Cover Page
Cover Page - shares | 3 Months Ended | |
Mar. 31, 2021 | Apr. 26, 2021 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Mar. 31, 2021 | |
Document Fiscal Year Focus | 2021 | |
Document Fiscal Period Focus | Q1 | |
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 | 330,655,500 | |
Entity Interactive Data Current | Yes | |
Entity 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, $.01 par value | |
Security Exchange Name | NYSE |
Condensed Consolidated Income S
Condensed Consolidated Income Statements - USD ($) shares in Thousands, $ in Millions | 3 Months Ended | |
Mar. 31, 2021 | Mar. 31, 2020 | |
Income Statement [Abstract] | ||
Revenues | $ 13,977 | $ 12,861 |
Salaries and benefits | 6,301 | 6,118 |
Supplies | 2,224 | 2,123 |
Other operating expenses | 2,421 | 2,427 |
Equity in earnings of affiliates | (21) | (7) |
Depreciation and amortization | 697 | 674 |
Interest expense | 384 | 428 |
Gains on sales of facilities | (2) | (7) |
Losses on retirement of debt | 0 | 295 |
Total expenses including equity in earnings of affiliates | 12,004 | 12,051 |
Income before income taxes | 1,973 | 810 |
Provision for income taxes | 393 | 112 |
Net income | 1,580 | 698 |
Net income attributable to noncontrolling interests | 157 | 117 |
Net income attributable to HCA Healthcare, Inc. | $ 1,423 | $ 581 |
Per share data: | ||
Basic earnings | $ 4.21 | $ 1.72 |
Diluted earnings | $ 4.14 | $ 1.69 |
Shares used in earnings per share calculations (in millions): | ||
Basic | 338,123 | 338,242 |
Diluted | 343,321 | 344,096 |
Condensed Consolidated Comprehe
Condensed Consolidated Comprehensive Income Statements - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2021 | Mar. 31, 2020 | |
Statement of Comprehensive Income [Abstract] | ||
Net income | $ 1,580 | $ 698 |
Other comprehensive income (loss) before taxes: | ||
Foreign currency translation | 8 | (73) |
Unrealized losses on available-for-sale securities | (11) | (5) |
Defined benefit plans | 0 | 0 |
Pension costs included in salaries and benefits | 7 | 4 |
Total defined benefit plans | 7 | 4 |
Change in fair value of derivative financial instruments | 1 | (60) |
Interest expense (benefits) included in interest expense | 9 | (1) |
Total change in fair value of derivative financial instruments | 10 | (61) |
Other comprehensive loss before taxes | 14 | (135) |
Income taxes (benefits) related to other comprehensive income items | 3 | (24) |
Other comprehensive income (loss) | 11 | (111) |
Comprehensive income | 1,591 | 587 |
Comprehensive income attributable to noncontrolling interests | 157 | 117 |
Comprehensive income attributable to HCA Healthcare, Inc. | $ 1,434 | $ 470 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Millions | Mar. 31, 2021 | Dec. 31, 2020 |
Current assets: | ||
Cash and cash equivalents | $ 1,030 | $ 1,793 |
Accounts receivable | 7,424 | 7,051 |
Inventories | 2,068 | 2,025 |
Other | 1,514 | 1,464 |
Total current assets | 12,036 | 12,333 |
Property and equipment, at cost | 49,877 | 49,317 |
Accumulated depreciation | (26,689) | (26,118) |
Property and equipment, net | 23,188 | 23,199 |
Investments of insurance subsidiaries | 393 | 388 |
Investments in and advances to affiliates | 427 | 422 |
Goodwill and other intangible assets | 8,575 | 8,578 |
Right-of-use operating lease assets | 2,083 | 2,024 |
Other | 575 | 546 |
Total assets | 47,277 | 47,490 |
Current liabilities: | ||
Accounts payable | 3,524 | 3,535 |
Accrued salaries | 1,767 | 1,720 |
Other accrued expenses | 3,117 | 3,240 |
Long-term debt due within one year | 234 | 209 |
Total current liabilities | 8,642 | 8,704 |
Long-term debt, less debt issuance costs and discounts of $229 and $236 | 30,838 | 30,795 |
Professional liability risks | 1,553 | 1,486 |
Right-of-use operating lease obligations | 1,730 | 1,673 |
Income taxes and other liabilities | 2,032 | 1,940 |
Stockholders' equity: | ||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 338,714,500 shares — 2021 and 339,425,600 shares — 2020 | 3 | 3 |
Capital in excess of par value | 0 | 294 |
Accumulated other comprehensive loss | (491) | (502) |
Retained earnings | 735 | 777 |
Stockholders' equity attributable to HCA Healthcare, Inc. | 247 | 572 |
Noncontrolling interests | 2,235 | 2,320 |
Total stockholders' equity | 2,482 | 2,892 |
Total liabilities and stockholders' equity | $ 47,277 | $ 47,490 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions | Mar. 31, 2021 | Dec. 31, 2020 |
Statement of Financial Position [Abstract] | ||
Debt issuance costs | $ 229 | $ 236 |
Common stock, par value | $ 0.01 | $ 0.01 |
Common stock, shares authorized | 1,800,000,000 | 1,800,000,000 |
Common stock, shares outstanding | 333,714,500 | 339,425,600 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Stockholders' Equity (Deficit) - USD ($) $ in Millions | Total | Common Stock [Member] | Capital in Excess of Par Value [Member] | Accumulated Other Comprehensive Loss [Member] | Retained Earnings (Deficit) [Member] | Equity Attributable to Noncontrolling Interests [Member] |
Balances at Dec. 31, 2019 | $ (565) | $ 3 | $ (460) | $ (2,351) | $ 2,243 | |
Balance, shares at Dec. 31, 2019 | 338,446,000 | |||||
Comprehensive income (loss) | 587 | (111) | 581 | 117 | ||
Repurchase of common stock | (441) | (441) | ||||
Repurchase of common stock, shares | (3,287,000) | |||||
Share-based benefit plans | (33) | $ 2 | (35) | |||
Share-based benefit plans, shares | 2,449,000 | |||||
Cash dividends declared | (148) | (148) | ||||
Distributions | (154) | (154) | ||||
Other | 51 | (2) | 53 | |||
Balance at Mar. 31, 2020 | (703) | $ 3 | (571) | (2,394) | 2,259 | |
Balance, shares at Mar. 31, 2020 | 337,608,000 | |||||
Comprehensive income (loss) | 1,225 | 9 | 1,079 | 137 | ||
Share-based benefit plans | 93 | 93 | ||||
Share-based benefit plans, shares | 352,000 | |||||
Distributions | (45) | (45) | ||||
Other | (2) | (5) | 3 | |||
Balance at Jun. 30, 2020 | 568 | $ 3 | 88 | (562) | (1,315) | 2,354 |
Balance, shares at Jun. 30, 2020 | 337,960,000 | |||||
Comprehensive income (loss) | 826 | 47 | 668 | 111 | ||
Share-based benefit plans | 97 | 97 | ||||
