TENET HEALTHCARE CORP, 10-K filed on 2/16/2024
Annual Report
v3.24.0.1
Cover Page - USD ($)
shares in Thousands, $ in Billions
 12 Months Ended
Dec. 31, 2023
Jan. 31, 2024
Jun. 30, 2023
Entity Information [Line Items]      
Document Type 10-K    
Document Annual Report true    
Document Period End Date Dec. 31, 2023    
Current Fiscal Year End Date --12-31    
Document Transition Report false    
Entity File Number 1-7293    
Entity Registrant Name TENET HEALTHCARE CORP    
Entity Incorporation, State or Country Code NV    
Entity Tax Identification Number 95-2557091    
Entity Address, Address Line One 14201 Dallas Parkway    
Entity Address, City or Town Dallas    
Entity Address, State or Province TX    
Entity Address, Postal Zip Code 75254    
City Area Code 469    
Local Phone Number 893-2200    
Entity Well-known Seasoned Issuer Yes    
Entity Voluntary Filers No    
Entity Current Reporting Status Yes    
Entity Interactive Data Current Yes    
Entity Filer Category Large Accelerated Filer    
Entity Small Business false    
Entity Emerging Growth Company false    
ICFR Auditor Attestation Flag true    
Document Financial Statement Error Correction false    
Entity Shell Company false    
Entity Public Float     $ 6.4
Entity Common Stock, Shares Outstanding   99,995  
Documents Incorporated by Reference
Portions of the Registrant’s definitive proxy statement for the 2024 annual meeting of shareholders are incorporated by reference into Part III of this Form 10-K.
    
Entity Central Index Key 0000070318    
Amendment Flag false    
Document Fiscal Year Focus 2023    
Document Fiscal Period Focus FY    
Common Stock | New York Stock Exchange      
Entity Information [Line Items]      
Title of 12(b) Security Common stock, $0.05 par value    
Trading Symbol THC    
Security Exchange Name NYSE    
6.875% Senior Notes due 2031 | New York Stock Exchange      
Entity Information [Line Items]      
Title of 12(b) Security 6.875% Senior Notes due 2031    
Trading Symbol THC31    
Security Exchange Name NYSE    
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Audit Information
 12 Months Ended
Dec. 31, 2023
Audit Information [Abstract]  
Auditor Name DELOITTE & TOUCHE LLP
Auditor Location Dallas, Texas
Auditor Firm ID 34
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CONSOLIDATED BALANCE SHEETS - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Current assets:    
Cash and cash equivalents $ 1,228 $ 858
Accounts receivable 2,914 2,943
Inventories of supplies, at cost 411 405
Assets held for sale 775 0
Other current assets 1,839 1,775
Total current assets  7,167 5,981
Investments and other assets 3,157 3,147
Deferred income taxes 77 19
Property and equipment, at cost, less accumulated depreciation and amortization ($6,478 at December 31, 2023 and $6,201 at December 31, 2022) 6,236 6,462
Goodwill 10,307 10,123
Other intangible assets, at cost, less accumulated amortization ($1,447 at December 31, 2023 and $1,428 at December 31, 2022) 1,368 1,424
Total assets  28,312 27,156
Current liabilities:    
Current portion of long-term debt 120 145
Accounts payable 1,408 1,504
Accrued compensation and benefits 930 778
Professional and general liability reserves 254 255
Accrued interest payable 200 213
Liabilities held for sale 69 0
Other current liabilities 1,779 1,581
Total current liabilities  4,760 4,476
Long-term debt, net of current portion 14,882 14,934
Professional and general liability reserves 792 790
Defined benefit plan obligations 335 331
Deferred income taxes 326 217
Other long-term liabilities 1,709 1,800
Total liabilities  22,804 22,548
Commitments and contingencies
Redeemable noncontrolling interests in equity of consolidated subsidiaries 2,391 2,149
Shareholders’ equity:    
Common stock, $0.05 par value; authorized 262,500 shares; 157,271 shares issued at December 31, 2023 and 156,462 shares issued at December 31, 2022 8 8
Additional paid-in capital 4,834 4,778
Accumulated other comprehensive loss (181) (181)
Accumulated deficit (192) (803)
Common stock in treasury, at cost, 57,321 shares at December 31, 2023 and 54,215 shares at December 31, 2022 (2,861) (2,660)
Total shareholders’ equity 1,608 1,142
Noncontrolling interests  1,509 1,317
Total equity  3,117 2,459
Total liabilities and equity  $ 28,312 $ 27,156
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CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($)
shares in Thousands, $ in Millions
Dec. 31, 2023
Dec. 31, 2022
Statement of Financial Position [Abstract]    
Property and equipment, accumulated depreciation and amortization $ 6,478 $ 6,201
Other intangible assets, accumulated amortization $ 1,447 $ 1,428
Common stock, par value (in dollars per share) $ 0.05 $ 0.05
Common stock, number of shares authorized (in shares) 262,500 262,500
Common stock, number of shares issued (in shares) 157,271 156,462
Common stock, number of shares held in treasury (in shares) 57,321 54,215
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CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($)
shares in Thousands, $ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Statement [Abstract]      
Net operating revenues  $ 20,548 $ 19,174 $ 19,485
Grant income 16 194 191
Equity in earnings of unconsolidated affiliates 228 216 218
Operating expenses:      
Salaries, wages and benefits 9,146 8,844 8,878
Supplies 3,590 3,273 3,328
Other operating expenses, net 4,515 3,998 4,206
Depreciation and amortization 870 841 855
Impairment and restructuring charges, and acquisition-related costs 137 226 85
Litigation and investigation costs 47 70 116
Net gains on sales, consolidation and deconsolidation of facilities (23) (1) (445)
Operating income 2,510 2,333 2,871
Interest expense (901) (890) (923)
Other non-operating income, net 19 10 14
Loss from early extinguishment of debt (11) (109) (74)
Income from continuing operations, before income taxes 1,617 1,344 1,888
Income tax expense (306) (344) (411)
Income from continuing operations, before discontinued operations 1,311 1,000 1,477
Discontinued operations:      
Income (loss) from operations 0 1 (1)
Income (loss) from discontinued operations, net of tax 0 1 (1)
Net income 1,311 1,001 1,476
Less: Net income available to noncontrolling interests 700 590 562
Net income available to Tenet Healthcare Corporation common shareholders 611 411 914
Amounts available to Tenet Healthcare Corporation common shareholders:      
Income from continuing operations, net of tax 611 410 915
Income (loss) from discontinued operations, net of tax 0 1 (1)
Net income available to Tenet Healthcare Corporation common shareholders $ 611 $ 411 $ 914
Basic      
Continuing operations (in dollars per share) $ 6.01 $ 3.83 $ 8.56
Discontinued operations (in dollars per share) 0 0.01 (0.01)
Total earnings (loss) per share, Basic (in dollars per share) 6.01 3.84 8.55
Diluted      
Continuing operations (in dollars per share) 5.71 3.78 8.43
Discontinued operations (in dollars per share) 0 0.01 (0.01)
Total earnings (loss) per share, Diluted (in dollars per share) $ 5.71 $ 3.79 $ 8.42
Weighted average shares and dilutive securities outstanding (in thousands):      
Basic (in shares) 101,639 106,929 106,833
Diluted (in shares) 104,800 110,516 108,571
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CONSOLIDATED STATEMENTS OF OTHER COMPREHENSIVE INCOME - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Statement of Comprehensive Income [Abstract]      
Net income $ 1,311 $ 1,001 $ 1,476
Other comprehensive income:      
Adjustments for defined benefit plans (9) 63 50
Amortization of net actuarial loss included in other non-operating income, net 7 9 11
Unrealized gain (loss) on debt securities held as available-for-sale 2 (4) 0
Foreign currency translation adjustments and other 0 1 1
Other comprehensive income before income taxes 0 69 62
Income tax expense related to items of other comprehensive income 0 (17) (14)
Total other comprehensive income, net of tax 0 52 48
Comprehensive net income 1,311 1,053 1,524
Less: Comprehensive income available to noncontrolling interests 700 590 562
Comprehensive income available to Tenet Healthcare Corporation common shareholders $ 611 $ 463 $ 962
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CONSOLIDATED STATEMENTS OF CHANGES IN EQUITY - USD ($)
shares in Thousands, $ in Millions
Total
Common Stock
Additional Paid-in Capital
Accumulated Other Comprehensive Loss
Accumulated Deficit
Treasury Stock
Noncontrolling Interests
Beginning balance (in shares) at Dec. 31, 2020   106,070          
Beginning balance at Dec. 31, 2020 $ 937 $ 7 $ 4,844 $ (281) $ (2,128) $ (2,414) $ 909
Changes in Shareholders' Equity              
Net income 1,140       914   226
Distributions paid to noncontrolling interests (206)           (206)
Other comprehensive income 48     48      
Accretion of redeemable noncontrolling interests (11)   (11)        
Purchases of businesses and noncontrolling interests, net 97   0       97
Stock-based compensation expense, tax benefit and issuance of common stock (in shares)   1,119          
Stock-based compensation expense, tax benefit and issuance of common stock 49 $ 1 44     4  
Ending balance (in shares) at Dec. 31, 2021   107,189          
Ending balance at Dec. 31, 2021 2,054 $ 8 4,877 (233) (1,214) (2,410) 1,026
Changes in Shareholders' Equity              
Net income 653       411   242
Distributions paid to noncontrolling interests (229)           (229)
Other comprehensive income 52     52      
Accretion of redeemable noncontrolling interests (104)   (104)        
Purchases of businesses and noncontrolling interests, net 244   (34)       278
Repurchases of common stock (in shares)   (5,889)          
Repurchases of common stock (250)         (250)  
Stock-based compensation expense, tax benefit and issuance of common stock (in shares)   947          
Stock-based compensation expense, tax benefit and issuance of common stock 39 $ 0 39     0  
Ending balance (in shares) at Dec. 31, 2022   102,247          
Ending balance at Dec. 31, 2022 2,459 $ 8 4,778 (181) (803) (2,660) 1,317
Changes in Shareholders' Equity              
Net income 945       611   334
Distributions paid to noncontrolling interests (289)           (289)
Other comprehensive income 0            
Purchases of businesses and noncontrolling interests, net 152   5       147
Repurchases of common stock (in shares)   (3,112)          
Repurchases of common stock (201)         (201)  
Stock-based compensation expense, tax benefit and issuance of common stock (in shares)   815          
Stock-based compensation expense, tax benefit and issuance of common stock 51   51        
Ending balance (in shares) at Dec. 31, 2023   99,950          
Ending balance at Dec. 31, 2023 $ 3,117 $ 8 $ 4,834 $ (181) $ (192) $ (2,861) $ 1,509
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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Statement of Cash Flows [Abstract]      
Net income $ 1,311 $ 1,001 $ 1,476
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 870 841 855
Deferred income tax expense 52 209 250
Stock-based compensation expense 66 56 56
Impairment and restructuring charges, and acquisition-related costs 137 226 85
Litigation and investigation costs 47 70 116
Net gains on sales, consolidation and deconsolidation of facilities (23) (1) (445)
Loss from early extinguishment of debt 11 109 74
Equity in earnings of unconsolidated affiliates, net of distributions received (13) 2 (10)
Amortization of debt discount and debt issuance costs 32 33 33
Pre-tax loss (income) from discontinued operations 0 (1) 1
Net gains from the sale of investments and long-lived assets (29) (117) (23)
Other items, net (4) 13 (10)
Changes in cash from operating assets and liabilities:      
Accounts receivable (29) (140) (197)
Inventories and other current assets (139) (64) (52)
Income taxes 10 (26) 68
Accounts payable, accrued expenses, contract liabilities and other current liabilities 215 (898) (584)
Other long-term liabilities 14 (15) 28
Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements (154) (214) (153)
Net cash used in operating activities from discontinued operations, excluding income taxes 0 (1) 0
Net cash provided by operating activities 2,374 1,083 1,568
Cash flows from investing activities:      
Purchases of property and equipment (751) (762) (658)
Purchases of businesses or joint venture interests, net of cash acquired (224) (234) (1,220)
Proceeds from sales of facilities and other assets 71 210 1,248
Proceeds from sales of marketable securities and long-term investments 50 76 31
Purchases of marketable securities and equity investments (104) (92) (108)
Other items, net (11) (6) (7)
Net cash used in investing activities (969) (808) (714)
Cash flows from financing activities:      
Repayments of borrowings (1,542) (2,851) (3,221)
Proceeds from borrowings 1,370 2,023 2,872
Repurchases of common stock (200) (250) 0
Debt issuance costs (16) (24) (31)
Distributions paid to noncontrolling interests (594) (560) (423)
Proceeds from the sale of noncontrolling interests 43 27 25
Purchases of noncontrolling interests (167) (100) (27)
Medicare advances and grants received by unconsolidated affiliates, net of recoupment 0 0 (67)
Other items, net 71 (46) (64)
Net cash used in financing activities (1,035) (1,781) (936)
Net increase (decrease) in cash and cash equivalents 370 (1,506) (82)
Cash and cash equivalents at beginning of period 858 2,364 2,446
Cash and cash equivalents at end of period 1,228 858 2,364
Supplemental disclosures:      
Interest paid, net of capitalized interest (882) (848) (937)
Income tax payments, net $ (243) $ (161) $ (92)
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SIGNIFICANT ACCOUNTING POLICIES
 12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
SIGNIFICANT ACCOUNTING POLICIES SIGNIFICANT ACCOUNTING POLICIES
Description of Business
Tenet Healthcare Corporation (together with our subsidiaries, referred to herein as “Tenet,” “we” or “us”) is a diversified healthcare services company headquartered in Dallas, Texas. At December 31, 2022, our business was organized into three separate reporting segments: Hospital Operations and other, Ambulatory Care and Conifer. During the three months ended December 31, 2023, we combined our Hospital Operations and other and Conifer segments into a single reporting segment named Hospital Operations and Services (“Hospital Operations”). The results of the revenue cycle management and value-based care services we provide to hospitals, health systems, physician practices, employers and other clients previously reported under our Conifer segment are now combined with our Hospital Operations segment. See below for additional discussion of this change.
Our expansive, nationwide care delivery network now consists of our Hospital Operations and Ambulatory Care segments. As of December 31, 2023, our Hospital Operations segment was comprised of our 61 acute care and specialty hospitals, a network of employed physicians and 164 outpatient facilities, including imaging centers, urgent care centers (each, a “UCC”), ancillary emergency facilities and micro‑hospitals. Our Ambulatory Care segment is comprised of the operations of our subsidiary USPI Holding Company, Inc. (“USPI”), which held indirect ownership interests in 461 ambulatory surgery centers and 24 surgical hospitals at December 31, 2023. USPI held noncontrolling interests in 155 of these facilities, which are recorded using the equity method of accounting. Effective June 30, 2022, we purchased all of the shares in USPI that Baylor University Medical Center (“Baylor”) held on that date for $406 million, which increased our ownership interest in USPI’s voting shares from 95% to 100% (see Note 13 for additional information about this transaction). In addition, we operate a Global Business Center (“GBC”) in Manila, Philippines.
Basis of Presentation
Our Consolidated Financial Statements include the accounts of Tenet and its wholly owned and majority‑owned subsidiaries. We eliminate intercompany accounts and transactions in consolidation, and we include the results of operations of businesses that are newly acquired in purchase transactions from their dates of acquisition. We account for significant investments in other affiliated companies using the equity method. We also utilize the equity method when we have the ability to exercise significant influence over the affiliated company, despite not holding a significant percentage of its ownership interest. Unless otherwise indicated, all financial and statistical data included in these notes to our Consolidated Financial Statements relate to our continuing operations, with dollar amounts expressed in millions (except per‑share amounts) and share amounts expressed in thousands.
We adopted the Financial Accounting Standards Board’s (“FASB”) Accounting Standards Update (“ASU”) 2020-06, “Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity” (“ASU 2020-06”), effective as of January 1, 2022 using the modified retrospective method. Among other amendments, ASU 2020-06 changed the accounting for diluted earnings‑per‑share for convertible instruments and contracts that may be settled in cash or stock. ASU 2020-06 eliminated an entity’s ability to rebut the presumption of share settlement for convertible instruments and contracts that can be partially or fully settled in cash at the issuer’s election. Additionally, ASU 2020-06 requires that the if‑converted method, which is more dilutive than the treasury stock method, be used for all convertible instruments. As a result of our adoption of ASU 2020-06, diluted weighted average shares outstanding increased by approximately 2,364 thousand shares and 2,673 thousand shares for the years ended December 31, 2023 and 2022, respectively, and diluted earnings per share available to Tenet common shareholders decreased by $0.26 and $0.01, respectively, for these same periods.
Changes to prior-year presentation—At December 31, 2022, our business was organized into three separate reporting segments: Hospital Operations and other, Ambulatory Care and Conifer. During the three months ended December 31, 2023, we combined our Hospital Operations and other and Conifer segments into a single reporting segment named Hospital Operations and Services (Hospital Operations). This change was made to reflect recent updates to the organizational and management structure of our Conifer and Hospital Operations and other segments. All prior‑period data presented in this report has been adjusted to conform to our new reporting segment structure.
As of December 31, 2023, our business was organized into two reporting segments:
•our Hospital Operations segment, which includes (1) our acute care and specialty hospitals, physician practices, imaging centers, UCCs, ancillary emergency facilities and micro‑hospitals, and (2) the revenue cycle management and value‑based care services we provide to hospitals, health systems, physician practices, employers and other clients through our Conifer Health Solutions, LLC joint venture; and
•our Ambulatory Care segment, which is comprised of the ambulatory surgery center and surgical hospital operations of our subsidiary USPI Holding Company, Inc.
Use of Estimates
The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America (“GAAP”) requires us to make estimates and assumptions that affect the amounts reported in our Consolidated Financial Statements and these accompanying notes. We regularly evaluate the accounting policies and estimates we use. In general, we base the estimates on historical experience and on assumptions that we believe to be reasonable given the particular circumstances in which we operate. Although we believe all adjustments considered necessary for a fair presentation have been included, actual results may vary from those estimates. The financial and statistical information we report to other regulatory agencies may be prepared on a basis other than GAAP or using different assumptions or reporting periods and, therefore, may vary from the amounts presented herein. Although we make every effort to ensure that the information we report to those agencies is accurate, complete and consistent with applicable reporting guidelines, we cannot be responsible for the accuracy of the information they make available to the public.
COVID-19 Pandemic
During the COVID‑19 pandemic, federal, state and local authorities undertook several actions designed to assist healthcare providers in delivering care to COVID‑19 and other patients and to mitigate the adverse economic impact of the pandemic. Among other things, federal legislation (collectively, the “COVID Acts”) authorized grant payments to be distributed through the Public Health and Social Services Emergency Fund (“PRF”) to healthcare providers who experienced lost revenues and increased expenses as a result of the pandemic. The COVID Acts also revised the Medicare accelerated payment program (“MAPP”) and permitted employers to defer payroll Social Security tax payments in 2020. Our participation in these programs and the related accounting policies are summarized below. The Secretary of the U.S. Department of Health and Human Services (“HHS”) ended the COVID‑19 Public Health Emergency in May 2023.
Grant Income—As detailed in the table below, we received cash payments from the PRF and state and local grant programs during the years ended December 31, 2023, 2022 and 2021. Grant funds received by our Hospital Operations segment and those facilities in our Ambulatory Care segment that we consolidate are included in cash flows from operating activities in our consolidated statements of cash flows. Grant funds received by unconsolidated affiliates for which we provide cash management services (“Cash‑Managed Affiliates”) are included in cash flows from financing activities.
Years Ended December 31,
202320222021
Grant funds received from COVID-19 relief programs:
Included in cash flows from operating activities:
Hospital Operations$10 $193 $142 
Ambulatory Care— 3 36 
$10 $196 $178 
Included in cash flows from financing activities:
Cash‑Managed Affiliates
$— $— $37 
To receive distributions, providers agreed to certain terms and conditions, including, among other things, that the funds would be used for lost revenues and unreimbursed pandemic‑related costs as defined by HHS, and that the providers would not seek collection of out‑of‑pocket payments from a COVID‑19 patient that are greater than what the patient would have otherwise been required to pay if the care had been delivered by an in‑network provider. All recipients of PRF payments are required to comply with the reporting requirements described in the terms and conditions and as determined by the Secretary of HHS. PRF funds not utilized by the established deadlines, generally 12 to 18 months after receipt, will be recouped by HHS.
We recognize grant payments as income when there is reasonable assurance that we have complied with the conditions associated with the grant. The table below summarizes grant income recognized by our Hospital Operations and Ambulatory Care segments, which is presented in grant income, and grant income recognized through our unconsolidated affiliates, which is presented in equity in earnings of unconsolidated affiliates, in each case in our consolidated statements of operations.
Years Ended December 31,
202320222021
Grant income recognized from COVID-19 relief programs:
Included in grant income:
Hospital Operations$15 $190 $142 
Ambulatory Care1 4 49 
$16 $194 $191 
Included in equity in earnings of unconsolidated affiliates:
Unconsolidated affiliates$— $— $14 
We had no deferred grant payments remaining at December 31, 2023, and we had $7 million of deferred grant payments at December 31, 2022, which amount was recorded in other current liabilities in the accompanying Consolidated Balance Sheet.
Medicare Accelerated Payment Program (MAPP)—In certain circumstances, when a healthcare facility is experiencing financial difficulty due to delays in receiving payment for the Medicare services it provided, it may be eligible for an accelerated or advance payment pursuant to the MAPP. The COVID Acts revised the MAPP to disburse payments to healthcare providers more quickly and to allow recipients to retain the advance payments for one year from the date of receipt before recoupment commenced through offsets of Medicare claims payments. Recipients were also permitted to repay the advance payments at any time. Our Hospital Operations and Ambulatory Care segments both received advance payments from the MAPP following its expansion under the COVID Acts in the year ended December 31, 2020; however, no additional advances were received in the subsequent years.
The table below summarizes MAPP advances received in prior periods that were repaid or recouped during the years ended December 31, 2022 and 2021. No advances were repaid or recouped during the year ended December 31, 2023. Advances to our Hospital Operations segment and those facilities in our Ambulatory Care segment that we consolidate were recouped through a reduction of their respective Medicare claims payments and, together with any repayments, are presented in cash flows from operating activities in our consolidated statements of cash flows. Advance payments to our Cash‑Managed Affiliates were recouped through a reduction of those affiliates’ Medicare claims payments and, together with any repayments, are presented in cash flows from financing activities.
Years Ended December 31,
20222021
MAPP advances repaid or recouped:
Included in cash flows from operating activities:
Hospital Operations$876 $457 
Ambulatory Care4 55 
$880 $512 
Included in cash flows from financing activities:
Cash‑Managed Affiliates
$— $104 
All remaining MAPP advances we previously received were fully repaid or recouped during the year ended December 31, 2022, which resulted in no outstanding liability at December 31, 2023 and 2022.
Deferral of Employment Tax Payments—The COVID Acts permitted employers to defer payment of the 6.2% employer Social Security tax beginning March 27, 2020 through December 31, 2020. Deferred tax amounts were required to be paid in equal amounts over two years beginning in December 2021. We remitted the employer’s Social Security tax payments deferred during 2020 in payments of $128 million in December 2022 and 2021.
Translation of Foreign Currencies
Our GBC, which is located in the Philippines, performs certain administrative functions and other support tasks. The GBC’s accounts are measured in its local currency (the Philippine peso) and then translated into U.S. dollars. All assets and liabilities denominated in foreign currency are translated using the current rate of exchange at the balance sheet date. Results of operations denominated in foreign currency are translated using the average rates prevailing throughout the period of operations. Translation gains or losses resulting from changes in exchange rates are accumulated in shareholders’ equity.
Net Operating Revenues
We recognize net operating revenues in the period in which we satisfy our performance obligations under contracts by transferring services to our customers. Net operating revenues are recognized in the amounts we expect to be entitled to, which are the transaction prices allocated for the distinct services. Net operating revenues for our Hospital Operations and Ambulatory Care segments primarily consist of net patient service revenues, principally for patients covered by Medicare, Medicaid, managed care and other health plans, as well as certain uninsured patients under our Compact with Uninsured Patients (“Compact”) and other uninsured discount and charity programs.
Net Patient Service Revenues
We report net patient service revenues at the amounts that reflect the consideration we expect to be entitled to in exchange for providing patient care. These amounts are due from patients, third‑party payers (including managed care payers and government programs) and others, and they include variable consideration for retroactive revenue adjustments due to settlement of audits, reviews and investigations. Generally, we bill our patients and third‑party payers several days after the services are performed or shortly after discharge. Revenues are recognized as performance obligations are satisfied.
We determine performance obligations based on the nature of the services we provide. We recognize revenues for performance obligations satisfied over time based on actual charges incurred in relation to total expected charges. We believe that this method provides a faithful depiction of the transfer of services over the term of performance obligations based on the inputs needed to satisfy the obligations. Generally, performance obligations satisfied over time relate to patients in our hospitals receiving inpatient acute care services. We measure performance obligations from admission to the point when there are no further services required for the patient, which is generally the time of discharge. We recognize revenues for performance obligations satisfied at a point in time, which generally relate to patients receiving outpatient services, when (1) services are provided, and (2) we do not believe the patient requires additional services.
Because our patient service performance obligations relate to contracts with a duration of less than one year, we have elected to apply the optional exemption provided in FASB Accounting Standards Codification (“ASC”) 606‑10‑50‑14(a) and, therefore, we are not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations referred to above are primarily related to inpatient acute care services at the end of the reporting period. The performance obligations for these contracts are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period.
We determine the transaction price based on gross charges for services provided, reduced by contractual adjustments recognized for third‑party payers, discounts provided to uninsured patients in accordance with our Compact, and estimated implicit price concessions related primarily to uninsured patients. We determine our estimates of contractual adjustments and discounts based on contractual agreements, our discount policies and historical experience. We determine our estimate of implicit price concessions based on our historical collection experience using a portfolio approach as a practical expedient to account for patient contracts as collective groups rather than individually. The financial statement effects of using this practical expedient are not materially different from an individual contract approach.
Gross charges are retail charges. They are not the same as actual pricing, and they generally do not reflect what a hospital is ultimately paid and, therefore, are not displayed in our consolidated statements of operations. Hospitals are typically paid amounts that are negotiated with insurance companies or are set by the government. Gross charges are used to calculate Medicare outlier payments and to determine certain elements of payment under managed care contracts (such as stop‑loss payments). Because Medicare requires that a hospital’s gross charges be the same for all patients (regardless of payer category), gross charges are what hospitals charge all patients prior to the application of discounts and allowances.
