Three of the nation’s largest for-profit hospital operators are increasingly describing themselves in broader terms as their businesses expand well beyond the walls of acute care hospitals.
HCA Healthcare, Community Health Systems and Tenet Healthcare are pursuing different versions of the same strategic shift: Hospitals remain important, but growth is increasingly tied to building broader networks that include surgery centers, urgent care clinics, freestanding emergency departments, physician practices and other outpatient assets.
The distinction is more than branding. HCA is targeting an average of 20 outpatient facilities for every hospital by 2030. CHS has intentionally stopped referring to itself as a “hospital company” as it consolidates around regional networks of care. And Tenet has transformed its portfolio so dramatically that its ambulatory subsidiary, United Surgical Partners International, now operates more than 10 times as many ASCs as Tenet operates acute care hospitals.
The strategies spotlight how the traditional hospital company is being redefined as care continues migrating into lower-cost settings and operators look to capture patients across a broader continuum.
HCA: A ‘hospital-centric network healthcare company’
Nashville, Tenn.-based HCA’s hospitals remain at the center of its strategy, but CFO Mike Marks made clear during the Sept. 15 Jefferies Healthcare Services and Technology Conference that Nashville, Tenn.-based HCA sees itself as something broader.
“We are a hospital-centric network healthcare company,” Mr. Marks said.
That distinction helps explain one of HCA’s biggest growth targets for the remainder of the decade.
The company averaged about 12 outpatient facilities per hospital at its 2023 investor day. That figure has since climbed above 14, and HCA now expects it could reach 20 outpatient facilities per hospital by the end of the decade.
“Our goal, based on what we’re seeing in our markets, is that that would likely be 20 outpatient facilities per hospital by the end of the decade,” Mr. Marks said. “That reflects what we’re seeing for demand in our markets and just the value of having a comprehensive network of ambulatory sites to support your hospitals.”
HCA’s approach involves surrounding acute care hospitals with urgent care centers, freestanding emergency departments, ASCs and physician practices. The goal is to create multiple entry points into the system and keep patients within the network as their care needs change.
The strategy also gives HCA options as procedures migrate from inpatient hospitals to outpatient settings. The company has about 150 surgery centers across its 43 markets in 19 states.
“As cases sometimes move from inpatient to outpatient, we have the facilities, the surgeon community and the access for patients at all levels of care,” Mr. Marks said.
HCA is not shrinking its hospital infrastructure to fund that shift. The company has been adding about 600 hospital beds annually in recent years while investing in additional operating rooms, emergency department capacity and higher-acuity service lines.
Instead, HCA is pursuing both simultaneously: expanding acute care capacity where demand supports it while accelerating development of outpatient access points around those hospitals.
“We just continue to see really good opportunities in our markets to expand and optimize our networks,” Mr. Marks said. “It’s really our key growth strategy.”
CHS drops the ‘hospital company’ label
Franklin, Tenn.-based CHS has been even more explicit about the terminology.
CEO Kevin Hammons told Becker’s in December that the company had intentionally stopped referring to itself as a “hospital company” in its public filings.
“This is a nuanced point, but it was very intentional,” Mr. Hammons said. “We’ve stopped referring to ourselves as a “hospital company. We now call ourselves a ‘healthcare company’ because we’re delivering services across the full continuum — from primary care clinics and ambulatory surgery centers to imaging centers and, of course, hospitals. We build these networks of care around an acute care hospital, but they also include behavioral health, skilled nursing facilities and inpatient rehab. It’s truly a broad continuum of care.”
CHS’ shift has been years in the making.
The company once operated a far more geographically dispersed hospital portfolio, including what Mr. Hammons described as “single dots on a map.” Beginning in the late 2010s, CHS began consolidating around markets where it could build more comprehensive regional networks.
The portfolio overhaul has also been central to CHS’ financial strategy. The company entered 2026 with nearly 40 fewer hospitals than it had in 2019, but executives said projected 2025 revenue and adjusted EBITDA remained roughly comparable with 2019 levels. Debt, meanwhile, was projected to be about $3 billion lower.
Many of the hospitals CHS divested did not fit its network strategy, according to Mr. Hammons.
“Refocusing has allowed us to hone in on our core markets, where we have the full continuum of care and can truly leverage our scale,” he said.
Like HCA, CHS still views the acute care hospital as the anchor.
“Our model is a multi-pronged approach, still centered on the acute care hospital as the anchor in our markets,” Mr. Hammons said. “Some of our peer companies have taken a different path — moving individually into areas like surgery centers, in some cases even competing with their own hospitals or operating in markets without an acute care presence.
“We’re continuing to pursue a strategy where the acute care hospital is the hub, and we’re building a network of care around it — adding service lines that support and extend the hospital’s role within the market.”
Tenet’s portfolio tells a different story
Dallas-based Tenet represents perhaps the clearest example of how far the model can shift.
Tenet has spent more than a decade expanding USPI while reducing its acute care hospital footprint. As of June 30, 2026, USPI had ownership interests in 538 ASCs and 26 surgical hospitals in 37 states. Tenet, by comparison, now operates 50 acute care hospitals.
The ambulatory business has become a major financial engine.
USPI generated $5.2 billion in revenue and about $2 billion in adjusted EBITDA in 2025, compared with $16.1 billion in revenue from Tenet’s hospital business. Tenet invested nearly $350 million in USPI M&A and de novo development during the year and has said it plans to continue deploying at least $250 million annually toward ASC acquisitions.
The shift accelerated when Tenet sold 14 hospitals for more than $4.8 billion in 2024. CEO Saum Sutaria, MD, described the transaction as marking a “new era” in which a greater share of Tenet’s performance would be driven by ambulatory care.
USPI added another 34 ASCs and one surgical hospital in 2025, with much of its development focused on higher-acuity procedures such as orthopedics. The company has said its pipeline for acquisitions and newly developed centers remains strong.
Dr. Sutaria said in February that Tenet’s portfolio has become “more predictable,” with consistent performance from both its hospital business and USPI.
The company continues investing in selected hospital markets, particularly higher-acuity services, but executives have repeatedly identified USPI as a top capital priority.
Tenet has also expanded beyond direct care delivery. In February, the company reached a deal to regain full ownership of revenue cycle subsidiary Conifer Health Solutions as Chicago-based CommonSpirit Health exits their partnership.
Three companies, different versions of the same shift
The three companies are not following identical playbooks.
HCA and CHS continue to describe hospitals as the hubs around which their broader networks are built. HCA is simultaneously adding inpatient capacity and rapidly expanding ambulatory access, while CHS has used divestitures to concentrate resources in markets where it can offer a fuller continuum of care.
Tenet has gone further in reshaping its asset mix. Its hospital portfolio is significantly smaller than it was several years ago while USPI has become the country’s largest ASC operator and a growing share of Tenet’s earnings base.
But the strategic direction is converging.
Rather than measuring scale principally by hospital count, the companies are increasingly focused on the breadth of their networks, the number of patient access points they control and their ability to retain patients as care moves between settings.
For HCA, that could eventually mean 20 outpatient facilities surrounding each hospital. For CHS, it means replacing isolated hospitals with more integrated regional networks. For Tenet, it has meant building an ambulatory platform more than 10 times the size of its acute care portfolio.
The hospital remains important to all three. Increasingly, though, it is one piece of a much larger healthcare company.
