1,039 6.4 939 6.3 Managed care and insurers 7,687 47.4 7,184 47.9 International (managed care and insurers) 375 2.3 311 2.1 Other 1,016 6.3 942 6.3 Revenues $ 16,213 100.0 % $ 14,971 100.0 % Nine Months 2023 Ratio 2022 Ratio Medicare $ 7,865 16.5 % $ 7,790 17.4 % Managed Medicare 7,635 16.0 6,813 15.2 Medicaid 2,478 5.2 1,987 4.4 Managed Medicaid 2,846 6.0 3,003 6.7 Managed care and insurers 23,140 48.5 21,480 48.1 International (managed care and insurers) 1,127 2.4 992 2.2 Other 2,574 5.4 2,671 6.0 Revenues $ 47,665 100.0 % $ 44,736 100.0 % |
Schedule of Estimated Cost of Uncompensated Care | A summary of the estimated cost of total uncompensated care for the quarters and nine months ended September 30, 2023 and 2022 follows (dollars in millions): Quarter Nine Months 2023 2022 2023 2022 Patient care costs (salaries and benefits, supplies, other $ 14,121 $ 12,828 $ 40,839 $ 38,096 Cost-to-charges ratio (patient care costs as percentage of gross 10.9 % 11.2 % 10.6 % 11.2 % Total uncompensated care $ 9,042 $ 8,050 $ 25,516 $ 23,512 Multiply by the cost-to-charges ratio 10.9 % 11.2 % 10.6 % 11.2 % Estimated cost of total uncompensated care $ 975 $ 901 $ 2,705 $ 2,633 |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 9 Months Ended |
Sep. 30, 2023 | |
Earnings Per Share [Abstract] | |
Schedule of Computations of Basic and Diluted Earnings Per Share | The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2023 and 2022 (dollars and shares in millions, except per share amounts): Quarter Nine Months 2023 2022 2023 2022 Net income attributable to HCA Healthcare, Inc. $ 1,079 $ 1,134 $ 3,635 $ 3,562 Weighted average common shares outstanding 271.173 285.958 274.171 293.583 Effect of dilutive incremental shares 4.251 3.894 4.002 4.119 Shares used for diluted earnings per share 275.424 289.852 278.173 297.702 Earnings per share: Basic earnings $ 3.98 $ 3.97 $ 13.26 $ 12.13 Diluted earnings $ 3.91 $ 3.91 $ 13.07 $ 11.97 |
Investments of Insurance Subs_2
Investments of Insurance Subsidiaries (Tables) | 9 Months Ended |
Sep. 30, 2023 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | A summary of our insurance subsidiaries’ investments at September 30, 2023 and December 31, 2022 follows (dollars in millions): September 30, 2023 Unrealized Amortized Gains Losses Fair Debt securities $ 404 $ — $ ( 43 ) $ 361 Money market funds and other 124 — — 124 $ 528 $ — $ ( 43 ) 485 Amounts classified as current assets ( 103 ) Investment carrying value $ 382 December 31, 2022 Unrealized Amortized Gains Losses Fair Debt securities $ 415 $ — $ ( 38 ) $ 377 Money market funds and other 96 — — 96 $ 511 $ — $ ( 38 ) 473 Amounts classified as current assets ( 92 ) Investment carrying value $ 381 |
Schedule of Maturities of Investments | Scheduled maturities of investments in debt securities at September 30, 2023 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 13 $ 13 Due after one year through five years 148 139 Due after five years through ten years 165 140 Due after ten years 78 69 $ 404 $ 361 |
Assets and Liabilities Measur_2
Assets and Liabilities Measured at Fair Value (Tables) | 9 Months Ended |
Sep. 30, 2023 | |
Fair Value Disclosures [Abstract] | |
Schedule of Assets Measured at Fair Value on Recurring Basis | The following tables summarize our assets measured at fair value on a recurring basis as of September 30, 2023 and December 31, 2022, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): September 30, 2023 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Investments of insurance subsidiaries: Debt securities $ 361 $ — $ 361 $ — Money market funds and other 124 124 — — Investments of insurance subsidiaries 485 124 361 — Less amounts classified as current assets ( 103 ) ( 103 ) — — $ 382 $ 21 $ 361 $ — December 31, 2022 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Investments of insurance subsidiaries: Debt securities $ 377 $ — $ 377 $ — Money market funds and other 96 96 — — Investments of insurance subsidiaries 473 96 377 — Less amounts classified as current assets ( 92 ) ( 92 ) — — $ 381 $ 4 $ 377 $ — |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 9 Months Ended |
