HCA Healthcare (NYSE: HCA) is doubling down on outpatient care as a core growth engine, even as ambulatory surgery center (ASC) volumes softened modestly at the end of 2025, executives said on the company’s fourth-quarter earnings call on Jan. 27.
Leadership emphasized that outpatient revenue continued to grow faster than inpatient care, supported by ongoing investment in ASC development, technology and network expansion. The strategy, executives said, is designed to strengthen access, improve payer alignment and build long-term resiliency across HCA’s markets.
“When we look at overall revenue production of the company, … our outpatient revenue as a percent of total was actually up on a year-over-year basis,” CEO Sam Hazen said on the call.
HCA leaders also signaled that outpatient expansion could accelerate further as the company sees increased acquisition opportunities in the space.
HCA’s total revenue for Q4 2025 totaled $19.51 billion, a nearly 7% increase compared to $18.29 billion during the same period a year ago. For the full year 2025, HCA’s revenue totaled $75.6 billion, again a roughly 7% increase compared to $70.6 billion in 2024.
Beyond these top-line benchmarks, the call shed light on how outpatient care — including ASCs — fits into HCA’s broader operating and capital strategy.
Outpatient surgery volumes decline, but revenue holds steady
Year-over-year comparison reveals HCA’s outpatient surgery volumes declined modestly in the fourth quarter.
“Our same-facility cases were down about 50 basis points in the fourth quarter over the prior year, with hospitals being about flat and ASCs down about 1.5%,” CFO Mike Marks said on the call.
Despite the lower procedure volumes, outpatient surgery revenue and earnings remained solid, supported by pricing, case mix and broader outpatient activity across the system.
“So as a result, we had good growth in net revenue and earnings in our outpatient surgery business overall, inclusive of both the hospitals and the ambulatory surgery center platform,” Marks said.
Executives attributed the volume dip in part to pressure from Medicaid. Case mix also played a role.
“In addition to the payer mix environment, we saw a decline in lower intensity cases like ENT,” Marks said.
More broadly, HCA reported solid growth across all major outpatient categories, including emergency services, ambulatory platforms such as physician clinics and urgent care, and hospital-based outpatient services like cardiology and diagnostics. Outpatient revenue growth exceeded inpatient growth during the quarter, reinforcing the segment’s strategic importance, executives said.
HCA saw a total number of outpatient surgery cases for Q4 2025 of 264,401, a slight uptick compared to 263,832 in the same period a year ago. For the year, HCA performed more than 1.02 million outpatient surgery cases, on par with the previous year’s totals.
‘We continue to invest significantly’
The Nashville, Tennessee-based HCA continued to expand its outpatient footprint throughout 2025 and expects that momentum to carry into the next several years.
“We continue to invest significantly in outpatient facility development. Just this past year, we added roughly 100 business units to our outpatient footprint across the company,” Hazen said.
Overall, the company has approximately 2,700 outpatient facilities, Hazen said. It had 121 outpatient surgery centers at the end of 2025, compared to 124 at the end of 2024, according to the company.
Looking ahead, outpatient development is a priority even as inpatient investments continue.
“We find ourselves heading into 2026 and 2027 with significant capital in the pipeline that’s geared toward, yes, some inpatient capacity and inpatient capabilities, but also quite a bit of outpatient development,” Hazen said.
Outpatient sites such as ASCs offer levels of convenience and cost savings that make them preferable for both patients and payers, leaders said.
As Hazen put it, the goal is “creating an environment where patients have easier access into the HCA Healthcare system, and our payers actually have better price points for their members,” Hazen said.
In addition to organic growth, HCA sees significant opportunity in outpatient acquisitions that complement existing hospital markets.
“We have seen some acceleration in the outpatient space, and our pipeline through acquisitions is a little greater than it’s been in past years,” Hazen said.
The role of AI
HCA leaders also highlighted technology, data and automation as key enablers improving throughput and controlling costs.
Potential benefits include improved scheduling, staffing and overall efficiency across ORs.
“We are leveraging three primary capabilities in driving our financial resiliency program,” Marks said. “First, internal and external benchmarking and advanced analytics; second, digital transformation with AI and automation; and third, expanding and leveraging our shared service platforms.”