Government Programs—The final determination of certain fee‑for‑service (“FFS”) Medicare and Medicaid program payments to our hospitals, such as Indirect Medical Education, Direct Graduate Medical Education, disproportionate share hospital and bad debt expense reimbursement, are retrospectively determined based on our hospitals’ cost reports. The final determination of these payments often takes many years to resolve because of audits by the program representatives, providers’ rights of appeal, and the application of numerous technical reimbursement provisions. We therefore record accruals to reflect the expected final settlements on our cost reports. For filed cost reports, we adjust the accrual for estimated cost report settlements based on those cost reports and subsequent activity, and we consider the necessity of recording a valuation allowance based on historical settlement results. The accrual for estimated cost report settlements for periods for which a cost report is yet to be filed is recorded based on estimates of what we expect to report on the filed cost reports, and a corresponding valuation allowance is recorded, if necessary, based on the method previously described. Cost reports must generally be filed
within five months after the end of the annual cost report reporting period. After the cost report is filed, the accrual and corresponding valuation allowance may need to be adjusted.
Settlements with third‑party payers for retroactive revenue adjustments due to audits, reviews or investigations are considered variable consideration and are included in the determination of the estimated transaction price for providing patient care using the most likely outcome method. These settlements are estimated based on the terms of the payment agreement with the payer, correspondence from the payer and our historical settlement activity, including an assessment to ensure that it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainty associated with the retroactive adjustment is subsequently resolved. Estimated settlements are adjusted in future periods as adjustments become known (that is, new information becomes available), or as years are settled or are no longer subject to such audits, reviews and investigations. Because the laws, regulations, instructions and rule interpretations governing Medicare and Medicaid reimbursement are complex and change frequently, the estimates we record could change by material amounts.
Private Insurance—Revenues under managed care plans are based primarily on payment terms involving predetermined rates per diagnosis, per‑diem rates, discounted FFS rates and/or other similar contractual arrangements. These revenues are also subject to review and possible audit by the payers, which can take several years before they are completely resolved. The payers are billed for patient services on an individual patient basis. An individual patient’s bill is subject to adjustment on a patient‑by‑patient basis in the ordinary course of business by the payers following their review and adjudication of each particular bill. We estimate the discounts for contractual allowances at the individual hospital level utilizing billing data on an individual patient basis. At the end of each month, on an individual hospital basis, we estimate our expected reimbursement for patients of managed care plans based on the applicable contract terms. Contractual allowance estimates are periodically reviewed for accuracy by taking into consideration known contract terms, as well as payment history. We believe our estimation and review process enables us to identify instances on a timely basis where such estimates need to be revised. We do not believe there were any adjustments to estimates of patient bills that were material to our revenues during the years ended December 31, 2023, 2022 or 2021. In addition, on a corporate‑wide basis, we do not record any general provision for adjustments to estimated contractual allowances for managed care plans. Managed care accounts, net of contractual allowances recorded, are further reduced to their net realizable value through implicit price concessions based on historical collection trends for these payers and other factors that affect the estimation process.
We know of no claims, disputes or unsettled matters with any payer that would materially affect our revenues for which we have not adequately provided in the accompanying Consolidated Financial Statements.
Uninsured Patients—Generally, patients who are covered by third‑party payers are responsible for related co‑pays, co‑insurance and deductibles, which vary in amount. We also provide services to uninsured patients and offer uninsured patients a discount from standard charges. We estimate the transaction price for patients with co‑pays, co‑insurance and deductibles and for those who are uninsured based on historical collection experience and current market conditions. Under our Compact and other uninsured discount programs, the discount offered to certain uninsured patients is recognized as a contractual allowance, which reduces net operating revenues at the time the self‑pay accounts are recorded. The uninsured patient accounts, net of contractual allowances recorded, are further reduced to their net realizable value at the time they are recorded through implicit price concessions based on historical collection trends for self‑pay accounts and other factors that affect the estimation process.
Implicit Price Concessions—We record implicit price concessions, primarily related to uninsured patients and patients with co‑pays, co‑insurance and deductibles. The implicit price concessions included in estimating the transaction price represent the difference between amounts billed to patients and the amounts we expect to collect based on our collection history with similar patients. Although outcomes vary, our policy is to attempt to collect amounts due from patients, including co‑pays, co‑insurance and deductibles due from patients with insurance, at the time of service while complying with all federal and state statutes and regulations, including, but not limited to, the Emergency Medical Treatment and Active Labor Act (“EMTALA”). Generally, as required by EMTALA, patients may not be denied emergency treatment due to inability to pay. Therefore, services, including the legally required medical screening examination and stabilization of the patient, are performed without delaying to obtain insurance information. In non‑emergency circumstances or for elective procedures and services, it is our policy to verify insurance prior to a patient being treated; however, there are various exceptions that can occur. Such exceptions can include, for example, instances where (1) we are unable to obtain verification because the patient’s insurance company was unable to be reached or contacted, (2) a determination is made that a patient may be eligible for benefits under various government programs, such as Medicaid or Victims of Crime, and it takes several days or weeks before qualification for such benefits is confirmed or denied, and (3) under physician orders we provide services to patients that require immediate treatment.
There are various factors that can impact collection trends, such as: changes in the economy, which in turn have an impact on unemployment rates and the number of uninsured and underinsured patients; the volume of patients through our
emergency departments; the increased burden of co‑pays, co‑insurance amounts and deductibles to be made by patients with insurance; and business practices related to collection efforts. These factors continuously change and can have an impact on collection trends and our estimation process. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to net patient service revenues in the period of the change.
We also provide charity care to patients who are financially unable to pay for the healthcare services they receive. Most patients who qualify for charity care are charged a per‑diem amount for services received, subject to a cap. Except for the per‑diem amounts, our policy is not to pursue collection of amounts determined to qualify as charity care; therefore, we do not report these amounts in net operating revenues. Patient advocates from our Eligibility and Enrollment Services program screen patients in the hospital to determine whether those patients meet eligibility requirements for financial assistance programs. They also expedite the process of applying for these government programs.
Amounts related to services provided to patients for which we have not billed and that do not meet the conditions of unconditional right to payment at the end of the reporting period are contract assets. Approximately 88% of our Hospital Operations segment’s contract assets meet the conditions for unconditional right to payment and are reclassified to patient receivables within 90 days.
Revenue Cycle Management and Other Services
Our Hospital Operations segment also provides revenue cycle management and other services to health systems, individual hospitals and physician practices. We recognize revenue from our contracts when the underlying performance obligations are satisfied, which is generally as services are rendered. Revenue is recognized in an amount that reflects the consideration to which we expect to be entitled.
At contract inception, we assess the services specified in our contracts with customers and identify a performance obligation for each distinct contracted service. We generally consider the following distinct services as separate performance obligations:
•revenue cycle management services;
•value‑based care services;
•patient communication and engagement services;
•consulting services; and
•other client‑defined projects.
Our contracts generally consist of fixed‑price, volume‑based or contingency‑based fees. Long‑term contracts typically provide for the delivery of recurring monthly services over a multi‑year period. The contracts are typically priced such that our monthly fee to our customer represents the value obtained by the customer in the month for those services. Such multi‑year service contracts may have upfront fees related to transition or integration work performed by us to set up the delivery for the ongoing services. Such transition or integration work typically does not result in a separately identifiable obligation; thus, the fees and expenses related to such work are deferred and recognized over the life of the related contractual service period. For contracts in which the amortization period of the asset is one year or less, we have elected to apply the practical expedient provided by FASB ASC 340‑40‑25‑4 and expense these costs as incurred.
Revenue for fixed‑priced contracts is typically recognized at the time of billing unless evidence suggests that the revenue is earned or our obligations are fulfilled in a different pattern. Revenue for volume‑based contracts is typically recognized as the services are being performed at the contractually billable rate, which is generally a percentage of collections or a percentage of client net patient revenue.
Contract Assets and Liabilities—Our client contract terms, including payment conditions, are diverse. For non‑fixed‑price arrangements, we may invoice clients before we perform the contracted services, with subsequent adjustments (true‑up) to align with actual fees. In contrast, some contracts require payment after we have performed the contracted services (in arrears). Contracts may also feature performance‑based incentives or penalties, along with other variable consideration. Revenue recognition occurs when services are rendered and the client gains control or benefit of the services, regardless of the invoicing schedule, leading to the recognition of a contract asset for unbilled revenue. Unbilled revenue is recognized as receivables in the month the services are performed. Conversely, advance payments from clients result in the recognition of a contract liability for deferred revenue until the revenue recognition requirements are met.
Cash and Cash Equivalents
We treat highly liquid investments with original maturities of three months or less as cash equivalents. Cash and cash equivalents were $1.228 billion and $858 million at December 31, 2023 and 2022, respectively. At December 31, 2023 and 2022, our book overdrafts were $187 million and $266 million, respectively, which were classified as accounts payable. At December 31, 2023 and 2022, $100 million and $140 million, respectively, of total cash and cash equivalents in the accompanying Consolidated Balance Sheets were intended for the operations of our insurance‑related subsidiaries.
At December 31, 2023, 2022 and 2021, we had $154 million, $196 million and $95 million, respectively, of property and equipment purchases accrued for items received but not yet paid. Of these amounts, $141 million, $191 million and $88 million, respectively, were included in accounts payable.
In June 2022, we acquired all of Baylor’s 5% voting ownership interest in USPI. We paid $11 million from cash on hand and recognized a liability of $377 million, the present value of the liability on the acquisition date, for the remainder of the purchase price. We recorded reductions in redeemable noncontrolling interest of $365 million for the carrying value of Baylor’s ownership interest and $23 million to additional paid-in capital for the difference between the carrying value and present value of the purchase price for the shares on the acquisition date. This has been reflected as noncash financing activity in the accompanying Consolidated Statement of Cash Flows for the year ended December 31, 2022. Payments made subsequent to the transaction’s close are reflected as cash activity within the financing section of our consolidated statements of cash flows in the respective period. See Note 18 for additional information about this transaction.
Investments in Debt and Equity Securities
We classify investments in debt securities as either available‑for‑sale, held‑to‑maturity or as part of a trading portfolio. Our policy is to classify investments in debt securities that may be needed for cash requirements as “available‑for‑sale.” At December 31, 2023 and 2022, we had no significant investments in debt securities classified as either held‑to‑maturity or trading. We carry debt securities classified as available‑for‑sale at fair value. We report their unrealized gains and losses, net of taxes, as accumulated other comprehensive income (loss). We periodically evaluate available-for-sale securities in unrealized loss positions for credit impairment, using both qualitative and quantitative criteria. In the event a security is deemed to be impaired as the result of a credit loss, we record a loss in our consolidated statements of operations.
We carry equity securities at fair value, and we report their unrealized gains and losses in other non-operating income, net, in our consolidated statements of operations. If the equity security does not have a readily determinable fair value, the carrying value of the security is adjusted only when there is a price change that is observable from a transaction of an identical or similar investment. We include realized gains or losses in our consolidated statements of operations based on the specific identification method.
Investments in Unconsolidated Affiliates
As of December 31, 2023, we controlled 330 of the facilities in our Ambulatory Care segment and, therefore, consolidated their results. We account for many of the facilities in which our Ambulatory Care segment holds ownership interests (155 of 485 at December 31, 2023), as well as additional companies in which our Hospital Operations segment holds ownership interests, under the equity method as investments in unconsolidated affiliates and report only our share of net income as equity in earnings of unconsolidated affiliates in the accompanying Consolidated Statements of Operations. In the year ended December 31, 2021, equity in earnings of unconsolidated affiliates included $14 million from grant funds recognized by our Ambulatory Care segment’s unconsolidated affiliates. No additional revenue was recognized from grant funds by unconsolidated affiliates during the years ended December 31, 2023 and 2022.
Summarized financial information for equity method investees is included in the following table. For investments acquired during the reported periods, amounts below include 100% of the investee’s results beginning on the date of our acquisition of the investment.
December 31,
 202320222021
Current assets$1,223 $1,142 $1,176 
Noncurrent assets$1,355 $1,356 $1,390 
Current liabilities$(456)$(479)$(495)
Noncurrent liabilities$(917)$(878)$(855)
Noncontrolling interests$(670)$(644)$(659)
 Years Ended December 31,
 202320222021
Net operating revenues$3,510 $3,360 $3,030 
Net income$860 $805 $836 
Net income attributable to the investees$484 $453 $499 
The equity method investment that contributed the most to our equity in earnings of unconsolidated affiliates during the years ended December 31, 2023, 2022 and 2021 was Texas Health Ventures Group, LLC (“THVG”), which is operated by USPI. THVG represented $104 million, $89 million and $107 million of total equity in earnings of unconsolidated affiliates of $228 million, $216 million and $218 million in the years ended December 31, 2023, 2022 and 2021, respectively.
Property and Equipment
Additions and improvements to property and equipment exceeding established minimum amounts with a useful life greater than one year are capitalized at cost. Expenditures for maintenance and repairs are charged to expense as incurred. We use the straight‑line method of depreciation for buildings, building improvements and equipment. The estimated useful life for buildings and improvements is primarily 15 to 40 years, and for equipment three to 15 years. Newly constructed hospitals are usually depreciated over 50 years. Interest costs related to construction projects are capitalized. In the years ended December 31, 2023, 2022 and 2021, capitalized interest was $9 million, $8 million and $4 million, respectively.
We evaluate our long‑lived assets for possible impairment annually or whenever events or changes in circumstances indicate that the carrying amount of the asset, or related group of assets, may not be recoverable from estimated future undiscounted cash flows. If the estimated future undiscounted cash flows are less than the carrying value of the assets, we calculate the amount of an impairment charge only if the carrying value of the long‑lived assets exceeds their fair value. The fair value of the asset is estimated based on third‑party appraisals, established market values of comparable assets or internally developed estimates of future net cash flows expected to result from the use and ultimate disposition of the asset. The estimates of these future cash flows are based on assumptions and projections we believe to be reasonable and supportable. Estimates require our subjective judgments and take into account assumptions about revenue and expense growth rates, operating margins and recoverable disposition values, based on industry and operating factors. These assumptions may vary by type of asset and presume stable, improving or, in some cases, declining results, depending on their circumstances. If the presumed level of performance does not occur as expected, impairment may result.
We report long‑lived assets to be disposed of at the lower of their carrying amounts or fair values less costs to sell. In such circumstances, our estimates of fair value are based on third‑party appraisals, established market prices for comparable assets or internally developed estimates of future net cash flows.
Leases
We determine if an arrangement is a lease at inception of the contract. Our right‑of‑use assets represent our right to use the underlying assets for the lease term and our lease liabilities represent our obligation to make lease payments arising from the leases. Right‑of‑use assets and lease liabilities are recognized at the commencement date based on the present value of lease payments over the lease term. We use our estimated incremental borrowing rate, which is derived from information available at the lease commencement date, in determining the present value of lease payments. For our Hospital Operations segment, we estimate our incremental borrowing rates for our portfolio of leases using documented rates included in our recent equipment finance leases or, if applicable, recent secured debt issuances that correspond to various lease terms. We also give consideration to information obtained from our bankers, our secured debt fair value and publicly available data for instruments with similar characteristics. For our Ambulatory Care segment, we estimate an incremental borrowing rate for each center by utilizing
historical and projected financial data, estimating a hypothetical credit rating using publicly available market data and adjusting the market data to reflect the effects of collateralization.
Our operating leases are primarily for real estate, including off‑campus outpatient facilities, medical office buildings, and corporate and other administrative offices, as well as medical and office equipment. Our finance leases are primarily for medical equipment and information technology and telecommunications assets. Our real estate lease agreements typically have initial terms of five to 10 years, and our equipment lease agreements typically have initial terms of three years. We do not record leases with an initial term of 12 months or less (short‑term leases) in our consolidated balance sheets.
Our real estate leases may include one or more options to renew, with renewals that can extend the lease term from five to 10 years. The exercise of lease renewal options is at our sole discretion. In general, we do not consider renewal options to be reasonably likely to be exercised, therefore, renewal options are generally not recognized as part of our right‑of‑use assets and lease liabilities. Certain leases also include options to purchase the leased property. The useful life of assets and leasehold improvements are limited by the expected lease term, unless there is a transfer of title or purchase option reasonably certain of exercise. The majority of our medical equipment leases have terms of three years with a bargain purchase option that is reasonably certain of exercise, so these assets are depreciated over their useful life, typically ranging from five to seven years. Similarly, some of our leases of information technology and telecommunications assets include a transfer of title and, therefore, have useful lives of 15 years.
Certain of our lease agreements for real estate include payments based on actual common area maintenance expenses and others include rental payments adjusted periodically for inflation. These variable lease payments are recognized in other operating expenses, net, but are not included in the right‑of‑use asset or liability balances. Our lease agreements do not contain any material residual value guarantees, restrictions or covenants.
We have elected the practical expedient that allows lessees to choose to not separate lease and non‑lease components by class of underlying asset and are applying this expedient to all relevant asset classes. We have also elected the practical expedient package to not reassess at adoption (1) expired or existing contracts for whether they are or contain a lease, (2) the lease classification of any existing leases or (3) initial indirect costs for existing leases.
Goodwill and Other Intangible Assets
Goodwill represents the excess of costs over the fair value of assets of businesses acquired. Goodwill and other intangible assets acquired in purchase business combinations and determined to have indefinite useful lives are not amortized, but instead are subject to impairment tests performed at least annually. Our reporting segments are the reporting units used to perform our goodwill analysis. If we determine the carrying value of goodwill is impaired, or if the carrying value of a business that is to be sold or otherwise disposed of exceeds its fair value, we reduce the carrying value, including any allocated goodwill, to fair value. Estimates of fair value are based on third‑party appraisals, established market prices for comparable assets or internally developed estimates of future net cash flows and presume stable, improving or, in some cases, declining results at our hospitals, depending on their circumstances.
Other intangible assets consist of capitalized software costs, which are amortized on a straight‑line basis over the estimated useful life of the software, which ranges from three to 15 years, costs of acquired management and other contract service rights, most of which have indefinite lives, and miscellaneous intangible assets.
Accruals for General and Professional Liability Risks
We accrue for estimated professional and general liability claims, to the extent not covered by insurance, when they are probable and can be reasonably estimated. We maintain reserves, which are based on modeled estimates for the portion of our professional liability risks, including incurred but not reported claims, to the extent we do not have insurance coverage. Our liability consists of estimates established based upon calculations using several factors, including the number of expected claims, estimates of losses for these claims based on recent and historical settlement amounts, estimates of incurred but not reported claims based on historical experience and the timing of historical payments. Our liabilities are adjusted for new claims information in the period such information becomes known. Malpractice expense is recorded within other operating expenses in our consolidated statements of operations.
Income Taxes
We account for income taxes using the asset and liability method. This approach requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of temporary differences between the carrying amounts and
the tax bases of assets and liabilities. Income tax receivables and liabilities and deferred tax assets and liabilities are recognized based on the amounts that more likely than not will be sustained upon ultimate settlement with taxing authorities.
Developing our provision for income taxes and analysis of uncertain tax positions requires significant judgment and knowledge of federal and state income tax laws, regulations and strategies, including the determination of deferred tax assets and liabilities and, if necessary, any valuation allowances that may be required for deferred tax assets.
We assess the realization of our deferred tax assets to determine whether an income tax valuation allowance is required. Based on all available evidence, both positive and negative, and the weight of that evidence to the extent such evidence can be objectively verified, we determine whether it is more likely than not that all or a portion of the deferred tax assets will be realized. The main factors that we consider include:
•Cumulative profits/losses in recent years, adjusted for certain nonrecurring items;
•Income/losses expected in future years;
•Unsettled circumstances that, if unfavorably resolved, would adversely affect future operations and profit levels;
•The availability, or lack thereof, of taxable income in prior carryback periods that would limit realization of tax benefits; and
•The carryforward period associated with the deferred tax assets and liabilities.
We consider many factors when evaluating our uncertain tax positions, and such judgments are subject to periodic review. Tax benefits associated with uncertain tax positions are recognized in the period in which one of the following conditions is satisfied: (1) the more likely than not recognition threshold is satisfied; (2) the position is ultimately settled through negotiation or litigation; or (3) the statute of limitations for the taxing authority to examine and challenge the position has expired. Tax benefits associated with an uncertain tax position are derecognized in the period in which the more likely than not recognition threshold is no longer satisfied.
Segment Reporting
Our Hospital Operations segment generated 81%, 83% and 86% of our net operating revenues in the years ended December 31, 2023, 2022 and 2021, respectively. Major decisions, including capital resource allocations, are made at the consolidated level, not at the market or hospital level. The factors for determining the reportable segments include the manner in which management evaluates operating performance combined with the nature of the individual business activities.
Costs Associated with Exit or Disposal Activities
We recognize costs associated with exit (including restructuring) or disposal activities when they are incurred and can be measured at fair value, rather than at the date of a commitment to an exit or disposal plan.
v3.24.0.1
EQUITY
 12 Months Ended
Dec. 31, 2023
Stockholders' Equity Note [Abstract]  
EQUITY EQUITY
Nonredeemable Noncontrolling Interests
Our nonredeemable noncontrolling interests balances at December 31, 2023 and 2022 in the accompanying Consolidated Statements of Changes in Equity were comprised of $185 million and $132 million, respectively, from our Hospital Operations segment, and $1.324 billion and $1.185 billion, respectively, from our Ambulatory Care segment. Our net income attributable to nonredeemable noncontrolling interests for the years ended December 31, 2023, 2022 and 2021 were comprised of $30 million, $21 million and $21 million, respectively, from our Hospital Operations segment, and $304 million, $221 million and $205 million, respectively, from our Ambulatory Care segment.
Share Repurchase Program
In October 2022, we announced that our board of directors had authorized the repurchase of up to $1 billion of our common stock through a share repurchase program that expires on December 31, 2024. Under the program, shares can be purchased in the open market or through privately negotiated transactions in a manner consistent with applicable securities laws and regulations, including pursuant to a Rule 10b5-1 plan if established by the Company, at times and in amounts based on market conditions and other factors.
The table below summarizes transactions completed under the repurchase program during the years ended December 31, 2023 and 2022:
PeriodTotal Number of Shares PurchasedAverage Price Paid per ShareTotal Number of Shares Purchased as Part of Publicly Announced ProgramMaximum Dollar Value of Shares That May Yet be Purchased Under the Program
 (In Thousands)(In Thousands)(In Millions)
Inception through October 31, 20221,800$41.81 1,800$925 
November 1 through November 30, 20224,089$42.74 4,089$750 
December 1 through December 31, 2022—$— —$750 
Inception through December 31, 20225,889$42.45 5,889
January 1 through January 31, 2023—$— —$750 
February 1 through February 28, 2023—$— —$750 
March 1 through March 31, 2023906$55.03 906$700 
April 1 through April 30, 2023—$— —$700 
May 1 through May 31, 2023580$69.17 580$660 
June 1 through June 30, 2023—$— —$660 
July 1 through July 31, 2023—$— —$660 
August 1 through August 31, 2023—$— —$660 
September 1 through September 30, 2023—$— —$660 
October 1 through October 31, 2023—$— —$660 
November 1 through November 30, 2023982$67.12 982$594 
December 1 through December 31, 2023644$68.53 644$550 
Year ended December 31, 2023
3,112$64.27 3,112
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ACCOUNTS RECEIVABLE
 12 Months Ended
Dec. 31, 2023
Accounts Receivable Additional Disclosures [Abstract]  
ACCOUNTS RECEIVABLE ACCOUNTS RECEIVABLE
The principal components of accounts receivable are shown in the table below:
December 31,
 20232022
Patient accounts receivable$2,719 $2,746 
Estimated future recoveries148 149 
Net cost reports and settlements receivable and valuation allowances47 48 
Accounts receivable, net 
$2,914 $2,943 
Patient accounts receivable, including billed accounts and certain unbilled accounts, as well as estimated amounts due from third‑party payers for retroactive adjustments, are receivables if our right to consideration is unconditional and only the passage of time is required before payment of that consideration is due. Estimated uncollectable amounts are generally considered implicit price concessions that are a direct reduction to patient accounts receivable rather than allowance for doubtful accounts.
We also provide financial assistance through our charity and uninsured discount programs to uninsured patients who are unable to pay for the healthcare services they receive. Our policy is not to pursue collection of amounts determined to qualify for financial assistance; therefore, we do not report these amounts in net operating revenues. Most states include an estimate of the cost of charity care in the determination of a hospital’s eligibility for Medicaid disproportionate share hospital payments. These payments are intended to mitigate our cost of uncompensated care.
Some states have also developed provider fee or other supplemental payment programs to mitigate the shortfall of Medicaid reimbursement compared to the cost of caring for Medicaid patients. We participate in various provider fee programs, which help reduce the amount of uncompensated care from indigent patients and those covered by Medicaid. The following table summarizes the amount and classification of assets and liabilities in the accompanying Consolidated Balance Sheets related to California’s provider fee program:
December 31,
 20232022
Assets:
Other current assets$329 $367 
Investments and other assets$334 $197 
Liabilities:
Other current liabilities$172 $145 
Other long-term liabilities$135 $63 
The following table presents our estimated costs (based on selected operating expenses, which include salaries, wages and benefits, supplies and other operating expenses) of caring for our uninsured and charity patients:
 Years Ended December 31,
 202320222021
Estimated costs for:   
Uninsured patients$499 $537 $650 
Charity care patients110 83 97 
$609 $620 $747 
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CONTRACT BALANCES
 12 Months Ended
Dec. 31, 2023
Revenue from Contract with Customer [Abstract]  
CONTRACT BALANCES CONTRACT BALANCES
Hospital Operations Segment
Our Hospital Operations segment’s contract assets and liabilities primarily derive from: (1) patients receiving ongoing inpatient care from one of our facilities at the end of the reporting period; (2) timing differences between our performance of revenue cycle management and other contractually-based services and the invoicing or receipt of payment for these services; and, with respect to the year ended December 31, 2021 as discussed below, (3) advance payments from the MAPP following its expansion under the COVID Acts. Our Hospital Operations segment’s contract assets were included in other current assets, and its contract liabilities are included in other current liabilities or other long‑term liabilities, depending upon when we expect to recognize the underlying revenue, in the accompanying Consolidated Balance Sheets at December 31, 2023 and 2022.