Sep. 30, 2023 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | A summary of long-term debt at September 30, 2023 and December 31, 2022, including related interest rates at September 30, 2023, follows (dollars in millions): September 30, December 31, Senior secured asset-based revolving credit facility (effective interest rate of 6.7 %) $ 1,480 $ 2,900 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 6.8 %) 1,331 1,880 Other senior secured debt (effective interest rate of 4.0 %) 974 953 Senior secured debt 3,785 5,733 Senior unsecured notes (effective interest rate of 5.0 %) 35,902 32,652 Debt issuance costs and discounts ( 341 ) ( 301 ) Total debt (average life of 9.6 years, rates averaging 5.1 %) 39,346 38,084 Less amounts due within one year 2,553 370 $ 36,793 $ 37,714 |
Share Repurchase Transactions_2
Share Repurchase Transactions and Accumulated Other Comprehensive Loss (Tables) | 9 Months Ended |
Sep. 30, 2023 | |
Federal Home Loan Banks [Abstract] | |
Components of Accumulated Other Comprehensive Loss | The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized Foreign Defined Total Balances at December 31, 2022 $ ( 30 ) $ ( 373 ) $ ( 87 ) $ ( 490 ) Unrealized losses on available-for-sale securities, net of $ 1 income ( 4 ) ( 4 ) Foreign currency translation adjustments, net of $ 1 of income 2 2 Expense reclassified into operations from other 1 1 Balances at September 30, 2023 $ ( 34 ) $ ( 371 ) $ ( 86 ) $ ( 491 ) |
Segment and Geographic Inform_2
Segment and Geographic Information (Tables) | 9 Months Ended |
Sep. 30, 2023 | |
Segment Reporting [Abstract] | |
Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization | The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2023 and 2022 are summarized in the following table (dollars in millions): Quarter Nine Months 2023 2022 2023 2022 Revenues: National Group $ 4,352 $ 4,092 $ 13,340 $ 12,382 Atlantic Group 5,470 4,951 15,617 14,337 American Group 5,491 5,117 16,226 15,528 Corporate and other 900 811 2,482 2,489 $ 16,213 $ 14,971 $ 47,665 $ 44,736 Equity in (earnings) losses of affiliates: National Group $ — $ — $ ( 2 ) $ ( 1 ) Atlantic Group — ( 1 ) ( 2 ) ( 2 ) American Group ( 13 ) ( 13 ) ( 35 ) ( 31 ) Corporate and other ( 6 ) 4 45 5 $ ( 19 ) $ ( 10 ) $ 6 $ ( 29 ) Adjusted segment EBITDA: National Group $ 799 $ 780 $ 2,826 $ 2,602 Atlantic Group 1,158 1,014 3,219 2,833 American Group 1,210 1,178 3,662 3,832 Corporate and other ( 287 ) ( 70 ) ( 599 ) ( 379 ) $ 2,880 $ 2,902 $ 9,108 $ 8,888 Depreciation and amortization: National Group $ 206 $ 207 $ 621 $ 598 Atlantic Group 249 231 735 686 American Group 244 236 719 701 Corporate and other 70 75 213 234 $ 769 $ 749 $ 2,288 $ 2,219 Adjusted segment EBITDA $ 2,880 $ 2,902 $ 9,108 $ 8,888 Depreciation and amortization 769 749 2,288 2,219 Interest expense 483 446 1,447 1,288 Losses (gains) on sales of facilities ( 2 ) 3 12 25 Losses on retirement of debt — — — 78 Income before income taxes $ 1,630 $ 1,704 $ 5,361 $ 5,278 |
Basis of Presentation and Sig_4
Basis of Presentation and Significant Accounting Policies - Additional Information (Detail) $ in Millions | 1 Months Ended | 3 Months Ended | 9 Months Ended | ||
Nov. 30, 2017 | Sep. 30, 2023 USD ($) Hospital SurgeryCenter State EndoscopyCenter | Sep. 30, 2022 USD ($) | Sep. 30, 2023 USD ($) Hospital SurgeryCenter State EndoscopyCenter | Sep. 30, 2022 USD ($) | |
Summary Of Significant Accounting Policies [Line Items] | |||||
Number of owned and operated hospitals | Hospital | 183 | 183 | |||
Number of freestanding surgery centers | SurgeryCenter | 126 | 126 | |||
Number of freestanding endoscopy centers | EndoscopyCenter | 22 | 22 | |||
Number of facilities locations | State | 20 | 20 | |||
General and administrative expense | $ 80 | $ 74 | $ 227 | $ 228 | |
Charity care amount | 3,531 | 3,206 | 10,684 | 10,281 | |
