Q1 splits the market: USPI adds facilities while HCA's outpatient surgeries slip
Tenet's ambulatory arm grew adjusted EBITDA 6.1% and added 10 facilities in the quarter; HCA's same-facility outpatient surgeries fell 1.7%.
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First-quarter earnings drew the sector’s dividing line in plain numbers: dedicated ambulatory platforms grew while hospital outpatient surgery shrank.
Tenet’s USPI segment posted $1.32 billion in revenue and $484 million in adjusted EBITDA, up 6.1%, at a 36.7% margin. Same-facility system-wide revenues rose 5.3% on net revenue per case up 5.6% — and same-facility ASC total joint cases grew 10.3%. USPI added ten facilities in the quarter, seven by acquisition and three de novo, against management’s stated baseline of about $250 million a year for M&A and development. The portfolio stood at 541 ASCs and 26 surgical hospitals at quarter-end.
HCA, by contrast, reported same-facility outpatient surgeries down 1.7% (inpatient surgeries down 0.3%) even as revenues grew to $19.1 billion on admissions up 0.9%.
Surgery Partners sat in between: revenues of $810.9 million, up 4.5%, same-facility revenue up 4.4% on revenue per case up 3.8%, with full-year guidance reaffirmed at $3.35–3.45 billion in revenue. The company ended take-private talks with Bain Capital in June 2025 and still trades well below the withdrawn $25.75 proposal.
The takeaway for operators: per-case economics are improving faster than case counts everywhere — and the volume that hospitals are losing is showing up in someone else’s ASC.