With a combined revenue of $21 trillion and $2.1 trillion in profits, the 2026 Fortune 500 is the definitive list of America's largest companies.

Fortune 500

AI is a major force shaping this year’s list—but it’s far from the only story.

World's Most Admired Companies

Almost $20 trillion in revenue—and a record-breaking $1.87 trillion in profits. Introducing the 2025 Fortune 500, the definitive list of the biggest companies in America.

Leaders in all industries rely more than ever on Big Tech—and appreciate the giants that deliver, at scale, without drama.

Industries included in the sector are insurance and managed care, medical products and facilities, pharmacy services, and pharmaceutical companies.

Fortune Sector Leaders: Health Care

The Fortune 500, in its 70th year in 2024, ranks the biggest U.S. companies by revenue.

The Fortune 500, in its 69th year in 2023, ranks the biggest U.S. companies by revenue.

This year’s Fortune 500 marks the 68th running of the list.

This year’s Fortune 500 marks the 67th running of the list.

F500-2021-167-Tenet Healthcare

The health care services company operates 65 hospitals and approximately 450 other facilities in addition to providing health care support services to clients. In April, Tenet announced it completed the sale of its urgent care platform to FastMed for $80 million.

For an astounding 13th straight year, Apple claims the top spot in Fortune’s annual ranking of corporate reputation, based on a survey of almost 3,800 executives, directors, and analysts.

This year's Fortune 500 marks the 66th running of the list.

F500-2020-174-Tenet-Healthcare

The Dallas-based health care company and its subsidiaries operate acute care and specialty hospitals, as well as ambulatory surgery centers and other health care facilities around the U.S.

Here are the World's Most Admired Companies for 2019 as ranked in their industries. See who made the list.

This year's Fortune 500 marks the 65th running of the list.

This year's Fortune 500 marks the 64th running of the list.

This year's Fortune 500 marks the 63rd running of the list.

Here are the World's Most Admired Companies for 2016 as ranked in their industries. See who made the list.

This year's Fortune 500 marks the 62nd running of the list.

This year's Fortune 500 marks the 61st running of the list. Wal-Mart claims the top spot again. See who made the list.

Wal-Mart stayed on top as its sales crept closer to half-a-trillion dollars. Apple moved into the top five. And UnitedHealth Group continued its steady climb. 

Fortune Global 500

Sector

Industry

Current All-Star Rank

Previous All-Star Rank

Industry Rank

Previous Industry Rank

Overall Score

Innovation

People Management

Use of Corporate Assets

Social Responsibility

Quality of Management

Financial Soundness

Long-Term Investment Value

Quality of Products/Services

Global Competitiveness

Key Financials (last Fiscal Year)

Revenues ($M)

Profits ($M)

Assets ($M)

Total Stockholder Equity ($M)

Profit Ratios

Profit as % of Revenues

Profits as % of Assets

Profits as % of Stockholder Equity

Earnings Per Share (last Fiscal Year)

Earnings Per Share ($)

EPS % Change (from prior fiscal year)

EPS % Change (5 year annual rate)

EPS % Change (10 year annual rate)

Total Return

Total Return to Investors (last year)

Total Return to Investors (5 year, annualized)

Total Return to Investors (10 year, annualized)

Tenet Healthcare operates a network of hospitals, acute care centers, emergency departments, imaging centers, and ambulatory surgery centers through its subsidiaries and joint ventures, comprising one of the largest for-profit hospital chains in the U.S. Its Conifer Health Solutions subsidiary provides revenue cycle management to hospitals and health systems nationwide.

Q2 2026

Q1 2026

Q4 2025

Q3 2025

Q2 2025

Q1 2025

Q4 2024

Tenet Healthcare (THC): Company Profile, Stock Price, News, Rankings

legacy

Tenet Healthcare

tenet healthcare

Good morning. Welcome to Tennant Healthcare's Fourth Quarter twenty twenty four Earnings Conference Call. After the speaker remarks, there will be a question and answer session for industry analysts.