Share-based benefit plans, shares | 410,000 | |||||
Distributions | (194) | (194) | ||||
Other | 2 | 2 | ||||
Balance at Sep. 30, 2020 | 1,299 | $ 3 | 185 | (515) | (647) | 2,273 |
Balance, shares at Sep. 30, 2020 | 338,370,000 | |||||
Comprehensive income (loss) | 1,707 | 13 | 1,426 | 268 | ||
Share-based benefit plans | 108 | 108 | ||||
Share-based benefit plans, shares | 1,056,000 | |||||
Cash dividends declared | (2) | (2) | ||||
Distributions | (233) | (233) | ||||
Other | 13 | 1 | 12 | |||
Balance at Dec. 31, 2020 | 2,892 | $ 3 | 294 | (502) | 777 | 2,320 |
Balance, shares at Dec. 31, 2020 | 339,426,000 | |||||
Comprehensive income (loss) | 1,591 | 11 | 1,423 | 157 | ||
Repurchase of common stock | $ (1,527) | (225) | (1,302) | |||
Repurchase of common stock, shares | (8,477,000) | (8,477,000) | ||||
Share-based benefit plans | $ (75) | (75) | ||||
Share-based benefit plans, shares | 2,765,000 | |||||
Cash dividends declared | (163) | (163) | ||||
Distributions | (234) | (234) | ||||
Other | (2) | $ 6 | (8) | |||
Balance at Mar. 31, 2021 | $ 2,482 | $ 3 | $ (491) | $ 735 | $ 2,235 | |
Balance, shares at Mar. 31, 2021 | 333,714,000 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Stockholders' Equity (Deficit) (Parenthetical) - $ / shares | 3 Months Ended | ||
Mar. 31, 2021 | Dec. 31, 2020 | Mar. 31, 2020 | |
Statement of Stockholders' Equity [Abstract] | |||
Cash dividends declared, per share | $ 0.48 | $ 0.43 | $ 0.43 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2021 | Mar. 31, 2020 | |
Cash flows from operating activities: | ||
Net income | $ 1,580 | $ 698 |
Increase (decrease) in cash from operating assets and liabilities: | ||
Accounts receivable | (371) | 464 |
Inventories and other assets | (85) | (196) |
Accounts payable and accrued expenses | (371) | (784) |
Depreciation and amortization | 697 | 674 |
Income taxes | 406 | 121 |
Gains on sales of facilities | (2) | (7) |
Losses on retirement of debt | 0 | 295 |
Amortization of debt issuance costs and discounts | 8 | 7 |
Share-based compensation | 97 | 82 |
Other | 29 | 21 |
Net cash provided by operating activities | 1,988 | 1,375 |
Cash flows from investing activities: | ||
Purchase of property and equipment | (654) | (853) |
Acquisition of hospitals and health care entities | (22) | (328) |
Sales of hospitals and health care entities | 20 | 35 |
Change in investments | (2) | (1) |
Other | 9 | 2 |
Net cash used in investing activities | (649) | (1,145) |
Cash flows from financing activities: | ||
Issuances of long-term debt | 0 | 2,700 |
Net change in revolving credit facilities | 80 | 1,440 |
Repayment of long-term debt | (47) | (3,327) |
Distributions to noncontrolling interests | (234) | (154) |
Payment of debt issuance costs | 0 | (34) |
Payment of dividends | (169) | (152) |
Repurchase of common stock | (1,527) | (441) |
Other | (207) | (141) |
Net cash used in financing activities | (2,104) | (109) |
Effect of exchange rate changes on cash and cash equivalents | 2 | (11) |
Change in cash and cash equivalents | (763) | 110 |
Cash and cash equivalents at beginning of period | 1,793 | 621 |
Cash and cash equivalents at end of period | 1,030 | 731 |
Interest payments | 375 | 468 |
Income tax refunds, net | $ (13) | $ (9) |
Basis of Presentation and Signi
Basis of Presentation and Significant Accounting Policies | 3 Months Ended |
Mar. 31, 2021 | |
Accounting Policies [Abstract] | |
Basis of Presentation and Significant Accounting Policies | NOTE 1 — BASIS OF PRESENTATION 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 March 31, 2021, these affiliates owned and operated 186 hospitals, 121 freestanding surgery centers, 21 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 Regulation S-X. 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 $87 million and $96 million for the quarters ended March 31, 2021 and 2020, respectively. Operating results for the quarter ended March 31, 2021 are not necessarily indicative of the results that may be expected for the year ending December 31, 2021. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K . COVID-19 On March 11, 2020, the World Health Organization designated COVID-19 COVID-19 COVID-19 operations. 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 $ million related to the settlement of Medicare outlier calculations for prior periods. 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 discounts and contractual 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 ended March 31, 2021 and 2020 are summarized in the following table (dollars in millions): 2021 Ratio 2020 Ratio Medicare $ 2,559 18.3 % $ 2,743 21.3 % Managed Medicare 2,053 14.7 1,826 14.2 Medicaid 527 3.8 414 3.2 Managed Medicaid 725 5.2 666 5.2 Managed care and insurers 6,885 49.1 6,645 51.6 International (managed care and insurers) 333 2.4 292 2.3 Other 895 6.5 275 2.2 Revenues $ 13,977 100.0 % $ 12,861 100.0 % 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 ended March 31, 2021 and 2020 follows (dollars in millions): 2021 2020 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 11,643 $ 11,342 Cost-to-charges 11.4 % 11.9 % Total uncompensated care $ 6,821 $ 7,873 Multiply by the cost-to-charges 11.4 % 11.9 % Estimated cost of total uncompensated care $ 778 $ 937 The total uncompensated care amounts include charity care of $2.942 billion and $3.735 billion, respectively, and the related estimated costs of charity care were $335 million and $444 million, respectively, . Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Acquisitions and Dispositions
Acquisitions and Dispositions | 3 Months Ended |
Mar. 31, 2021 | |
Business Combinations [Abstract] | |