Estimated costs of charity care | $ 382 | $ 359 | $ 1,133 | $ 1,151 | |
Inpatient Services [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Performance obligations for inpatient/ outpatient services satisfied period | Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges | ||||
Maximum [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Percentage of income of federal poverty level eligible for charity care | 400% | ||||
Maximum [Member] | Outpatient Services [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Performance obligations for inpatient/ outpatient services satisfied period | Our performance obligations for outpatient services are generally satisfied over a period of less than one day |
Basis of Presentation and Sig_5
Basis of Presentation and Significant Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2023 | Sep. 30, 2022 | Sep. 30, 2023 | Sep. 30, 2022 | |
Revenues From Third Party Payers [Line Items] | ||||
Revenues | $ 16,213 | $ 14,971 | $ 47,665 | $ 44,736 |
Revenues ratio from third party payers | 100% | 100% | 100% | 100% |
Medicare [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 2,560 | $ 2,569 | $ 7,865 | $ 7,790 |
Revenues from third party payers, Ratio | 15.80% | 17.20% | 16.50% | 17.40% |
Managed Medicare [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 2,535 | $ 2,229 | $ 7,635 | $ 6,813 |
Revenues from third party payers, Ratio | 15.60% | 14.90% | 16% | 15.20% |
Medicaid [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 1,001 | $ 797 | $ 2,478 | $ 1,987 |
Revenues from third party payers, Ratio | 6.20% | 5.30% | 5.20% | 4.40% |
Managed Medicaid [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 1,039 | $ 939 | $ 2,846 | $ 3,003 |
Revenues from third party payers, Ratio | 6.40% | 6.30% | 6% | 6.70% |
Managed Care and Insurers [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 7,687 | $ 7,184 | $ 23,140 | $ 21,480 |
Revenues from third party payers, Ratio | 47.40% | 47.90% | 48.50% | 48.10% |
International (Managed Care and Insurers) [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 375 | $ 311 | $ 1,127 | $ 992 |
Revenues from third party payers, Ratio | 2.30% | 2.10% | 2.40% | 2.20% |
Other [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues | $ 1,016 | $ 942 | $ 2,574 | $ 2,671 |
Other, Ratio | 6.30% | 6.30% | 5.40% | 6% |
Basis of Presentation and Sig_6
Basis of Presentation and Significant Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2023 | Sep. 30, 2022 | Sep. 30, 2023 | Sep. 30, 2022 | |
Accounting Policies [Abstract] | ||||
Patient care costs (salaries and benefits, supplies, other operating expense and depreciation and amortization) | $ 14,121 | $ 12,828 | $ 40,839 | $ 38,096 |
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) | 10.90% | 11.20% | 10.60% | 11.20% |
Total uncompensated care | $ 9,042 | $ 8,050 | $ 25,516 | $ 23,512 |
Multiply by the cost-to-charges ratio | 10.90% | 11.20% | 10.60% | 11.20% |
Estimated cost of total uncompensated care | $ 975 | $ 901 | $ 2,705 | $ 2,633 |
Acquisitions and Dispositions -
Acquisitions and Dispositions - Additional Information (Detail) $ in Millions | 9 Months Ended | |
Sep. 30, 2023 USD ($) Hospital | Sep. 30, 2022 USD ($) | |
Business Acquisition [Line Items] | ||
Proceeds from sale of business | $ 183 | $ 652 |
Pretax gain (loss) before tax | (12) | (25) |
Real Estate and Other Investments [Member] | ||
Business Acquisition [Line Items] | ||
Proceeds from sale of business | 21 | 38 |
Discontinued Operations, Disposed of by Sale [Member] | ||
Business Acquisition [Line Items] | ||
Proceeds from sale of business | 614 | |
Nonhospital Health Care [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | 198 | $ 176 |
Hospital Facility [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | 83 | |
Proceeds from sale of business | $ 162 | |
Number of hospitals sold | Hospital | 2 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2023 | Sep. 30, 2022 | Sep. 30, 2023 | Sep. 30, 2022 | Dec. 31, 2022 | |