I'll now turn the call over to your host, Mr. Will McDowell, Vice President of Investor Relations. Mr. McDowell, you may begin.

Good morning, everyone, and thank you for joining today's call. I am Will McDowell, Vice President of Investor Relations. We're pleased to have you join us for a discussion of Tennant's fourth quarter twenty twenty four results as well as a discussion of our financial outlook. Tennant senior management participating in today's call will be Doctor. Saum Satoria, Chairman and Chief Executive Officer and Sun Park, Executive Vice President and Chief Financial Officer.

Our webcast this morning includes a slide presentation, which has been posted to the Investor Relations section of our website, tennanthealth.com. Listeners to this call are advised that certain statements made during our discussion today are forward looking and represent management's expectations based on currently available information. Actual results and plans could differ materially. Tennant is under no obligation to update any forward looking statements based on subsequent information. Investors should take note of the cautionary statement slide included in today's presentation as well as the risk factors discussed in our most recent Form 10 K and other filings with the Securities and Exchange Commission.

And with that, I'll turn the call over to Sal.

Thank you, Will, and good morning, everyone. We delivered outstanding performance in 2024 characterized by strong same store revenue growth, disciplined operations and effective capital deployment. In addition, the year was highlighted by portfolio transactions that have transformed our franchise to be well positioned for long term growth with strategic flexibility and a deleveraged balance sheet. We reported 2024 net operating revenues of 20,700,000,000 and consolidated adjusted EBITDA of $4,000,000,000 which represents 13% growth over 2023. Full year adjusted EBITDA margin of 19.3% improved over 200 basis points from prior year.

Our fourth quarter results were above our expectations driven by continued same store revenue strength, high acuity growth, as well as effective cost management. Our disciplined approach has enabled us to consistently exceed our performance expectations each quarter this year furthering our track record. I would note that our full year adjusted EBITDA ended the year over $600,000,000 higher than the midpoint of our initial expectations, driven by strong growth and operational performance. USPI had a fantastic year in 2024. We generated $1,810,000,000 in adjusted EBITDA, which represents 17% growth over 2023 and adjusted EBITDA margins of 40%.

Same facility revenues grew 7.8% in 2024, another year substantially above our long term goals. High acuity volume growth was highlighted by total joint replacements in the ASCs, up 19% over prior year. Importantly, customer service levels in our centers remain quite high as we earned a 96.6 overall patient experience score in 2024. Turning to our hospital segment, despite the sale of 14 hospitals during the year, we generated $2,185,000,000 of adjusted EBITDA in 2024, which represents nine percent growth over prior year. Same store hospital admissions were up 4.7% as we continue to open up capacity to respond to a strong utilization environment.

Acuity and payer mix were strong throughout 2024 and drove a 4.6% increase in same store revenue per adjusted admission over prior year. This was an important year for Tennant as we transformed our portfolio of businesses through the multiple high multiple sales of 14 hospitals and related operations generating $5,000,000,000 in gross proceeds and enabling significant balance sheet deleveraging. In addition, we added nearly 70 ambulatory surgical centers to the portfolio in 2024 as we were very active in both M and A and de novo development. And finally, over the past two years, we have returned capital to shareholders via share repurchase, retiring approximately 14% of our outstanding shares for $1,120,000,000 since our repurchase program began in the fourth quarter of twenty twenty two. Going forward, we plan to be active repurchasers of our shares, particularly at our current valuation multiples.

These actions have resulted in a portfolio of businesses that is more predictable, capital efficient and able to operate in a variety of environments with better margins and ample free cash flow for the benefit of shareholders. In summary, we're very pleased with our team's performance in 2024 and we believe that we will carry this momentum into the new year. Turning to 2025 guidance, we are projecting full year 2025 adjusted EBITDA of $3,975,000,000 to $4,175,000,000 which is an attractive 7% growth rate at the midpoint on a normalized basis. We anticipate adjusted EBITDA growth at USPI of approximately 8.5% at the midpoint of our guidance for 2025 based on our expectation of 3% to 6% growth in same facility revenue fueled by ongoing strength in demand and acuity, continuing effective operational execution and additional sites of care joining the portfolio. We intend to invest approximately $250,000,000 each year towards M and A in the ambulatory space and the pipeline of opportunities remains strong.

