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Tenet Healthcare Corp.: Q4 FY2025 earnings call

What management said about Q4 FY2025, from the documents filed with the SEC on 11 February 2026: press release. Guidance figures: 36 new. The quarter’s numbers.

Key takeaways

  • Quarterly adjusted EPS rose 36.6%: Adjusted diluted EPS was $4.70 against $3.44. GAAP net income to common shareholders was $371 million, or $4.22 per diluted share, against $318 million, or $3.32. Source
  • Quarterly Adjusted EBITDA rose 12.9%: Adjusted EBITDA was $1.183 billion against $1.048 billion. Management tied the increase to same facility revenue growth, higher acuity and expense discipline. Source
  • Hospital profit rose on payer mix: Hospital Adjusted EBITDA was $603 million against $518 million, a 14.7% margin against 13.6%. Hospital revenue rose 7.3% to $4.094 billion. Source
  • Ambulatory same-facility revenue rose 7.2%: Cases rose 1.6% and revenue per case 5.5%, which management attributed to higher acuity and favorable payer mix. Full-year same-facility revenue growth was 7.5%. Source
  • Operating cash flow rose sharply: Free cash flow was $2.53 billion against $1.116 billion. Operating cash in 2024 included $855 million of income taxes paid on hospital sale gains. Source
  • CommonSpirit agreement on Conifer: CommonSpirit agreed to pay Tenet $1.9 billion in annual installments over three years under the January 27, 2026 agreement on Conifer. Source
  • Full-year 2026 ranges issued: Ranges were given for consolidated results and for each segment, covering revenue, Adjusted EBITDA, cash flow and volume changes. Source

“2025 extended Tenet’s track record of strong revenue growth, disciplined operations, improved margins and robust free cash flow generation”

Saum Sutaria, M.D., Chairman and Chief Executive Officer of Tenet

Guidance

AreaPeriodFigureAgainst last quarter
Net operating revenues (consolidated) SourceFY 2026$21,500 to $22,300 millionNew
Net income available to common shareholders SourceFY 2026$2,605 to $2,840 millionNew
Adjusted EBITDA (consolidated) SourceFY 2026$4,485 to $4,785 millionNew
Adjusted EBITDA margin SourceFY 202620.9% to 21.5%New
Diluted income per common share SourceFY 2026$29.60 to $32.27New
Adjusted net income SourceFY 2026$1,425 to $1,625 millionNew
Adjusted diluted earnings per share SourceFY 2026$16.19 to $18.47New
Equity in earnings of unconsolidated affiliates SourceFY 2026$265 to $275 millionNew
Depreciation and amortization SourceFY 2026$875 to $925 millionNew
Interest expense SourceFY 2026$800 to $810 millionNew
Income tax expense SourceFY 2026$985 to $1,060 millionNew
Net income available to noncontrolling interests SourceFY 2026$910 to $960 millionNew
Weighted average diluted common shares SourceFY 2026about 88 millionNew
Net cash provided by operating activities SourceFY 2026$3,640 to $4,090 millionNew
Adjusted net cash provided by operating activities SourceFY 2026$3,200 to $3,600 millionNew
Capital expenditures SourceFY 2026$700 to $800 millionNew
Free cash flow SourceFY 2026$2,940 to $3,290 millionNew
Adjusted free cash flow SourceFY 2026$2,500 to $2,800 millionNew
NCI cash distributions SourceFY 2026$900 to $970 millionNew
Revenue from CommonSpirit contract termination SourceFY 2026about $1.65 billionNew
Tax expense associated with the transaction SourceFY 2026about $500 millionNew
Tax payments associated with the transaction SourceFY 2026about $150 millionNew
Ambulatory net operating revenues SourceFY 2026$5,500 to $5,700 millionNew
Ambulatory Adjusted EBITDA SourceFY 2026$2,130 to $2,230 millionNew
Ambulatory NCI SourceFY 2026$865 to $895 millionNew
Ambulatory Adjusted EBITDA less NCI SourceFY 2026$1,265 to $1,335 millionNew
Ambulatory same-facility system-wide revenue change SourceFY 2026up 3.0% to 6.0%New
Hospital net operating revenues SourceFY 2026$16,000 to $16,600 millionNew
Hospital Adjusted EBITDA SourceFY 2026$2,355 to $2,555 millionNew
Hospital NCI SourceFY 2026$45 to $65 millionNew
Hospital inpatient admissions change SourceFY 2026up 1.0% to 2.0%New
Hospital adjusted admissions change SourceFY 2026up 1.0% to 2.0%New
Favorable revenue adjustment Sourcequarter ended March 31, 2026$40 millionNew
Other non-operating income, net (reconciliation) SourceFY 2026$150 million to $200 millionNew
Restructuring charges estimate (reconciliation) SourceFY 2026(100) low; (50) highNew
Cash received for contract termination SourceFY 2026$540 millionNew