Income Tax Disclosure [Abstract] | |||||
Provision for income taxes | $ 355 | $ 360 | $ 1,131 | $ 1,090 | |
Effective tax rate | 24.80% | 24.10% | 23.70% | 23.40% | |
Provision for tax benefits related to settlement of employee awards | $ 89 | $ 70 | |||
Gross unrecognized tax benefits, excluding accrued interest | $ 653 | 653 | $ 639 | ||
Unrecognized tax benefits, accrued interest | 168 | 168 | 129 | ||
Unrecognized tax benefits that would impact effective tax rate | $ 326 | $ 326 | $ 278 |
Earnings Per Share - Schedule o
Earnings Per Share - Schedule of Computations of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2023 | Sep. 30, 2022 | Sep. 30, 2023 | Sep. 30, 2022 | |
Earnings Per Share [Abstract] | ||||
Net income attributable to HCA Healthcare, Inc. | $ 1,079 | $ 1,134 | $ 3,635 | $ 3,562 |
Weighted average common shares outstanding | 271,173 | 285,958 | 274,171 | 293,583 |
Effect of dilutive incremental shares | 4,251 | 3,894 | 4,002 | 4,119 |
Shares used for diluted earnings per share | 275,424 | 289,852 | 278,173 | 297,702 |
Basic earnings per share | $ 3.98 | $ 3.97 | $ 13.26 | $ 12.13 |
Diluted earnings per share | $ 3.91 | $ 3.91 | $ 13.07 | $ 11.97 |
Investments of Insurance Subs_3
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions | Sep. 30, 2023 | Dec. 31, 2022 |
Debt Securities, Available-for-sale [Line Items] | ||
Amounts classified as current assets | $ (103) | $ (92) |
Investment carrying value | 382 | 381 |
Money market funds and other, Amortized Cost | 124 | 96 |
Money market funds and other, Unrealized Gains | 0 | 0 |
Money market funds and other, Unrealized Losses | 0 | 0 |
Money market funds and other, Fair Value | 124 | 96 |
Investment Owned, at Cost, Total | 528 | 511 |
Investment Gains | 0 | 0 |
Investment Losses | (43) | (38) |
Investment Fiar Value | 485 | 473 |
Debt Securities [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 404 | 415 |
Unrealized Amounts, Gains | 0 | 0 |
Unrealized Amounts, Losses | (43) | (38) |
Fair Value | $ 361 | $ 377 |
Investments of Insurance Subs_4
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions | Sep. 30, 2023 USD ($) |
Investments, Debt and Equity Securities [Abstract] | |
Due in one year or less, Amortized Cost | $ 13 |
Due after one year through five years, Amortized Cost | 148 |
Due after five years through ten years, Amortized Cost | 165 |
Due after ten years, Amortized Cost | 78 |
Amortized Cost, Total | 404 |
Due in one year or less, Fair Value | 13 |
Due after one year through five years, Fair Value | 139 |
Due after five years through ten years, Fair Value | 140 |
Due after ten years, Fair Value | 69 |
Fair Value, Total | $ 361 |
Investments of Insurance Subs_5
Investments of Insurance Subsidiaries - Additional Information (Detail) | 9 Months Ended |
Sep. 30, 2023 | |
Investments, Debt and Equity Securities [Abstract] | |
Available for sale securities expected maturity of debt securities | 5 years 2 months 12 days |
Available for sale securities average scheduled maturity | 8 years 8 months 12 days |
Assets and Liabilities Measur_3
Assets and Liabilities Measured at Fair Value - Schedule of Assets Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Millions | Sep. 30, 2023 | Dec. 31, 2022 |
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Money market funds and other | $ 124 | $ 96 |
Investments of insurance subsidiaries | 485 | 473 |
Less amounts classified as current assets | (103) | (92) |
Asset fair value | 382 | 381 |
Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt securities | 361 | 377 |
Quoted Prices in Active Markets for Identical Assets (Level 1) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Money market funds and other | 124 | 96 |
Investments of insurance subsidiaries | 124 | 96 |
Less amounts classified as current assets | (103) | (92) |
Asset fair value | 21 | 4 |
Significant Other Observable Inputs (Level 2) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Investments of insurance subsidiaries | 361 | 377 |