We anticipate adding 10 to 12 de novo centers in 2025. Our ability to consistently scale our platform to create additional low cost sites of care for patients and physicians continues to pay dividends as it improves our overall growth, profitability, capital efficiency and resiliency in this regulatory environment. Turning to our Hospital segment, we are expecting adjusted EBITDA growth of approximately 5.7% on a normalized basis at the midpoint for 2025. This projected growth is expected to be driven by 2% to 3% adjusted admissions growth and the strong operating discipline that our team has now demonstrated for many years. The hospital segment's performance will be enhanced by strategic capital deployment, expanded service lines and further contributions from the new Westover Hills facility, which opened in the third quarter of twenty twenty four.

Additionally, as we have noted, we have expanded the relationships that Conifer has with acquirers of hospitals we've sold and this should contribute to growth in 2025. Finally, we acknowledge that there is currently a great deal of focus on the impact of potential regulatory changes in our space. We have demonstrated an ability to perform well in a variety of operating environments and believe we are differentiated from our peer set as we navigate potential changes going forward. For example, our ASCs operate with freestanding ASC rates, which insulates that important part of our business from potential changes in site neutrality rules. In summary, we had an outstanding year in 2024 and believe that we are in a great position for another strong year in 2025.

Our guidance reflects the opportunities before us and the momentum that we carry into the new year. Our established management team stands ready to execute our focused strategy and deliver value for patients, physician partners and in turn shareholders. And with that, Sun will now provide a more detailed review of our financial results. Sun?

Thank you, Sam, and good morning, everyone. We are very pleased with the strong finish to the year. In the fourth quarter, we generated total net operating revenues of $5,100,000,000 and consolidated adjusted EBITDA of $1,048,000,000 which represents an adjusted EBITDA margin of 20.7%, up almost 200 basis points from fourth quarter of twenty twenty three. For full year 2024, we generated $20,700,000,000 of total net operating revenues and consolidated adjusted EBITDA of $3,995,000,000 These results were driven by strong same store revenue growth, continued high patient acuity, favorable payer mix and effective cost controls. I would now like to highlight some key items for each of our segments beginning with USPI, which again delivered strong operating results.

In the fourth quarter, USPI's adjusted EBITDA grew 14% over last year with adjusted EBITDA margin at 42.1%. USPI delivered an 8.6% increase in same facility system wide revenues driven by high acuity levels and favorable payer mix. Same facility system wide surgical case volume grew slightly over last year. And turning to our Hospital segment, fourth quarter adjusted EBITDA was $518,000,000 with margins up 90 basis points over last year at 13.6%. Normalized for the divested hospitals, adjusted EBITDA grew 13% over fourth quarter of twenty twenty three.

Same hospital inpatient admissions increased 5% and revenue per adjusted admission grew 0.6%. Our consolidated salary, wages and benefits in fourth quarter of twenty twenty four was 41.3% of net revenues and our consolidated contract labor expense was 2.1% of SWV, both substantially lower than the 43% and the 2.8% respectively that we reported in the fourth quarter of twenty twenty three. Next, we will discuss our cash flow, balance sheet and capital structure. Our cash flow performance was very strong in 'twenty four with $1,100,000,000 of free cash flow for the year. This includes the payment of $855,000,000 in income taxes related to our completed divestitures.

Excluding these tax payments, this represents nearly $2,000,000,000 of free cash flow for the year or $1,300,000,000 of free cash flow after distributions to non controlling interests

NCI. For full year 2024, we repurchased 5,600,000.0 shares of our stock for $672,000,000 We finished the year with over $3,000,000,000 of cash on hand with no borrowings outstanding under our $1,500,000,000 line of credit facility. Our year end leverage ratio was 2.5 times EBITDA or 3.2 times EBITDA less NCI, a substantial improvement over the past year, reflecting the proceeds that we received from our hospital divestitures as well as our outstanding operational performance. We are very pleased with our ongoing cash flow generation and have a commitment to a deleveraged balance sheet. We believe we have significant financial flexibility to support our capital allocation priorities and drive shareholder value.