Acquisitions and Dispositions | NOTE 2 — ACQUISITIONS AND DISPOSITIONS During the quarter ended March 31, 2021, we paid $22 million 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 quarter ended March 31, 2020, we paid to acquire a hospital in New Hampshire and nonhospital health care entities. The consolidated financial statements include the accounts and operations of the acquired entities subsequent to the respective acquisition dates. The pro forma effects of these acquired entities on our results of operations for periods prior to the respective acquisition dates were not significant. During the quarter ended March 31, 2021, we received proceeds of $20 million and recognized a pretax gain of $2 million related to sales of real estate and other investments. During the quarter ended March 31, 2020, we received proceeds of $35 million and recognized a pretax gain of $7 million related to sales of real estate and other investments. |
Income Taxes
Income Taxes | 3 Months Ended |
Mar. 31, 2021 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | NOTE 3 — INCOME TAXES Our provisions for income taxes for the quarters ended March 31, 2021 and 2020 were Our provision for income taxes included tax benefits related to settlements of employee equity awards of Our liability for unrecognized tax benefits was $596 million, including accrued interest of $88 million, as of March 31, 2021 ($508 million and $73 million, respectively, as of December 31, 2020). Unrecognized tax benefits of $179 million ($157 million as of December 31, 2020) would affect the effective rate, if recognized. The Internal Revenue Service was conducting an examination of the Company’s 2016, 2017 and 2018 federal income tax returns at March 31, 2021. We are also subject to examination by state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign 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 | 3 Months Ended |
Mar. 31, 2021 | |
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. The following table sets forth the computation of basic and diluted earnings per share for the quarters ended March 31, 2021 and 2020 (dollars and shares in millions, except per share amounts): 2021 2020 Net income attributable to HCA Healthcare, Inc. $ 1,423 $ 581 Weighted average common shares outstanding 338.123 338.242 Effect of dilutive incremental shares 5.198 5.854 Shares used for diluted earnings per share 343.321 344.096 Earnings per share: Basic earnings $ 4.21 $ 1.72 Diluted earnings $ 4.14 $ 1.69 |
Investments of Insurance Subsid
Investments of Insurance Subsidiaries | 3 Months Ended |
Mar. 31, 2021 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments of Insurance Subsidiaries | NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES A summary of our insurance subsidiaries’ investments at March 31, 2021 and December 31, 2020 follows (dollars in millions): March 31, 2021 Amortized Cost Unrealized Amounts Fair Value Gains Losses Debt securities $ 376 $ 22 $ (1 ) $ 397 Money market funds and other 104 — — 104 $ 480 $ 22 $ (1 ) 501 Amounts classified as current assets (108 ) Investment carrying value $ 393 December 31, 2020 Amortized Cost Unrealized Amounts Fair Value Gains Losses Debt securities $ 384 $ 32 $ — $ 416 Money market funds and other 88 — — 88 $ 472 $ 32 $ — 504 Amounts classified as current assets (116 ) Investment carrying value $ 388 At March 31, 2021 and December 31, 2020, the investments in debt securities of our insurance subsidiaries were classified as “available-for-sale.” Scheduled maturities of investments in debt securities at March 31, 2021 were as follows (dollars in millions): Amortized Cost Fair Value Due in one year or less $ 4 $ 4 Due after one year through five years 144 152 Due after five years through ten years 157 167 Due after ten years 71 74 $ 376 $ 397 The average expected maturity of the investments in debt securities at March 31, 2021 was 5.0 years, compared to the average scheduled maturity of 9.2 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. |
Financial Instruments
Financial Instruments | 3 Months Ended |
Mar. 31, 2021 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Financial Instruments | NOTE 6 — FINANCIAL INSTRUMENTS Interest Rate Swap Agreements We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between us and our counterparties based on common notional principal amounts and maturity dates. Pay-fixed The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at March 31, 2021 (dollars in millions): Notional Amount Maturity Date Fair Value Pay-fixed $ 2,000 December 2021 $ (20 ) Pay-fixed 500 December 2022 (16 ) During the next 12 months, we estimate $30 million will be reclassified from other comprehensive income (“OCI”) and will be included in interest expense. Derivatives — Results of Operations The following table presents the effect of our interest rate swaps on our results of operations for the quarter ended March 31, 2021 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Gain Recognized in OCI on Derivatives, Net of Tax Location of Loss Reclassified from Accumulated OCI into Operations Amount of Loss Reclassified from Accumulated OCI into Operations Interest rate swaps $ 1 Interest expense $ 9 Credit-risk-related Contingent Features We have agreements with each of our derivative counterparties that contain a provision where we could be declared in default on our derivative obligations if repayment of the underlying indebtedness is accelerated by the lender due to our default on the indebtedness. As of March 31, 2021, we have not been required to post any collateral related to these agreements. If we had breached these provisions at March 31, 2021, we would have been required to settle our obligations under the agreements at their aggregate, estimated termination value of $37 million. |
Assets and Liabilities Measured
Assets and Liabilities Measured at Fair Value | 3 Months Ended |
Mar. 31, 2021 | |
Fair Value Disclosures [Abstract] | |
