Elective surgical demand softened at the four major publicly traded for-profit health systems in the third quarter of 2026 even as patient volumes grew, with executives pointing to ACA exchange coverage losses and rising out-of-pocket costs.
“I would not say this is a gangbusters surgical environment right now,” Tenet Chairman and CEO Saum Sutaria, MD, said on the Dallas-based system’s Oct. 29 earnings call.
At Nashville, Tenn.-based HCA Healthcare, same-facility inpatient surgeries fell 1.4% year over year, and outpatient surgeries fell 3.7%, even as equivalent admissions rose 3% and ER visits rose 5.1%. Surgeries at its ASCs dropped 5.4%.
HCA CEO Sam Hazen said on the system’s Oct. 27 earnings call that coverage is the primary force weighing on elective care, followed by general affordability. HCA’s exchange equivalent admissions fell about 19%, and those patients are shifting almost one for one to uninsured.
Medicare also weighed on HCA’s surgical volumes. CFO Mike Marks said it was the second-largest driver of the system’s elective weakness, particularly on the inpatient side, due in part to the first year of Medicare’s three-year phase-out of the inpatient-only list. So far, the phase-out has focused on orthopedic and musculoskeletal procedures.
King of Prussia, Pa.-based Universal Health Services saw a similar pattern. Same-facility acute care surgeries fell 0.7% while adjusted admissions rose 4.9%, and its patient mix shifted toward medical cases, which weighed on pricing.
“Inpatient medical admissions significantly outpaced surgical admissions, which negatively skewed pricing trends in the quarter,” UHS CFO Steve Filton said on the system’s Oct. 28 earnings call.
Franklin, Tenn.-based Community Health Systems did see surgical volume growth, with same-store surgeries up 2%. But CFO Jason Johnson said on the system’s Oct. 29 earnings call that “demand in commercial elective procedures remained below expectations.” CEO Kevin
Hammons pointed to affordability. He said copays and deductibles keep rising while higher prices for gas, groceries, insurance and rent squeeze patients’ ability to pay them. Patients who haven’t met their deductibles by October may wait until the new plan year, he said.
However, Mr. Hammons said the care is being delayed, not lost. Clinic visits rose 7.9%, and orthopedic MRIs are outpacing the prior year, though those visits “are not translating into the higher acuity procedure at the same rate as we have seen in the past.”
“Ultimately, we think that it comes back into the system, because when you need a joint replacement, it is not going to heal on its own,” he said.
Tenet’s results show where some of that surgical volume is going. Total joint replacements at United Surgical Partners International, its ASC business, grew 12.8% year over year, which Dr. Sutaria attributed in part to cases moving from hospital outpatient departments to freestanding surgery centers. USPI’s overall same-facility case volume fell 1.5%, but net revenue per case rose 6.1% as the company focuses on higher-acuity procedures.
Whether the backlog returns in 2027 remains an open question. Mr. Johnson said it is reasonable to expect some deferred procedures to come back next year. HCA expects 2% to 3% volume growth in 2027 but has not yet projected surgical volume. Mr. Hazen said the company first wants to see how fourth-quarter seasonality plays out.
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