The opening and closing balances of our Hospital Operations segment’s receivables, contract assets, and current and long‑term contract liabilities were as follows:
ReceivablesContract Assets –
Unbilled Revenue		Contract Liabilities –
Current
Deferred Revenue and Advances from Medicare		Contract Liabilities –
Long-Term
Deferred Revenue
December 31, 2022$37 $200 $110 $13 
December 31, 202321 208 59 12 
Increase (decrease)$(16)$8 $(51)$(1)
December 31, 2021$28 $199 $955 $15 
December 31, 202237 200 110 13 
Increase (decrease)$9 $1 $(845)$(2)
At December 31, 2021, the current portion of our Hospital Operations segment’s contract liabilities included $876 million of MAPP advances. All remaining MAPP advances received by our Hospital Operations segment were either repaid or recouped during 2022, which resulted in no outstanding liability at December 31, 2023 and 2022.
In the years ended December 31, 2023 and 2022, we recognized revenue totaling $71 million and $56 million, respectively, from our revenue cycle management services that was included in the opening current deferred revenue liability.
This revenue consists primarily of prepayments for those contract clients who were billed in advance, changes in estimates related to metric‑based services and up‑front integration services that are recognized over the service period.
Contract Costs—We recognized amortization expense related to deferred contract setup costs of $5 million in the year ended December 31, 2023, and $4 million in each of the years ended December 31, 2022 and 2021. At December 31, 2023 and 2022, the unamortized customer contract costs were $22 million and $24 million, respectively, and were presented as part of investments and other assets in the accompanying Consolidated Balance Sheets.
Ambulatory Care Segment
All remaining MAPP advances received by our Ambulatory Care segment were either repaid or recouped during 2022, which resulted in no outstanding liability at December 31, 2023 and 2022. The opening and closing balances of contract liabilities for our Ambulatory Care segment were as follows:
Contract Liabilities – Current Advances from Medicare
December 31, 2021$4 
December 31, 2022— 
Decrease$(4)
NET OPERATING REVENUES
Net operating revenues for our Hospital Operations and Ambulatory Care segments primarily consist of net patient service revenues, principally for patients covered by Medicare, Medicaid, managed care and other health plans, as well as certain uninsured patients under our Compact and other uninsured discount and charity programs. Net operating revenues for our Hospital Operations segment also includes revenues from providing revenue cycle management and value‑based care services to hospitals, health systems, physician practices, employers and other clients.
The table below presents our sources of net operating revenues:
Years Ended December 31,
202320222021
Hospital Operations:
Net patient service revenues from hospitals and related outpatient facilities:
Medicare$2,383 $2,369 $2,615 
Medicaid1,233 1,069 1,254 
Managed care10,248 9,607 9,985 
Uninsured96 141 199 
Indemnity and other590 661 706 
Total14,550 13,847 14,759 
Other revenues(1)
2,133 2,079 2,008 
Total Hospital Operations16,683 15,926 16,767 
Ambulatory Care3,865 3,248 2,718 
Net operating revenues$20,548 $19,174 $19,485 
(1)Primarily revenue from physician practices and revenue cycle management. Revenue from revenue cycle management services is included in other revenues for all periods presented to conform with our new reporting segment structure.
Revenues related to the Texas Comprehensive Hospital Increase Reimbursement Program (“CHIRP”) are presented in managed care net patient service revenues in the table above. Amounts we were assessed to support CHIRP following its approval in 2022 were presented in Medicaid revenues during that period, but have been reclassified to managed care revenues to conform to the current‑year presentation in the same payer group as the revenues to more clearly reflect the results of our participation in this program. Assessments to support CHIRP totaled $126 million and $123 million during the years ended December 31, 2023 and 2022, respectively.
Adjustments for prior‑year cost reports and related valuation allowances, principally related to Medicare and Medicaid, increased revenues in the years ended December 31, 2023, 2022 and 2021 by $24 million, $10 million and $26 million, respectively. Estimated cost report settlements and valuation allowances were included in accounts receivable in the accompanying Consolidated Balance Sheets (see Note 3). We believe that we have made adequate provision for any adjustments that may result from final determination of amounts earned under all the above arrangements with Medicare and Medicaid.
The following table presents the composition of net operating revenues for our Ambulatory Care segment:
Years Ended December 31,
202320222021
Net patient service revenues
$3,713 $3,115 $2,604 
Management fees123 110 86 
Revenue from other sources29 23 28 
Net operating revenues$3,865 $3,248 $2,718 
Performance Obligations
The following table includes revenue from revenue cycle management services that is expected to be recognized in the future related to performance obligations that are unsatisfied, or partially unsatisfied, at the end of the reporting period. The amounts in the table primarily consist of revenue cycle management fixed fees, which are typically recognized ratably as the performance obligation is satisfied. The estimated revenue does not include volume‑ or contingency‑based contracts, variable‑based escalators, performance incentives, penalties or other variable consideration that is considered constrained. Our contract with Catholic Health Initiatives (“CHI”), a minority interest owner of Conifer Health Solutions, LLC, represents the majority of the fixed‑fee revenue related to remaining performance obligations. Conifer’s contract term with CHI ends December 31, 2032.
  Years Ending December 31,Later Years
 Total20242025202620272028
Performance obligations$6,026 $685 $684 $683 $683 $683 $2,608 
v3.24.0.1
ASSETS AND LIABILITIES HELD FOR SALE
 12 Months Ended
Dec. 31, 2023
Discontinued Operations and Disposal Groups [Abstract]  
ASSETS AND LIABILITIES HELD FOR SALE ASSETS AND LIABILITIES HELD FOR SALE
In November 2023, we entered into a definitive agreement for the sale of three hospitals located in South Carolina and certain related operations (together, the “SC Hospitals”), all of which were held by our Hospital Operations segment. The assets and liabilities related to the SC Hospitals were included in assets held for sale and liabilities held for sale, respectively, in the accompanying Consolidated Balance Sheet at December 31, 2023. We received pre-tax proceeds of approximately $2.400 billion when this sale closed in January 2024.
In January 2023, we entered into a definitive agreement to sell our 51% ownership interest in San Ramon Regional Medical Center and certain related operations (“San Ramon RMC”), which is held by our Hospital Operations segment, to John Muir Health (“John Muir”). We reclassified the assets and liabilities related to San Ramon RMC to assets held for sale and liabilities held for sale, respectively, in our consolidated balance sheet following our decision to sell our ownership interest. John Muir announced it no longer intended to pursue the acquisition after the U.S. Federal Trade Commission took action to challenge the transaction, following which we removed the assets and liabilities from held for sale and reclassified them as held and used in our consolidated balance sheet.
We completed the sale of five Miami‑area hospitals and certain related operations (the “Miami Hospitals”) held by our Hospital Operations segment in August 2021, resulting in our recognition of a pre‑tax gain on sale of $406 million in the year ended December 31, 2021.
In the three months ended June 30, 2021, we completed the sale of the majority of our UCCs operated under the MedPost and CareSpot brands by our Hospital Operations and Ambulatory Care segments, and we also completed the separate sale of a Philadelphia‑area building held by our Hospital Operations segment. We recorded a gain related to the sale of the UCCs of $14 million and a gain of $2 million related to the sale of the building in Philadelphia in 2021.
Gains related to the sales described above were included in net gains on sales, consolidation and deconsolidation of facilities in the accompanying Consolidated Statement of Operations for the year ended December 31, 2021. No impairment charge was incurred during the years ended December 31, 2023, 2022 or 2021 related to planned divestitures.
Assets and liabilities classified as held for sale at December 31, 2023 were comprised of the following:
Accounts receivable$78 
Other current assets25 
Investments and other long-term assets26 
Property and equipment204 
Other intangible assets17 
Goodwill425 
Current liabilities(45)
Long-term liabilities(24)
Net assets held for sale$706 
The following table presents amounts included in income from continuing operations, before income taxes, related to significant components of our business that were recently disposed of or were classified as held for sale at December 31, 2023:
 Years Ended December 31,
 202320222021
Significant disposals:  
Income (loss) from continuing operations, before income taxes:
Miami Hospitals (includes a $406 million gain on sale in 2021)
$(3)$10 $455 
Significant planned divestitures classified as held for sale:
Income from continuing operations, before income taxes:
SC Hospitals$130 $127 $135 
v3.24.0.1
IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS
 12 Months Ended
Dec. 31, 2023
Restructuring Costs and Asset Impairment Charges [Abstract]  
IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS
We recognized impairment charges on certain assets in 2023, 2022 and 2021 because the fair values of those assets or groups of assets indicated that the carrying amount was not recoverable. The fair value estimates were derived from third‑party appraisals, established market values of comparable assets, or internally developed estimates of future net cash flows. These fair value estimates can change by material amounts in subsequent periods. Many factors and assumptions can impact the estimates, including the future financial results of the facilities, how the facilities are operated in the future, changes in healthcare industry trends and regulations, and the nature of the ultimate disposition of the assets. In certain cases, these fair value estimates assume the highest and best use of facility assets in the future to a marketplace participant is other than as a medical facility. In these cases, the estimates are based on the fair value of the real property and equipment if utilized other than as a medical facility. The impairment recognized does not include the costs of closing the facilities or other future operating costs, which could be substantial. Accordingly, the ultimate net cash realized from the facilities, should we choose to sell them, could be significantly less than their impaired value.
Our impairment tests presume stable, improving or, in some cases, declining operating results in our facilities, which are based on programs and initiatives being implemented that are designed to achieve each facility’s most recent projections. If these projections are not met, or negative trends occur that impact our future outlook, future impairments of long-lived assets and goodwill may occur, and we may incur additional restructuring charges, which could be material.
Our reporting segments are the reporting units used to perform our goodwill analysis. At December 31, 2022, our business was organized into three separate reporting segments: Hospital Operations and other, Ambulatory Care and Conifer. As discussed in Note 1, we combined our Hospital Operations and other and Conifer segments into a single reporting segment named Hospital Operations and Services (Hospital Operations) during the three months ended December 31, 2023. We performed our annual goodwill impairment analysis as of October 1, 2023 based on our three separate reporting segments. We performed an additional goodwill impairment analysis as of December 31, 2023, following the combination of our Hospital Operations and other and Conifer segments, based on our new two-segment structure. Neither of the impairment analyses resulted in the identification of a goodwill impairment.
We periodically incur costs to implement restructuring efforts for specific operations, which are recorded in our statement of operations as they are incurred. Our restructuring plans focus on various aspects of operations, including aligning our operations in the most strategic and cost‑effective structure, such as the establishment of support operations at our GBC. Certain restructuring and acquisition‑related costs are based on estimates. Changes in estimates are recognized as they occur.
Year Ended December 31, 2023
During the year ended December 31, 2023, we recorded impairment and restructuring charges and acquisition‑related costs of $137 million, consisting of $79 million of restructuring charges, $43 million of impairment charges and $15 million of acquisition‑related transaction costs. Impairment charges for the year ended December 31, 2023 primarily arose from the write‑down of our investment in certain equity method investments held by our Ambulatory Care segment. Restructuring charges consisted of $36 million of legal costs related to the sale of certain businesses, $15 million of employee severance costs, $12 million related to the transition of various administrative functions to our GBC, $10 million of contract and lease termination fees, and $6 million of other restructuring costs.
Year Ended December 31, 2022
During the year ended December 31, 2022, we recorded impairment and restructuring charges and acquisition‑related costs of $226 million, consisting of $118 million of restructuring charges, $94 million of impairment charges and $14 million of acquisition‑related transaction costs. Impairment charges included $82 million for the write‑down of certain buildings and medical equipment located in one of our markets to their estimated fair values, which assets are part of our Hospital Operations segment. Material adverse trends in our estimates of future undiscounted cash flows of the hospitals indicated the aggregate carrying value of the hospitals’ long‑lived assets was not recoverable from their estimated future cash flows. We believe the most significant factors contributing to the adverse financial trends included decreased revenues and lower patient volumes due to the pandemic and competition, as well as higher labor costs because of the pandemic. As a result, we updated the estimate of the fair value of the hospitals’ long‑lived assets and compared it to the aggregate carrying value of those assets. Because the fair value estimates were lower than the aggregate carrying value of the long‑lived assets, an impairment charge was recorded for the difference in the amounts. The aggregate carrying value of the hospitals’ assets held and used for which impairment charges were recorded was $167 million at December 31, 2022. Impairment charges for the year ended December 31, 2022 were comprised of $88 million from our Hospital Operations segment and $6 million from our Ambulatory Care segment.
Restructuring charges consisted of $27 million of employee severance costs, $16 million related to the transition of various administrative functions to our GBC, $32 million of contract and lease termination fees, and $43 million of other restructuring costs.
Year Ended December 31, 2021
During the year ended December 31, 2021, we recorded impairment and restructuring charges and acquisition‑related costs of $85 million, consisting of $57 million of restructuring charges, $8 million of impairment charges and $20 million of acquisition‑related costs. Restructuring charges consisted of $14 million of employee severance costs, $19 million related to the transition of various administrative functions to our GBC and $24 million of other restructuring costs. Our impairment charges for the year ended December 31, 2021, comprised of $5 million from our Ambulatory Care segment and $3 million from our Hospital Operations segment, primarily consisted of charges to reduce the carrying value of certain management contract intangible assets held by our Ambulatory Care segment to their estimated fair value. Acquisition‑related costs for the year ended December 31, 2021 consisted of $20 million of transaction costs.
v3.24.0.1
LEASES
 12 Months Ended
Dec. 31, 2023
Leases [Abstract]  
LEASES LEASES
The following table presents the components of our right‑of‑use assets and liabilities related to leases and their classification in our Consolidated Balance Sheets:
December 31,
Component of Lease BalancesClassification in Consolidated Balance Sheets20232022
Assets:  
Operating lease assetsInvestments and other assets$1,083 $1,129 
Finance lease assets
Property and equipment, at cost, less
accumulated depreciation and amortization
253 303 
Total leased assets$1,336 $1,432 
Liabilities:
Operating lease liabilities:
CurrentOther current liabilities$204 $207 
Long-termOther long-term liabilities1,007 1,046 
Total operating lease liabilities1,211 1,253 
Finance lease liabilities:
CurrentCurrent portion of long-term debt84 99 
Long-termLong-term debt, net of current portion120 165 
Total finance lease liabilities204 264 
Total lease liabilities$1,415 $1,517 
The following table presents the components of our lease expense and their classification in our Consolidated Statements of Operations:
Component of Lease ExpenseClassification in Consolidated Statements of OperationsYears Ended December 31,
202320222021
Operating lease expenseOther operating expenses, net$259 $262 $241 
Finance lease expense:
Amortization of leased assetsDepreciation and amortization55 58 71 
Interest on lease liabilitiesInterest expense8 8 9 
Total finance lease expense63 66 80 
Variable and short term-lease expenseOther operating expenses, net159 150 171 
Total lease expense$481 $478 $492 
The weighted‑average lease terms and discount rates for operating and finance leases are presented in the following table:
Years Ended December 31,
202320222021
Weighted-average remaining lease term (years):
Operating leases7.68.07.5
Finance leases6.05.55.7
Weighted-average discount rate:
Operating leases5.0 %4.8 %5.1 %
Finance leases6.5 %5.9 %5.4 %
Cash flow and other information related to leases is included in the following table:
Years Ended December 31,
202320222021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases$258 $250 $237 
Operating cash outflows from finance leases$13 $14 $12 
Financing cash outflows from finance leases$107 $118 $140 
Right-of-use assets obtained in exchange for lease obligations:
Operating leases$168 $341 $176 
Finance leases$55 $97 $136 
Future maturities of lease liabilities at December 31, 2023 are presented in the following table:
Operating LeasesFinance LeasesTotal
2024$255 $95 $350 
2025225 54 279 
2026190 24 214 
2027165 9 174 
2028136 7 143 
Later years494 70 564 
Total lease payments1,465 259 1,724 
Less: Imputed interest254 55 309 
Total lease obligations1,211 204 1,415 
Less: Current obligations204 84 288 
Long-term lease obligations$1,007 $120 $1,127 
During the three months ended March 31, 2022, we sold several medical office buildings held in our Hospital Operations segment for net cash proceeds of $147 million and concurrently entered into operating lease agreements to continue use of the facilities. We recognized a gain of $69 million from the sale of these buildings, included in other operating expenses, net in the accompanying Consolidated Statement of Operations, and we recognized right-of-use assets and operating lease obligations of $103 million, in each case in the three months ended March 31, 2022.
LEASES LEASES
The following table presents the components of our right‑of‑use assets and liabilities related to leases and their classification in our Consolidated Balance Sheets:
December 31,
Component of Lease BalancesClassification in Consolidated Balance Sheets20232022
Assets:  
Operating lease assetsInvestments and other assets$1,083 $1,129 
Finance lease assets
Property and equipment, at cost, less
accumulated depreciation and amortization
253 303 
Total leased assets$1,336 $1,432 
Liabilities:
Operating lease liabilities:
CurrentOther current liabilities$204 $207 
Long-termOther long-term liabilities1,007 1,046 
Total operating lease liabilities1,211 1,253 
Finance lease liabilities:
CurrentCurrent portion of long-term debt84 99 
Long-termLong-term debt, net of current portion120 165 
Total finance lease liabilities204 264 
Total lease liabilities$1,415 $1,517 
The following table presents the components of our lease expense and their classification in our Consolidated Statements of Operations:
Component of Lease ExpenseClassification in Consolidated Statements of OperationsYears Ended December 31,
202320222021
Operating lease expenseOther operating expenses, net$259 $262 $241 
Finance lease expense:
Amortization of leased assetsDepreciation and amortization55 58 71 
Interest on lease liabilitiesInterest expense8 8 9 
Total finance lease expense63 66 80 
Variable and short term-lease expenseOther operating expenses, net159 150 171 
Total lease expense$481 $478 $492 
The weighted‑average lease terms and discount rates for operating and finance leases are presented in the following table:
Years Ended December 31,
202320222021
Weighted-average remaining lease term (years):
Operating leases7.68.07.5
Finance leases6.05.55.7
Weighted-average discount rate:
Operating leases5.0 %4.8 %5.1 %
Finance leases6.5 %5.9 %5.4 %
Cash flow and other information related to leases is included in the following table:
Years Ended December 31,
202320222021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases$258 $250 $237 
Operating cash outflows from finance leases$13 $14 $12 
Financing cash outflows from finance leases$107 $118 $140 
Right-of-use assets obtained in exchange for lease obligations:
Operating leases$168 $341 $176 
Finance leases$55 $97 $136 
Future maturities of lease liabilities at December 31, 2023 are presented in the following table:
Operating LeasesFinance LeasesTotal
2024$255 $95 $350 
2025225 54 279 
2026190 24 214 
2027165 9 174 
2028136 7 143 
Later years494 70 564 
Total lease payments1,465 259 1,724 
Less: Imputed interest254 55 309 
Total lease obligations1,211 204 1,415 
Less: Current obligations204 84 288 
Long-term lease obligations$1,007 $120 $1,127 
During the three months ended March 31, 2022, we sold several medical office buildings held in our Hospital Operations segment for net cash proceeds of $147 million and concurrently entered into operating lease agreements to continue use of the facilities. We recognized a gain of $69 million from the sale of these buildings, included in other operating expenses, net in the accompanying Consolidated Statement of Operations, and we recognized right-of-use assets and operating lease obligations of $103 million, in each case in the three months ended March 31, 2022.
v3.24.0.1
LONG-TERM DEBT
 12 Months Ended
Dec. 31, 2023
Long-Term Debt and Lease Obligation [Abstract]  
LONG-TERM DEBT LONG-TERM DEBT
The table below presents our long‑term debt included in the accompanying Consolidated Balance Sheets:
December 31,
 20232022
Senior unsecured notes:  
6.125% due 2028
$2,500 $2,500 
6.875% due 2031
362 362 
Senior secured first lien notes:  
4.625% due July 2024
— 756 
4.625% due September 2024
— 589 
4.875% due 2026
2,100 2,100 
5.125% due 2027
1,500 1,500 
4.625% due 2028
600 600 
4.250% due 2029
1,400 1,400 
4.375% due 2030
1,450 1,450 
6.125% due 2030
2,000 2,000 
6.750% due 2031
1,350 — 
Senior secured second lien notes:
6.250% due 2027
1,500 1,500 
Finance leases, mortgages and other notes361 453 
Unamortized issue costs and note discounts(121)(131)
Long-term debt15,002 15,079 
Less: Current portion120 145 
Long-term debt, net of current portion$14,882 $14,934 
Senior Unsecured Notes and Senior Secured Notes
At December 31, 2023, we had senior unsecured notes and senior secured notes with aggregate principal amounts outstanding of $14.762 billion. These notes have fixed interest rates ranging from 4.250% to 6.875% and require semi‑annual interest payments in arrears. A payment of the principal and any accrued but unpaid interest is due upon the maturity date of the respective notes, which dates are staggered from January 2026 through November 2031. We completed the following transactions related to our senior secured notes during the years ended December 31, 2023 and 2022.
2023 Transactions:
•In May 2023, we issued $1.350 billion aggregate principal amount of 6.750% senior secured first lien notes, which will mature on May 15, 2031 (the “2031 Senior Secured First Lien Notes”). We pay interest on the 2031 Senior Secured First Lien Notes semi-annually in arrears on May 15 and November 15 of each year, which payments commenced on November 15, 2023. We used the issuance proceeds, together with cash on hand, to finance the redemption of our 4.625% senior secured first lien notes due September 2024 (the “September 2024 Senior Secured First Lien Notes”) and our 4.625% senior secured first lien notes due July 2024 (the “July 2024 Senior Secured First Lien Notes”), as described below.
•Also in May 2023, we paid $596 million using a portion of the proceeds from the issuance of our 2031 Senior Secured First Lien Notes to redeem all $589 million aggregate principal amount outstanding of our September 2024 Senior Secured First Lien Notes in advance of their maturity date.
•In June 2023, we used the remaining proceeds from the issuance of our 2031 Senior Secured First Lien Notes along with cash on hand to redeem all $756 million aggregate principal amount outstanding of our July 2024 Senior Secured First Lien Notes in advance of their maturity date.
2022 Transactions:
•On February 23, 2022, we redeemed all $700 million aggregate principal amount outstanding of our 7.500% senior secured first lien notes due 2025 in advance of their maturity date. We paid $730 million from cash on hand to redeem the notes.
•On June 15, 2022, we issued $2.000 billion aggregate principal amount of 6.125% senior secured first lien notes, which will mature on June 15, 2030 (the “2030 Senior Secured First Lien Notes”). We pay interest on the
2030 Senior Secured First Lien Notes semi‑annually in arrears on June 15 and December 15 of each year, which payments commenced in December 2022. As further discussed below, we used a substantial portion of the issuance proceeds from the 2030 Senior Secured First Lien Notes, after payment of fees and expenses, to finance the redemption of our 6.750% senior unsecured notes due 2023 (the “2023 Senior Unsecured Notes”).
•Through a series of open‑market transactions during the six months ended June 30, 2022, we repurchased $124 million aggregate principal amount outstanding of our 2023 Senior Unsecured Notes using cash on hand. Following the issuance of our 2030 Senior Secured First Lien Notes, we used a substantial portion of the proceeds to redeem the then-remaining $1.748 billion aggregate principal outstanding of the 2023 Senior Unsecured Notes in advance of their maturity date. In total, we paid $1.933 billion during the six months ended June 30, 2022 to retire all $1.872 billion aggregate principal amount outstanding of our 2023 Senior Unsecured Notes.
•During the three months ended December 31, 2022, we paid a total of $13 million from cash on hand through multiple open‑market transactions to repurchase $14 million of the $770 million aggregate principal amount then outstanding of our July 2024 Senior Secured First Lien Notes in advance of their maturity date.
•Also during the three months ended December 31, 2022, we repurchased $11 million of the then‑remaining $600 million aggregate principal amount outstanding of our September 2024 Senior Secured First Lien Notes in advance of their maturity date. We made aggregate payments of $11 million from cash on hand through multiple open‑market transactions to repurchase these notes.
We recorded net losses from the early extinguishment of debt of $11 million and $109 million in connection with the aforementioned purchases and redemptions during the years ended December 31, 2023 and 2022, respectively. The losses recognized during both periods primarily related to the differences between the purchase or redemption prices and the par values of the notes, as well as the write‑off of associated unamortized issuance costs.
All of our senior secured notes are guaranteed by certain of our wholly owned domestic hospital company subsidiaries and secured by a pledge of the capital stock and other ownership interests of those subsidiaries on either a first lien or second lien basis, as indicated in the table above. All of our senior secured notes and the related subsidiary guarantees are our and the subsidiary guarantors’ senior secured obligations. All of our senior secured notes rank equally in right of payment with all of our other senior secured indebtedness. Our senior secured notes rank senior to any subordinated indebtedness that we or such subsidiary guarantors may incur; they are effectively senior to our and such subsidiary guarantors’ existing and future unsecured indebtedness and other liabilities to the extent of the value of the collateral securing the notes and the subsidiary guarantees; they are effectively subordinated to our and such subsidiary guarantors’ obligations under our senior secured revolving credit facility (as amended to date, the “Credit Agreement”) to the extent of the value of the collateral securing borrowings thereunder; and they are structurally subordinated to all obligations of our non‑guarantor subsidiaries.
The indentures setting forth the terms of our senior secured notes contain provisions governing our ability to redeem the notes and the terms by which we may do so. At our option, we may redeem our senior secured notes, in whole or in part, at any time at a redemption price equal to 100% of the principal amount of the notes redeemed plus the make‑whole premium set forth in the related indenture, together with accrued and unpaid interest thereon, if any, to the redemption date. Certain series of the senior secured notes may also be redeemed, in whole or in part, at certain redemption prices set forth in the applicable indentures, together with accrued and unpaid interest. In addition, we may be required to purchase for cash all or any part of each series of our senior secured notes upon the occurrence of a change of control (as defined in the applicable indentures) for a cash purchase price of 101% of the aggregate principal amount of the notes, plus accrued and unpaid interest.
All of our senior unsecured notes are general unsecured senior debt obligations that rank equally in right of payment with all of our other unsecured senior indebtedness, but are effectively subordinated to our senior secured notes described above, the obligations of our subsidiaries and any obligations under our Credit Agreement to the extent of the value of the collateral. We may redeem any series of our senior unsecured notes, in whole or in part, at any time at a redemption price equal to 100% of the principal amount of the notes redeemed, plus a make‑whole premium specified in the applicable indenture, if any, together with accrued and unpaid interest to the redemption date.