Let me now turn to our outlook for 2025. We expect consolidated net operating revenues in the range of $20,600,000,000 to $21,000,000,000 Our projected consolidated adjusted EBITDA is in the range of 3,975,000,000 to $4,175,000,000 As a reminder, there are two normalizing items that I would call out when comparing our $25,000,000 adjusted EBITDA to the prior year. First, we reported $114,000,000 of adjusted EBITDA from facilities that we divested in '24 and will not recur. Additionally, we reported $74,000,000 of out of period supplemental Medicaid payments in Michigan and Texas in 2024. After normalizing for these items, our '25 adjusted EBITDA is expected to grow seven percent at the midpoint of our range.

Our '25 outlook assumes continued growth in same store volumes and effective pricing as well as strong operational efficiencies and disciplined cost controls. Additionally, we anticipate further contributions from recent investments and partnerships in the hospital segment, as well as from M and A and de novo center openings at USPI. In addition, we are also assuming the following: same hospital admissions growth of 2% to 3% and adjusted admissions growth of 2% to 3% and for USPI, same facility revenue growth of 3% to 6%. On a normalized basis, we expect adjusted EBITDA to grow 8.5% at USPI and 5.7% for our Hospital segment at the respective midpoints of our guidance ranges. Our outlook also assumes $35,000,000 of net revenues from the Tennessee supplemental Medicaid programs.

About one third of this increase is related to the second half of twenty twenty four and is expected to be recorded in the first quarter of this year. Finally, we would expect first quarter twenty twenty five consolidated adjusted EBITDA to be in the range of 24% to 25% of our full year consolidated EBITDA at the midpoint. We anticipate that USPI's EBITDA in the first quarter this year will be 21% to 22% of our full year USPI EBITDA at the midpoint. Turning to our cash flow for '25, we expect cash flow from operations in the range of $2,500,000,000 to $2,850,000,000 capital expenditures in the range of $700,000,000 to $800,000,000 resulting in free cash flows in the range of $1,800,000,000 to $2,050,000,000 In addition, we're also assuming distributions to NCI in the range of $750,000,000 to $800,000,000 which would result in free cash flow after NCI in the range of $1,050,000,000 to $1,250,000,000 And finally, as a reminder, our capital deployment priorities have not changed. First, we will continue to prioritize capital investments to grow USPI through M and A.

Second, we expect to continue to invest in key hospital growth opportunities, including our focus on higher acuity service offerings. Third, we will evaluate opportunities to retire and or refinance debt. And finally, we'll have a balanced approach to share repurchases depending on market conditions and other investment opportunities. Given our attractive free cash flow profile and current valuations, we plan to be active repurchasers of shares in 2025. In conclusion, we had an outstanding year in 2024 with effective operational execution, robust growth and a transformed portfolio of businesses.

We're confident in our ability to deliver on our outlook for '25 and continue to drive value for patients, physician partners and shareholders. And with that, we're ready to begin our Q and A. Operator?

Thank you. At this time, we'll be conducting a question and answer session. Our first question comes from Pedro Chikharin with Deutsche Bank. Please proceed with your question.

Good morning, guys. Thanks for taking my question. So looking at tenants over the last few years, the biggest change has been the cash flows in your deleveraging. Your cash flow guidance for this year is up 90% year over year with nearly $1,000,000,000 more cash flow from operations. So looking at your cash flow guidance for this year after NCI, it's about $1,150,000,000 at the midpoint.

If we pull out $250,000,000 for M and A, it's about $900,000,000 left to deploy with the leverage at sort of 3.2 times EBITDA less NCI. Can you refresh us on what your ideal target leverage ratios are? And should we be modeling the rest of that going to share repo at this point? Thank you.