Asset fair value | 361 | 377 |
Significant Other Observable Inputs (Level 2) [Member] | Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt securities | $ 361 | $ 377 |
Assets and Liabilities Measur_4
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions | Sep. 30, 2023 | Dec. 31, 2022 |
Fair Value Disclosures [Abstract] | ||
Estimated fair value of long-term debt | $ 36,120 | $ 35,555 |
Carrying amounts of debt | $ 39,687 | $ 38,385 |
Long-Term Debt - Schedule of Lo
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($) $ in Millions | Sep. 30, 2023 | Dec. 31, 2022 |
Debt Instrument [Line Items] | ||
Senior secured debt | $ 3,785 | $ 5,733 |
Debt issuance costs and discounts | (341) | (301) |
Total debt (average life of 9.6 years, rates averaging 5.1%) | 39,346 | 38,084 |
Less amounts due within one year | 2,553 | 370 |
Long-term debt | 36,793 | 37,714 |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 1,480 | 2,900 |
Senior Secured Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 0 | 0 |
Senior Secured Term Loan Facilities [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 1,331 | 1,880 |
Other Senior Secured Debt [Member] | ||
Debt Instrument [Line Items] | ||
Other senior secured debt | 974 | 953 |
Senior Unsecured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior unsecured notes | $ 35,902 | $ 32,652 |
Long-Term Debt - Schedule of _2
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) | 9 Months Ended |
Sep. 30, 2023 | |
Debt Instrument [Line Items] | |
Total debt average term | 9 years 7 months 6 days |
Total debt average rate | 5.10% |
Senior Secured Asset-Based Revolving Credit Facility [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 6.70% |
Senior Secured Term Loan Facilities [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 6.80% |
Other Senior Secured Debt [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 4% |
Senior Unsecured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 5% |
Long-Term Debt - Additional Inf
Long-Term Debt - Additional Information (Detail) - USD ($) $ in Millions | 1 Months Ended | 3 Months Ended | 9 Months Ended | |||
Jan. 31, 2023 | Sep. 30, 2023 | Sep. 30, 2022 | Sep. 30, 2023 | Sep. 30, 2022 | May 31, 2023 | |
Debt Instrument [Line Items] | ||||||
Gain (loss) on extinguishment of debt | $ 0 | $ 0 | $ 0 | $ (78) | ||
Senior Secured Revolving Credit Facility Maturing On June Thirty Two Thousand Twenty Six [Member] | ||||||
Debt Instrument [Line Items] | ||||||
Line of credit facility | $ 3,500 | |||||
Senior Secured Term Loan B Facility [Member] | ||||||
Debt Instrument [Line Items] | ||||||
Increase in revolving credit facility | $ 1,500 | |||||
Senior Notes [Member] | ||||||
Debt Instrument [Line Items] | ||||||
Debt instrument, principal amount | $ 3,250 | |||||
Senior Notes [Member] | Senior Notes Due 2028 [Member] | ||||||
Debt Instrument [Line Items] | ||||||
Debt instrument, principal amount | $ 1,000 | |||||
Debt instrument, stated interest | 5.20% | |||||
Senior Notes [Member] | Senior Notes Due 2033 [Member] | ||||||
Debt Instrument [Line Items] | ||||||
Debt instrument, principal amount | $ 1,250 | |||||
Debt instrument, stated interest | 5.50% | |||||
Senior Notes [Member] | Senior Notes Due 2053 [Member] | ||||||
Debt Instrument [Line Items] | ||||||
Debt instrument, principal amount | $ 1,000 | |||||
Debt instrument, stated interest | 5.90% |
Share Repurchase Transactions_3
Share Repurchase Transactions and Accumulated Other Comprehensive Loss - Additional Information (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions | 9 Months Ended | ||
Sep. 30, 2023 | Jan. 31, 2023 | Jan. 31, 2022 | |
Repurchase of common stock, shares | 10,818 | ||
Repurchase price of common stock, per share | $ 268.18 | ||
Board of Directors Chairman [Member] | |||
Share repurchase program authorized amount | $ 1,685 | $ 3,000 | $ 8,000 |
Share Repurchase Transactions_4