Assets and Liabilities Measured at Fair Value | NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE Accounting Standards Codification 820, Fair Value Measurements and Disclosures 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 marke t activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment. Cash Traded Investments Our cash traded investments 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. Derivative Financial Instruments We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments. The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of March 31, 2021 and December 31, 2020, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): March 31, 2021 Fair Value Measurements Using Fair Value Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Assets: Investments of insurance subsidiaries: Debt securities $ 397 $ — $ 397 $ — Money market funds and other 104 104 — — Investments of insurance subsidiaries 501 104 397 — Less amounts classified as current assets (108 ) (101 ) (7 ) — $ 393 $ 3 $ 390 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 36 $ — $ 36 $ — December 31, 2020 Fair Value Measurements Using Fair Value Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Assets: Investments of insurance subsidiaries: Debt securities $ 416 $ — $ 416 $ — Money market funds and other 88 88 — — Investments of insurance subsidiaries 504 88 416 — Less amounts classified as current assets (116 ) (87 ) (29 ) — $ 388 $ 1 $ 387 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 46 $ — $ 46 $ — The estimated fair value of our long-term debt was $34.872 billion and $35.814 billion at March 31, 2021 and December 31, 2020, respectively, compared to carrying amounts, excluding debt issuance costs and discounts, aggregating $31.301 billion and $31.240 billion, respectively. The estimates of fair value are generally based upon the quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities. |
Long-Term Debt
Long-Term Debt | 3 Months Ended |
Mar. 31, 2021 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | NOTE 8 — LONG-TERM DEBT A summary of long-term debt at March 31, 2021 and December 31, 2020, including related interest rates at March 31, 2021, follows (dollars in millions): March 31, 2021 December 31, 2020 Senior secured asset-based revolving credit facility (effective interest rate of 1.4%) $ 80 $ — Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 2.8%) 3,657 3,671 Senior secured notes (effective interest rate of 5.1%) 13,850 13,850 Other senior secured debt (effective interest rate of 4.6%) 762 767 Senior secured debt 18,349 18,288 Senior unsecured notes (effective interest rate of 5.5%) 12,952 12,952 Debt issuance costs and discounts (229 ) (236 ) Total debt (average life of 8.6 years, rates averaging 5.0%) 31,072 31,004 Less amounts due within one year 234 209 $ 30,838 $ 30,795 |
Contingencies
Contingencies | 3 Months Ended |
Mar. 31, 2021 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | NOTE 9 — 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 qui tam 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 (“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 qui tam qui tam |
Share Repurchase Transactions a
Share Repurchase Transactions and Other Comprehensive Loss | 3 Months Ended |
Mar. 31, 2021 | |
Federal Home Loan Banks [Abstract] | |
Share Repurchases Transactions and Other Comprehensive Loss | NOTE 10 — SHARE REPURCHASE TRANSACTIONS AND OTHER COMPREHENSIVE LOSS During January 2020 and 2019, our Board of Directors authorized share repurchase programs for up to $4 billion ($2 billion for each authorization) of our outstanding common stock. During February 2021, our Board of Directors authorized an additional $6 billion for repurchases of our outstanding common stock. During the quarter ended March 31, 2021, we repurchased 8.477 million shares of our common stock at an average price of $180.11 per share through market purchases pursuant to the $2.0 billion share repurchase program authorized during January 2019 (which was completed during the first quarter of 2021) and the January 2020 authorization. At March 31, 2021, we had $7.274 billion of repurchase authorization available under the January 2020 and February 2021 authorizations . The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized Gains on Available- for-Sale Securities Foreign Currency Translation Adjustments Defined Benefit Plans Change in Fair Value of Derivative Instruments Total Balances at December 31, 2020 $ 25 $ (271 ) $ (220 ) $ (36 ) $ (502 ) Unrealized losses on available-for-sale (9 ) (9 ) Foreign currency translation adjustments, net of $1 of income tax 7 7 Change in fair value of derivative instruments 1 1 Expense reclassified into operations from other comprehensive income, net of $2 and $2 income tax benefits, respectively 5 7 12 Balances at March 31, 2021 $ 16 $ (264 ) $ (215 ) $ (28 ) $ (491 ) |
Segment and Geographic Informat
Segment and Geographic Information | 3 Months Ended |
Mar. 31, 2021 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | NOTE 11 — SEGMENT AND GEOGRAPHIC INFORMATION We operate in one line of business, which is operating hospitals and related health care entities. We operate in two geographically organized groups: the National and American Groups. The National Group includes 97 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, North Carolina, South Carolina, Utah and Virginia, and the American Group includes 82 hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, Missouri, Tennessee and Texas. We also operate seven hospitals in England, and these facilities are included in the Corporate and other group. Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, gains 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 The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters ended March 31, 2021 and 2020 are summarized in the following table (dollars in millions): 202 1 2020 Revenues: National Group $ 7,056 $ 6,474 American Group 6,291 5,744 Corporate and other 630 643 $ 13,977 $ 12,861 2021 2020 Equity in earnings of affiliates: National Group $ (7 ) $ 1 American Group (12 ) (9 ) Corporate and other (2 ) 1 $ (21 ) $ (7 ) Adjusted segment EBITDA: National Group $ 1,705 $ 1,215 American Group 1,501 1,115 Corporate and other (154 ) (130 ) $ 3,052 $ 2,200 Depreciation and amortization: National Group $ 323 $ 306 American Group 293 287 Corporate and other 81 81 $ 697 $ 674 Adjusted segment EBITDA $ 3,052 $ 2,200 Depreciation and amortization 697 674 Interest expense 384 428 Gains on sales of facilities (2 ) (7 ) Losses on retirement of debt — 295 Income before income taxes $ 1,973 $ 810 |
Basis of Presentation and Sig_2
Basis of Presentation and Significant Accounting Policies (Policies) | 3 Months Ended |