Credit Agreement
Our Credit Agreement provides for revolving loans in an aggregate principal amount of up to $1.500 billion with a $200 million subfacility for standby letters of credit. In April 2021, we amended the Credit Agreement to, among other things, extend the incremental borrowing capacity made temporarily available to us beginning in April 2020 (the “Increased Commitments”), which was schedule to expire in April 2021, through April 2022 and reduce the interest rate margins. In March 2022, we further amended our Credit Agreement to, among other things, (1) decrease the aggregate revolving credit commitments from the previous Increased Commitments to aggregate revolving credit commitments not to exceed
$1.500 billion, subject to borrowing availability, (2) extend the scheduled maturity date to March 16, 2027, and (3) replace the London Interbank Offered Rate (“LIBOR”) as the reference interest rate. At December 31, 2023, we had no cash borrowings outstanding under the Credit Agreement, and we had less than $1 million of standby letters of credit outstanding. Based on our eligible receivables, $1.500 billion was available for borrowing at December 31, 2023.
Outstanding revolving loans accrue interest depending on the type of loan at either (a) a base rate plus an applicable margin ranging from 0.25% to 0.75% per annum or (b) Term Secured Overnight Financing Rate (“SOFR”), Daily Simple SOFR or the Euro Interbank Offered Rate (EURIBOR) (each, as defined in the Credit Agreement) plus an applicable margin ranging from 1.25% to 1.75% per annum and (in the case of Term SOFR and Daily Simple SOFR only) a credit spread adjustment of 0.10%, in each case based on available credit. An unused commitment fee payable on the undrawn portion of the revolving loans ranges from 0.25% to 0.375% per annum based on available credit. Our borrowing availability is based on a specified percentage of eligible inventory and accounts receivable, including self‑pay accounts.
Obligations under the Credit Agreement continue to be guaranteed by substantially all of our domestic wholly owned hospital subsidiaries and secured by a first‑priority lien on the eligible inventory and accounts receivable owned by us and the subsidiary guarantors, including receivables for Medicaid supplemental payments.
Letter of Credit Facility
We have a letter of credit facility (as amended to date, the “LC Facility”) that provides for the issuance, from time to time, of standby and documentary letters of credit in an aggregate principal amount of up to $200 million. We amended the LC Facility in September 2023 to, among other things, (1) extend the scheduled maturity date from September 12, 2024 to March 16, 2027, and (2) replace LIBOR with Term SOFR as the reference interest rate. Drawings under any letter of credit issued under the LC Facility that we have not reimbursed within three business days after notice thereof accrue interest at a base rate, as defined in the LC Facility, plus a margin of 0.50% per annum. An unused commitment fee is payable at an initial rate of 0.25% per annum with a step up to 0.375% per annum should our secured‑debt‑to‑EBITDA ratio equal or exceed 3.00 to 1.00 at the end of any fiscal quarter. A fee on the aggregate outstanding amount of issued but undrawn letters of credit accrues at a rate of 1.50% per annum. An issuance fee equal to 0.125% per annum of the aggregate face amount of each outstanding letter of credit is payable to the account of the issuer of the related letter of credit. The LC Facility is subject to an effective maximum secured debt covenant of 4.25 to 1.00. Obligations under the LC Facility are guaranteed and secured by a first‑priority pledge of the capital stock and other ownership interests of certain of our wholly owned domestic hospital subsidiaries on an equal‑ranking basis with our senior secured first lien notes. At December 31, 2023, we had $111 million of standby letters of credit outstanding under the LC Facility and were in compliance with all applicable covenants and conditions.
Covenants
Senior Secured Notes—The indentures governing our senior secured notes contain covenants that, among other things, restrict our ability and the ability of our subsidiaries to incur liens, consummate asset sales, enter into sale and lease‑back transactions or consolidate, merge or sell all or substantially all of our or their assets, other than in certain transactions between one or more of our wholly owned subsidiaries. These restrictions, however, are subject to a number of exceptions and qualifications. In particular, there are no restrictions on our ability or the ability of our subsidiaries to incur additional indebtedness, make restricted payments, pay dividends or make distributions in respect of capital stock, purchase or redeem capital stock, enter into transactions with affiliates or make advances to, or invest in, other entities (including unaffiliated entities). In addition, the indentures governing our senior secured notes contain a covenant that neither we nor any of our subsidiaries will incur secured debt, unless at the time of and after giving effect to the incurrence of such debt, the aggregate amount of all such secured debt (including the aggregate principal amount of senior secured notes outstanding and any outstanding borrowings under our Credit Agreement at such time) does not exceed the amount that would cause the secured debt ratio (as defined in the indentures) to exceed 4.00 to 1.00.
Senior Unsecured Notes—The indentures governing our senior unsecured notes contain covenants and conditions that have, among other requirements, limitations on (1) liens on “principal properties” and (2) sale and lease‑back transactions with respect to principal properties. A principal property is defined in the senior unsecured notes indentures as a hospital that has an asset value on our books in excess of 5% of our consolidated net tangible assets, as defined in such indentures. The above limitations do not apply, however, to (1) debt that is not secured by principal properties or (2) debt that is secured by principal properties if the aggregate of such secured debt does not exceed 15% of our consolidated net tangible assets, as further described in the indentures. The senior unsecured notes indentures also prohibit the consolidation, merger or sale of all or substantially all assets unless no event of default would result after giving effect to such transaction.
Credit Agreement—Our Credit Agreement contains customary covenants for an asset‑backed facility, including a minimum fixed charge coverage ratio to be met if the designated excess availability under the revolving credit facility falls
below $150 million, as well as limits on debt, asset sales and prepayments of certain other debt. The Credit Agreement also includes a provision, which we believe is customary in receivables‑backed credit facilities, that gives our lenders the right to require that proceeds of collections of substantially all of our consolidated accounts receivable be applied directly to repay outstanding loans and other amounts that are due and payable under the Credit Agreement at any time that unused borrowing availability under the revolving credit facility is less than $150 million for three consecutive business days or if an event of default has occurred and is continuing thereunder. In that event, we would seek to re‑borrow under the Credit Agreement to satisfy our operating cash requirements. Our ability to borrow under the Credit Agreement is subject to conditions that we believe are customary in revolving credit facilities, including that no events of default then exist.
Future Maturities
Future long‑term debt maturities, including finance lease obligations were as follows as of December 31, 2023:
  Years Ending December 31,Later Years
 Total20242025202620272028
Long-term debt, including finance lease obligations$15,123 $120 $92 $2,149 $3,029 $3,114 $6,619 
v3.24.0.1
GUARANTEES
 12 Months Ended
Dec. 31, 2023
Guarantees [Abstract]  
GUARANTEES GUARANTEES
Consistent with our policy on physician relocation and recruitment, we provide income guarantee agreements to certain physicians who agree to relocate to fill a community need in the service area of one of our hospitals and commit to remain in practice in the area for a specified period of time. Under such agreements, we are required to make payments to the physicians in excess of the amounts they earn in their practices up to the amount of the income guarantee. The income guarantee periods are typically 12 months. If a physician does not fulfill his or her commitment period to the community, which is typically three years subsequent to the guarantee period, we seek recovery of the income guarantee payments from the physician on a prorated basis. We also provide revenue collection guarantees to hospital‑based physician groups providing certain services at our hospitals with terms generally ranging from one to three years.
At December 31, 2023, the maximum potential amount of future payments under our income guarantees to certain physicians who agree to relocate and revenue collection guarantees to hospital‑based physician groups providing certain services at our hospitals was $356 million. We had a total liability of $274 million recorded for these guarantees included in other current liabilities in the accompanying Consolidated Balance Sheet at December 31, 2023.
At December 31, 2023, we also had issued guarantees of the indebtedness and other obligations of our investees to third parties, the maximum potential amount of future payments under which was approximately $88 million. Of the total, $21 million relates to the obligations of consolidated subsidiaries, which obligations were recorded in other current liabilities in the accompanying Consolidated Balance Sheet at December 31, 2023.
v3.24.0.1
EMPLOYEE BENEFIT PLANS
 12 Months Ended
Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]  
EMPLOYEE BENEFIT PLANS EMPLOYEE BENEFIT PLANS
Share-Based Compensation Plans
We have granted stock options and restricted stock units (“RSUs”) to certain of our employees and directors pursuant to our stock incentive plans. Stock options have an exercise price equal to the fair market value of the shares on the date of grant and generally expire 10 years from the date of grant. An RSU is a contractual right to receive one share of our common stock in the future, and the fair value of the RSU is based on our share price on the grant date. Typically, stock options and time‑based RSUs vest one‑third on each of the first three anniversary dates of the grant; however, certain special retention awards may have different vesting terms. Shares underlying vested RSUs are generally distributed to participants (settled) immediately after the vesting date. In addition, grants of RSUs to our non‑employee directors as part of their annual compensation vest immediately and are settled on the third anniversary of the date of grant, while initial grants made to directors vested immediately but will not settle until separation from the board. We did not make any new initial grants to a non‑employee director in either 2023 or 2022. Compensation cost is measured by the fair value of the awards on their grant dates and is recognized over the requisite service period of the awards, whether or not the awards had any intrinsic value during the period.
We also grant performance‑based RSUs that vest subject to the achievement of specified performance goals within a specified time frame. The performance‑based RSUs may contain provisions that increase or decrease the number of RSUs that ultimately vest, depending upon the level of achievement. For certain of our performance‑based awards, the number of options or RSUs that ultimately vest is also subject to adjustment based on the achievement of a market‑based condition. These adjustments generally range from 0% to 200% of the number of RSUs initially granted for awards made prior to December 31, 2022, and from 0% to 225% for certain awards granted after that date. The fair value of awards that contain a
market‑based condition is estimated using a discrete model to analyze the fair value of the subject shares. The discrete model utilizes multiple stock paths, through the use of a Monte Carlo simulation, which paths are then analyzed to determine the fair value of the subject shares.
Pursuant to the terms of our stock‑based compensation plans, awards granted under the plan vest and may be exercised as determined by the human resources committee of our board of directors. In the event of a change in control, the human resources committee of our board of directors may, at its sole discretion without obtaining shareholder approval, accelerate the vesting or performance periods of the awards.
At December 31, 2023, assuming outstanding performance‑based RSUs for which performance has not yet been determined will achieve target performance, approximately 8,895 thousand shares of common stock were available under our 2019 Stock Incentive Plan for future stock option grants and other equity incentive awards, including RSUs. The accompanying Consolidated Statements of Operations include pre-tax compensation costs related to our stock‑based compensation arrangements of $66 million for the year ended December 31, 2023, and $56 million for each of the years ended December 31, 2022 and 2021.
Stock Options
The following table summarizes stock option activity during the years ended December 31, 2023, 2022 and 2021:
 Number of OptionsWtd. Avg.
Exercise Price
Per Share		Aggregate
Intrinsic Value		Wtd. Avg
Remaining Life
   (In Millions) 
Outstanding at December 31, 2020912,531 $22.51   
Exercised(391,533)$20.66   
Outstanding at December 31, 2021520,998 $23.90   
Exercised(60,051)$28.26   
Outstanding at December 31, 2022460,947 $23.33   
Exercised(76,507)$26.07   
Outstanding at December 31, 2023384,440 $22.79 $20 4.1 years
The stock options exercised during both of the years ended December 31, 2023 and 2022 had aggregate intrinsic values of $4 million, and the stock options exercised during the year ended December 31, 2021 had an aggregate intrinsic value of $15 million. No stock options were granted during the years ended December 31, 2023, 2022 or 2021, and all outstanding options were vested and exercisable at December 31, 2023.
The following table summarizes information about our outstanding stock options at December 31, 2023:
 Options Outstanding and Exercisable
Range of Exercise Prices Number of
Options		Wtd. Avg.
Remaining
Contractual Life		Wtd. Avg.
Exercise Price
$18.99 to $20.609
255,845 3.6 years$19.62 
$20.61 to $35.430
128,595 5.1 years$29.07 
 384,440 4.1 years$22.79 
As of December 31, 2023, 30.8% of all our outstanding options were held by current employees and 69.2% were held by former employees. All of our outstanding options were in‑the‑money, that is, they had exercise price less than the $75.57 market price of our common stock on December 31, 2023.
Restricted Stock Units
The following table summarizes RSU activity during the years ended December 31, 2023, 2022 and 2021:
 Restricted
Stock Units		Wtd. Avg. Grant Date Fair
Value Per Unit
Unvested at December 31, 20202,095,206 $25.87 
Granted900,018 $58.61 
Vested(765,814)$30.51 
Forfeited(58,208)$37.60 
Unvested at December 31, 20212,171,202 $40.51 
Granted641,205 $80.79 
Vested(1,187,384)$37.18 
Forfeited(104,605)$53.58 
Unvested at December 31, 20221,520,418 $66.36 
Granted759,590 $60.88 
Performance-based adjustment185,901 $48.97 
Vested(954,401)$48.75 
Forfeited(90,445)$64.61 
Unvested at December 31, 20231,421,063 $66.46 
The table below summarizes the time-based RSUs granted during the year ended December 31, 2023:
No. of
RSUs Granted
Vesting Terms
309,282
RSUs will vest and be settled ratably over a three‑year period from the grant date
42,626
RSUs will vest and be settled on the fifth anniversary of the grant date
42,100
RSUs granted to our non-employee directors for the 2023-2024 board service year, which vested immediately and will be settled on the third anniversary of the grant date
33,586
RSUs vested and settled in December 2023
20,707
RSUs will vest and be settled upon the relocation of one of our executive officers
2,007
RSUs will vest and be settled on the third anniversary of the grant date
The table below summarizes the performance-based RSUs granted during the year ended December 31, 2023:
No. of
RSUs Granted
Performance PeriodPotential Vesting Range
Vesting TermsMinimumMaximum
301,562
RSUs will vest and be settled on the third anniversary of the grant date
2023 to 2025
— %225 %
185,901
RSUs vested and settled immediately as a result of our level of achievement with respect to performance‑based RSUs granted in 2020
7,720
RSUs will vest and be settled on the third anniversary of the grant date
2023 to 2025
— %200 %
The table below summarizes the time-based RSUs granted during the year ended December 31, 2022:
No. of
RSUs Granted
Vesting Terms
237,381
RSUs will vest and be settled ratably over a three‑year period from the grant date
53,716
RSUs were scheduled to vest and be settled ratably over 11 quarterly periods
35,482
RSUs granted to our non-employee directors for the 2022-2023 board service year vested immediately and will be settled on the third anniversary of the grant date
9,215
RSUs will vest and be settled ratably over a four-year period from the grant date
7,325
RSUs granted to a non-executive member of the board of directors for his service as chairman of the board; award vested and settled in December 2023
6,170
RSUs will vest and be settled evenly on the third and fourth anniversaries of the grant date
4,608
RSUs will vest and be settled on the second anniversary of the grant date
In addition, we granted 287,308 performance‑based RSUs during the year ended December 31, 2022; the vesting of these RSUs is contingent on our achievement of specified performance goals for the years 2022 to 2024. Provided the goals are achieved, the performance‑based RSUs will vest and be settled on the third anniversary of the grant date. The actual number of performance‑based RSUs that could vest will range from 0% to 200% of the 287,308 units granted, depending on our level of achievement with respect to the performance goals.
The table below summarizes the time-based RSUs granted during the year ended December 31, 2021:
No. of
RSUs Granted
Vesting Terms
263,180
RSUs will vest and be settled ratably over a three-year period from the grant date
189,215
RSUs were scheduled to vest and be settled ratably over eight quarterly periods from the grant date
53,341
RSUs will vest and be settled on the fourth anniversary of the grant date
38,366
RSUs granted to our non-employee directors for the 2021-2022 board service year, which vested immediately and will be settled on the third anniversary of the grant date
33,351
RSUs will vest and be settled on the third anniversary of the grant date
14,192
RSUs vested on December 31, 2021 and were settled in January 2022
8,509
RSUs, one-third of which will vest and be settled on the second anniversary of the grant date and the remainder of which will vest and be settled on the fourth anniversary
1,372
RSUs granted to a new member of our board of directors, which vested immediately and will be settled upon separation from the board
The table below summarizes the performance-based RSUs granted during the year ended December 31, 2021:
No. of
RSUs Granted
Performance PeriodPotential Vesting Range
Vesting TermsMinimumMaximum
244,259
RSUs will vest and be settled on the third anniversary of the grant
2021 to 2023— %200 %
53,341
RSUs will vest and be settled on the fourth anniversary of the grant date
2021 to 2025— %200 %
892
RSUs vested and settled immediately as a result of our level of achievement with respect to performance‑based RSUs granted in 2018
Included in the 2022 and 2021 time-based RSU grants were 53,716 and 189,215 RSUs, respectively, granted to our former Executive Chairman. Furthermore, of the total 2022 performance-based RSUs, 53,716 were also granted to him. These RSUs vested and settled in October 2022, ahead of their scheduled vesting dates, in accordance with the disability provisions of our stock incentive plan. The performance-based awards vested at 100%.
Compensation costs related to our stock-based compensation arrangements for the years ended December 31, 2023, 2022 and 2021 included $46 million, $45 million and $42 million of pre-tax compensation costs related to our RSUs, respectively. At December 31, 2023, there were $42 million of total unrecognized compensation costs related to RSUs. These costs are expected to be recognized over a weighted average period of 2.1 years.
For certain of the performance-based RSU grants, the number of units that will ultimately vest is subject to adjustment based on the achievement of a market-based condition. The fair value of these RSUs is estimated through the use of a Monte Carlo simulation. Significant inputs used in our valuation of these RSUs included the following:
Years Ended December 31,
202320222021
Expected volatility
53.6% - 65.6%
39.6% - 68.1%
65.2% - 79.3%
Risk-free interest rate
4.2% - 4.8%
1.0% - 1.7%
0.1% - 0.6%
USPI Management Equity Plan
USPI maintains a separate restricted stock plan (the “USPI Management Equity Plan”) under which it grants RSUs representing a contractual right to receive one share of USPI’s non‑voting common stock in the future. The vesting of RSUs granted under the plan varies based on the terms of the underlying award agreement. Once the RSUs have vested and the subsequent requisite holding period is met, during specified times, the participant can sell the underlying shares to USPI at their estimated fair market value. At our sole discretion, the purchase of any non‑voting common shares can be made in cash or in shares of Tenet’s common stock.
The following table summarizes RSU activity under the USPI Management Equity Plan during the years ended December 31, 2023, 2022 and 2021:
Restricted
Stock Units		Wtd. Avg. Grant Date Fair
Value Per Unit
Unvested at December 31, 20202,025,056 $34.13 
Granted76,990 $34.13 
Vested(388,588)$34.13 
Forfeited(218,576)$34.13 
Unvested at December 31, 20211,494,882 $34.13 
Vested(369,691)$34.13 
Forfeited(202,351)$34.13 
Unvested at December 31, 2022922,840 $34.13 
Vested(303,171)$34.13 
Forfeited(11,685)$34.13 
Unvested at December 31, 2023607,984 $34.13 
USPI did not make any grants under the USPI Management Equity Plan during the years ended December 31, 2023 and 2022. During the year ended December 31, 2021, USPI granted 76,990 RSUs under its management equity plan. Twenty percent of these RSUs vests on each of the first and second anniversaries of the grant date, and the remaining 60% vests on the third anniversary of the grant date.
At December 31, 2023, 607,984 RSUs were outstanding under the USPI Management Equity Plan, all of which are expected to vest. The accompanying Consolidated Statements of Operations for the years ended December 31, 2023, 2022 and 2021 included $20 million, $11 million and $13 million, respectively, of pre-tax compensation costs related to USPI’s management equity plan. During the years ended December 31, 2023, 2022 and 2021, USPI paid $13 million, $11 million and $9 million, respectively, to repurchase a portion of the non‑voting common stock previously issued under the USPI Management Equity Plan. At December 31, 2023, there were 51 thousand outstanding vested shares of non‑voting common stock eligible to be sold to USPI.
Other Employee Benefit and Retirement Plans
Employee Stock Purchase Plan
We have an employee stock purchase plan under which we are currently authorized to issue up to 4,070 thousand shares of common stock to our eligible employees. As of December 31, 2023, there were approximately 2,501 thousand shares available for issuance under our employee stock purchase plan. Under the terms of the plan, eligible employees may elect to have between 1% and 10% of their base earnings withheld each quarter to purchase shares of our common stock. Shares are purchased at a price equal to 95% of the closing price on the last day of the quarter. The plan requires a one‑year holding period for all shares issued. The holding period does not apply upon termination of employment. Under the plan, no individual may purchase, in any year, shares with a fair market value in excess of $25,000. The plan is currently not considered to be compensatory.
We issued the following numbers of shares under our employee stock purchase plan:
 Years Ended December 31, 
 202320222021
Number of shares (in thousands)69 98 90 
Weighted average price$65.62 $54.19 $63.01 
Defined Contribution Retirement Plans
We maintain various other defined contribution plans for the benefit of our employees. During the years ended December 31, 2023, 2022 and 2021, we incurred total expenses from these plans of $126 million, $86 million and $98 million, respectively, primarily related to our contributions to the plans.
Substantially all of our employees, upon qualification, are eligible to participate in our defined contribution 401(k) plans. Under the plans, employees may contribute a portion of their eligible compensation, which we may match with employer contributions at our discretion. Employer matching contributions will vary depending on which of our subsidiaries employs the participant and whether the employee is covered under a collective bargaining agreement.
Defined Benefit Retirement Plans
We maintain three frozen non‑qualified defined benefit pension plans (“SERPs”) that provide supplemental retirement benefits to certain of our current and former executives. These plans are not funded, and plan obligations for these plans are paid from our working capital. Pension benefits are generally based on years of service and compensation. Upon completing the acquisition of Vanguard Health Systems, Inc. on October 1, 2013, we assumed a frozen qualified defined benefit plan (“DMC Pension Plan”) covering substantially all of the employees of our Detroit market that were hired prior to June 1, 2003. The benefits paid under the DMC Pension Plan are primarily based on years of service and final average earnings. During the year ended December 31, 2021, the Society of Actuaries issued the MP‑2021 mortality improvement scale, which we incorporated into the estimates of our defined benefit plan obligations at December 31, 2023 and 2022.
The following tables summarize the balance sheet impact, as well as the benefit obligations, funded status and rate assumptions associated with the SERPs and the DMC Pension Plan based on actuarial valuations prepared:
 December 31,
 20232022
Reconciliation of funded status of plans and the amounts included in the Consolidated Balance Sheets:  
Projected benefit obligations(1)
  
Beginning obligations$(1,002)$(1,313)
Interest cost(53)(37)
Actuarial gain (loss)(15)265 
Benefits paid84 83 
Annuity purchase36 — 
Special termination benefit costs(1)— 
Ending obligations(951)(1,002)
Fair value of plans assets  
Beginning plan assets648 867 
Gain (loss) on plan assets41 (161)
Employer contribution— 2 
Benefits paid(61)(60)
Annuity purchase(36)— 
Ending plan assets592 648 
Funded status of plans$(359)$(354)
Amounts recognized in the Consolidated Balance Sheets consist of:  
Other current liability$(24)$(23)
Other long-term liability$(335)$(331)
Accumulated other comprehensive loss$224 $222 
SERP Assumptions:  
Discount rate5.50 %5.75 %
Compensation increase rate3.00 %3.00 %
Measurement dateDecember 31, 2023December 31, 2022
DMC Pension Plan Assumptions:  
Discount rate5.25 %5.51 %
Compensation increase rateFrozenFrozen
Measurement dateDecember 31, 2023December 31, 2022
(1)The accumulated benefit obligation at December 31, 2023 and 2022 was approximately $951 million and $1.002 billion, respectively.
The components of net periodic benefit costs and related assumptions are as follows:
 Years Ended December 31,
 202320222021
Interest costs$53 $37 $36 
Expected return on plan assets(36)(42)(53)
Amortization of net actuarial loss7 9 11 
Special termination benefit costs1 — — 
Net periodic benefit cost (income)$25 $4 $(6)
SERP Assumptions:   
Discount rate5.75 %3.00 %2.75 %
Compensation increase rate3.00 %3.00 %3.00 %
Measurement dateJanuary 1, 2023January 1, 2022January 1, 2021
Census dateJanuary 1, 2023January 1, 2022January 1, 2021
DMC Pension Plan Assumptions:   
Discount rate5.51 %2.89 %2.53 %
Long-term rate of return on assets5.75 %5.00 %6.25 %
Compensation increase rateFrozenFrozenFrozen
Measurement dateJanuary 1, 2023January 1, 2022January 1, 2021
Census dateJanuary 1, 2023January 1, 2022January 1, 2021
Net periodic benefit costs for the current year are based on assumptions determined at the valuation date of the prior year for the SERPs and the DMC Pension Plan.
We recorded gain (loss) adjustments of $(2) million, $72 million and $61 million in other comprehensive income in the years ended December 31, 2023, 2022 and 2021, respectively, to recognize changes in the funded status of our SERPs and the DMC Pension Plan. Changes in the funded status are recorded as a direct increase or decrease to shareholders’ equity through accumulated other comprehensive loss. Net actuarial gains (losses) of $(9) million, $63 million and $50 million were recognized during the years ended December 31, 2023, 2022 and 2021, respectively, and the amortization of net actuarial loss of $7 million, $9 million and $11 million for the years ended December 31, 2023, 2022 and 2021, respectively, were recognized in other comprehensive income. Actuarial gains (losses) affecting the benefit obligation during the years ended December 31, 2023, 2022 and 2021 are primarily attributable to changes in the discount rate utilized for the SERP and DMC Pension Plan. Cumulative net actuarial losses totaled $224 million, $222 million and $294 million as of December 31, 2023, 2022 and 2021, respectively. There were no unrecognized prior service costs at December 31, 2023, 2022 and 2021 that had not yet been recognized as components of net periodic benefit cost.
To develop the expected long‑term rate of return on plan assets assumption, the DMC Pension Plan considers the current level of expected returns on risk‑free investments (primarily government bonds), the historical level of risk premium associated with the other asset classes in which the portfolio is invested and the expectations for future returns on each asset class. The expected return for each asset class is then weighted based on the target asset allocation to develop the expected long‑term rate of return on assets assumption for the portfolio.
