Image by Sasin Tipchai from PixabayHCA Healthcare Inc. (NYSE: HCA) executives are satisfied with the performance of their ambulatory surgery centers (ASCs) despite a slight decline in surgery volume.
Outpatient surgery volume for HCA dipped 1.7% in the first quarter of 2026 compared to the prior-year period, CFO William Rutherford said during HCA’s April 24 earnings call. That breaks down to a 2.1% decline in hospital-based outpatient surgeries and 1% in ASCs.
“On the hospital side, we saw a little bit of weakness in our ortho-related cases,” Rutherford said. “On the ASC side, it was really more of the low-acuity service lines like ophthalmology and ENT [ear, nose and throat] that drove the statistical decline.”
Still, he added: “I would say we were pleased with our revenue performance in our ASCs, for sure.”
One potential explanation for the patient-volume dip was a January winter storm that affected key HCA markets including Texas, Tennessee, North Carolina and Virginia, CEO Sam Hazen explained.
“When you think about the storm, it affects, obviously, the emergency room and our outpatient surgery and our imaging, all three categories,” Hazen said.
Outpatient surgeries make up roughly one-third of the Tennessee-based health system’s overall outpatient revenue, with emergency departments and imaging comprising another third each, he noted.
Putting such temporary headwinds aside, HCA’s CEO echoed remarks from other publicly traded health systems by touting the company’s investments in outpatient care assets.
“We continue to invest significantly in network development with our capital spending and with selective outpatient facility acquisitions,” Hazen said during his prepared remarks.
Hazen later added that HCA saw “a number of outpatient acquisitions” close in the first quarter.
“Those were primarily related to opportunities in urgent care, in ambulatory surgery and in our freestanding emergency room business unit,” Hazen said.
An example of HCA’s recent investments into urgent care specifically include MD Now’s purchase of Avecina Medical, which operates 18 urgent care centers in Jacksonville and Central Florida. Financial terms of the deal were not disclosed.
Looking ahead, HCA continues to believe that the outpatient area is where most M&A activity will take place, with the goal of complementing its hospital networks, Hazen continued.
“Our pipeline has a number of promising projects in it, and I’m hopeful that we’ll get to close those as we push into the balance of the year,” he said.
Overall in the quarter, HCA’s revenues increased 4.3% compared to the prior-year period, reaching $19.1 billion. The company’s adjusted earnings before interest, taxes, depreciation and amortization (EBITDA) increased 1.9% year over year to $3.8 billion, and its cash flows from operating activities increased 22% percent to $2 billion.
Hazen said that the first quarter “presented a dynamic environment” for HCA, with lower-than-usual respiratory disease admissions and the January storm putting pressure on patient volume.
Still, a greater-than-anticipated net benefit from state-based supplemental payment programs – which help bridge the gap between low Medicaid reimbursement rates and the actual cost of care – mostly offset the impact from the volume shortfall, he said.
HCA reaffirmed its 2026 guidance, which is adjusted earnings per share of $29.10 to $31.50 and revenues of $76.5 billion to $80 billion.
As of March 31, HCA operated 189 hospitals and about 2,600 ambulatory sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics, in 19 states plus the U.K.
The company’s financial release for Q1 2026 noted HCA now has 119 freestanding outpatient surgery centers, six fewer than Q1 2025.