Mar. 31, 2021 | |
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 Regulation S-X. 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 $87 million and $96 million for the quarters ended March 31, 2021 and 2020, respectively. Operating results for the quarter ended March 31, 2021 are not necessarily indicative of the results that may be expected for the year ending December 31, 2021. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K . COVID-19 On March 11, 2020, the World Health Organization designated COVID-19 COVID-19 COVID-19 operations. |
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 $ million related to the settlement of Medicare outlier calculations for prior periods. 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 discounts and contractual 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 ended March 31, 2021 and 2020 are summarized in the following table (dollars in millions): 2021 Ratio 2020 Ratio Medicare $ 2,559 18.3 % $ 2,743 21.3 % Managed Medicare 2,053 14.7 1,826 14.2 Medicaid 527 3.8 414 3.2 Managed Medicaid 725 5.2 666 5.2 Managed care and insurers 6,885 49.1 6,645 51.6 International (managed care and insurers) 333 2.4 292 2.3 Other 895 6.5 275 2.2 Revenues $ 13,977 100.0 % $ 12,861 100.0 % 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 ended March 31, 2021 and 2020 follows (dollars in millions): 2021 2020 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 11,643 $ 11,342 Cost-to-charges 11.4 % 11.9 % Total uncompensated care $ 6,821 $ 7,873 Multiply by the cost-to-charges 11.4 % 11.9 % Estimated cost of total uncompensated care $ 778 $ 937 The total uncompensated care amounts include charity care of $2.942 billion and $3.735 billion, respectively, and the related estimated costs of charity care were $335 million and $444 million, respectively, . |
Reclassifications | Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Basis of Presentation and Sig_3
Basis of Presentation and Significant Accounting Policies (Tables) | 3 Months Ended |
Mar. 31, 2021 | |
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 ended March 31, 2021 and 2020 are summarized in the following table (dollars in millions): 2021 Ratio 2020 Ratio Medicare $ 2,559 18.3 % $ 2,743 21.3 % Managed Medicare 2,053 14.7 1,826 14.2 Medicaid 527 3.8 414 3.2 Managed Medicaid 725 5.2 666 5.2 Managed care and insurers 6,885 49.1 6,645 51.6 International (managed care and insurers) 333 2.4 292 2.3 Other 895 6.5 275 2.2 Revenues $ 13,977 100.0 % $ 12,861 100.0 % |
Schedule of Estimated Cost of Uncompensated Care | A summary of the estimated cost of total uncompensated care for the quarters ended March 31, 2021 and 2020 follows (dollars in millions): 2021 2020 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 11,643 $ 11,342 Cost-to-charges 11.4 % 11.9 % Total uncompensated care $ 6,821 $ 7,873 Multiply by the cost-to-charges 11.4 % 11.9 % Estimated cost of total uncompensated care $ 778 $ 937 |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 3 Months Ended |
Mar. 31, 2021 | |
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 ended March 31, 2021 and 2020 (dollars and shares in millions, except per share amounts): 2021 2020 Net income attributable to HCA Healthcare, Inc. $ 1,423 $ 581 Weighted average common shares outstanding 338.123 338.242 Effect of dilutive incremental shares 5.198 5.854 Shares used for diluted earnings per share 343.321 344.096 Earnings per share: Basic earnings $ 4.21 $ 1.72 Diluted earnings $ 4.14 $ 1.69 |
Investments of Insurance Subs_2
Investments of Insurance Subsidiaries (Tables) | 3 Months Ended |
Mar. 31, 2021 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | A summary of our insurance subsidiaries’ investments at March 31, 2021 and December 31, 2020 follows (dollars in millions): March 31, 2021 Amortized Cost Unrealized Amounts Fair Value Gains Losses Debt securities $ 376 $ 22 $ (1 ) $ 397 Money market funds and other 104 — — 104 $ 480 $ 22 $ (1 ) 501 Amounts classified as current assets (108 ) Investment carrying value $ 393 December 31, 2020 Amortized Cost Unrealized Amounts Fair Value Gains Losses Debt securities $ 384 $ 32 $ — $ 416 Money market funds and other 88 — — 88 $ 472 $ 32 $ — 504 Amounts classified as current assets (116 ) Investment carrying value $ 388 |
Schedule of Maturities of Investments | Scheduled maturities of investments in debt securities at March 31, 2021 were as follows (dollars in millions): Amortized Cost Fair Value Due in one year or less $ 4 $ 4 Due after one year through five years 144 152 Due after five years through ten years 157 167 Due after ten years 71 74 $ 376 $ 397 |
Financial Instruments (Tables)
Financial Instruments (Tables) | 3 Months Ended |
Mar. 31, 2021 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges | The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at March 31, 2021 (dollars in millions): Notional Amount Maturity Date Fair Value Pay-fixed $ 2,000 December 2021 $ (20 ) Pay-fixed 500 December 2022 (16 ) |
Effect of Interest Rate on Results of Operations | The following table presents the effect of our interest rate swaps on our results of operations for the quarter ended March 31, 2021 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Gain Recognized in OCI on Derivatives, Net of Tax Location of Loss Reclassified from Accumulated OCI into Operations Amount of Loss Reclassified from Accumulated OCI into Operations Interest rate swaps $ 1 Interest expense $ 9 |
Assets and Liabilities Measur_2
Assets and Liabilities Measured at Fair Value (Tables) | 3 Months Ended |
Mar. 31, 2021 | |
Fair Value Disclosures [Abstract] | |
