The third quarter split the four largest publicly traded for-profit hospital operators down the middle. Tenet and HCA signaled stronger expectations for 2026, while Community Health Systems and Universal Health Services tempered theirs.
Here’s how each system’s 2026 outlook shifted after the third quarter:
HCA Healthcare (Nashville, Tenn.)
HCA left its 2026 guidance ranges unchanged but now expects full-year results to land in the upper half of the outlook it issued July 14. That outlook calls for revenue of $77 billion to $79.5 billion and adjusted EBITDA of $15.4 billion to $16.1 billion.
The 189-hospital system held its position despite a payer mix shift tied to patients who lost coverage on the health insurance exchanges. HCA estimated the shift, driven by an increase in uninsured volume, reduced third-quarter pretax income by about $400 million.
Third-quarter revenue rose 3.6% year over year to $19.8 billion, and adjusted EBITDA rose 1.2% to $3.9 billion. Same-facility admissions grew 2.7% and equivalent admissions grew 3%. The system also cited improved cost results and a modest increase in the net benefit from Medicaid supplemental payment programs.
“We believe HCA Healthcare is positioned to end the year positively,” CEO Sam Hazen said.
Tenet raised its 2026 adjusted EBITDA guidance for the second straight quarter, to $5.05 billion to $5.2 billion. That’s a $195 million increase at the midpoint from its prior range of $4.83 billion to $5.03 billion.
The health system narrowed its revenue guidance to $22.05 billion to $22.45 billion, from $21.9 billion to $22.5 billion. It now expects net income available to common shareholders of $2.97 billion to $3.08 billion, and raised its adjusted free cash flow outlook by $100 million at the midpoint to $2.83 billion to $3.13 billion. The outlook excludes contract termination revenue tied to the early end of Conifer’s agreement with CommonSpirit Health.
Third-quarter adjusted EBITDA rose 23.3% year over year to $1.36 billion. Ambulatory segment revenue grew 7.5% to $1.4 billion, and hospital segment revenue grew 6.1% to $4.3 billion, though Tenet cited an unfavorable payer mix due to lower exchange admissions.
Tenet’s outperformance in the third quarter “was driven by sustained strength in same-store revenue growth” and effective expense management, CEO Saum Sutaria, MD, said.
Community Health Systems (Franklin, Tenn.)
CHS cut its 2026 guidance for the second consecutive quarter. The health system now expects revenue of $11.3 billion to $11.5 billion, down from $11.4 billion to $11.6 billion, and adjusted EBITDA of $1.225 billion to $1.275 billion, down from $1.3 billion to $1.375 billion. It projects a net loss of $1.60 to $1.70 per diluted share.
Third-quarter revenue fell 10.7% year over year to $2.76 billion as divestitures continued to reshape the portfolio, and adjusted EBITDA fell 25.5% to $280 million. Same-store revenue rose 3.8%, same-store admissions rose 2.2% and same-store adjusted admissions rose 3.6%. CHS posted an $86 million net loss attributable to stockholders, compared with $130 million in net income a year earlier.
“While volume trends and cash flow improved sequentially in the third quarter, payor mix and acuity did not develop as expected due to the challenging macro environment, negatively impacting financial results for the third quarter and our expectations for the remainder of the year,” CEO Kevin Hammons.
Universal Health Services (King of Prussia, Pa.)
UHS reiterated the 2026 forecast ranges it issued in July but said it now expects results toward the lower end. The July outlook called for net revenue of $18.501 billion to $18.762 billion and adjusted EBITDA of $2.61 billion to $2.717 billion.
The outlook reflects year-to-date trends and the ongoing ramp of acute care hospitals in Washington, D.C., and Palm Beach Gardens, Fla., CFO Steve Filton said during the system’s Oct. 28 earnings call. Third-quarter adjusted EBITDA came in “below our internal expectations” due to a slower-than-expected ramp at de novo hospitals and softer surgical trends, Mr. Filton said.
Third-quarter net revenue rose 5.3% year over year to $4.73 billion, while adjusted EBITDA net of noncontrolling interests fell to $624.6 million from $670.6 million. Same-facility acute care adjusted admissions rose 4.9% and behavioral health adjusted admissions rose 2.5%. UHS completed its $835 million acquisition of virtual behavioral health company Talkspace in August and plans to detail expected synergies with its 2027 guidance in February.
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