The weighted‑average asset allocations by asset category as of December 31, 2023, were as follows:
TargetActual
Cash and cash equivalents— %1 %
Equity securities20 %6 %
Debt securities73 %75 %
Alternative investments7 %18 %
The DMC Pension Plan assets are invested in public commingled vehicles, segregated separately managed accounts, and private commingled vehicles, all of which are managed by professional investment management firms. The objective for all asset categories is to maximize total return without assuming undue risk exposure. The DMC Pension Plan maintains a well‑diversified asset allocation that meets these objectives. The DMC Pension Plan assets are largely comprised of cash and cash equivalents, including but not limited to money market funds and repurchase agreements secured by U.S. Treasury or federal agency obligations, equity securities, including but not limited to the publicly traded shares of U.S. companies with
various market capitalizations in addition to international and convertible securities, debt securities including, but not limited to, domestic and foreign government obligations, corporate bonds, and mortgage‑backed securities, and alternative investments. Alternative investments is a broadly defined asset category with the objective of diversifying the overall portfolio, complementing traditional equity and fixed‑income securities and improving the overall performance consistency of the portfolio. Alternative investments may include, but are not limited to, diversified hedge funds in the form of professionally managed pooled limited partnership investments and investments in private markets via professionally managed pooled limited partnership interests.
In each investment account, the DMC Pension Plan investment managers are responsible for monitoring and reacting to economic indicators, such as gross domestic product, consumer price index and U.S. monetary policy that may affect the performance of their account. The performance of all managers and the aggregate asset allocation are formally reviewed on a quarterly basis. The current asset allocation objective is to maintain a certain percentage within each asset class allowing for deviation within the established range for each asset class. The portfolio is rebalanced on an as‑needed basis to keep these allocations within the accepted ranges.
In general, fair values determined by Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. We consider a security that trades at least weekly to have an active market. Fair values determined by Level 2 inputs utilize data points that are observable, such as quoted prices for similar assets, interest rates and yield curves. Fair values determined by Level 3 inputs utilize unobservable data points for the asset or liability, and include situations where there is little, if any, market activity for the asset or liability.
The following tables summarize the DMC Pension Plan assets measured at fair value on a recurring basis as of December 31, 2023 and 2022, aggregated by the level in the fair value hierarchy within which those measurements are determined:
TotalLevel 1Level 2Level 3
As of December 31, 2023:
Cash and cash equivalents$6 $6 $— $— 
Equity securities39 39 — — 
Fixed income funds442 442 — — 
Alternative investments:
Private equity securities97 — — 97 
Hedge funds8 — — 8 
 $592 $487 $— $105 
As of December 31, 2022:
Cash and cash equivalents$7 $7 $— $— 
Equity securities89 89 — — 
Debt Securities:
U.S. government obligations200 200 — — 
Corporate debt securities249 249 — — 
Alternative investments:
Private equity securities78 — — 78 
Hedge funds25 — — 25 
$648 $545 $— $103 
The following table presents the estimated future benefit payments to be made from the SERPs and the DMC Pension Plan, a portion of which will be funded from plan assets, for the next five years and in the aggregate for the five years thereafter:
  Years Ending December 31, Five Years Thereafter
 Total20242025202620272028
Estimated benefit payments$789 $84 $84 $83 $82 $81 $375 
The SERP and DMC Pension Plan obligations of $359 million at December 31, 2023 are classified in the accompanying Consolidated Balance Sheet as an other current liability of $24 million and defined benefit plan obligations of $335 million based on an estimate of the expected payment patterns. We expect to make total contributions to the plans of approximately $24 million for the year ending December 31, 2024.
v3.24.0.1
PROPERTY AND EQUIPMENT
 12 Months Ended
Dec. 31, 2023
Property, Plant and Equipment [Abstract]  
PROPERTY AND EQUIPMENT PROPERTY AND EQUIPMENT
The principal components of property and equipment are shown in the table below:
 December 31,
 20232022
Land$625 $661 
Buildings and improvements6,692 6,646 
Construction in progress269 195 
Equipment4,750 4,748 
Finance lease assets378 413 
 12,714 12,663 
Accumulated depreciation and amortization(6,478)(6,201)
Net property and equipment$6,236 $6,462 
Property and equipment is stated at cost, less accumulated depreciation and amortization and impairment write‑downs related to assets held and used. We recognized depreciation expense of $696 million, $669 million and $667 million in the accompanying Consolidated Statements of Operations for the years ended December 31, 2023, 2022 and 2021, respectively.
v3.24.0.1
GOODWILL AND OTHER INTANGIBLE ASSETS
 12 Months Ended
Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]  
GOODWILL AND OTHER INTANGIBLE ASSETS GOODWILL AND OTHER INTANGIBLE ASSETS
The following table provides information on changes in the carrying amount of goodwill:
December 31,
 20232022
Hospital Operations  
Goodwill at beginning of period, net of accumulated impairment losses$3,411 $3,413 
Goodwill acquired during the year133 1 
Goodwill related to assets held for sale and disposed(425)(3)
Goodwill at end of period, net of accumulated impairment losses$3,119 $3,411 
Ambulatory Care
Goodwill at beginning of period$6,712 $5,848 
Goodwill acquired during the year and purchase price allocation adjustments493 866 
Goodwill related to assets held for sale and disposed or deconsolidated facilities(17)(2)
Goodwill at end of period$7,188 $6,712 
There were $2.430 billion of accumulated impairment losses related to the goodwill of our Hospital Operations segment at both December 31, 2023 and 2022. There were no accumulated goodwill impairment losses related to our Ambulatory Care segment in either period.
The following table provides information regarding other intangible assets, which were included in the accompanying Consolidated Balance Sheets:
 Gross
Carrying
Amount		Accumulated
Amortization		Net Book
Value
At December 31, 2023:   
Other intangible assets with finite useful lives:
Capitalized software costs$1,712 $(1,205)$507 
Contracts294 (164)130 
Other91 (78)13 
Other intangible assets with finite lives2,097 (1,447)650 
Other intangible assets with indefinite useful lives:
Trade names105 — 105 
Contracts609 — 609 
Other4 — 4 
Other intangible assets with indefinite lives718 — 718 
Other intangible assets, net$2,815 $(1,447)$1,368 
At December 31, 2022:
Other intangible assets with finite useful lives:
Capitalized software costs$1,751 $(1,206)$545 
Contracts295 (146)149 
Other92 (76)16 
Total other intangible assets with finite lives2,138 (1,428)710 
Other intangible assets with indefinite useful lives:
Trade names105 — 105 
Contracts603 — 603 
Other6 — 6 
Total other intangible assets with indefinite lives714 — 714 
Total other intangible assets, net$2,852 $(1,428)$1,424 
Estimated future amortization of intangible assets with finite useful lives at December 31, 2023 was as follows:
 TotalYears Ending December 31,Later Years
 20242025202620272028
Amortization of intangible assets$650 $132 $124 $99 $84 $61 $150 
We recognized amortization expense of $174 million, $172 million and $188 million in the accompanying Consolidated Statements of Operations for the years ended December 31, 2023, 2022 and 2021, respectively.
v3.24.0.1
OTHER ASSETS
 12 Months Ended
Dec. 31, 2023
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]  
OTHER ASSETS OTHER ASSETS
The principal components of other current assets in the accompanying Consolidated Balance Sheets were as follows:
December 31,
 20232022
Prepaid expenses$391 $400 
Contract assets208 200 
California provider fee program receivables329 367 
Receivables from other government programs282 187 
Guarantees274 143 
Non-patient receivables260 390 
Other95 88 
Total other current assets$1,839 $1,775 
The principal components of investments and other assets in the accompanying Consolidated Balance Sheets were as follows:
 December 31,
 20232022
Marketable securities$48 $30 
Equity investments in unconsolidated healthcare entities1,512 1,599 
Total investments1,560 1,629 
Cash surrender value of life insurance policies43 37 
Long-term deposits50 56 
California provider fee program receivables334 197 
Operating lease assets1,083 1,129 
Other long-term receivables and other assets87 99 
Total investments and other assets$3,157 $3,147 
v3.24.0.1
ACCUMULATED OTHER COMPREHENSIVE LOSS
 12 Months Ended
Dec. 31, 2023
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]  
ACCUMULATED OTHER COMPREHENSIVE LOSS ACCUMULATED OTHER COMPREHENSIVE LOSS
The table below presents our accumulated other comprehensive loss by component:
 December 31,
 20232022
Adjustments for defined benefit plans$(180)$(178)
Unrealized gains on investments(1)(3)
Accumulated other comprehensive loss$(181)$(181)
The following table presents the income tax expense (benefit) from each component of our other comprehensive income:
 December 31,
 20232022
Adjustments for defined benefit plans$— $18 
Foreign currency translation adjustments and other— (1)
Net income tax expense related to items of other comprehensive income$— $17 
v3.24.0.1
NET OPERATING REVENUES
 12 Months Ended
Dec. 31, 2023
Revenue from Contract with Customer [Abstract]  
NET OPERATING REVENUES CONTRACT BALANCES
Hospital Operations Segment
Our Hospital Operations segment’s contract assets and liabilities primarily derive from: (1) patients receiving ongoing inpatient care from one of our facilities at the end of the reporting period; (2) timing differences between our performance of revenue cycle management and other contractually-based services and the invoicing or receipt of payment for these services; and, with respect to the year ended December 31, 2021 as discussed below, (3) advance payments from the MAPP following its expansion under the COVID Acts. Our Hospital Operations segment’s contract assets were included in other current assets, and its contract liabilities are included in other current liabilities or other long‑term liabilities, depending upon when we expect to recognize the underlying revenue, in the accompanying Consolidated Balance Sheets at December 31, 2023 and 2022.
The opening and closing balances of our Hospital Operations segment’s receivables, contract assets, and current and long‑term contract liabilities were as follows:
ReceivablesContract Assets –
Unbilled Revenue		Contract Liabilities –
Current
Deferred Revenue and Advances from Medicare		Contract Liabilities –
Long-Term
Deferred Revenue
December 31, 2022$37 $200 $110 $13 
December 31, 202321 208 59 12 
Increase (decrease)$(16)$8 $(51)$(1)
December 31, 2021$28 $199 $955 $15 
December 31, 202237 200 110 13 
Increase (decrease)$9 $1 $(845)$(2)
At December 31, 2021, the current portion of our Hospital Operations segment’s contract liabilities included $876 million of MAPP advances. All remaining MAPP advances received by our Hospital Operations segment were either repaid or recouped during 2022, which resulted in no outstanding liability at December 31, 2023 and 2022.
In the years ended December 31, 2023 and 2022, we recognized revenue totaling $71 million and $56 million, respectively, from our revenue cycle management services that was included in the opening current deferred revenue liability.
This revenue consists primarily of prepayments for those contract clients who were billed in advance, changes in estimates related to metric‑based services and up‑front integration services that are recognized over the service period.
Contract Costs—We recognized amortization expense related to deferred contract setup costs of $5 million in the year ended December 31, 2023, and $4 million in each of the years ended December 31, 2022 and 2021. At December 31, 2023 and 2022, the unamortized customer contract costs were $22 million and $24 million, respectively, and were presented as part of investments and other assets in the accompanying Consolidated Balance Sheets.
Ambulatory Care Segment
All remaining MAPP advances received by our Ambulatory Care segment were either repaid or recouped during 2022, which resulted in no outstanding liability at December 31, 2023 and 2022. The opening and closing balances of contract liabilities for our Ambulatory Care segment were as follows:
Contract Liabilities – Current Advances from Medicare
December 31, 2021$4 
December 31, 2022— 
Decrease$(4)
NET OPERATING REVENUES
Net operating revenues for our Hospital Operations and Ambulatory Care segments primarily consist of net patient service revenues, principally for patients covered by Medicare, Medicaid, managed care and other health plans, as well as certain uninsured patients under our Compact and other uninsured discount and charity programs. Net operating revenues for our Hospital Operations segment also includes revenues from providing revenue cycle management and value‑based care services to hospitals, health systems, physician practices, employers and other clients.
The table below presents our sources of net operating revenues:
Years Ended December 31,
202320222021
Hospital Operations:
Net patient service revenues from hospitals and related outpatient facilities:
Medicare$2,383 $2,369 $2,615 
Medicaid1,233 1,069 1,254 
Managed care10,248 9,607 9,985 
Uninsured96 141 199 
Indemnity and other590 661 706 
Total14,550 13,847 14,759 
Other revenues(1)
2,133 2,079 2,008 
Total Hospital Operations16,683 15,926 16,767 
Ambulatory Care3,865 3,248 2,718 
Net operating revenues$20,548 $19,174 $19,485 
(1)Primarily revenue from physician practices and revenue cycle management. Revenue from revenue cycle management services is included in other revenues for all periods presented to conform with our new reporting segment structure.
Revenues related to the Texas Comprehensive Hospital Increase Reimbursement Program (“CHIRP”) are presented in managed care net patient service revenues in the table above. Amounts we were assessed to support CHIRP following its approval in 2022 were presented in Medicaid revenues during that period, but have been reclassified to managed care revenues to conform to the current‑year presentation in the same payer group as the revenues to more clearly reflect the results of our participation in this program. Assessments to support CHIRP totaled $126 million and $123 million during the years ended December 31, 2023 and 2022, respectively.
Adjustments for prior‑year cost reports and related valuation allowances, principally related to Medicare and Medicaid, increased revenues in the years ended December 31, 2023, 2022 and 2021 by $24 million, $10 million and $26 million, respectively. Estimated cost report settlements and valuation allowances were included in accounts receivable in the accompanying Consolidated Balance Sheets (see Note 3). We believe that we have made adequate provision for any adjustments that may result from final determination of amounts earned under all the above arrangements with Medicare and Medicaid.
The following table presents the composition of net operating revenues for our Ambulatory Care segment:
Years Ended December 31,
202320222021
Net patient service revenues
$3,713 $3,115 $2,604 
Management fees123 110 86 
Revenue from other sources29 23 28 
Net operating revenues$3,865 $3,248 $2,718 
Performance Obligations
The following table includes revenue from revenue cycle management services that is expected to be recognized in the future related to performance obligations that are unsatisfied, or partially unsatisfied, at the end of the reporting period. The amounts in the table primarily consist of revenue cycle management fixed fees, which are typically recognized ratably as the performance obligation is satisfied. The estimated revenue does not include volume‑ or contingency‑based contracts, variable‑based escalators, performance incentives, penalties or other variable consideration that is considered constrained. Our contract with Catholic Health Initiatives (“CHI”), a minority interest owner of Conifer Health Solutions, LLC, represents the majority of the fixed‑fee revenue related to remaining performance obligations. Conifer’s contract term with CHI ends December 31, 2032.
  Years Ending December 31,Later Years
 Total20242025202620272028
Performance obligations$6,026 $685 $684 $683 $683 $683 $2,608 
v3.24.0.1
INSURANCE
 12 Months Ended
Dec. 31, 2023
Property and Professional and General Liablity Insurance [Abstract]  
INSURANCE INSURANCE
Property Insurance
We have property, business interruption and related insurance coverage to mitigate the financial impact of catastrophic events or perils that is subject to deductible provisions based on the terms of the policies. These policies are issued on an occurrence basis. For the policy period of April 1, 2023 through March 31, 2024, we have coverage totaling $850 million per occurrence, after deductibles and exclusions, with annual aggregate sub‑limits of $100 million for floods, $200 million for earthquakes in California, $200 million for all other earthquakes and a per‑occurrence sub‑limit of $200 million per named windstorm with no annual aggregate. With respect to fires and other perils, excluding floods, earthquakes and named windstorms, the total $850 million limit of coverage per occurrence applies. Deductibles are 5% of insured values for earthquakes in California and named windstorms, and 2% of insured values for earthquakes in the New Madrid fault zone, each with a maximum deductible per claim of $25 million. All other covered losses are subject to a minimum deductible of $5 million per occurrence.
We also purchase cyber liability insurance from third parties. In April 2022, we experienced a cybersecurity incident that temporarily disrupted a subset of our hospital operations and involved the exfiltration of certain confidential company and patient information. We received $41 million and $14 million of insurance recoveries related to this cybersecurity incident during the years ended December 31, 2023 and 2022, respectively; of these amounts, we recorded $34 million and $6 million as net operating revenues during 2023 and 2022, respectively.
Professional and General Liability Reserves
We are self‑insured for the majority of our professional and general liability claims, and we purchase insurance from third‑parties to cover catastrophic claims. At December 31, 2023 and 2022, the aggregate current and long‑term professional and general liability reserves in the accompanying Consolidated Balance Sheets was $1.046 billion and $1.045 billion, respectively. These accruals include the reserves recorded by our captive insurance subsidiaries and our self‑insured retention reserves recorded based on modeled estimates for the portion of our professional and general liability risks, including incurred but not reported claims, for which we do not have insurance coverage.
Commercial insurance we purchase is subject to per‑claim and policy period aggregate limits. If the policy period aggregate limit of any of our policies is exhausted, in whole or in part, it could deplete or reduce the limits available to pay other material claims applicable to that policy period.
Malpractice expense of $369 million, $276 million and $355 million was included in other operating expenses, net, in the accompanying Consolidated Statements of Operations for the years ended December 31, 2023, 2022 and 2021, respectively, of which $116 million, $74 million and $131 million, respectively, related to adverse claims development for prior years.
v3.24.0.1
CLAIMS AND LAWSUITS
 12 Months Ended
Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]  
CLAIMS AND LAWSUITS CLAIMS AND LAWSUITS
We operate in a highly regulated and litigious industry. Healthcare companies are subject to numerous investigations by various governmental agencies. Further, private parties have the right to bring qui tam or “whistleblower” lawsuits against companies that allegedly submit false claims for payments to, or improperly retain overpayments from, the government and, in some states, private payers. We and our subsidiaries have received inquiries in recent years from government agencies, and we may receive similar inquiries in future periods. We are also subject to class action lawsuits, employment‑related claims and other legal actions in the ordinary course of business, including potential claims related to, among other things, the care and treatment provided at our hospitals and outpatient facilities, the application of various federal and state labor and privacy laws, tax audits and other matters. Some of these actions may involve large demands, as well as substantial defense costs. We cannot predict the outcome of current or future legal actions against us or the effect that judgments or settlements in such matters may have on us; however, we believe that the ultimate resolution of our existing ordinary‑course claims and lawsuits will not have a material effect on our business or financial condition.
New claims or inquiries may be initiated against us from time to time. These matters could (1) require us to pay substantial damages or amounts in judgments or settlements, which, individually or in the aggregate, could exceed amounts, if any, that may be recovered under our insurance policies where coverage applies and is available, (2) cause us to incur substantial expenses, (3) require significant time and attention from our management, and (4) cause us to close or sell hospitals or otherwise modify the way we conduct business.
We record accruals for estimated losses relating to claims and lawsuits when available information indicates that a loss is probable and we can reasonably estimate the amount of the loss or a range of loss. Significant judgment is required in both the determination of the probability of a loss and the determination as to whether a loss is reasonably estimable. These
determinations are updated at least quarterly and are adjusted to reflect the effects of negotiations, settlements, rulings, advice of legal counsel and technical experts, and other information and events pertaining to a particular matter, but are subject to significant uncertainty regarding numerous factors that could affect the ultimate loss levels. If a loss on a material matter is reasonably possible and estimable, we disclose an estimate of the loss or a range of loss. We do not disclose an estimate when we have concluded that a loss is either not reasonably possible or a loss, or a range of loss, is not reasonably estimable, based on available information. Given the inherent uncertainties associated with material legal matters, especially those involving governmental agencies, and the indeterminate damages sought in some cases, we are unable to predict the ultimate liability we may incur from such matters, and an adverse outcome in one or more of these matters could be material to our results of operations or cash flows for any particular reporting period.
The following table presents reconciliations of the beginning and ending liability balances in connection with legal settlements and related costs:
 Balances at
Beginning
of Period		Litigation and
Investigation
Costs		Cash
Payments		OtherBalances at
End of
Period
Year Ended December 31, 2023$51 $47 $(59)$1 $40 
Year Ended December 31, 2022$78 $70 $(100)$3 $51 
Year Ended December 31, 2021$26 $116 $(59)$(5)$78 
v3.24.0.1
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES
 12 Months Ended
Dec. 31, 2023
Noncontrolling Interest [Abstract]  
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES
We had a put/call agreement (the “Baylor Put/Call Agreement”) with Baylor that contained put and call options with respect to the 5% voting ownership interest Baylor previously held in USPI. Based on the nature of the Baylor Put/Call Agreement, Baylor’s minority interest in USPI was classified as a redeemable noncontrolling interest in our consolidated balance sheet.
In June 2022, we entered into an agreement to purchase Baylor’s entire 5% ownership interest for $406 million. We paid $11 million upon execution of the share purchase agreement and are obligated to make a total of 35 additional non-interest-bearing monthly payments of approximately $11 million, which payments commenced in August 2022. In June 2022, we recorded the present value of the purchase price as a liability on our balance sheet, with an offset to redeemable noncontrolling interest of $365 million for the carrying amount of the shares and $23 million to additional paid‑in capital for the difference between the carrying value and present value of the purchase price for the shares. At both December 31, 2023 and 2022, we had a liability of $135 million recorded in other current liabilities in the accompanying Consolidated Balance Sheets for the purchase of these shares. The long-term portion of our obligation related to the share repurchase was $63 million and $190 million at December 31, 2023 and 2022, respectively, which amounts were included in other long-term liabilities in the accompanying Consolidated Balance Sheets.
The following table shows the changes in redeemable noncontrolling interests in equity of consolidated subsidiaries:
 December 31,
 20232022
Balances at beginning of period 
$2,149 $2,203 
Net income366 348 
Distributions paid to noncontrolling interests(305)(331)
Accretion of redeemable noncontrolling interests— 104 
Purchases and sales of businesses and noncontrolling interests, net181 (175)
Balances at end of period 
$2,391 $2,149 
The following tables show the composition by segment of our redeemable noncontrolling interests balances, as well as our net income available to redeemable noncontrolling interests:
December 31,
 20232022
Hospital Operations$860 $792 
Ambulatory Care1,531 1,357 
Redeemable noncontrolling interests$2,391 $2,149 
 Years Ended December 31,
 202320222021
Hospital Operations$84 $100 $93 
Ambulatory Care282 248 243 
Net income available to redeemable noncontrolling interests$366 $348 $336 
v3.24.0.1
INCOME TAXES
 12 Months Ended
Dec. 31, 2023
Income Tax Disclosure [Abstract]  
INCOME TAXES INCOME TAXES
The provision for income taxes for continuing operations for the years ended December 31, 2023, 2022 and 2021 consisted of the following:
 Years Ended December 31,
 202320222021
Current tax expense:   
Federal$208 $78 $50 
State46 57 111 
 254 135 161 
Deferred tax expense (benefit):   
Federal55 174 267 
State(3)35 (17)
 52 209 250 
 $306 $344 $411 
A reconciliation between the amount of reported income tax expense and the amount computed by multiplying income from continuing operations before income taxes by the statutory federal tax rate is presented below. Foreign pre-tax loss was $3 million, $8 million and $5 million for the years ended December 31, 2023, 2022 and 2021, respectively.
 Years Ended December 31,
 202320222021
Tax expense at statutory federal rate of 21%$340 $282 $396 
State income taxes, net of federal income tax benefit70 64 77 
Tax benefit attributable to noncontrolling interests(147)(122)(114)
Nondeductible goodwill— 1 35 
Nondeductible executive compensation6 10 8 
Impact of change in state filing method, net of change in unrecognized tax benefit(20)— — 
Nondeductible litigation costs— — 1 
Stock-based compensation tax benefit(2)(6)(5)
Changes in valuation allowance71 120 2 
Prior-year provision to return adjustments and other changes in deferred taxes(9)(12)8 
Other items(3)7 3 
Income tax expense$306 $344 $411 
A change in the business interest expense disallowance rules took effect in 2022, resulting in a larger amount of interest disallowance compared to prior years.
Deferred income taxes reflect the tax effects of temporary differences between the carrying amount of assets and liabilities for financial reporting purposes and the amount used for income tax purposes. The following table discloses those significant components of our deferred tax assets and liabilities, including any valuation allowance:
 December 31, 2023December 31, 2022
 AssetsLiabilitiesAssetsLiabilities
Depreciation and fixed-asset differences$— $430 $— $436 
Reserves related to discontinued operations and restructuring charges6 — 5 — 
Receivables (doubtful accounts and adjustments)222 — 246 — 
Medicare advance payments— — — — 
Accruals for retained insurance risks232 — 227 — 
Intangible assets— 429 — 416 
Other long-term liabilities32 — 27 — 
Benefit plans233 — 207 — 
Other accrued liabilities20 — 30 — 
Investments and other assets— 119 — 112 
Interest expense limitation206 — 133 — 
Net operating loss carryforwards71 — 74 — 
Stock-based compensation13 — 13 — 
Right-of-use lease assets and obligations129 111 192 173 
Other items4 80 11 49 
 1,168 1,169 1,165 1,186 
Valuation allowance(248)— (177)— 
 $920 $1,169 $988 $1,186 
Below is a reconciliation of the deferred tax assets and liabilities and the corresponding amounts reported in the accompanying Consolidated Balance Sheets:
 December 31,
 20232022
Deferred income tax assets$77 $19 
Deferred tax liabilities(326)(217)
Net deferred tax liability$(249)$(198)
During the year ended December 31, 2023, the valuation allowance increased by $71 million, including an increase of $73 million due to limitations on the tax deductibility of interest expense, and a decrease of $2 million due to changes in the expected realizability of deferred tax assets. The balance in the valuation allowance as of December 31, 2023 was $248 million.
During the year ended December 31, 2022, the valuation allowance increased by $120 million, including an increase of $123 million due to limitations on the tax deductibility of interest expense, a decrease of $1 million due to the expiration or worthlessness of unutilized net operating loss carryovers, and a decrease of $2 million due to changes in the expected realizability of deferred tax assets. The balance in the valuation allowance as of December 31, 2022 was $177 million.
During the year ended December 31, 2021, the valuation allowance increased by $2 million, including an increase of $2 million due to limitations on the tax deductibility of interest expense, a decrease of $2 million due to the expiration or worthlessness of unutilized state net operating loss carryovers, and an increase of $2 million due to changes in the expected realizability of deferred tax assets. The remaining balance in the valuation allowance at December 31, 2021 was $57 million.
We account for uncertain tax positions in accordance with FASB ASC 740-10-25, which prescribes a comprehensive model for the financial statement recognition, measurement, presentation and disclosure of uncertain tax positions taken or expected to be taken in income tax returns. The following table summarizes the total changes in unrecognized tax benefits in continuing operations during the years ended December 31, 2023, 2022 and 2021. There were no such changes in discontinued operations. The additions and reductions for tax positions include the impact of items for which the ultimate deductibility is highly certain, but for which there is uncertainty about the timing of such deductions. Such amounts include unrecognized tax benefits that have impacted deferred tax assets and liabilities at December 31, 2023, 2022 and 2021.