Schedule of Assets Measured at Fair Value on Recurring Basis | The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of March 31, 2021 and December 31, 2020, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): March 31, 2021 Fair Value Measurements Using Fair Value Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Assets: Investments of insurance subsidiaries: Debt securities $ 397 $ — $ 397 $ — Money market funds and other 104 104 — — Investments of insurance subsidiaries 501 104 397 — Less amounts classified as current assets (108 ) (101 ) (7 ) — $ 393 $ 3 $ 390 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 36 $ — $ 36 $ — December 31, 2020 Fair Value Measurements Using Fair Value Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Assets: Investments of insurance subsidiaries: Debt securities $ 416 $ — $ 416 $ — Money market funds and other 88 88 — — Investments of insurance subsidiaries 504 88 416 — Less amounts classified as current assets (116 ) (87 ) (29 ) — $ 388 $ 1 $ 387 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 46 $ — $ 46 $ — |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 3 Months Ended |
Mar. 31, 2021 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | A summary of long-term debt at March 31, 2021 and December 31, 2020, including related interest rates at March 31, 2021, follows (dollars in millions): March 31, 2021 December 31, 2020 Senior secured asset-based revolving credit facility (effective interest rate of 1.4%) $ 80 $ — Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 2.8%) 3,657 3,671 Senior secured notes (effective interest rate of 5.1%) 13,850 13,850 Other senior secured debt (effective interest rate of 4.6%) 762 767 Senior secured debt 18,349 18,288 Senior unsecured notes (effective interest rate of 5.5%) 12,952 12,952 Debt issuance costs and discounts (229 ) (236 ) Total debt (average life of 8.6 years, rates averaging 5.0%) 31,072 31,004 Less amounts due within one year 234 209 $ 30,838 $ 30,795 |
Share Repurchase Transactions_2
Share Repurchase Transactions and Other Comprehensive Loss (Tables) | 3 Months Ended |
Mar. 31, 2021 | |
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 Gains on Available- for-Sale Securities Foreign Currency Translation Adjustments Defined Benefit Plans Change in Fair Value of Derivative Instruments Total Balances at December 31, 2020 $ 25 $ (271 ) $ (220 ) $ (36 ) $ (502 ) Unrealized losses on available-for-sale (9 ) (9 ) Foreign currency translation adjustments, net of $1 of income tax 7 7 Change in fair value of derivative instruments 1 1 Expense reclassified into operations from other comprehensive income, net of $2 and $2 income tax benefits, respectively 5 7 12 Balances at March 31, 2021 $ 16 $ (264 ) $ (215 ) $ (28 ) $ (491 ) |
Segment and Geographic Inform_2
Segment and Geographic Information (Tables) | 3 Months Ended |
Mar. 31, 2021 | |
Segment Reporting [Abstract] | |
Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization, Assets and Goodwill and other intangible assets. | The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters ended March 31, 2021 and 2020 are summarized in the following table (dollars in millions): 202 1 2020 Revenues: National Group $ 7,056 $ 6,474 American Group 6,291 5,744 Corporate and other 630 643 $ 13,977 $ 12,861 2021 2020 Equity in earnings of affiliates: National Group $ (7 ) $ 1 American Group (12 ) (9 ) Corporate and other (2 ) 1 $ (21 ) $ (7 ) Adjusted segment EBITDA: National Group $ 1,705 $ 1,215 American Group 1,501 1,115 Corporate and other (154 ) (130 ) $ 3,052 $ 2,200 Depreciation and amortization: National Group $ 323 $ 306 American Group 293 287 Corporate and other 81 81 $ 697 $ 674 Adjusted segment EBITDA $ 3,052 $ 2,200 Depreciation and amortization 697 674 Interest expense 384 428 Gains on sales of facilities (2 ) (7 ) Losses on retirement of debt — 295 Income before income taxes $ 1,973 $ 810 |
Basis of Presentation and Sig_4
Basis of Presentation and Significant Accounting Policies - Additional Information (Detail) $ in Millions | 3 Months Ended | |
Mar. 31, 2021USD ($)StateHospitalSurgery_CenterEndoscopy_Center | Mar. 31, 2020USD ($) | |
Summary Of Significant Accounting Policies [Line Items] | ||
Number of owned and operated hospitals | Hospital | 186 | |
Number of freestanding surgery centers | Surgery_Center | 121 | |
Number of freestanding endoscopy centers | Endoscopy_Center | 21 | |
Number of facilities locations | State | 20 | |
General and administrative expense | $ 87 | $ 96 |
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. | |
Charity care amount | $ 2,942 | 3,735 |
Estimated costs of charity care | 335 | $ 444 |
Out of Network Services [Member] | ||
Summary Of Significant Accounting Policies [Line Items] | ||
Revenues | $ 55 | |
Minimum [Member] | ||
Summary Of Significant Accounting Policies [Line Items] | ||
Percentage of income of federal poverty level eligible for charity care | 400.00% |
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 | |
Mar. 31, 2021 | Mar. 31, 2020 | |
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 13,977 | $ 12,861 |
Revenues ratio from third party payers | 100.00% | 100.00% |
Medicare [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 2,559 | $ 2,743 |
Revenues from third party payers, Ratio | 18.30% | 21.30% |
Managed Medicare [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 2,053 | $ 1,826 |
Revenues from third party payers, Ratio | 14.70% | 14.20% |
Medicaid [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 527 | $ 414 |
Revenues from third party payers, Ratio | 3.80% | 3.20% |
Managed Medicaid [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 725 | $ 666 |
Revenues from third party payers, Ratio | 5.20% | 5.20% |
Managed Care and Insurers [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 6,885 | $ 6,645 |
Revenues from third party payers, Ratio | 49.10% | 51.60% |
International (managed care and insurers) [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 333 | $ 292 |
Revenues from third party payers, Ratio | 2.40% | 2.30% |
Other [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 895 | $ 275 |
Other, Ratio | 6.50% | 2.20% |
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 | |
Mar. 31, 2021 | Mar. 31, 2020 | |
Accounting Policies [Abstract] | ||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | $ 11,643 | $ 11,342 |
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) | 11.40% | 11.90% |
Total uncompensated care | $ 6,821 | $ 7,873 |
Multiply by the cost-to-charges ratio | 11.40% | 11.90% |
Estimated cost of total uncompensated care | $ 778 | $ 937 |