Hey, Peter, it's Sam. First of all, I appreciate reiterating the improvements that we've made in generating free cash flow from this business from operations. It's obviously been a very important part of our goal over the last few years and getting to this point probably earlier than we thought. We're very comfortable with the leverage that we operate at today. And importantly, it gives us we look at it and say it gives us significant strategic flexibility with respect to the business, both in terms of activity that we may pursue in growing and scaling USPI, as I noted in my comments, but also from the perspective, especially as I said at these valuation multiples, in terms of share repurchase and both Sun and I noted that we would plan to be active repurchasers of our shares at these multiples makes complete sense.

We don't have debt coming due for a couple of years, right? I mean, so we're not in any situation of urgency there regardless. And I think the return on share repurchase at this point would be higher anyway. So our thinking is relatively clear about that in the coming years. Obviously, we need to continue executing operationally with the track record that we've built to generate that free cash flow.

But as we've talked about in the last couple of years, we've really hardwired our approach there. The last thing I would point out in addition to what I said about USPI in my comments, we don't USPI does not have a tremendous amount of Medicaid exposure. So when you think about utilization of our cash flows and regulatory risks that may be out there, I mean, the reality is half our EBITDA is generated in a segment that isn't really facing risk from any scenario out there related to Medicaid programs. And that's very helpful. It's very different than it might have looked five or six years ago.

So we feel confident about the valuation opportunities for the company.

Our next question comes from Jamie Persse with Goldman Sachs. Please proceed with your question.

Hey, good morning. Thanks for taking the question. Can you maybe spend a minute on just the volume environment that you're seeing today? Obviously, 2023 and 2024 were pretty strong years, some of that just recovery and normalization post the pandemic. Where do you think we're at from a volume perspective today?

do you expect volumes to progress throughout the course of the year?

Yes. Thanks, Jimmy. I mean, the simplest statement I would make right now is that we've anticipated the volume environment continuing to be strong coming into 2025. I mean, that's the simplest summary statement I would make. We don't there aren't obvious trends from December 31 to January 1 that appear to have changed.

I mean, the coverage environment looks good. The employment environment looks good. Demographics, both in terms of areas where at least our portfolio is now positioned relative to where it was, has attractive demographics. And as we've noted, we've had opportunity to expand capacity and take on that capacity without excessive cost to do so, and we're doing it in a deliberate way. So we I mean, our guidance reflects that.

We feel pretty good about going into 2020, '20 '20 '5.

Our next question comes from Brian Tanalworth with Jefferies. Please proceed with your question.

I think about your comments on Medicaid and USPI, just curious how you're thinking about the risk overall for the company from all the political headlines that are out there and what the republics are trying to do with changes to health care policy and what you're doing to prepare for that, just for that potential change, whether it's Medicaid or health insurance exchanges across both business lines? Thanks.

Yes. Thanks, Brian. A few things. So I mean, first of all, the fundamental underpinnings of success in an environment with any kind of uncertainty, in our view is operating discipline in what we do, right? And the other important underpinning is having a clear understanding of the economics of our business internally, meaning we understand clearly our service lines, our markets, etcetera, that may have greater dependency or less dependency upon certain types of supplemental payments, where, for example, the strength in the exchanges has contributed to earnings, etcetera.

So the combination of the operating discipline and the insights about the business probably give us an opportunity to manage and pivot as needed depending on what happens. You're right, the segments are different. I mean, I we've taken the opportunity over the past few years to create resiliency in USPI by making sure that the ambulatory surgery centers as a part of USPI are on freestanding rates. The Medicaid exposure is de minimis in that business and that's very helpful from that perspective. And the exchange business there has had less impact than it's had on the acute care segment in terms of the exchange growth from that perspective.

So from a USPI perspective, look, this is all about an important tailwind of moving things into a lower cost setting in an expensive portion of the healthcare industry, which is surgical care, right, and doing so in a way where we're constantly increasing the acuity of the work at USPI because it creates more value for the purchaser. On the acute care hospital side, I think it's important to continue to search for efficiencies that allow us to generate margins. We always talk about the concept of Medicare profitability, right? Can you generate margins on Medicare reimbursement in order to have a metric out there for efficiency goals that you would create because it's important to be able to operate in that type of environment. Specifically on the acute care side, the number one adaptive action today is helping the regulators understand the importance that these programs provide for basic access for people that wouldn't otherwise have access to care.