 Continuing
Operations
Balance At December 31, 2020$31 
Reductions due to a lapse of statute of limitations3 
Balance At December 31, 2021$34 
Reductions due to a lapse of statute of limitations— 
Balance At December 31, 2022$34 
Increases due to tax positions taken in prior periods31 
Reductions due to a lapse of statute of limitations(1)
Balance At December 31, 2023$64 
The total amount of unrecognized tax benefits as of December 31, 2023 was $64 million, of which $63 million, if recognized, would affect our effective tax rate and income tax benefit from continuing operations. Income tax expense in the year ended December 31, 2023 included expense of $24 million in continuing operations attributable an increase in our estimated liabilities for uncertain tax positions, net of related deferred tax effects. The total amount of unrecognized tax benefits as of December 31, 2022 was $34 million, of which $32 million, if recognized, would affect our effective tax rate and income tax benefit from continuing operations. In the year ended December 31, 2022, there was no change in our estimated liabilities for uncertain tax positions, net of related deferred tax effects. The total amount of unrecognized tax benefits as of December 31, 2021 was $34 million, of which $32 million, if recognized, would affect our effective tax rate and income tax benefit from continuing operations. Income tax expense in the year ended December 31, 2021 included expense of $3 million in continuing operations attributable to an increase in our estimated liabilities for uncertain tax positions, net of related deferred tax effects.
Our practice is to recognize interest and penalties related to income tax matters in income tax expense in our consolidated statements of operations. Approximately $2 million of interest and penalties related to accrued liabilities for uncertain tax positions are included in the accompanying Consolidated Statement of Operations for the year ended December 31, 2023. Total accrued interest or penalties on unrecognized tax benefits as of December 31, 2023 was $2 million.
The IRS has completed audits of our tax returns for all tax years ended on or before December 31, 2007. All disputed issues with respect to these audits have been resolved and all related tax assessments (including interest) have been paid. Our tax returns for years ended after December 31, 2007 and USPI’s tax returns for years ended after December 31, 2020 remain subject to audit by the IRS.
As of December 31, 2023, no significant changes in unrecognized federal and state tax benefits are expected in the next 12 months as a result of the settlement of audits, the filing of amended tax returns or the expiration of statutes of limitations.
At December 31, 2023, our carryforwards available to offset future taxable income consisted of (1) federal net operating loss (“NOL”) carryforwards of approximately $41 million pre‑tax, $39 million of which expires in 2026 to 2037 and $2 million of which has no expiration date, (2) charitable contribution carryforwards of approximately $52 million expiring in 2025 through 2027 and (3) state NOL carryforwards of approximately $3.339 billion expiring in 2024 through 2043 for which the associated deferred tax benefit, net of valuation allowance and federal tax impact, is approximately $35 million. Our ability to utilize NOL carryforwards to reduce future taxable income may be limited under Section 382 of the Internal Revenue Code if certain ownership changes in our company occur during a rolling three‑year period. These ownership changes include purchases of common stock under share repurchase programs, the offering of stock by us, the purchase or sale of our stock by 5% shareholders, as defined in the Treasury regulations, or the issuance or exercise of rights to acquire our stock. If such ownership changes by 5% shareholders result in aggregate increases that exceed 50 percentage points during the three‑year period, then Section 382 imposes an annual limitation on the amount of our taxable income that may be offset by the NOL carryforwards or tax credit carryforwards at the time of ownership change.
v3.24.0.1
EARNINGS PER COMMON SHARE
 12 Months Ended
Dec. 31, 2023
Earnings Per Share [Abstract]  
EARNINGS PER COMMON SHARE EARNINGS PER COMMON SHARE
The following table is a reconciliation of the numerators and denominators of our basic and diluted earnings per common share calculations for our continuing operations. Net income available to our common shareholders is expressed in millions and weighted average shares are expressed in thousands.
 Net Income Available to Common Shareholders (Numerator)Weighted
Average Shares
(Denominator)		Per-Share
Amount
Year Ended December 31, 2023   
Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share$611 101,639 $6.01 
Effect of dilutive stock options, restricted stock units, deferred compensation units, convertible instruments and dividends on preferred stock(13)3,161 (0.30)
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share$598 104,800 $5.71 
Year Ended December 31, 2022   
Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share$410 106,929 $3.83 
Effect of dilutive stock options, restricted stock units, deferred compensation units, convertible instruments and dividends on preferred stock8 3,587 (0.05)
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share$418 110,516 $3.78 
Year Ended December 31, 2021   
Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share$915 106,833 $8.56 
Effect of dilutive stock options, restricted stock units and deferred compensation units— 1,738 (0.13)
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share$915 108,571 $8.43 
During the years ended December 31, 2023 and 2022, our convertible instruments consisted of an agreement related to the ownership interest in a Hospital Operations segment joint venture and RSUs issued under the USPI Management Equity Plan; however, during the first six months of 2022, our convertible instruments also included the Baylor Put/Call Agreement. Additional information about the USPI Management Equity Plan and the Baylor Put/Call Agreement is included in Notes 10 and 18, respectively.
v3.24.0.1
FAIR VALUE MEASUREMENTS
 12 Months Ended
Dec. 31, 2023
Fair Value Disclosures [Abstract]  
FAIR VALUE MEASUREMENTS FAIR VALUE MEASUREMENTS
We are required to provide additional disclosures about fair value measurements as part of our financial statements for each major category of assets and liabilities measured at fair value. In general, fair values determined by Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities, which generally are not applicable to non‑financial assets and liabilities. Fair values determined by Level 2 inputs utilize data points that are observable, such as definitive sales agreements, appraisals or established market values of comparable assets. Fair values determined by Level 3 inputs utilize unobservable data points for the asset or liability and include situations where there is little, if any, market activity for the asset or liability, such as internal estimates of future cash flows.
Non-Recurring Fair Value Measurements
Our non‑financial assets and liabilities not permitted or required to be measured at fair value on a recurring basis typically relate to long‑lived assets held and used, long‑lived assets held for sale and goodwill.
The following table presents this information about assets measured at fair value at December 31, 2023 and 2022 and indicates the fair value hierarchy of the valuation techniques we utilized to determine such fair values:
 TotalQuoted Prices
in Active
Markets for
Identical Assets
(Level 1)		Significant Other
Observable Inputs
(Level 2)		Significant
Unobservable
Inputs
(Level 3)
December 31, 2023
Long-lived assets held for sale$775 $— $775 $— 
December 31, 2022
Long-lived assets held and used$167 $— $167 $— 
As discussed in Note 6, we recognized an impairment charge of $82 million to write down certain long‑lived assets located in one of our markets to their estimated fair value during the year ended December 31, 2022.
Financial Instruments
The fair value of our long‑term debt (except for borrowings under the Credit Agreement) is based on quoted market prices (Level 1). The inputs used to establish the fair value of the borrowings outstanding under the Credit Agreement are considered to be Level 2 inputs. At December 31, 2023 and 2022, the estimated fair value of our long‑term debt was approximately 96.9% and 92.8%, respectively, of the carrying value of the debt.
v3.24.0.1
ACQUISITIONS
 12 Months Ended
Dec. 31, 2023
Business Combination and Asset Acquisition [Abstract]  
ACQUISITIONS ACQUISITIONS
In December 2023, we purchased 55% of the ownership interest held by NextCare, Inc. and certain of its affiliates (“NextCare”) in NextCare Arizona I JV, LLC (“NextCare JV I”), a joint venture established to own and operate 41 UCCs and a telehealth center in Arizona. We paid $75 million from cash on hand on the acquisition date and retained an additional $10 million in escrow pending NextCare’s compliance with certain conditions. We recognized goodwill of $133 million from our acquisition of NextCare JV I. This transaction allowed us to expand our existing network in Arizona with UCCs which are already established and operational. NextCare JV I is included in our Hospital Operations segment.
During the year ended December 31, 2023, we acquired controlling ownership interests in 20 ambulatory surgery centers through a series of transactions. In addition, we acquired controlling ownership interests in 11 previously unconsolidated ambulatory surgery centers during 2023. We paid an aggregate of $149 million to acquire controlling ownership interests in all of the aforementioned facilities.
In July 2022, we acquired controlling ownership interests in 19 fully operational ambulatory surgery centers and three centers then in development from United Urology Group. We paid $104 million, net of cash acquired, for our ownership interests in these facilities and recognized goodwill of $316 million. The aggregate acquisition date fair value of the non‑controlling interests in the facilities we acquired was $223 million. The acquisition of these facilities provided us with access to new markets and further diversified our ambulatory care services portfolio.
We acquired controlling interests in an additional 11 ambulatory surgery centers through a series of transactions during the year ended December 31, 2022. We paid an aggregate purchase price of $65 million, net of cash acquired, for these facilities. During 2022, we also acquired controlling interests in 23 ambulatory surgery centers in which we previously owned a noncontrolling interest for an aggregate purchase price of $65 million.
In December 2021, subsidiaries of USPI acquired ownership interests in 86 ambulatory surgery centers and related ambulatory support services (collectively, the “SCD Centers”) from Surgical Center Development #3, LLC and Surgical Center Development #4, LLC (together, “SCD”). Of these, we acquired controlling interests in 15 ambulatory surgery centers, noncontrolling interests in 57 centers and interests in 14 centers still in the development stage. The newly acquired facilities augmented our Ambulatory Care segment’s existing musculoskeletal service line and expanded the number of markets it serves. We made a cash payment of $1.125 billion, net of cash acquired, to acquire these facilities.
In addition to the SCD Centers, we paid an aggregate purchase price of $74 million to acquire controlling interests in 11 outpatient businesses and various physician practices during the year ended December 31, 2021. During 2021, we also acquired controlling interests in three surgical hospitals and two ambulatory surgery centers in which we previously owned a noncontrolling interest for $21 million.
We are required to allocate the purchase prices of acquired businesses to assets acquired or liabilities assumed and, if applicable, noncontrolling interests based on their fair values. The excess of the purchase price allocated over those fair values is recorded as goodwill. The purchase price allocations for certain acquisitions completed in 2023 are preliminary. We are in process of assessing working capital balances as well as obtaining and evaluating valuations of the acquired property and equipment, management contracts and other intangible assets, and noncontrolling interests. Therefore, those purchase price allocations, including goodwill, recorded in the accompanying consolidated financial statements are subject to adjustment once the assessments and valuation work are completed and evaluated. Such adjustments will be recorded as soon as practical and within the measurement period as defined by the accounting literature. During the year ended December 31, 2023, we adjusted the initial purchase allocation of certain acquisitions completed in 2022 based on the results of completed valuations. These adjustments resulted in a net decrease in our Ambulatory Care segment’s goodwill of $18 million.
Preliminary or final purchase price allocations for all the acquisitions made during the years ended December 31, 2023, 2022 and 2021 are as follows:
Years Ended December 31,
 202320222021
Current assets$34 $38 $59 
Property and equipment28 54 88 
Other intangible assets5 2 8 
Goodwill644 860 664 
Other long-term assets32 99 796 
Previously held equity method investments(99)(207)(43)
Current liabilities(36)(41)(25)
Long-term liabilities(37)(118)(70)
Redeemable noncontrolling interests in equity of consolidated subsidiaries(229)(180)(139)
Noncontrolling interests(102)(273)(95)
Cash paid, net of cash acquired(224)(234)(1,220)
Gains on consolidations$16 $— $23 
With the exception of NextCare JV I, which is included in our Hospital Operations segment, all of the facilities described above are included in our Ambulatory Care segment. The majority of the goodwill generated from our 2023 and 2021 acquisitions will be deductible for income tax purposes; however, the majority of the goodwill generated from our 2022 transactions will not be. The goodwill generated from these transactions can be attributed to the benefits that we expect to realize from operating efficiencies and growth strategies. Approximately $15 million, $14 million and $20 million in transaction costs related to prospective and closed acquisitions were expensed during the years ended December 31, 2023, 2022 and 2021, respectively, and are included in impairment and restructuring charges, and acquisition‑related costs in the accompanying Consolidated Statements of Operations.
During the year ended December 31, 2023 and 2021, we recognized gains totaling $16 million and $23 million, respectively, associated with stepping up our ownership interests in previously held equity investments, which we began consolidating after we acquired controlling interests. No such gain or loss was recognized in the year ended December 31, 2022.
v3.24.0.1
SEGMENT INFORMATION
 12 Months Ended
Dec. 31, 2023
Segment Reporting [Abstract]  
SEGMENT INFORMATION SEGMENT INFORMATION
At December 31, 2022, our business was organized into three separate reporting segments: Hospital Operations and other, Ambulatory Care and Conifer. During the three months ended December 31, 2023, we combined our Hospital Operations and other and Conifer segments into a single reporting segment named Hospital Operations and Services (Hospital Operations). See Note 1 for additional discussion of this change.
Our Hospital Operations segment is comprised of our acute care and specialty hospitals, physician practices and outpatient facilities. At December 31, 2023, our subsidiaries operated 61 hospitals, serving primarily urban and suburban communities in nine states, as well as 164 outpatient facilities, primarily imaging centers, UCCs, ancillary emergency facilities and micro-hospitals. The following transactions changed the number of facilities in our Hospital Operations segment during the years ended December 31, 2023, 2022 and 2021:
•On April 1, 2021, we transferred 24 imaging centers from our Ambulatory Care segment to our Hospital Operations segment; the total assets associated with the imaging centers transferred to our Hospital Operations segment constituted less than 1% of our consolidated total assets at March 31, 2021;
•Also in April 2021, we completed the sale of the majority of the UCCs then held by our Hospital Operations segment to an unaffiliated urgent care provider;
•We completed the sale of the Miami Hospitals in August 2021;
•In September 2022, we opened Piedmont Medical Center Fort Mill, a new hospital located in South Carolina; and
•In December 2023, we acquired a controlling interest in NextCare JV I and a minority interest in NextCare Arizona II JV, LLC. Through these transactions, we acquired a controlling interest in 41 fully operational UCCs and a telehealth center and a noncontrolling interest in an additional 15 fully operational UCCs, all located in Arizona.
Our Hospital Operations segment also provides revenue cycle management and value‑based care services to hospitals, health systems, physician practices, employers and other clients.
Our Ambulatory Care segment is comprised of the operations of USPI. At December 31, 2023, USPI had ownership interests in 461 ambulatory surgery centers (322 consolidated) and 24 surgical hospitals (eight consolidated) in 35 states. We completed the divestiture of 40 UCCs held by our Ambulatory Care segment on April 1, 2021. Effective June 30, 2022, we purchased all of the shares in USPI that Baylor held on that date for $406 million, which increased our ownership interest in USPI’s voting shares from 95% to 100% (see Note 18 for additional information about this transaction).
The following tables include amounts for each of our reportable segments and the reconciling items necessary to agree to amounts reported in the accompanying Consolidated Balance Sheets and Consolidated Statements of Operations, as applicable:
December 31,
 202320222021
Assets:  
Hospital Operations$17,268 $16,599 $18,106 
Ambulatory Care11,044 10,557 9,473 
Total 
$28,312 $27,156 $27,579 
 Years Ended December 31,
 202320222021
Capital expenditures:   
Hospital Operations$671 $687 $592 
Ambulatory Care80 75 66 
Total 
$751 $762 $658 
Net operating revenues:   
Hospital Operations$16,683 $15,926 $16,767 
Ambulatory Care3,865 3,248 2,718 
Total 
$20,548 $19,174 $19,485 
Equity in earnings of unconsolidated affiliates:   
Hospital Operations$10 $10 $25 
Ambulatory Care218 206 193 
Total 
$228 $216 $218 
Adjusted EBITDA:   
Hospital Operations$1,997 $2,142 $2,286 
Ambulatory Care1,544 1,327 1,197 
Total 
$3,541 $3,469 $3,483 
Depreciation and amortization:   
Hospital Operations$750 $729 $760 
Ambulatory Care120 112 95 
Total 
$870 $841 $855 
Years Ended December 31,
202320222021
Adjusted EBITDA $3,541 $3,469 $3,483 
Loss from divested and closed businesses— — (1)
Depreciation and amortization(870)(841)(855)
Impairment and restructuring charges, and acquisition-related costs(137)(226)(85)
Litigation and investigation costs(47)(70)(116)
Interest expense(901)(890)(923)
Loss from early extinguishment of debt(11)(109)(74)
Other non-operating income, net19 10 14 
Gains on sales, consolidation and deconsolidation of facilities23 1 445 
Income from continuing operations, before income taxes$1,617 $1,344 $1,888 
v3.24.0.1
RECENT ACCOUNTING STANDARDS
 12 Months Ended
Dec. 31, 2023
Accounting Standards Update and Change in Accounting Principle [Abstract]  
RECENT ACCOUNTING STANDARDS RECENT ACCOUNTING STANDARDS
Recently Issued Accounting Standards
In November 2023, the FASB issued ASU 2023-07, “Improvements to Reportable Segment Disclosures” (“ASU 2023-07”). The standard expands reportable segment disclosure requirements by requiring disclosures of significant reportable segment expenses that are regularly provided to the chief operating decision maker (“CODM”) and included within each reported measure of a segment's profit or loss. The ASU also requires disclosure of the title and position of the individual identified as the CODM and an explanation of how the CODM uses the reported measures of a segment's profit or loss in assessing segment performance and deciding how to allocate resources. Additionally, ASU 2023-07 requires all segment profit or loss and assets disclosures to be provided on an annual and interim basis. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning one year later. Early adoption is permitted and the amendments must be applied retrospectively to all prior periods presented. The adoption of this guidance will not affect our consolidated results of operations, financial position or cash flows and we are currently evaluating the effect the guidance will have on our disclosures.
In August 2023, the FASB issued ASU 2023-05, “Business Combinations – Joint Venture Formations (Subtopic 805-60): Recognition and Initial Measurement” (“ASU 2023-05”), which clarifies the business combination accounting for joint venture formations. The amendments in the ASU seek to reduce diversity in practice that has resulted from a lack of authoritative guidance regarding the accounting for the formation of joint ventures in separate financial statements. The amendments also seek to clarify the initial measurement of joint venture net assets, including businesses contributed to a joint venture. The guidance is applicable to all entities involved in the formation of a joint venture. ASU 2023-05 is effective prospectively for all joint venture formations with a formation date on or after January 1, 2025. Early adoption and retrospective application of the amendments are permitted. We do not expect adoption of the new guidance to have a material impact on our consolidated financial statements and disclosures.
The FASB issued ASU 2022‑03, “Fair Value Measurement (Topic 820) – Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions” (“ASU 2022‑03”) in June 2022. Through ASU 2022‑03 the FASB clarified that an entity should measure the fair value of an equity security subject to contractual sale restriction the same way it measures an identical equity security that is not subject to such a restriction and enhanced the disclosure requirements related to these instruments. The ASU is effective for public entities for fiscal years beginning after December 15, 2023, including interim periods within those fiscal years, and early adoption is permitted. For non‑investment companies, ASU 2022‑03 will be applied prospectively with adjustments resulting from the initial adoption recognized in earnings and disclosed. We do not expect adoption of ASU 2022‑03 to have a material impact on our consolidated financial statements and disclosures.
Recently Adopted Accounting Standards
As further discussed in Note 1, we adopted ASU 2020-06 effective January 1, 2022. We applied the modified retrospective transition approach as of the period of adoption.
v3.24.0.1
SUBSEQUENT EVENT
 12 Months Ended
Dec. 31, 2023
Subsequent Events [Abstract]  
SUBSEQUENT EVENT SUBSEQUENT EVENT
In January 2024, we entered into a definitive agreement for the sale of four hospitals and related operations in Orange County and Los Angeles County, California, all of which are in our Hospital Operations segment. We anticipate the transaction will close in early 2024, subject to customary regulatory approvals, clearances and closing conditions.
v3.24.0.1
SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS
 12 Months Ended
Dec. 31, 2023
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]  
SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS
SCHEDULE II—VALUATION AND QUALIFYING ACCOUNTS
(In Millions)
 Balance at
Beginning
of Period

Costs and
Expenses(1)
DeductionsOther
Items		Balance at
End of
Period
Valuation allowance for deferred tax assets:
     
Year ended December 31, 2023$177 $71 $— $— $248 
Year ended December 31, 2022$57 $120 $— $— $177 
Year ended December 31, 2021$55 $2 $— $— $57 
(1)
Includes amounts recorded in discontinued operations.
v3.24.0.1
Insider Trading Arrangements
 3 Months Ended
Dec. 31, 2023
Trading Arrangements, by Individual  
Rule 10b5-1 Arrangement Adopted false
Non-Rule 10b5-1 Arrangement Adopted false
Rule 10b5-1 Arrangement Terminated false
Non-Rule 10b5-1 Arrangement Terminated false
v3.24.0.1
SIGNIFICANT ACCOUNTING POLICIES (Policies)
 12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
Basis of Presentation
Our Consolidated Financial Statements include the accounts of Tenet and its wholly owned and majority‑owned subsidiaries. We eliminate intercompany accounts and transactions in consolidation, and we include the results of operations of businesses that are newly acquired in purchase transactions from their dates of acquisition. We account for significant investments in other affiliated companies using the equity method. We also utilize the equity method when we have the ability to exercise significant influence over the affiliated company, despite not holding a significant percentage of its ownership interest. Unless otherwise indicated, all financial and statistical data included in these notes to our Consolidated Financial Statements relate to our continuing operations, with dollar amounts expressed in millions (except per‑share amounts) and share amounts expressed in thousands.
Changes to prior-year presentation
Changes to prior-year presentation—At December 31, 2022, our business was organized into three separate reporting segments: Hospital Operations and other, Ambulatory Care and Conifer. During the three months ended December 31, 2023, we combined our Hospital Operations and other and Conifer segments into a single reporting segment named Hospital Operations and Services (Hospital Operations). This change was made to reflect recent updates to the organizational and management structure of our Conifer and Hospital Operations and other segments. All prior‑period data presented in this report has been adjusted to conform to our new reporting segment structure.
As of December 31, 2023, our business was organized into two reporting segments:
•our Hospital Operations segment, which includes (1) our acute care and specialty hospitals, physician practices, imaging centers, UCCs, ancillary emergency facilities and micro‑hospitals, and (2) the revenue cycle management and value‑based care services we provide to hospitals, health systems, physician practices, employers and other clients through our Conifer Health Solutions, LLC joint venture; and
•our Ambulatory Care segment, which is comprised of the ambulatory surgery center and surgical hospital operations of our subsidiary USPI Holding Company, Inc.
In addition, contract liabilities and contract liabilities – long-term are no longer significant enough to present separately. These obligations are now included in other current liabilities and other long-term liabilities, respectively, in the accompanying Consolidated Balance Sheets.
Use of Estimates
The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America (“GAAP”) requires us to make estimates and assumptions that affect the amounts reported in our Consolidated Financial Statements and these accompanying notes. We regularly evaluate the accounting policies and estimates we use. In general, we base the estimates on historical experience and on assumptions that we believe to be reasonable given the particular circumstances in which we operate. Although we believe all adjustments considered necessary for a fair presentation have been included, actual results may vary from those estimates. The financial and statistical information we report to other regulatory agencies may be prepared on a basis other than GAAP or using different assumptions or reporting periods and, therefore, may vary from the amounts presented herein. Although we make every effort to ensure that the information we report to those agencies is accurate, complete and consistent with applicable reporting guidelines, we cannot be responsible for the accuracy of the information they make available to the public.
Translation of Foreign Currencies
Our GBC, which is located in the Philippines, performs certain administrative functions and other support tasks. The GBC’s accounts are measured in its local currency (the Philippine peso) and then translated into U.S. dollars. All assets and liabilities denominated in foreign currency are translated using the current rate of exchange at the balance sheet date. Results of operations denominated in foreign currency are translated using the average rates prevailing throughout the period of operations. Translation gains or losses resulting from changes in exchange rates are accumulated in shareholders’ equity.
Net Operating Revenues
We recognize net operating revenues in the period in which we satisfy our performance obligations under contracts by transferring services to our customers. Net operating revenues are recognized in the amounts we expect to be entitled to, which are the transaction prices allocated for the distinct services. Net operating revenues for our Hospital Operations and Ambulatory Care segments primarily consist of net patient service revenues, principally for patients covered by Medicare, Medicaid, managed care and other health plans, as well as certain uninsured patients under our Compact with Uninsured Patients (“Compact”) and other uninsured discount and charity programs.
Net Patient Service Revenues
We report net patient service revenues at the amounts that reflect the consideration we expect to be entitled to in exchange for providing patient care. These amounts are due from patients, third‑party payers (including managed care payers and government programs) and others, and they include variable consideration for retroactive revenue adjustments due to settlement of audits, reviews and investigations. Generally, we bill our patients and third‑party payers several days after the services are performed or shortly after discharge. Revenues are recognized as performance obligations are satisfied.
We determine performance obligations based on the nature of the services we provide. We recognize revenues for performance obligations satisfied over time based on actual charges incurred in relation to total expected charges. We believe that this method provides a faithful depiction of the transfer of services over the term of performance obligations based on the inputs needed to satisfy the obligations. Generally, performance obligations satisfied over time relate to patients in our hospitals receiving inpatient acute care services. We measure performance obligations from admission to the point when there are no further services required for the patient, which is generally the time of discharge. We recognize revenues for performance obligations satisfied at a point in time, which generally relate to patients receiving outpatient services, when (1) services are provided, and (2) we do not believe the patient requires additional services.
Because our patient service performance obligations relate to contracts with a duration of less than one year, we have elected to apply the optional exemption provided in FASB Accounting Standards Codification (“ASC”) 606‑10‑50‑14(a) and, therefore, we are not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations referred to above are primarily related to inpatient acute care services at the end of the reporting period. The performance obligations for these contracts are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period.
We determine the transaction price based on gross charges for services provided, reduced by contractual adjustments recognized for third‑party payers, discounts provided to uninsured patients in accordance with our Compact, and estimated implicit price concessions related primarily to uninsured patients. We determine our estimates of contractual adjustments and discounts based on contractual agreements, our discount policies and historical experience. We determine our estimate of implicit price concessions based on our historical collection experience using a portfolio approach as a practical expedient to account for patient contracts as collective groups rather than individually. The financial statement effects of using this practical expedient are not materially different from an individual contract approach.
Gross charges are retail charges. They are not the same as actual pricing, and they generally do not reflect what a hospital is ultimately paid and, therefore, are not displayed in our consolidated statements of operations. Hospitals are typically paid amounts that are negotiated with insurance companies or are set by the government. Gross charges are used to calculate Medicare outlier payments and to determine certain elements of payment under managed care contracts (such as stop‑loss payments). Because Medicare requires that a hospital’s gross charges be the same for all patients (regardless of payer category), gross charges are what hospitals charge all patients prior to the application of discounts and allowances.