Acquisitions and Dispositions -
Acquisitions and Dispositions - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2021 | Mar. 31, 2020 | |
Business Acquisition [Line Items] | ||
Proceeds from sale of business | $ 20 | $ 35 |
Real Estate and Other Investments [Member] | ||
Business Acquisition [Line Items] | ||
Pretax gain (loss) before tax | 2 | 7 |
Proceeds from sale of business | 20 | 35 |
Nonhospital Health Care [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | $ 22 | $ 328 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | ||
Mar. 31, 2021 | Mar. 31, 2020 | Dec. 31, 2020 | |
Income Tax Contingency [Line Items] | |||
Effective tax rate | 21.70% | 16.20% | |
Provision for tax benefits related to settlement of employee awards | $ 74 | $ 53 | |
Provision for income taxes | 393 | $ 112 | |
Liability for unrecognized tax benefits | 596 | $ 508 | |
Unrecognized tax benefits, accrued interest | 88 | 73 | |
Unrecognized tax benefits that would impact effective tax rate | $ 179 | $ 157 |
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 | |
Mar. 31, 2021 | Mar. 31, 2020 | |
Earnings Per Share [Abstract] | ||
Net income attributable to HCA Healthcare, Inc. | $ 1,423 | $ 581 |
Weighted average common shares outstanding | 338,123 | 338,242 |
Effect of dilutive incremental shares | 5,198 | 5,854 |
Shares used for diluted earnings per share | 343,321 | 344,096 |
Basic earnings per share | $ 4.21 | $ 1.72 |
Diluted earnings per share | $ 4.14 | $ 1.69 |
Investments of Insurance Subs_3
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions | Mar. 31, 2021 | Dec. 31, 2020 |
Debt Securities, Available-for-sale [Line Items] | ||
Amounts classified as current assets | $ (108) | $ (116) |
Investment carrying value | 393 | 388 |
Amortized Cost | 480 | 472 |
Unrealized Amounts, Gains | 22 | 32 |
Unrealized Amounts, Losses | (1) | |
Fair Value | 501 | 504 |
Money Market Funds and Other [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 104 | 88 |
Fair Value | 104 | 88 |
Debt Securities [Member] | States and Municipalities [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 376 | 384 |
Unrealized Amounts, Gains | 22 | 32 |
Unrealized Amounts, Losses | (1) | |
Fair Value | $ 397 | $ 416 |
Investments of Insurance Subs_4
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions | Mar. 31, 2021USD ($) |
Investments, Debt and Equity Securities [Abstract] | |
Due in one year or less, Amortized Cost | $ 4 |
Due after one year through five years, Amortized Cost | 144 |
Due after five years through ten years, Amortized Cost | 157 |
Due after ten years, Amortized Cost | 71 |
Amortized Cost, Total | 376 |
Due in one year or less, Fair Value | 4 |
Due after one year through five years, Fair Value | 152 |
Due after five years through ten years, Fair Value | 167 |
Due after ten years, Fair Value | 74 |
Fair Value, Total | $ 397 |
Investments of Insurance Subs_5
Investments of Insurance Subsidiaries - Additional Information (Detail) | 3 Months Ended |
Mar. 31, 2021 | |
Investments, Debt and Equity Securities [Abstract] | |
Available for sale securities expected maturity of debt securities | 5 years |
Available for sale securities average scheduled maturity | 9 years 2 months 12 days |
Financial Instruments - Schedul
Financial Instruments - Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges (Detail) - Pay-Fixed Interest Rate Swaps [Member] $ in Millions | 3 Months Ended |
Mar. 31, 2021USD ($) | |
Maturity Date, 2021 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 2,000 |
Fair Value | $ (20) |
Maturity Date | 2021-12 |
Maturity Date, 2022 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 500 |
Fair Value | $ (16) |
Maturity Date | 2022-12 |
Financial Instruments - Additio
Financial Instruments - Additional Information (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2021USD ($) | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Estimated amount reclassified from other comprehensive income and reduce interest expense | $ 30 |
Estimated termination value | $ 37 |
Financial Instruments - Effect
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2021USD ($) | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Amount of Gain Recognized in OCI on Derivatives, Net of Tax | $ (1) |
Interest Rate Swaps [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Amount of Gain Recognized in OCI on Derivatives, Net of Tax | 1 |
Interest Rate Swaps [Member] | Reclassification out of Accumulated Other Comprehensive Income into Operations [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Interest rate swaps | $ 9 |
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 | Mar. 31, 2021 | Dec. 31, 2020 |
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | $ 501 | $ 504 |
Less amounts classified as current assets | (108) | (116) |
Investments of insurance subsidiaries, noncurrent | 393 | 388 |
Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Derivative Liability | 36 | 46 |
Money Market Funds and Other [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 104 | 88 |
Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Securities, Available-for-sale Securities | 397 | 416 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 104 | 88 |
Less amounts classified as current assets | (101) | (87) |
Investments of insurance subsidiaries, noncurrent | 3 | 1 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Money Market Funds and Other [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 104 | 88 |
Significant Other Observable Inputs (Level 2) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 397 | 416 |
Less amounts classified as current assets | (7) | (29) |
Investments of insurance subsidiaries, noncurrent | 390 | 387 |
Significant Other Observable Inputs (Level 2) [Member] | Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Derivative Liability | 36 | 46 |
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, Available-for-sale Securities | $ 397 | $ 416 |
Assets and Liabilities Measur_4
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions | Mar. 31, 2021 | Dec. 31, 2020 |
Fair Value Disclosures [Abstract] | ||
