HCA Healthcare (HCA) Q4 2024 earnings summary

Executive summary

• Finished 2024 with strong business fundamentals, stable operations, and robust demand for healthcare services.

• Fourth quarter 2024 revenues reached $18.285 billion, up from $17.303 billion year-over-year.

• Net income for Q4 2024 was $1.438 billion ($5.63 per diluted share), impacted by $0.60 per share from hurricanes.

• Full-year 2024 revenues totaled $70.603 billion, with net income of $5.760 billion ($22.00 per diluted share).

• Board authorized a new $10B share repurchase program and increased quarterly dividend to $0.72/share.

Financial highlights

• Q4 adjusted diluted EPS increased 5.4% year-over-year, including a $0.60/share hurricane impact.

• Q4 2024 Adjusted EBITDA was $3.712 billion, up from $3.618 billion in Q4 2023.

• Full-year 2024 Adjusted EBITDA reached $13.882 billion, up from $12.726 billion in 2023.

• Q4 revenue grew approximately 6% year-over-year; same-facility inpatient admissions and equivalent admissions up 3%.

• Full-year 2024 revenue up 8.7%, adjusted EBITDA up 9%, and adjusted EPS up 15.5% year-over-year.

• Full-year hurricane impact estimated at $250M or $0.73/share.

• Supplemental payment programs provided a $400M net benefit in 2024, higher than expected due to one-time payments.

Outlook and guidance

• 2025 revenue guidance: $72.8B–$75.8B; net income: $5.85B–$6.29B; adjusted EBITDA: $14.3B–$15.1B.

• 2025 diluted EPS guidance: $24.05–$25.85; capital spending: $5B–$5.2B.

• Equivalent admissions expected to grow 3–4%; net revenue per equivalent admission to rise 2–3%.

• Full-year margins expected to be consistent with 2024; cash flow from operations projected at $10.75B–$11.25B.

• Medicaid supplemental payments in 2025 expected to be flat to a $250M headwind versus 2024.

• No material tailwind from hurricane recovery in 2025 as gains in Largo offset by lingering North Carolina impacts.

• Guidance assumes stable operating environment, ongoing hurricane impacts, and excludes gains/losses on facility sales.