Government Programs—The final determination of certain fee‑for‑service (“FFS”) Medicare and Medicaid program payments to our hospitals, such as Indirect Medical Education, Direct Graduate Medical Education, disproportionate share hospital and bad debt expense reimbursement, are retrospectively determined based on our hospitals’ cost reports. The final determination of these payments often takes many years to resolve because of audits by the program representatives, providers’ rights of appeal, and the application of numerous technical reimbursement provisions. We therefore record accruals to reflect the expected final settlements on our cost reports. For filed cost reports, we adjust the accrual for estimated cost report settlements based on those cost reports and subsequent activity, and we consider the necessity of recording a valuation allowance based on historical settlement results. The accrual for estimated cost report settlements for periods for which a cost report is yet to be filed is recorded based on estimates of what we expect to report on the filed cost reports, and a corresponding valuation allowance is recorded, if necessary, based on the method previously described. Cost reports must generally be filed
within five months after the end of the annual cost report reporting period. After the cost report is filed, the accrual and corresponding valuation allowance may need to be adjusted.
Settlements with third‑party payers for retroactive revenue adjustments due to audits, reviews or investigations are considered variable consideration and are included in the determination of the estimated transaction price for providing patient care using the most likely outcome method. These settlements are estimated based on the terms of the payment agreement with the payer, correspondence from the payer and our historical settlement activity, including an assessment to ensure that it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainty associated with the retroactive adjustment is subsequently resolved. Estimated settlements are adjusted in future periods as adjustments become known (that is, new information becomes available), or as years are settled or are no longer subject to such audits, reviews and investigations. Because the laws, regulations, instructions and rule interpretations governing Medicare and Medicaid reimbursement are complex and change frequently, the estimates we record could change by material amounts.
Private Insurance—Revenues under managed care plans are based primarily on payment terms involving predetermined rates per diagnosis, per‑diem rates, discounted FFS rates and/or other similar contractual arrangements. These revenues are also subject to review and possible audit by the payers, which can take several years before they are completely resolved. The payers are billed for patient services on an individual patient basis. An individual patient’s bill is subject to adjustment on a patient‑by‑patient basis in the ordinary course of business by the payers following their review and adjudication of each particular bill. We estimate the discounts for contractual allowances at the individual hospital level utilizing billing data on an individual patient basis. At the end of each month, on an individual hospital basis, we estimate our expected reimbursement for patients of managed care plans based on the applicable contract terms. Contractual allowance estimates are periodically reviewed for accuracy by taking into consideration known contract terms, as well as payment history. We believe our estimation and review process enables us to identify instances on a timely basis where such estimates need to be revised. We do not believe there were any adjustments to estimates of patient bills that were material to our revenues during the years ended December 31, 2023, 2022 or 2021. In addition, on a corporate‑wide basis, we do not record any general provision for adjustments to estimated contractual allowances for managed care plans. Managed care accounts, net of contractual allowances recorded, are further reduced to their net realizable value through implicit price concessions based on historical collection trends for these payers and other factors that affect the estimation process.
We know of no claims, disputes or unsettled matters with any payer that would materially affect our revenues for which we have not adequately provided in the accompanying Consolidated Financial Statements.
Uninsured Patients—Generally, patients who are covered by third‑party payers are responsible for related co‑pays, co‑insurance and deductibles, which vary in amount. We also provide services to uninsured patients and offer uninsured patients a discount from standard charges. We estimate the transaction price for patients with co‑pays, co‑insurance and deductibles and for those who are uninsured based on historical collection experience and current market conditions. Under our Compact and other uninsured discount programs, the discount offered to certain uninsured patients is recognized as a contractual allowance, which reduces net operating revenues at the time the self‑pay accounts are recorded. The uninsured patient accounts, net of contractual allowances recorded, are further reduced to their net realizable value at the time they are recorded through implicit price concessions based on historical collection trends for self‑pay accounts and other factors that affect the estimation process.
Implicit Price Concessions—We record implicit price concessions, primarily related to uninsured patients and patients with co‑pays, co‑insurance and deductibles. The implicit price concessions included in estimating the transaction price represent the difference between amounts billed to patients and the amounts we expect to collect based on our collection history with similar patients. Although outcomes vary, our policy is to attempt to collect amounts due from patients, including co‑pays, co‑insurance and deductibles due from patients with insurance, at the time of service while complying with all federal and state statutes and regulations, including, but not limited to, the Emergency Medical Treatment and Active Labor Act (“EMTALA”). Generally, as required by EMTALA, patients may not be denied emergency treatment due to inability to pay. Therefore, services, including the legally required medical screening examination and stabilization of the patient, are performed without delaying to obtain insurance information. In non‑emergency circumstances or for elective procedures and services, it is our policy to verify insurance prior to a patient being treated; however, there are various exceptions that can occur. Such exceptions can include, for example, instances where (1) we are unable to obtain verification because the patient’s insurance company was unable to be reached or contacted, (2) a determination is made that a patient may be eligible for benefits under various government programs, such as Medicaid or Victims of Crime, and it takes several days or weeks before qualification for such benefits is confirmed or denied, and (3) under physician orders we provide services to patients that require immediate treatment.
There are various factors that can impact collection trends, such as: changes in the economy, which in turn have an impact on unemployment rates and the number of uninsured and underinsured patients; the volume of patients through our
emergency departments; the increased burden of co‑pays, co‑insurance amounts and deductibles to be made by patients with insurance; and business practices related to collection efforts. These factors continuously change and can have an impact on collection trends and our estimation process. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to net patient service revenues in the period of the change.
We also provide charity care to patients who are financially unable to pay for the healthcare services they receive. Most patients who qualify for charity care are charged a per‑diem amount for services received, subject to a cap. Except for the per‑diem amounts, our policy is not to pursue collection of amounts determined to qualify as charity care; therefore, we do not report these amounts in net operating revenues. Patient advocates from our Eligibility and Enrollment Services program screen patients in the hospital to determine whether those patients meet eligibility requirements for financial assistance programs. They also expedite the process of applying for these government programs.
Amounts related to services provided to patients for which we have not billed and that do not meet the conditions of unconditional right to payment at the end of the reporting period are contract assets. Approximately 88% of our Hospital Operations segment’s contract assets meet the conditions for unconditional right to payment and are reclassified to patient receivables within 90 days.
Revenue Cycle Management and Other Services
Our Hospital Operations segment also provides revenue cycle management and other services to health systems, individual hospitals and physician practices. We recognize revenue from our contracts when the underlying performance obligations are satisfied, which is generally as services are rendered. Revenue is recognized in an amount that reflects the consideration to which we expect to be entitled.
At contract inception, we assess the services specified in our contracts with customers and identify a performance obligation for each distinct contracted service. We generally consider the following distinct services as separate performance obligations:
•revenue cycle management services;
•value‑based care services;
•patient communication and engagement services;
•consulting services; and
•other client‑defined projects.
Our contracts generally consist of fixed‑price, volume‑based or contingency‑based fees. Long‑term contracts typically provide for the delivery of recurring monthly services over a multi‑year period. The contracts are typically priced such that our monthly fee to our customer represents the value obtained by the customer in the month for those services. Such multi‑year service contracts may have upfront fees related to transition or integration work performed by us to set up the delivery for the ongoing services. Such transition or integration work typically does not result in a separately identifiable obligation; thus, the fees and expenses related to such work are deferred and recognized over the life of the related contractual service period. For contracts in which the amortization period of the asset is one year or less, we have elected to apply the practical expedient provided by FASB ASC 340‑40‑25‑4 and expense these costs as incurred.
Revenue for fixed‑priced contracts is typically recognized at the time of billing unless evidence suggests that the revenue is earned or our obligations are fulfilled in a different pattern. Revenue for volume‑based contracts is typically recognized as the services are being performed at the contractually billable rate, which is generally a percentage of collections or a percentage of client net patient revenue.
Contract Assets and Liabilities—Our client contract terms, including payment conditions, are diverse. For non‑fixed‑price arrangements, we may invoice clients before we perform the contracted services, with subsequent adjustments (true‑up) to align with actual fees. In contrast, some contracts require payment after we have performed the contracted services (in arrears). Contracts may also feature performance‑based incentives or penalties, along with other variable consideration. Revenue recognition occurs when services are rendered and the client gains control or benefit of the services, regardless of the invoicing schedule, leading to the recognition of a contract asset for unbilled revenue. Unbilled revenue is recognized as receivables in the month the services are performed. Conversely, advance payments from clients result in the recognition of a contract liability for deferred revenue until the revenue recognition requirements are met.
Cash and Cash Equivalents
We treat highly liquid investments with original maturities of three months or less as cash equivalents. Cash and cash equivalents were $1.228 billion and $858 million at December 31, 2023 and 2022, respectively. At December 31, 2023 and 2022, our book overdrafts were $187 million and $266 million, respectively, which were classified as accounts payable. At December 31, 2023 and 2022, $100 million and $140 million, respectively, of total cash and cash equivalents in the accompanying Consolidated Balance Sheets were intended for the operations of our insurance‑related subsidiaries.
At December 31, 2023, 2022 and 2021, we had $154 million, $196 million and $95 million, respectively, of property and equipment purchases accrued for items received but not yet paid. Of these amounts, $141 million, $191 million and $88 million, respectively, were included in accounts payable.
In June 2022, we acquired all of Baylor’s 5% voting ownership interest in USPI. We paid $11 million from cash on hand and recognized a liability of $377 million, the present value of the liability on the acquisition date, for the remainder of the purchase price. We recorded reductions in redeemable noncontrolling interest of $365 million for the carrying value of Baylor’s ownership interest and $23 million to additional paid-in capital for the difference between the carrying value and present value of the purchase price for the shares on the acquisition date. This has been reflected as noncash financing activity in the accompanying Consolidated Statement of Cash Flows for the year ended December 31, 2022. Payments made subsequent to the transaction’s close are reflected as cash activity within the financing section of our consolidated statements of cash flows in the respective period. See Note 18 for additional information about this transaction.
Investments in Debt and Equity Securities
We classify investments in debt securities as either available‑for‑sale, held‑to‑maturity or as part of a trading portfolio. Our policy is to classify investments in debt securities that may be needed for cash requirements as “available‑for‑sale.” At December 31, 2023 and 2022, we had no significant investments in debt securities classified as either held‑to‑maturity or trading. We carry debt securities classified as available‑for‑sale at fair value. We report their unrealized gains and losses, net of taxes, as accumulated other comprehensive income (loss). We periodically evaluate available-for-sale securities in unrealized loss positions for credit impairment, using both qualitative and quantitative criteria. In the event a security is deemed to be impaired as the result of a credit loss, we record a loss in our consolidated statements of operations.
We carry equity securities at fair value, and we report their unrealized gains and losses in other non-operating income, net, in our consolidated statements of operations. If the equity security does not have a readily determinable fair value, the carrying value of the security is adjusted only when there is a price change that is observable from a transaction of an identical or similar investment. We include realized gains or losses in our consolidated statements of operations based on the specific identification method.
Investments in Unconsolidated Affiliates
As of December 31, 2023, we controlled 330 of the facilities in our Ambulatory Care segment and, therefore, consolidated their results. We account for many of the facilities in which our Ambulatory Care segment holds ownership interests (155 of 485 at December 31, 2023), as well as additional companies in which our Hospital Operations segment holds ownership interests, under the equity method as investments in unconsolidated affiliates and report only our share of net income as equity in earnings of unconsolidated affiliates in the accompanying Consolidated Statements of Operations. In the year ended December 31, 2021, equity in earnings of unconsolidated affiliates included $14 million from grant funds recognized by our Ambulatory Care segment’s unconsolidated affiliates. No additional revenue was recognized from grant funds by unconsolidated affiliates during the years ended December 31, 2023 and 2022.
Summarized financial information for equity method investees is included in the following table. For investments acquired during the reported periods, amounts below include 100% of the investee’s results beginning on the date of our acquisition of the investment.
December 31,
 202320222021
Current assets$1,223 $1,142 $1,176 
Noncurrent assets$1,355 $1,356 $1,390 
Current liabilities$(456)$(479)$(495)
Noncurrent liabilities$(917)$(878)$(855)
Noncontrolling interests$(670)$(644)$(659)
 Years Ended December 31,
 202320222021
Net operating revenues$3,510 $3,360 $3,030 
Net income$860 $805 $836 
Net income attributable to the investees$484 $453 $499 
The equity method investment that contributed the most to our equity in earnings of unconsolidated affiliates during the years ended December 31, 2023, 2022 and 2021 was Texas Health Ventures Group, LLC (“THVG”), which is operated by USPI. THVG represented $104 million, $89 million and $107 million of total equity in earnings of unconsolidated affiliates of $228 million, $216 million and $218 million in the years ended December 31, 2023, 2022 and 2021, respectively.
Property and Equipment
Additions and improvements to property and equipment exceeding established minimum amounts with a useful life greater than one year are capitalized at cost. Expenditures for maintenance and repairs are charged to expense as incurred. We use the straight‑line method of depreciation for buildings, building improvements and equipment. The estimated useful life for buildings and improvements is primarily 15 to 40 years, and for equipment three to 15 years. Newly constructed hospitals are usually depreciated over 50 years. Interest costs related to construction projects are capitalized. In the years ended December 31, 2023, 2022 and 2021, capitalized interest was $9 million, $8 million and $4 million, respectively.
We evaluate our long‑lived assets for possible impairment annually or whenever events or changes in circumstances indicate that the carrying amount of the asset, or related group of assets, may not be recoverable from estimated future undiscounted cash flows. If the estimated future undiscounted cash flows are less than the carrying value of the assets, we calculate the amount of an impairment charge only if the carrying value of the long‑lived assets exceeds their fair value. The fair value of the asset is estimated based on third‑party appraisals, established market values of comparable assets or internally developed estimates of future net cash flows expected to result from the use and ultimate disposition of the asset. The estimates of these future cash flows are based on assumptions and projections we believe to be reasonable and supportable. Estimates require our subjective judgments and take into account assumptions about revenue and expense growth rates, operating margins and recoverable disposition values, based on industry and operating factors. These assumptions may vary by type of asset and presume stable, improving or, in some cases, declining results, depending on their circumstances. If the presumed level of performance does not occur as expected, impairment may result.
We report long‑lived assets to be disposed of at the lower of their carrying amounts or fair values less costs to sell. In such circumstances, our estimates of fair value are based on third‑party appraisals, established market prices for comparable assets or internally developed estimates of future net cash flows.
Leases
We determine if an arrangement is a lease at inception of the contract. Our right‑of‑use assets represent our right to use the underlying assets for the lease term and our lease liabilities represent our obligation to make lease payments arising from the leases. Right‑of‑use assets and lease liabilities are recognized at the commencement date based on the present value of lease payments over the lease term. We use our estimated incremental borrowing rate, which is derived from information available at the lease commencement date, in determining the present value of lease payments. For our Hospital Operations segment, we estimate our incremental borrowing rates for our portfolio of leases using documented rates included in our recent equipment finance leases or, if applicable, recent secured debt issuances that correspond to various lease terms. We also give consideration to information obtained from our bankers, our secured debt fair value and publicly available data for instruments with similar characteristics. For our Ambulatory Care segment, we estimate an incremental borrowing rate for each center by utilizing
historical and projected financial data, estimating a hypothetical credit rating using publicly available market data and adjusting the market data to reflect the effects of collateralization.
Our operating leases are primarily for real estate, including off‑campus outpatient facilities, medical office buildings, and corporate and other administrative offices, as well as medical and office equipment. Our finance leases are primarily for medical equipment and information technology and telecommunications assets. Our real estate lease agreements typically have initial terms of five to 10 years, and our equipment lease agreements typically have initial terms of three years. We do not record leases with an initial term of 12 months or less (short‑term leases) in our consolidated balance sheets.
Our real estate leases may include one or more options to renew, with renewals that can extend the lease term from five to 10 years. The exercise of lease renewal options is at our sole discretion. In general, we do not consider renewal options to be reasonably likely to be exercised, therefore, renewal options are generally not recognized as part of our right‑of‑use assets and lease liabilities. Certain leases also include options to purchase the leased property. The useful life of assets and leasehold improvements are limited by the expected lease term, unless there is a transfer of title or purchase option reasonably certain of exercise. The majority of our medical equipment leases have terms of three years with a bargain purchase option that is reasonably certain of exercise, so these assets are depreciated over their useful life, typically ranging from five to seven years. Similarly, some of our leases of information technology and telecommunications assets include a transfer of title and, therefore, have useful lives of 15 years.
Certain of our lease agreements for real estate include payments based on actual common area maintenance expenses and others include rental payments adjusted periodically for inflation. These variable lease payments are recognized in other operating expenses, net, but are not included in the right‑of‑use asset or liability balances. Our lease agreements do not contain any material residual value guarantees, restrictions or covenants.
We have elected the practical expedient that allows lessees to choose to not separate lease and non‑lease components by class of underlying asset and are applying this expedient to all relevant asset classes. We have also elected the practical expedient package to not reassess at adoption (1) expired or existing contracts for whether they are or contain a lease, (2) the lease classification of any existing leases or (3) initial indirect costs for existing leases.
Goodwill and Other Intangible Assets
Goodwill represents the excess of costs over the fair value of assets of businesses acquired. Goodwill and other intangible assets acquired in purchase business combinations and determined to have indefinite useful lives are not amortized, but instead are subject to impairment tests performed at least annually. Our reporting segments are the reporting units used to perform our goodwill analysis. If we determine the carrying value of goodwill is impaired, or if the carrying value of a business that is to be sold or otherwise disposed of exceeds its fair value, we reduce the carrying value, including any allocated goodwill, to fair value. Estimates of fair value are based on third‑party appraisals, established market prices for comparable assets or internally developed estimates of future net cash flows and presume stable, improving or, in some cases, declining results at our hospitals, depending on their circumstances.
Other intangible assets consist of capitalized software costs, which are amortized on a straight‑line basis over the estimated useful life of the software, which ranges from three to 15 years, costs of acquired management and other contract service rights, most of which have indefinite lives, and miscellaneous intangible assets.
Accruals for General and Professional Liability Risks
We accrue for estimated professional and general liability claims, to the extent not covered by insurance, when they are probable and can be reasonably estimated. We maintain reserves, which are based on modeled estimates for the portion of our professional liability risks, including incurred but not reported claims, to the extent we do not have insurance coverage. Our liability consists of estimates established based upon calculations using several factors, including the number of expected claims, estimates of losses for these claims based on recent and historical settlement amounts, estimates of incurred but not reported claims based on historical experience and the timing of historical payments. Our liabilities are adjusted for new claims information in the period such information becomes known. Malpractice expense is recorded within other operating expenses in our consolidated statements of operations.
Income Taxes
We account for income taxes using the asset and liability method. This approach requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of temporary differences between the carrying amounts and
the tax bases of assets and liabilities. Income tax receivables and liabilities and deferred tax assets and liabilities are recognized based on the amounts that more likely than not will be sustained upon ultimate settlement with taxing authorities.
Developing our provision for income taxes and analysis of uncertain tax positions requires significant judgment and knowledge of federal and state income tax laws, regulations and strategies, including the determination of deferred tax assets and liabilities and, if necessary, any valuation allowances that may be required for deferred tax assets.
We assess the realization of our deferred tax assets to determine whether an income tax valuation allowance is required. Based on all available evidence, both positive and negative, and the weight of that evidence to the extent such evidence can be objectively verified, we determine whether it is more likely than not that all or a portion of the deferred tax assets will be realized. The main factors that we consider include:
•Cumulative profits/losses in recent years, adjusted for certain nonrecurring items;
•Income/losses expected in future years;
•Unsettled circumstances that, if unfavorably resolved, would adversely affect future operations and profit levels;
•The availability, or lack thereof, of taxable income in prior carryback periods that would limit realization of tax benefits; and
•The carryforward period associated with the deferred tax assets and liabilities.
We consider many factors when evaluating our uncertain tax positions, and such judgments are subject to periodic review. Tax benefits associated with uncertain tax positions are recognized in the period in which one of the following conditions is satisfied: (1) the more likely than not recognition threshold is satisfied; (2) the position is ultimately settled through negotiation or litigation; or (3) the statute of limitations for the taxing authority to examine and challenge the position has expired. Tax benefits associated with an uncertain tax position are derecognized in the period in which the more likely than not recognition threshold is no longer satisfied.
Segment Reporting
Our Hospital Operations segment generated 81%, 83% and 86% of our net operating revenues in the years ended December 31, 2023, 2022 and 2021, respectively. Major decisions, including capital resource allocations, are made at the consolidated level, not at the market or hospital level. The factors for determining the reportable segments include the manner in which management evaluates operating performance combined with the nature of the individual business activities.
Costs Associated With Exit or Disposal Activities
We recognize costs associated with exit (including restructuring) or disposal activities when they are incurred and can be measured at fair value, rather than at the date of a commitment to an exit or disposal plan.
Recent Accounting Standards
We adopted the Financial Accounting Standards Board’s (“FASB”) Accounting Standards Update (“ASU”) 2020-06, “Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity” (“ASU 2020-06”), effective as of January 1, 2022 using the modified retrospective method. Among other amendments, ASU 2020-06 changed the accounting for diluted earnings‑per‑share for convertible instruments and contracts that may be settled in cash or stock. ASU 2020-06 eliminated an entity’s ability to rebut the presumption of share settlement for convertible instruments and contracts that can be partially or fully settled in cash at the issuer’s election. Additionally, ASU 2020-06 requires that the if‑converted method, which is more dilutive than the treasury stock method, be used for all convertible instruments. As a result of our adoption of ASU 2020-06, diluted weighted average shares outstanding increased by approximately 2,364 thousand shares and 2,673 thousand shares for the years ended December 31, 2023 and 2022, respectively, and diluted earnings per share available to Tenet common shareholders decreased by $0.26 and $0.01, respectively, for these same periods.
Recently Issued Accounting Standards
In November 2023, the FASB issued ASU 2023-07, “Improvements to Reportable Segment Disclosures” (“ASU 2023-07”). The standard expands reportable segment disclosure requirements by requiring disclosures of significant reportable segment expenses that are regularly provided to the chief operating decision maker (“CODM”) and included within each reported measure of a segment's profit or loss. The ASU also requires disclosure of the title and position of the individual identified as the CODM and an explanation of how the CODM uses the reported measures of a segment's profit or loss in assessing segment performance and deciding how to allocate resources. Additionally, ASU 2023-07 requires all segment profit or loss and assets disclosures to be provided on an annual and interim basis. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning one year later. Early adoption is permitted and the amendments must be applied retrospectively to all prior periods presented. The adoption of this guidance will not affect our consolidated results of operations, financial position or cash flows and we are currently evaluating the effect the guidance will have on our disclosures.
In August 2023, the FASB issued ASU 2023-05, “Business Combinations – Joint Venture Formations (Subtopic 805-60): Recognition and Initial Measurement” (“ASU 2023-05”), which clarifies the business combination accounting for joint venture formations. The amendments in the ASU seek to reduce diversity in practice that has resulted from a lack of authoritative guidance regarding the accounting for the formation of joint ventures in separate financial statements. The amendments also seek to clarify the initial measurement of joint venture net assets, including businesses contributed to a joint venture. The guidance is applicable to all entities involved in the formation of a joint venture. ASU 2023-05 is effective prospectively for all joint venture formations with a formation date on or after January 1, 2025. Early adoption and retrospective application of the amendments are permitted. We do not expect adoption of the new guidance to have a material impact on our consolidated financial statements and disclosures.
The FASB issued ASU 2022‑03, “Fair Value Measurement (Topic 820) – Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions” (“ASU 2022‑03”) in June 2022. Through ASU 2022‑03 the FASB clarified that an entity should measure the fair value of an equity security subject to contractual sale restriction the same way it measures an identical equity security that is not subject to such a restriction and enhanced the disclosure requirements related to these instruments. The ASU is effective for public entities for fiscal years beginning after December 15, 2023, including interim periods within those fiscal years, and early adoption is permitted. For non‑investment companies, ASU 2022‑03 will be applied prospectively with adjustments resulting from the initial adoption recognized in earnings and disclosed. We do not expect adoption of ASU 2022‑03 to have a material impact on our consolidated financial statements and disclosures.
Recently Adopted Accounting Standards
As further discussed in Note 1, we adopted ASU 2020-06 effective January 1, 2022. We applied the modified retrospective transition approach as of the period of adoption.
v3.24.0.1
SIGNIFICANT ACCOUNTING POLICIES (Tables)
 12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
Schedule of Grant Funds Received And Grant Income As detailed in the table below, we received cash payments from the PRF and state and local grant programs during the years ended December 31, 2023, 2022 and 2021. Grant funds received by our Hospital Operations segment and those facilities in our Ambulatory Care segment that we consolidate are included in cash flows from operating activities in our consolidated statements of cash flows. Grant funds received by unconsolidated affiliates for which we provide cash management services (“Cash‑Managed Affiliates”) are included in cash flows from financing activities.
Years Ended December 31,
202320222021
Grant funds received from COVID-19 relief programs:
Included in cash flows from operating activities:
Hospital Operations$10 $193 $142 
Ambulatory Care— 3 36 
$10 $196 $178 
Included in cash flows from financing activities:
Cash‑Managed Affiliates
$— $— $37 
The table below summarizes grant income recognized by our Hospital Operations and Ambulatory Care segments, which is presented in grant income, and grant income recognized through our unconsolidated affiliates, which is presented in equity in earnings of unconsolidated affiliates, in each case in our consolidated statements of operations.
Years Ended December 31,
202320222021
Grant income recognized from COVID-19 relief programs:
Included in grant income:
Hospital Operations$15 $190 $142 
Ambulatory Care1 4 49 
$16 $194 $191 
Included in equity in earnings of unconsolidated affiliates:
Unconsolidated affiliates$— $— $14 
Advance payments to our Cash‑Managed Affiliates were recouped through a reduction of those affiliates’ Medicare claims payments and, together with any repayments, are presented in cash flows from financing activities.
Years Ended December 31,
20222021
MAPP advances repaid or recouped:
Included in cash flows from operating activities:
Hospital Operations$876 $457 
Ambulatory Care4 55 
$880 $512 
Included in cash flows from financing activities:
Cash‑Managed Affiliates
$— $104 
Schedule of Equity Method Investments For investments acquired during the reported periods, amounts below include 100% of the investee’s results beginning on the date of our acquisition of the investment.
