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HCA ramps up Texas M&A

In the last two months, HCA Healthcare has scooped up multiple hospitals, freestanding emergency departments and surgery centers in Texas. 

A string of acquisitions came shortly after the third-quarter earnings call, when Nashville, Tenn.-based HCA outlined its multibillion-dollar plan to expand its emergency and high-acuity service lines and grow its healthcare services market share to 29% by 2030, up from its current market share of 27%.

In December, HCA's Medical City Healthcare in Dallas acquired Wise Health, a three-hospital system. The transaction makes Medical City a 19-hospital system, with Wise's facilities rebranding as Medical City Decatur, Medical City Argyle and Medical City Surgical Hospital | Alliance in Fort Worth. 

The for-profit hospital operator is also buying bankrupt Trinity Regional Hospital Sachse for $41 million in a deal that is expected to close by the end of the month. The 32-bed hospital opened in November 2021 but defaulted on about $70 million of municipal bonds that were issued in 2020. Trinity Regional Hospital Sachse's owner listed assets of $50 million to $100 million and liabilities of $100 million to $500 million on the bankruptcy petition.

HCA's most recent transaction was announced Jan. 22, when its subsidiary Surgery Ventures acquired majority stakes in two ambulatory surgery centers in North Texas. Both of the ASCs are affiliated with Medical City, which is now affiliated with 15 surgery centers in North Texas, HCA said in a Jan. 22 news release.

The health system also closed 2023 with its subsidiary HCA Houston Healthcare completing the acquisition of 11 Houston-area freestanding emergency departments from SignatureCare Emergency Center.

With the deal, HCA Houston now has 26 freestanding EDs, in addition to its hospital-based EDs, according to the health system. The move follows HCA's strategy in recent years to develop or acquire urgent care facilities as care continues to move toward outpatient settings where there is an emphasis on lower costs, higher quality and more convenience for patients. 

Health systems also understand that urgent care is not going away and many are acquiring or partnering with urgent care groups to reduce market competition and act as a funnel for their specialty care services. 

With this in mind, HCA completed the acquisition of 41 Texas urgent care centers from FastMed last summer. The deal includes 19 FastMed and 22 MedPost urgent care centers in several of Texas' major cities, including Dallas and Austin.

HCA now operates about 2,300 outpatient sites — 268 of which are urgent care facilities — and more than 180 hospitals. Forty-eight of those hospitals and 92 of those urgent care centers are in Texas, according to its website.

The health system has significantly ramped up its acquisitions in the Texas market over the last year and is also investing $5.3 billion into already approved projects nationwide to help boost its healthcare services market share. HCA has about 62 approved outpatient projects to build freestanding EDs and ASCs, totaling $1 billion, and has an additional 200 projects under consideration, executives said in the company's third-quarter earnings call. 

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