The four largest publicly traded for-profit health systems are holding steady on their 2026 financial projections after sharing their first-quarter results.
HCA Healthcare, Tenet Healthcare, Community Health Systems and Universal Health Services each reaffirmed 2026 guidance.
HCA
Nashville, Tenn.-based HCA is projecting a net income between $6.5 billion and $7 billion for full-year 2026 and revenue between $76.5 billion and $80 billion.
The system recorded a net income of $1.62 billion for the three months ended March 31, compared to $1.61 billion during the same period last year. Total operating revenue was $19.1 billion, up from $18.3 billion.
HCA did not experience a typical seasonal volume increase in the first quarter of 2026, largely due to lower respiratory-related admissions. The system saw a 42% decrease year over year in those visits, and a 32% decrease in respiratory-related emergency room visits. CEO Sam Hazen said system views the volume shortfall as only a first-quarter event.
“We believe our assumptions for the remainder of the year related to volumes, payer mix, and costs continue to remain in line with our original guidance,” Mr. Hazen said.
Tenet
Dallas-based Tenet is projecting net income between $2.61 billion and $2.84 billion in 2026 and total operating revenue between $21.5 billion and $22.3 billion.
Tenet reported net income of $702 million in the three months ended March 31, up from $406 million during the same period last year. The year-over-year jump was boosted by $413 million in revenue ($314 million after tax) from the early conclusion of Conifer’s revenue-cycle services contract with Chicago-based CommonSpirit Health, bringing full control of the company back under Tenet. The system reported total operating revenue of $5.4 billion, up from $5.2 billion.
“While we had strong fundamental outperformance in the first quarter and have continued confidence in our ability to achieve our full-year targets, it is early in the year and we will plan to revisit our full-year guidance as needed in subsequent quarters,” Tenet Executive Vice President and CFO Sun Park said.
CHS
Franklin, Tenn.-based CHS is projecting an adjusted EBITDA between $1.3 billion and $1.5 billion and total operating revenue between $11.6 billion and $12 billion. The system did not give guidance on net income.
CHS recorded a net loss of $58 million in the first quarter of 2026, compared to a $13 million loss during the same period last year. The system recorded total operating revenue of $3 billion, down from $3.2 billion. In the first quarter, CHS completed the divestiture of three hospitals and its 80% ownership interest in a fourth hospital, all effective Feb. 1.
“There are multiple items on the horizon that could affect guidance in the future, most notably the potential approval of new or enhanced state direct payment programs and potential tailwinds from the Rural Health Transformation Program,” CHS Executive Vice President and CFO Jason Johnson said. “We don’t have sufficient data to adjust the outlook at this early stage in the year.”
UHS
King of Prussia, Pa.-based UHS is projecting an adjusted EBITDA between $2.6 billion and $2.8 billion in 2026 and total operating revenue between $18.4 billion and $18.8 billion. The system did not give guidance on net income.
UHS reported a net income of $348.7 million in the first quarter of 2026, up from $316.7 million during the same period in 2025. Total operating revenue was $4.5 billion, up from $4.1 billion.
“Customary with our historical practice, we plan to reevaluate annual guidance as necessary in conjunction with our second quarter earnings planned for July,” UHS Executive Vice President and CFO Steve Filton said.
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