And that's really important because if that shapes or is a factor in shaping policy, I think that what comes out of that policy will likely be manageable for us and something that we can get behind. I'm not sure that right now taking a bunch of actions to restructure the business is the right thing to do. I think there's a very strong case to be made that many of these things are really critical to providing access. And it happens to be that that access is also being provided in states with voters that really matter to this administration and that's an important supporting factor as well.

Our next question comes from Andrew Mak with Barclays. Please proceed with your question.

Hi, good morning. When I look at the ASC case mix from '23 to '24, it doesn't look like there are significant mix changes. We actually see MSK down one percentage point and ophthalmology up one percentage point, but you're increasing acuity significantly to the point where you're seeing high single digit same store revenue growth without meaningful case growth. So can you speak to the types of cases driving acuity higher because it's not obvious from the case mix disclosures? Thanks.

Yes, no problem. I mean, just to clarify, the orthopedics line item has a lot of things in there. That's why we call out the highest security work in joint cases, for example, which is where you have the hips, knees, obviously, the shoulder expansion, that's where the acuity is actually growing. I mean, remember, when you look at certain low acuity procedures that we may do in ASCs, the revenue I mean, we're doing exactly what we wanted with the business, which is we're growing the acuity, we're growing the net revenue per case, we are reducing exposure to high volume, low revenue cases, in some cases, things that could also be done in offices that further strengthen the resiliency and value of what USPI is building. So that orthopedics line item has a lot of things in there from high acuity to low acuity cases.

And it's the reason we call out the really high acuity work because it's a fundamental driver of the net revenue per case strength which you're seeing.

Our next question comes from Justin Lake with Wolfe Research. Please proceed with your question.

Thanks. Good morning. Couple of things just numbers wise. Maybe you could tell us you've mentioned Tennessee as a tailwind at $35,000,000 You mentioned, for instance, Michigan is not going to you're going to have a little bit of a one time endwind there. But when you think about ex those issues kind of core DPP dollars year over year, can you tell us what's assumed in the guidance?

And then same for exchanges, like what kind of exchange growth do you kind of expect in your markets, exchange volume growth within that guidance? Thanks.

Hey, Justin, it's Sun, and thanks for the question. On your question about supplemental payments, yes, I think you called out the kind of the one timers that we've referenced. The other point in fiscal twenty twenty four is we still had a little bit of value from hospitals that were then that divested during the course of the year, but that's mostly in Q1. So there are a couple of those moving factors. But in fiscal 'twenty four, we generated about $1,160,000,000 of net Medicaid supplemental payments.

Going into 'twenty five, our guidance assumes something pretty consistent with that. You mentioned the Tennessee one time, but excluding that, we're pretty consistent year over year. On your question about exchange, as we've said multiple times, total emissions and revenues from exchange population was a strong growth driver in 2024. We expect that to continue per Saum's earlier comments around the overall volume environment. The enrollment, the renewal cycle seems to have been positive.

We'll see how much of that turns into actual admissions. But we certainly won't see the 40%, fifty % growth that we saw in 2024, but we still continue to see a strong environment. Just as an example, we're our strategy long term strategy has always to be in broad networks from a contracting standpoint as an example. So we see good things for '25. Thanks for the question.

Our next question comes from Benjamin Rossi with JPMorgan Chase. Please proceed with your question.

Hey, good morning. Thanks for the question here. So, just across supplies, we're

pressure here as a percentage of revenue with that category increasing about 100 bps year over year to 18.3. How would you characterize your current supply dynamics exiting the quarter? Is there anything discrete occurring within there? Is this largely a byproduct of your push to higher Just kind of curious where you're seeing that number settling out in the steady state during 2025? Thanks.

think it's what you said on the latter piece. It is just kind of part and parcel with our acuity strategy. So the supplies will go up as a percentage a little bit in Q4. But over the year, we've been pretty well balanced and we expect it to be again balanced in 2025.