What changed from last quarter

  • New guidance: First full-year 2026 ranges for consolidated revenue, earnings and cash flow are given in this release. The prior release gave only a 2025 Adjusted EBITDA estimate. Source
  • New: Accounting items not in the prior release: about $1.65 billion of termination revenue, about $500 million of tax expense and about $150 million of tax payments in 2026. Source

Results and growth drivers

  • Quarterly adjusted EPS rose 36.6%: Adjusted diluted EPS was $4.70 against $3.44. GAAP net income to common shareholders was $371 million, or $4.22 per diluted share, against $318 million, or $3.32. Source
  • Quarterly Adjusted EBITDA rose 12.9%: Adjusted EBITDA was $1.183 billion against $1.048 billion. Management tied the increase to same facility revenue growth, higher acuity and expense discipline. Source
  • 2024 net income included divestiture gain: Full-year 2025 net income to common shareholders was $1.407 billion, or $15.49 per diluted share, against $3.2 billion, or $32.70, in 2024. Source
  • Full-year revenue rose 3.1%: Net operating revenues were $21.31 billion against $20.675 billion. Full-year Adjusted EBITDA was $4.566 billion against $3.995 billion. Source

Segments and footprint

  • Ambulatory revenue rose 13.8% in Q4: Ambulatory Adjusted EBITDA was $580 million, up 9.4%, at a 40.5% margin against 42.1%. Source
  • Hospital profit rose on payer mix: Hospital Adjusted EBITDA was $603 million against $518 million, a 14.7% margin against 13.6%. Hospital revenue rose 7.3% to $4.094 billion. Source
  • Ambulatory network spans 37 states: USPI had interests in 533 ambulatory surgery centers, 401 consolidated, and 26 surgical hospitals, eight consolidated, at year-end. Full-year Ambulatory Adjusted EBITDA was $2.026 billion. Source

“We see continued demand for acute care and ambulatory surgical services in our markets and are confident in our ability to execute on our strategy”

Saum Sutaria, M.D., Chairman and Chief Executive Officer of Tenet

Volumes and revenue per case

  • Ambulatory same-facility revenue rose 7.2%: Cases rose 1.6% and revenue per case 5.5%, which management attributed to higher acuity and favorable payer mix. Full-year same-facility revenue growth was 7.5%. Source
  • Hospital admissions dipped in Q4: Admissions were down 0.7% in the quarter but up 1.7% for 2025. Adjusted admissions were flat in the quarter and up 1.2% for the year, while outpatient visits fell 3.0%. Source
  • Hospital revenue per admission grew: Same-hospital revenue per adjusted admission rose 7.5% in the quarter. Management linked it to payer mix, Medicaid supplemental revenues and a focus on higher acuity services. Source