Share Repurchase Transactions and Accumulated Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) $ in Millions | 9 Months Ended |
Sep. 30, 2023 USD ($) | |
Equity [Abstract] | |
Unrealized losses on available-for-sale securities, beginning balances | $ (30) |
Unrealized losses on available-for-sale securities | (4) |
Unrealized losses on available-for-sale securities, ending balances | (34) |
Foreign currency translation adjustments, beginning balances | (373) |
Foreign currency translation adjustments, net of income taxes | 2 |
Foreign currency translation adjustments, ending balances | (371) |
Defined benefit plans, beginning balances | (87) |
Defined benefit plans, expense reclassified into operations from other comprehensive loss | 1 |
Defined benefit plans, ending balances | (86) |
Accumulated other comprehensive loss, net of tax, beginning balances | (490) |
Unrealized losses on available-for-sale securities | (4) |
Foreign currency translation adjustments, net of income tax benefit | 2 |
Expense reclassified into operations from other comprehensive loss, Total | 1 |
Accumulated other comprehensive loss, net of tax, ending balances | $ (491) |
Share Repurchase Transactions_5
Share Repurchase Transactions and Accumulated Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) $ in Millions | 9 Months Ended |
Sep. 30, 2023 USD ($) | |
Equity [Abstract] | |
Unrealized losses on available-for-sale securities, tax benefit | $ 1 |
Foreign currency translation adjustments, income tax expense | $ 1 |
Segment and Geographic Inform_3
Segment and Geographic Information - Additional Information (Detail) | 9 Months Ended |
Sep. 30, 2023 Hospital | |
Segment Reporting Information [Line Items] | |
Number of geographically organized groups | 2 |
Number of owned and operated hospitals | 183 |
Reorganization Group [Member] | National Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 57 |
Reorganization Group [Member] | American Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 57 |
Reorganization Group [Member] | Atlantic Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 62 |
Reorganization Group [Member] | Corporate and Other [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 7 |
Segment and Geographic Inform_4
Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2023 | Sep. 30, 2022 | Sep. 30, 2023 | Sep. 30, 2022 | |
Segment Reporting Information [Line Items] | ||||
Revenues | $ 16,213 | $ 14,971 | $ 47,665 | $ 44,736 |
Equity in (earnings) losses of affiliates | (19) | (10) | 6 | (29) |
Adjusted segment EBITDA | 2,880 | 2,902 | 9,108 | 8,888 |
Depreciation and amortization | 769 | 749 | 2,288 | 2,219 |
Interest expense | 483 | 446 | 1,447 | 1,288 |
Losses (gains) on sales of facilities | (2) | 3 | 12 | 25 |
Losses on retirement of debt | 0 | 0 | 0 | 78 |
Income before income taxes | 1,630 | 1,704 | 5,361 | 5,278 |
National Group [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 4,352 | 4,092 | 13,340 | 12,382 |
Equity in (earnings) losses of affiliates | 0 | 0 | (2) | (1) |
Adjusted segment EBITDA | 799 | 780 | 2,826 | 2,602 |
Depreciation and amortization | 206 | 207 | 621 | 598 |
Atlantic Group [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 5,470 | 4,951 | 15,617 | 14,337 |
Equity in (earnings) losses of affiliates | 0 | (1) | (2) | (2) |
Adjusted segment EBITDA | 1,158 | 1,014 | 3,219 | 2,833 |
Depreciation and amortization | 249 | 231 | 735 | 686 |
American Group [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 5,491 | 5,117 | 16,226 | 15,528 |
Equity in (earnings) losses of affiliates | (13) | (13) | (35) | (31) |
Adjusted segment EBITDA | 1,210 | 1,178 | 3,662 | 3,832 |
Depreciation and amortization | 244 | 236 | 719 | 701 |
Corporate and Other [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 900 | 811 | 2,482 | 2,489 |
Equity in (earnings) losses of affiliates | (6) | 4 | 45 | 5 |
Adjusted segment EBITDA | (287) | (70) | (599) | (379) |
Depreciation and amortization | $ 70 | $ 75 | $ 213 | $ 234 |