Estimated fair value of long-term debt | $ 34,872 | $ 35,814 |
Carrying amounts of long-term debt | $ 31,301 | $ 31,240 |
Long-Term Debt - Schedule of Lo
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($) $ in Millions | Mar. 31, 2021 | Dec. 31, 2020 |
Debt Instrument [Line Items] | ||
Senior secured debt | $ 18,349 | $ 18,288 |
Net debt issuance costs | (229) | (236) |
Total debt (average life of [9.4 years, rates averaging 5.4]%) | 31,072 | 31,004 |
Less amounts due within one year | 234 | 209 |
Long-term debt | 30,838 | 30,795 |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 80 | 0 |
Senior Secured Term Loan Facilities [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 3,657 | 3,671 |
Senior Secured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 13,850 | 13,850 |
Other Senior Secured Debt [Member] | ||
Debt Instrument [Line Items] | ||
Other senior secured debt | 762 | 767 |
Senior Unsecured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior unsecured notes | 12,952 | 12,952 |
Senior Secured Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | $ 0 | $ 0 |
Long-Term Debt - Schedule of _2
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) | 3 Months Ended |
Mar. 31, 2021 | |
Debt Instrument [Line Items] | |
Total debt average term | 8 years 7 months 6 days |
Total debt average rate | 5.00% |
Senior Secured Asset-Based Revolving Credit Facility [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 1.40% |
Senior Secured Term Loan Facilities [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 2.80% |
Senior Secured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 5.10% |
Other Senior Secured Debt [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 4.60% |
Senior Unsecured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 5.50% |
Share Repurchase Transactions_3
Share Repurchase Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2021USD ($) | |
Equity [Abstract] | |
Unrealized gains on available-for-sale securities, beginning balances | $ 25 |
Unrealized gains (losses) on available-for-sale securities | (9) |
Unrealized gains on available-for-sale securities, ending balances | 16 |
Foreign currency translation adjustments, beginning balances | (271) |
Foreign currency translation adjustments | 7 |
Foreign currency translation adjustments, ending balances | (264) |
Defined benefit plans, beginning balances | (220) |
Defined benefit plans, (income) expense reclassified into operations from other comprehensive income | 5 |
Defined benefit plans, ending balances | (215) |
Change in fair value of derivative instruments, beginning balances | (36) |
Change in fair value of derivative instruments | 1 |
Change in fair value of derivatives instruments, (income) expense reclassified into operations from other comprehensive income | 7 |
Change in fair value of derivative instruments, ending balances | (28) |
Accumulated other comprehensive income (loss), net of tax, beginning balances | (502) |
Unrealized gains (losses) on available-for-sale securities, net of income taxes | (9) |
Foreign currency translation adjustments | 7 |
Change in fair value of derivative instruments, net of income tax benefit | 1 |
Expense (income) reclassified into operations from other comprehensive income, Total | 12 |
Accumulated other comprehensive income (loss), net of tax, ending balances | $ (491) |
Share Repurchase Transactions_4
Share Repurchase Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2021USD ($) | |
Equity [Abstract] | |
Unrealized gains (losses) on available-for-sale securities, tax benefit | $ 2 |
Foreign currency translation adjustments, income tax expense | 1 |
Defined benefit plans, Expense reclassified into operations from other comprehensive income, Income tax benefits | 2 |
Change in fair value of derivative instruments, Expense reclassified into operations from other comprehensive income, Income tax benefits | $ 2 |
Share Repurchase Transactions_5
Share Repurchase Transactions and Other Comprehensive Loss - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions | 3 Months Ended | |||
Mar. 31, 2021 | Feb. 28, 2021 | Jan. 31, 2020 | Jan. 31, 2019 | |
Repurchase of common stock, shares | 8,477,000 | |||
Repurchase price of common stock, per share | $ 180.11 | |||
Board of Directors Chairman [Member] | ||||
Share repurchase program authorized amount | $ 7,274 | $ 6,000 | $ 4,000 | $ 2,000 |
Segment and Geographic Inform_3
Segment and Geographic Information - Additional Information (Detail) | 3 Months Ended |
Mar. 31, 2021Hospital | |
Segment Reporting Information [Line Items] | |
Number of geographically organized groups | 2 |
Number of owned and operated hospitals | 186 |
Reorganization Group [Member] | National Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 97 |
Reorganization Group [Member] | American Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 82 |
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 and Assets (Detail) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2021 | Mar. 31, 2020 | |
Segment Reporting Information [Line Items] | ||
Revenues | $ 13,977 | $ 12,861 |
Equity in earnings of affiliates | (21) | (7) |
Adjusted segment EBITDA | 3,052 | 2,200 |
Depreciation and amortization | 697 | 674 |
Interest expense | 384 | 428 |
Gains on sales of facilities | (2) | (7) |
Losses on retirement of debt | 0 | 295 |
Income before income taxes | 1,973 | 810 |
National Group [Member] | ||
Segment Reporting Information [Line Items] | ||
Revenues | 7,056 | 6,474 |
Equity in earnings of affiliates | (7) | 1 |
Adjusted segment EBITDA | 1,705 | 1,215 |
Depreciation and amortization | 323 | 306 |
American Group [Member] | ||
Segment Reporting Information [Line Items] | ||
Revenues | 6,291 | 5,744 |
Equity in earnings of affiliates | (12) | (9) |
Adjusted segment EBITDA | 1,501 | 1,115 |
Depreciation and amortization | 293 | 287 |
Corporate and Other [Member] | ||
Segment Reporting Information [Line Items] | ||
Revenues | 630 | 643 |
Equity in earnings of affiliates | (2) | 1 |
Adjusted segment EBITDA | (154) | (130) |
Depreciation and amortization | $ 81 | $ 81 |