Nashville, Tenn.-based HCA Healthcare is pushing toward an average of 20 outpatient facilities for every hospital by the end of the decade as the company continues to make ambulatory expansion a centerpiece of its long-term growth strategy.
CFO Mike Marks said Sept. 15 at the Jefferies Healthcare Services and Technology Conference that HCA has already increased its outpatient footprint from about 12 facilities per hospital in 2023 to more than 14 today.
“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.”
The target builds on several years of accelerated outpatient investment. HCA added about 100 outpatient facilities in 2025 and entered 2026 with roughly 2,700 outpatient sites. CEO Sam Hazen said in January the system had “significant capital in the pipeline” for additional outpatient development in 2026 and 2027, with growth expected through both new construction and acquisitions.
Recent acquisitions have continued that expansion.
HCA acquired Texas MedClinic, a 40-center urgent care network, on Aug. 1. The deal followed the acquisition of 17 urgent care clinics in North Carolina and South Carolina in June and 13 urgent care centers in Texas earlier in the year. HCA also acquired Avecina Medical Urgent Care clinics across Jacksonville and North Central Florida on April 1, folding them into the same network as its existing MD Now urgent care brand.
The strategy is broader than simply adding standalone outpatient assets. Mr. Marks described the company as a “hospital-centric network healthcare company,” with hospitals serving as anchors surrounded by urgent care centers, freestanding emergency departments, ASCs and physician practices.
“We surround our hospitals with network assets,” he said. “Think about urgent care centers and freestanding emergency rooms and ambulatory surgery centers and physician clinics, with the idea of making it easy and convenient for patients to access our network when they need low-acuity care.”
The model is designed to keep patients connected to HCA as their needs change.
“As they need higher-acuity care, [we want] to make it seamless and convenient for them to access our acute care hospitals or our ambulatory surgery centers as they need it,” Mr. Marks said.
Outpatient growth as cases migrate
The expansion also positions HCA for the continued shift of procedures away from inpatient hospitals towards lower-cost outpatient settings.
HCA operates about 150 surgery centers across 43 markets in 19 states, according to Mr. Marks. Those facilities give the company another setting for procedures as clinical advances and reimbursement changes move more care outpatient.
“Surgery centers for us play a role within our network,” he said. “They help us secure our surgeons, and they have an investment opportunity in our surgery centers and then they tend to work in our inpatient facilities when they need to do inpatient care.”
“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,” he added.
That flexibility has become increasingly relevant as Medicare continues changes to its inpatient-only list. Mr. Marks said orthopedics and spine are among the areas most affected this year, with more procedures shifting to outpatient settings.
HCA is also dealing with softer elective surgery volumes as patients lose coverage through the health insurance exchanges. Mr. Marks identified coverage losses as the primary driver of HCA’s elective surgery slowdown while pointing to the inpatient-only list and consumer affordability pressures as additional factors.
Having a broader ambulatory network allows HCA to capture procedures that are shifting settings even as some elective demand faces pressure.
Hospitals remain part of the growth equation
HCA’s outpatient push does not mean the company is pulling back on acute care investment.
Mr. Marks said HCA has averaged about 600 new hospital beds annually over the past several years as inpatient demand has continued to grow. Occupancy remains in the low- to mid-70% range, and HCA is balancing additional capacity with efforts to improve patient throughput and reduce length of stay.
“Length of stay is a good example of that, and it pays dividends,” he said. “It’s the cheapest way to add capital capacity by not spending a nickel of capital.”
HCA is also adding operating rooms, emergency department capacity and service lines at its hospitals.
The company’s broader capital strategy is therefore running on two tracks: increasing hospital capacity where demand requires it while rapidly expanding access points outside the hospital.
“We use our capital spend for both,” Mr. Marks said. “For adding capacity as we need to, for doing the kind of normal routine maintenance-type capital and keeping our facilities competitive and then building out our network.”
HCA has been signaling that strategy for several years. In 2024, executives projected the system would eventually operate between 17 and 20 outpatient facilities per hospital, up from about 13 at the time. By early 2025, the average had climbed to about 14.
Now, 20 is becoming the clearer endpoint.
“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. When I think about our key strategic initiatives over the next five years, that’s still number one.”