Our next question comes from Joanna Gajic with Bank of America. Please proceed with your question.

Hi, good morning. Thanks so much for taking that question. So on the guidance element, Ambulatory same store revenue 3% to 6%, right? That seems to be sort of more like a normalized growth, right? Because clearly you grew very nicely in 24%, almost 8%.

So is it just conservatism? Could you maybe also break down volumes versus pricing that's included in that range? Thank you.

Yes. Hey, it's Sam. Look, a couple of things there. First of all, long term, as we've learned with USPI, and I think we've shared this data before, we've looked at ten years' worth of USPI's performance and same store growth rates of around 4% to 6% is what we guide to. Now history suggests over that ten year period, we've performed at the upper end of that range, 6%.

That has looked better, strengthened over the last five, six years actually over that average period, okay? So you point out this year almost or this year, past year twenty four, seven point eight percent. The prior year was 9.2% growth rate. So we're running very hot from that perspective in terms of long term averages with respect to USPI. So our guide just comes brings us right back to what our long term growth rate is.

In terms of the year to year, as you've seen, it can be lumpy, right? '23, huge volume growth '24, more growth in acuity and intensity. And part of what we're signaling for 2025 is it's definitely our plan to continue this shift to higher acuity procedures. I started to point out some of the factors driving that in terms of the revenue intensity of some of these cases, how efficiently we're able to do them in our operating rooms now and generate margin, how we are scaling those programs into more centers. We now have robots in almost 150 of our programs around the country.

This is the direction in which we're taking the organization. And so, yes, the guidance reflects kind of our long term average, but we've obviously been running quite a bit above that.

Our next question comes from A. J. Rice with UBS. Please proceed with your question.

Hi, everybody. Thought I would ask maybe on the where you're at with managed care contracting. I know we've been in a period where you've been getting a little bit toward the high end of historical rate updates to pay for some of the labor challenges in the last few years? Is 25 a year in which you'll still see that type of dynamic, maybe where you're at in terms of signing up contracts? And then also on the managed care side, any update on thoughts about denial activity, prior authorization challenges, other term changes that you're dealing with?

Yes. Why don't we take those in reverse? The I mean, I would say that the environment is no different than it has been. I mean, there's a constant back and forth of administrative costs that goes into adjudicating claims that probably is unnecessary, but obviously both sides have a point of view on that. What I would say more importantly than anything else from our perspective is the work that Conifer does in driving initial disputes to a very, very attractive low rate of denials is critical.

And our skill set in doing that in both working collaboratively with the payers and adversely where needed on the basis of solid documentation, appropriate coding, compliant coding and efficient revenue cycle operations has made a big difference. We're seeing a gap in what we generate in terms of lower denial rates than the industry from what we are seeing with respect to initial dispute rates. And that's good because that means we're doing things right in generating the appropriate cash flow from the work we're doing. Sun, maybe you want to comment on the managed care side.

Thanks, Sam. A. J, for your first part of the question, as we've said historically, we are continuing to see commercial rates increases in the 3% to 5% range and some of the contracts have been at or slightly above the high end of that range as respect to the inflationary pressures that you've mentioned. So I think the overall situation there is pretty consistent. And then in terms of contracting, going to 25%, we're about we're over 90% contracted for 25% and probably about over 50% contracted for 26% as well.

So we have great visibility into 25% and beyond. Thanks for your question.

Our next question comes from Stephen Baxter with Wells Fargo. Please proceed with your question.

Hi, thanks. Wanted to come back to the same store hospital volume guidance for 2025. I appreciate you're still expecting exchange growth inside of that number to some degree. Would also love to hear any quantification you can offer about how much hospital capacity you'll have online in 2025 compared to 2024? Trying to break out that 2% to 3% and maybe think about maybe what's the market level growth inside of that compared to how much of it's coming from capacity?

