HCA Healthcare led in total net income, while Tenet Healthcare posted the highest operating margin among the nation’s largest for-profit health systems in the third quarter. Each system reported improvements in revenue and patient volumes, but their bottom lines varied as payer mix, acuity levels and expense trends shaped quarterly performance.
HCA, Tenet, Community Health Systems and Universal Health Services — the four largest for-profit hospital operators — each reported third-quarter gains as volumes improved, payer mix strengthened and cost control efforts took hold across much of the sector.
Here’s how their financial and operational metrics compare in the third quarter:
HCA Healthcare (Nashville, Tenn.)
HCA reported net income of $1.6 billion for the third quarter, up 29% from $1.3 billion in the same period last year. Its net margin rose to 8.6%, up from 7.3% in the third quarter of 2024.
Operating revenue grew 9.6% year over year to $19.2 billion, driven by increases in both inpatient and outpatient volumes. Same-facility admissions were up 2.1%, while equivalent admissions climbed 2.4%.
Revenue per equivalent admission rose 6.6% year over year, supported by favorable payer mix and higher acuity levels. Cash flow from operations totaled $4.4 billion, up from $3.5 billion a year ago.
Capital expenditures reached $1.3 billion in the third quarter, excluding acquisitions. HCA raised its full-year 2025 guidance, with revenue now expected between $75 billion and $76.5 billion and adjusted EBITDA projected between $15.25 billion and $15.65 billion.
As of Sept. 30, HCA held $997 million in cash and cash equivalents, $44.5 billion in total debt and $59.7 billion in total assets.
Community Health Systems (Franklin, Tenn.)
CHS swung to profitability in the third quarter, reporting net income of $130 million (4.2% margin) compared with a net loss of $391 million (-12.7% margin) during the same period in 2024.
Operating income reached $243 million (7.9% margin), compared with a $205 million loss (-6.6% margin) a year earlier, reflecting a sharp turnaround in performance. Net operating revenues were flat at $3.1 billion, but same-store revenue grew 6% year over year.
Adjusted EBITDA rose to $376 million from $347 million in 2024, aided by a $28 million legal settlement, higher reimbursement rates and favorable payer mix.
CHS has been working to deleverage its balance sheet, reducing long-term debt to $10.6 billion from $11.4 billion a year earlier. The system has divested seven hospitals this year and plans to sell four more. It also entered into a $195 million agreement with Labcorp to sell its outpatient lab assets across 13 states.
As of Sept. 30, CHS’ long-term debt was $10.6 billion and its total assets were $13.2 billion.
Tenet reported operating income of $889 million (16.8% margin) for the third quarter, down from $1.1 billion (21.2% margin) during the same period in 2024.
Third-quarter operating revenue rose 3.9% year over year to $5.3 billion. Net income declined to $342 million from $472 million a year earlier.
Expenses reflected mixed trends: salaries, wages and benefits decreased 0.6% year over year to $2.2 billion, while supply costs increased 5.7% to $931 million.
Tenet’s ambulatory segment — United Surgical Partners International — continued to outperform, with operating revenue up 11.9% to $1.3 billion. Same-facility surgical cases grew 2.1%, and net revenue per case rose 6.1%, driven by higher acuity and favorable payer mix.
As of Sept. 30, Tenet had $13.1 billion in long-term debt and $29.4 billion in total assets.
Universal Health Services (King of Prussia, Pa.)
UHS reported net income of $373 million (8.3% margin) in the third quarter, up from $258.7 million (6.5% margin) a year ago. Operating income increased 36% year over year to $522 million (11.6% margin).
Third quarter revenue grew 13.4% year over year to $4.5 billion, reflecting solid growth across both acute and behavioral health divisions.
Acute care services generated $338 million in operating income (13.9% margin) on $2.43 billion in same-facility revenue, while behavioral health contributed $350 million (19.3% margin) on $1.81 billion in revenue.
Same-facility adjusted admissions rose 2% year over year, and net revenue per adjusted admission increased nearly 10%. UHS raised its full-year 2025 guidance, projecting net revenue between $17.3 billion and $17.4 billion.
As of Sept. 30, UHS reported $15.3 billion in total assets and $4.7 billion in total debt.
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