Costs and margins

  • Labor cost ratio fell in 2025: Salaries, wages and benefits fell to 40.8% of revenue from 42.6%, and dollars declined 1.1%. Supplies rose 3.6% to $3.78 billion, or 17.7% of revenue. Source
  • Full-year margin improved: Adjusted EBITDA as a percentage of net operating revenues was 21.4% for 2025, against 19.3% for 2024. Source
  • Expense discipline cited in ambulatory: Management attributed the ambulatory Adjusted EBITDA increase to same-facility revenue growth, disciplined expense management and contributions from acquisitions. Source

Cash, capital and returns

  • Operating cash flow rose sharply: Free cash flow was $2.53 billion against $1.116 billion. Operating cash in 2024 included $855 million of income taxes paid on hospital sale gains. Source
  • Capital spending rose to $1.01 billion: Hospital segment capital spending was $886 million of the total, and Ambulatory was $124 million, against $931 million in 2024. Source
  • Buybacks stepped up in 2025: Fourth-quarter repurchases were 0.94 million shares for $198 million. Full-year 2025 repurchases compare with $672 million spent in 2024. Source
  • November 2025 notes refinanced older debt: The company issued $1.5 billion of 5.5% senior secured first lien notes due 2032 and $750 million of 6.0% notes due 2033. It redeemed $1.5 billion of 6.25% second lien notes and partially redeemed $750 million of 6.125% notes due 2028. Source
  • Leverage ratio eased in 2025: Net debt to Adjusted EBITDA was 2.25 times at year-end, against 2.54 times at December 31, 2024. Source

Conifer transaction terms

  • CommonSpirit agreement on Conifer: CommonSpirit agreed to pay Tenet $1.9 billion in annual installments over three years under the January 27, 2026 agreement on Conifer. Source
  • Conifer buys out CommonSpirit's equity: Conifer pays CommonSpirit $540 million to eliminate its capital account and redeem its 23.8% stake, retroactively effective January 1, 2026. Source
  • Balance sheet effects in Q1 2026: Redeemable noncontrolling interest and other liabilities would fall by about $885 million, and paid-in capital would rise by about $305 million. Source

2026 guidance ranges

  • Full-year 2026 ranges issued: Ranges were given for consolidated results and for each segment, covering revenue, Adjusted EBITDA, cash flow and volume changes. Source
  • Termination revenue excluded from revenue: Revenue recognized from the CommonSpirit contract termination is excluded from net operating revenues in the 2026 ranges and reconciled separately to adjusted measures. Source
  • Adjusted cash flow definition: Adjusted free cash flow does not deduct cash for purchases of businesses or joint ventures, debt repayments or distributions to noncontrolling interests. Source

Coming up, as management said on 11 February 2026

  • Conifer support through 2026: Conifer will keep serving CommonSpirit through 2026 on financial terms consistent with the prior contract. Source

Figures management reported

FigureReported
Ambulatory same-facility system-wide net patient service revenue growth Source7.2% (Q4 2025); 7.5% (FY 2025)
Ambulatory same-facility system-wide surgical cases Source1.6% (Q4 2025); 0.3% (FY 2025)
Same-hospital net patient service revenues Source$3,499 million (Q4 2025); $13,791 million (FY 2025)
Same-hospital admissions Source(0.7)% (Q4 2025); 1.7% (FY 2025)
Same-hospital outpatient visits Source(3.0)% (Q4 2025); (1.8)% (FY 2025)
Same-hospital emergency room visits and hospital surgeries SourceER visits (0.3)% Q4 and (1.4)% FY; surgeries 0.1% Q4 and (0.6)% FY

Risks management discussed

  • Financial: Impairment, acquisition-related and litigation items are excluded from the 2026 ranges because management does not believe it can forecast them with sufficient accuracy. Source

Earlier plans management reported on

  • Not stated: Sutaria said the company is confident in its ability to achieve full year 2026 expectations. Progress against them is not reported in the release. Source

Other quarters

Summarised with AI from the documents the company filed with the SEC. Every point is checked against the filing before it is shown: management’s own words word for word, figures against the line or table row they come from. A point that fails the check is left out. Source opens the filing at that line.