Yes. Hey, Steven, it's obviously both. I mean, the majority of that is the market level demand that we're seeing versus the selective markets in which there's still capacity that we're bringing online. But it is a contributor, which is why I called it out before. We haven't quantified what that looks like between the two numbers, but it is both and the majority of it is market based demand across the board.

Some of this is also related to the service line choices we make, of course, which have higher growth rates. The things that we're doing that are taking care of people with multiple chronic illnesses that continue to grow in prevalence are continuing to create more demand than perhaps certain types of lower acuity work, which may be coming out of hospitals in our environment. And so that's really how we think about it in terms of the growth rates.

look, it's been a very busy year in the acute care environment. And as I said, I think the most important thing we're taking into the year from a mindset perspective is we're not seeing changes in the demand patterns. That was a comment to Jamie's question earlier. We're not seeing changes in the demand pattern right now. And so I mean, I'm not going to go forecasting what we may see in the later part of the year, but we're not seeing that right now.

Our next question comes from Michael with Baird. Please proceed with your question.

Hi, thank you. Just a quick clarification first and then my real one and apologies if I missed it, but your USPI 3% to 6% rev growth guide, what's the volume versus pricing split on that? And then my real question, I'm sorry to add one more question on policy. And I understand USPI is minimal Medicaid exposure, but for your hospital and maybe taking a different approach, just given all the news flow, NIH cuts, Doge's potential focus on Medicaid, administrative costs. If Doge were to implement those cuts, it might not be overly impactful, but still perhaps a couple percent of overall Medicaid spend.

So I'm curious to hear your view. If that were to happen, how do you think states might react? What's your view on the likelihood that states might potentially slow that Medicaid cut down to provider rates and impact tenant and hospitals more broadly? Thank you.

Yes. A couple of different things. So let's just start with the business side of it first. With respect to USPI, as I indicated, there's no long term deviation from our approach of thinking about half and half roughly managed care and volume at USPI. But because it's lumpy and it's proven to be lumpy, we're not guiding specifically for the year with respect to that.

And you can understand that. I mean, we're successfully now two years in a row executing our strategy of increasing lower volume, high acuity cases. And in fact, as you can tell from our quarterly beats consistently, we're exceeding what we expect from the standpoint of what we can do in same store revenue growth in that environment. And so we're pleased by that, that we can do that. We obviously had a little bit of fits and starts around that a few years ago in terms of how we were executing it.

But we got it right and it's working and I'm really pleased with that. So the long term algorithm is the same, but from a short term standpoint, we're giving you the revenue guidance with obviously the track record of it being stronger. I don't on the policy side, I think to be clear, like we don't have even in our academic medical center enterprises and affiliations, we don't have significant NIH or NSF indirect grant cost exposure in our business. So in particular, as you can imagine, when we saw that, we thought about that in our environment and where we had R01 grants and other things within our environment. But we don't have that significantly in our environment.

I think the broader question of Medicaid policy and other things is an important one. But look, the focus on that is articulated and you can't tell what's going to happen, but the focus that's articulated on reducing fraud and abuse, including in some of the public comments made yesterday all the way in the Oval Office. I think one thing that people may find is that Medicaid redeterminations over the last couple of years have probably done a lot to reduce the number of people eligible or not eligible who happen to be on Medicaid. And so I'm again, no way to predict for sure, but I'm somewhat comforted by the fact that some of that work has already been done through this redetermination process. So we'll see where this goes and what remains to be seen.

Finally, as to speculation, speculating on what the states' responses may be, I think the states are going to be important allies across the board in advocating for, the dollars that come through these Medicaid partnerships with the federal government. Because again, I go back to this is the only way to create access for the people that need it that are on Medicaid. This is not some program that's generating incredible windfalls for health systems on that basis. The unit reimbursement is still below the cost of that care. And so I think that that's going to be an important balancing factor.

The states will play an important role in this.

Our next question comes from Ann Hynes with Mizuho. Please proceed with your question.

Tenet Healthcare (THC) Q4 2024 Earnings Call Transcript

Company Participants