December 31,
 202320222021
Current assets$1,223 $1,142 $1,176 
Noncurrent assets$1,355 $1,356 $1,390 
Current liabilities$(456)$(479)$(495)
Noncurrent liabilities$(917)$(878)$(855)
Noncontrolling interests$(670)$(644)$(659)
 Years Ended December 31,
 202320222021
Net operating revenues$3,510 $3,360 $3,030 
Net income$860 $805 $836 
Net income attributable to the investees$484 $453 $499 
v3.24.0.1
EQUITY (Tables)
 12 Months Ended
Dec. 31, 2023
Stockholders' Equity Note [Abstract]  
Schedule of Share Repurchase Activity
The table below summarizes transactions completed under the repurchase program during the years ended December 31, 2023 and 2022:
PeriodTotal Number of Shares PurchasedAverage Price Paid per ShareTotal Number of Shares Purchased as Part of Publicly Announced ProgramMaximum Dollar Value of Shares That May Yet be Purchased Under the Program
 (In Thousands)(In Thousands)(In Millions)
Inception through October 31, 20221,800$41.81 1,800$925 
November 1 through November 30, 20224,089$42.74 4,089$750 
December 1 through December 31, 2022—$— —$750 
Inception through December 31, 20225,889$42.45 5,889
January 1 through January 31, 2023—$— —$750 
February 1 through February 28, 2023—$— —$750 
March 1 through March 31, 2023906$55.03 906$700 
April 1 through April 30, 2023—$— —$700 
May 1 through May 31, 2023580$69.17 580$660 
June 1 through June 30, 2023—$— —$660 
July 1 through July 31, 2023—$— —$660 
August 1 through August 31, 2023—$— —$660 
September 1 through September 30, 2023—$— —$660 
October 1 through October 31, 2023—$— —$660 
November 1 through November 30, 2023982$67.12 982$594 
December 1 through December 31, 2023644$68.53 644$550 
Year ended December 31, 2023
3,112$64.27 3,112
v3.24.0.1
ACCOUNTS RECEIVABLE (Tables)
 12 Months Ended
Dec. 31, 2023
Accounts Receivable Additional Disclosures [Abstract]  
Schedule of Components of Accounts Receivable
The principal components of accounts receivable are shown in the table below:
December 31,
 20232022
Patient accounts receivable$2,719 $2,746 
Estimated future recoveries148 149 
Net cost reports and settlements receivable and valuation allowances47 48 
Accounts receivable, net 
$2,914 $2,943 
Schedule of Location of Assets and Liabilities The following table summarizes the amount and classification of assets and liabilities in the accompanying Consolidated Balance Sheets related to California’s provider fee program:
December 31,
 20232022
Assets:
Other current assets$329 $367 
Investments and other assets$334 $197 
Liabilities:
Other current liabilities$172 $145 
Other long-term liabilities$135 $63 
Schedule of Estimated Costs for Charity Care and Self-Pay Patients
The following table presents our estimated costs (based on selected operating expenses, which include salaries, wages and benefits, supplies and other operating expenses) of caring for our uninsured and charity patients:
 Years Ended December 31,
 202320222021
Estimated costs for:   
Uninsured patients$499 $537 $650 
Charity care patients110 83 97 
$609 $620 $747 
v3.24.0.1
CONTRACT BALANCES (Tables)
 12 Months Ended
Dec. 31, 2023
Revenue from Contract with Customer [Abstract]  
Schedule of Opening and Closing Balances of Contracts Assets and Liabilities
The opening and closing balances of our Hospital Operations segment’s receivables, contract assets, and current and long‑term contract liabilities were as follows:
ReceivablesContract Assets –
Unbilled Revenue		Contract Liabilities –
Current
Deferred Revenue and Advances from Medicare		Contract Liabilities –
Long-Term
Deferred Revenue
December 31, 2022$37 $200 $110 $13 
December 31, 202321 208 59 12 
Increase (decrease)$(16)$8 $(51)$(1)
December 31, 2021$28 $199 $955 $15 
December 31, 202237 200 110 13 
Increase (decrease)$9 $1 $(845)$(2)
The opening and closing balances of contract liabilities for our Ambulatory Care segment were as follows:
Contract Liabilities – Current Advances from Medicare
December 31, 2021$4 
December 31, 2022— 
Decrease$(4)
v3.24.0.1
ASSETS AND LIABILITIES HELD FOR SALE (Tables)
 12 Months Ended
Dec. 31, 2023
Discontinued Operations and Disposal Groups [Abstract]  
Schedule of Assets and Liabilities Classified as Held for Sale and Components of Business that have Been Disposed of or have Been Classified as Held for Sale
Assets and liabilities classified as held for sale at December 31, 2023 were comprised of the following:
Accounts receivable$78 
Other current assets25 
Investments and other long-term assets26 
Property and equipment204 
Other intangible assets17 
Goodwill425 
Current liabilities(45)
Long-term liabilities(24)
Net assets held for sale$706 
The following table presents amounts included in income from continuing operations, before income taxes, related to significant components of our business that were recently disposed of or were classified as held for sale at December 31, 2023:
 Years Ended December 31,
 202320222021
Significant disposals:  
Income (loss) from continuing operations, before income taxes:
Miami Hospitals (includes a $406 million gain on sale in 2021)
$(3)$10 $455 
Significant planned divestitures classified as held for sale:
Income from continuing operations, before income taxes:
SC Hospitals$130 $127 $135 
v3.24.0.1
LEASES (Tables)
 12 Months Ended
Dec. 31, 2023
Leases [Abstract]  
Schedule of Supplemental Balance Sheet Information Related To Leases
The following table presents the components of our right‑of‑use assets and liabilities related to leases and their classification in our Consolidated Balance Sheets:
December 31,
Component of Lease BalancesClassification in Consolidated Balance Sheets20232022
Assets:  
Operating lease assetsInvestments and other assets$1,083 $1,129 
Finance lease assets
Property and equipment, at cost, less
accumulated depreciation and amortization
253 303 
Total leased assets$1,336 $1,432 
Liabilities:
Operating lease liabilities:
CurrentOther current liabilities$204 $207 
Long-termOther long-term liabilities1,007 1,046 
Total operating lease liabilities1,211 1,253 
Finance lease liabilities:
CurrentCurrent portion of long-term debt84 99 
Long-termLong-term debt, net of current portion120 165 
Total finance lease liabilities204 264 
Total lease liabilities$1,415 $1,517 
Schedule of Additional Information Related to Lease Expense, Terms and Discount Rates, and Cash Flow Information
The following table presents the components of our lease expense and their classification in our Consolidated Statements of Operations:
Component of Lease ExpenseClassification in Consolidated Statements of OperationsYears Ended December 31,
202320222021
Operating lease expenseOther operating expenses, net$259 $262 $241 
Finance lease expense:
Amortization of leased assetsDepreciation and amortization55 58 71 
Interest on lease liabilitiesInterest expense8 8 9 
Total finance lease expense63 66 80 
Variable and short term-lease expenseOther operating expenses, net159 150 171 
Total lease expense$481 $478 $492 
The weighted‑average lease terms and discount rates for operating and finance leases are presented in the following table:
Years Ended December 31,
202320222021
Weighted-average remaining lease term (years):
Operating leases7.68.07.5
Finance leases6.05.55.7
Weighted-average discount rate:
Operating leases5.0 %4.8 %5.1 %
Finance leases6.5 %5.9 %5.4 %
Cash flow and other information related to leases is included in the following table:
Years Ended December 31,
202320222021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases$258 $250 $237 
Operating cash outflows from finance leases$13 $14 $12 
Financing cash outflows from finance leases$107 $118 $140 
Right-of-use assets obtained in exchange for lease obligations:
Operating leases$168 $341 $176 
Finance leases$55 $97 $136 
Schedule of Operating Lease Liability Maturity
Future maturities of lease liabilities at December 31, 2023 are presented in the following table:
Operating LeasesFinance LeasesTotal
2024$255 $95 $350 
2025225 54 279 
2026190 24 214 
2027165 9 174 
2028136 7 143 
Later years494 70 564 
Total lease payments1,465 259 1,724 
Less: Imputed interest254 55 309 
Total lease obligations1,211 204 1,415 
Less: Current obligations204 84 288 
Long-term lease obligations$1,007 $120 $1,127 
Schedule of Finance Lease Liability Maturity
Future maturities of lease liabilities at December 31, 2023 are presented in the following table:
Operating LeasesFinance LeasesTotal
2024$255 $95 $350 
2025225 54 279 
2026190 24 214 
2027165 9 174 
2028136 7 143 
Later years494 70 564 
Total lease payments1,465 259 1,724 
Less: Imputed interest254 55 309 
Total lease obligations1,211 204 1,415 
Less: Current obligations204 84 288 
Long-term lease obligations$1,007 $120 $1,127 
v3.24.0.1
LONG-TERM DEBT (Tables)
 12 Months Ended
Dec. 31, 2023
Long-Term Debt and Lease Obligation [Abstract]  
Schedule of Long-Term Debt
The table below presents our long‑term debt included in the accompanying Consolidated Balance Sheets:
December 31,
 20232022
Senior unsecured notes:  
6.125% due 2028
$2,500 $2,500 
6.875% due 2031
362 362 
Senior secured first lien notes:  
4.625% due July 2024
— 756 
4.625% due September 2024
— 589 
4.875% due 2026
2,100 2,100 
5.125% due 2027
1,500 1,500 
4.625% due 2028
600 600 
4.250% due 2029
1,400 1,400 
4.375% due 2030
1,450 1,450 
6.125% due 2030
2,000 2,000 
6.750% due 2031
1,350 — 
Senior secured second lien notes:
6.250% due 2027
1,500 1,500 
Finance leases, mortgages and other notes361 453 
Unamortized issue costs and note discounts(121)(131)
Long-term debt15,002 15,079 
Less: Current portion120 145 
Long-term debt, net of current portion$14,882 $14,934 
Schedule of Future Long Term Debt Maturities
Future long‑term debt maturities, including finance lease obligations were as follows as of December 31, 2023:
  Years Ending December 31,Later Years
 Total20242025202620272028
Long-term debt, including finance lease obligations$15,123 $120 $92 $2,149 $3,029 $3,114 $6,619 
v3.24.0.1
EMPLOYEE BENEFIT PLANS (Tables)
 12 Months Ended
Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]  
Schedule of Stock Option Activity
The following table summarizes stock option activity during the years ended December 31, 2023, 2022 and 2021:
 Number of OptionsWtd. Avg.
Exercise Price
Per Share		Aggregate
Intrinsic Value		Wtd. Avg
Remaining Life
   (In Millions) 
Outstanding at December 31, 2020912,531 $22.51   
Exercised(391,533)$20.66   
Outstanding at December 31, 2021520,998 $23.90   
Exercised(60,051)$28.26   
Outstanding at December 31, 2022460,947 $23.33   
Exercised(76,507)$26.07   
Outstanding at December 31, 2023384,440 $22.79 $20 4.1 years
Schedule of Information About Stock Options by Range of Exercise Prices
The following table summarizes information about our outstanding stock options at December 31, 2023:
 Options Outstanding and Exercisable
Range of Exercise Prices Number of
Options		Wtd. Avg.
Remaining
Contractual Life		Wtd. Avg.
Exercise Price
$18.99 to $20.609
255,845 3.6 years$19.62 
$20.61 to $35.430
128,595 5.1 years$29.07 
 384,440 4.1 years$22.79 
Schedule of Restricted Stock Unit Activity
The following table summarizes RSU activity during the years ended December 31, 2023, 2022 and 2021:
 Restricted
Stock Units		Wtd. Avg. Grant Date Fair
Value Per Unit
Unvested at December 31, 20202,095,206 $25.87 
Granted900,018 $58.61 
Vested(765,814)$30.51 
Forfeited(58,208)$37.60 
Unvested at December 31, 20212,171,202 $40.51 
Granted641,205 $80.79 
Vested(1,187,384)$37.18 
Forfeited(104,605)$53.58 
Unvested at December 31, 20221,520,418 $66.36 
Granted759,590 $60.88 
Performance-based adjustment185,901 $48.97 
Vested(954,401)$48.75 
Forfeited(90,445)$64.61 
Unvested at December 31, 20231,421,063 $66.46 
The table below summarizes the time-based RSUs granted during the year ended December 31, 2023:
No. of
RSUs Granted
Vesting Terms
309,282
RSUs will vest and be settled ratably over a three‑year period from the grant date
42,626
RSUs will vest and be settled on the fifth anniversary of the grant date
42,100
RSUs granted to our non-employee directors for the 2023-2024 board service year, which vested immediately and will be settled on the third anniversary of the grant date
33,586
RSUs vested and settled in December 2023
20,707
RSUs will vest and be settled upon the relocation of one of our executive officers
2,007
RSUs will vest and be settled on the third anniversary of the grant date
The table below summarizes the performance-based RSUs granted during the year ended December 31, 2023:
No. of
RSUs Granted
Performance PeriodPotential Vesting Range
Vesting TermsMinimumMaximum
301,562
RSUs will vest and be settled on the third anniversary of the grant date
2023 to 2025
— %225 %
185,901
RSUs vested and settled immediately as a result of our level of achievement with respect to performance‑based RSUs granted in 2020
7,720
RSUs will vest and be settled on the third anniversary of the grant date
2023 to 2025
— %200 %
The table below summarizes the time-based RSUs granted during the year ended December 31, 2022:
No. of
RSUs Granted
Vesting Terms
237,381
RSUs will vest and be settled ratably over a three‑year period from the grant date
53,716
RSUs were scheduled to vest and be settled ratably over 11 quarterly periods
35,482
RSUs granted to our non-employee directors for the 2022-2023 board service year vested immediately and will be settled on the third anniversary of the grant date
9,215
RSUs will vest and be settled ratably over a four-year period from the grant date
7,325
RSUs granted to a non-executive member of the board of directors for his service as chairman of the board; award vested and settled in December 2023
6,170
RSUs will vest and be settled evenly on the third and fourth anniversaries of the grant date
4,608
RSUs will vest and be settled on the second anniversary of the grant date
The table below summarizes the time-based RSUs granted during the year ended December 31, 2021:
No. of
RSUs Granted
Vesting Terms
263,180
RSUs will vest and be settled ratably over a three-year period from the grant date
189,215
RSUs were scheduled to vest and be settled ratably over eight quarterly periods from the grant date
53,341
RSUs will vest and be settled on the fourth anniversary of the grant date
38,366
RSUs granted to our non-employee directors for the 2021-2022 board service year, which vested immediately and will be settled on the third anniversary of the grant date
33,351
RSUs will vest and be settled on the third anniversary of the grant date
14,192
RSUs vested on December 31, 2021 and were settled in January 2022
8,509
RSUs, one-third of which will vest and be settled on the second anniversary of the grant date and the remainder of which will vest and be settled on the fourth anniversary
1,372
RSUs granted to a new member of our board of directors, which vested immediately and will be settled upon separation from the board
The table below summarizes the performance-based RSUs granted during the year ended December 31, 2021:
No. of
RSUs Granted
Performance PeriodPotential Vesting Range
Vesting TermsMinimumMaximum
244,259
RSUs will vest and be settled on the third anniversary of the grant
2021 to 2023— %200 %
53,341
RSUs will vest and be settled on the fourth anniversary of the grant date
2021 to 2025— %200 %
892
RSUs vested and settled immediately as a result of our level of achievement with respect to performance‑based RSUs granted in 2018
The following table summarizes RSU activity under the USPI Management Equity Plan during the years ended December 31, 2023, 2022 and 2021:
Restricted
Stock Units		Wtd. Avg. Grant Date Fair
Value Per Unit
Unvested at December 31, 20202,025,056 $34.13 
Granted76,990 $34.13 
Vested(388,588)$34.13 
Forfeited(218,576)$34.13 
Unvested at December 31, 20211,494,882 $34.13 
Vested(369,691)$34.13 
Forfeited(202,351)$34.13 
Unvested at December 31, 2022922,840 $34.13 
Vested(303,171)$34.13 
Forfeited(11,685)$34.13 
Unvested at December 31, 2023607,984 $34.13 
Schedule of Share-based Payment Award, Awards Other Than Options, Valuation Assumptions Significant inputs used in our valuation of these RSUs included the following:
Years Ended December 31,
202320222021
Expected volatility
53.6% - 65.6%
39.6% - 68.1%
65.2% - 79.3%
Risk-free interest rate
4.2% - 4.8%
1.0% - 1.7%
0.1% - 0.6%
Schedule of Employee Stock Purchase Plan Activity
We issued the following numbers of shares under our employee stock purchase plan:
 Years Ended December 31, 
 202320222021
Number of shares (in thousands)69 98 90 
Weighted average price$65.62 $54.19 $63.01 
Schedule of Reconciliation of Funded Status of Plans, the Amounts included in the Consolidated Balance Sheets and Assumptions Used for Projected Benefit Obligations
The following tables summarize the balance sheet impact, as well as the benefit obligations, funded status and rate assumptions associated with the SERPs and the DMC Pension Plan based on actuarial valuations prepared:
 December 31,
 20232022
Reconciliation of funded status of plans and the amounts included in the Consolidated Balance Sheets:  
Projected benefit obligations(1)
  
Beginning obligations$(1,002)$(1,313)
Interest cost(53)(37)
Actuarial gain (loss)(15)265 
Benefits paid84 83 
Annuity purchase36 — 
Special termination benefit costs(1)— 
Ending obligations(951)(1,002)
Fair value of plans assets  
Beginning plan assets648 867 
Gain (loss) on plan assets41 (161)
Employer contribution— 2 
Benefits paid(61)(60)
Annuity purchase(36)— 
Ending plan assets592 648 
Funded status of plans$(359)$(354)
Amounts recognized in the Consolidated Balance Sheets consist of:  
Other current liability$(24)$(23)
Other long-term liability$(335)$(331)
Accumulated other comprehensive loss$224 $222 
SERP Assumptions:  
Discount rate5.50 %5.75 %
Compensation increase rate3.00 %3.00 %
Measurement dateDecember 31, 2023December 31, 2022
DMC Pension Plan Assumptions:  
Discount rate5.25 %5.51 %
Compensation increase rateFrozenFrozen
Measurement dateDecember 31, 2023December 31, 2022
(1)The accumulated benefit obligation at December 31, 2023 and 2022 was approximately $951 million and $1.002 billion, respectively.
Schedule of Components of Net Benefit Costs and Assumptions Used for Net Periodic Benefit Costs
The components of net periodic benefit costs and related assumptions are as follows:
 Years Ended December 31,
 202320222021
Interest costs$53 $37 $36 
Expected return on plan assets(36)(42)(53)
Amortization of net actuarial loss7 9 11 
Special termination benefit costs1 — — 
Net periodic benefit cost (income)$25 $4 $(6)
SERP Assumptions:   
Discount rate5.75 %3.00 %2.75 %
Compensation increase rate3.00 %3.00 %3.00 %
Measurement dateJanuary 1, 2023January 1, 2022January 1, 2021
Census dateJanuary 1, 2023January 1, 2022January 1, 2021
DMC Pension Plan Assumptions:   
Discount rate5.51 %2.89 %2.53 %
Long-term rate of return on assets5.75 %5.00 %6.25 %
Compensation increase rateFrozenFrozenFrozen
Measurement dateJanuary 1, 2023January 1, 2022January 1, 2021
Census dateJanuary 1, 2023January 1, 2022January 1, 2021
Schedule of Weighted-Average Asset Allocations by Asset Category
The weighted‑average asset allocations by asset category as of December 31, 2023, were as follows:
TargetActual
Cash and cash equivalents— %1 %
Equity securities20 %6 %
Debt securities73 %75 %
Alternative investments7 %18 %
Schedule of DMC Pension Plan Assets Measured at Fair Value on a Recurring Basis Aggregated by the Level in the Fair Value Hierarchy
The following tables summarize the DMC Pension Plan assets measured at fair value on a recurring basis as of December 31, 2023 and 2022, aggregated by the level in the fair value hierarchy within which those measurements are determined:
TotalLevel 1Level 2Level 3
As of December 31, 2023:
Cash and cash equivalents$6 $6 $— $— 
Equity securities39 39 — — 
Fixed income funds442 442 — — 
Alternative investments:
Private equity securities97 — — 97 
Hedge funds8 — — 8 
 $592 $487 $— $105 
As of December 31, 2022:
Cash and cash equivalents$7 $7 $— $— 
Equity securities89 89 — — 
Debt Securities:
U.S. government obligations200 200 — — 
Corporate debt securities249 249 — — 
Alternative investments:
Private equity securities78 — — 78 
Hedge funds25 — — 25 
$648 $545 $— $103 
Schedule of Estimated Future Benefit Payments
The following table presents the estimated future benefit payments to be made from the SERPs and the DMC Pension Plan, a portion of which will be funded from plan assets, for the next five years and in the aggregate for the five years thereafter:
  Years Ending December 31, Five Years Thereafter
 Total20242025202620272028
Estimated benefit payments$789 $84 $84 $83 $82 $81 $375 
v3.24.0.1
PROPERTY AND EQUIPMENT (Tables)
 12 Months Ended
Dec. 31, 2023
Property, Plant and Equipment [Abstract]  
Schedule of Components of Property and Equipment
The principal components of property and equipment are shown in the table below:
 December 31,
 20232022
Land$625 $661 
Buildings and improvements6,692 6,646 
Construction in progress269 195 
Equipment4,750 4,748 
Finance lease assets378 413 
 12,714 12,663 
Accumulated depreciation and amortization(6,478)(6,201)
Net property and equipment$6,236 $6,462 
v3.24.0.1
GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)
 12 Months Ended
Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]  
Schedule of Changes in the Carrying Amount of Goodwill
The following table provides information on changes in the carrying amount of goodwill:
December 31,
 20232022
Hospital Operations  
Goodwill at beginning of period, net of accumulated impairment losses$3,411 $3,413 
Goodwill acquired during the year133 1 
Goodwill related to assets held for sale and disposed(425)(3)
Goodwill at end of period, net of accumulated impairment losses$3,119 $3,411 
Ambulatory Care
Goodwill at beginning of period$6,712 $5,848 
Goodwill acquired during the year and purchase price allocation adjustments493 866 
Goodwill related to assets held for sale and disposed or deconsolidated facilities(17)(2)
Goodwill at end of period$7,188 $6,712 
Schedule of Other Intangible Assets
The following table provides information regarding other intangible assets, which were included in the accompanying Consolidated Balance Sheets:
 Gross
Carrying
Amount		Accumulated
Amortization		Net Book
Value
At December 31, 2023:   
Other intangible assets with finite useful lives:
Capitalized software costs$1,712 $(1,205)$507 
Contracts294 (164)130 
Other91 (78)13 
Other intangible assets with finite lives2,097 (1,447)650 
Other intangible assets with indefinite useful lives:
Trade names105 — 105 
Contracts609 — 609 
Other4 — 4 
Other intangible assets with indefinite lives718 — 718 
Other intangible assets, net$2,815 $(1,447)$1,368 
At December 31, 2022:
Other intangible assets with finite useful lives:
Capitalized software costs$1,751 $(1,206)$545 
Contracts295 (146)149 
Other92 (76)16 
Total other intangible assets with finite lives2,138 (1,428)710 
Other intangible assets with indefinite useful lives:
Trade names105 — 105 
Contracts603 — 603 
Other6 — 6 
Total other intangible assets with indefinite lives714 — 714 
Total other intangible assets, net$2,852 $(1,428)$1,424 
Schedule of Estimated Future Amortization of Intangibles with Finite Useful Lives
Estimated future amortization of intangible assets with finite useful lives at December 31, 2023 was as follows:
 TotalYears Ending December 31,Later Years
 20242025202620272028
Amortization of intangible assets$650 $132 $124 $99 $84 $61 $150 
v3.24.0.1
OTHER ASSETS (Tables)
 12 Months Ended
Dec. 31, 2023
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]  
Schedule of Other Current Assets
The principal components of other current assets in the accompanying Consolidated Balance Sheets were as follows:
December 31,
 20232022
Prepaid expenses$391 $400 
Contract assets208 200 
California provider fee program receivables329 367 
Receivables from other government programs282 187 
Guarantees274 143 
Non-patient receivables260 390 
Other95 88 
Total other current assets$1,839 $1,775 
Schedule of Investments and Other Assets
The principal components of investments and other assets in the accompanying Consolidated Balance Sheets were as follows:
 December 31,
 20232022
Marketable securities$48 $30 
Equity investments in unconsolidated healthcare entities1,512 1,599 
Total investments1,560 1,629 
Cash surrender value of life insurance policies43 37 
Long-term deposits50 56 
California provider fee program receivables334 197 
Operating lease assets1,083 1,129 
Other long-term receivables and other assets87 99 
Total investments and other assets$3,157 $3,147 
v3.24.0.1
ACCUMULATED OTHER COMPREHENSIVE LOSS (Tables)
 12 Months Ended
Dec. 31, 2023
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]  
Schedule of Accumulated Other Comprehensive Loss
The table below presents our accumulated other comprehensive loss by component:
 December 31,
 20232022
Adjustments for defined benefit plans$(180)$(178)
Unrealized gains on investments(1)(3)
Accumulated other comprehensive loss$(181)$(181)
The following table presents the income tax expense (benefit) from each component of our other comprehensive income:
 December 31,
 20232022
Adjustments for defined benefit plans$— $18 
Foreign currency translation adjustments and other— (1)
Net income tax expense related to items of other comprehensive income$— $17 
v3.24.0.1
NET OPERATING REVENUES - (Tables)
 12 Months Ended
Dec. 31, 2023
Revenue from Contract with Customer [Abstract]  
Schedule of Sources of Net Operating Revenues Less Provisions for Doubtful Accounts and Implicit Price Concessions
The table below presents our sources of net operating revenues:
Years Ended December 31,
202320222021
Hospital Operations:
Net patient service revenues from hospitals and related outpatient facilities:
Medicare$2,383 $2,369 $2,615 
Medicaid1,233 1,069 1,254 
Managed care10,248 9,607 9,985 
Uninsured96 141 199 
Indemnity and other590 661 706 
Total14,550 13,847 14,759 
Other revenues(1)
2,133 2,079 2,008 
Total Hospital Operations16,683 15,926 16,767 
Ambulatory Care3,865 3,248 2,718 
Net operating revenues$20,548 $19,174 $19,485 
(1)Primarily revenue from physician practices and revenue cycle management. Revenue from revenue cycle management services is included in other revenues for all periods presented to conform with our new reporting segment structure.
The following table presents the composition of net operating revenues for our Ambulatory Care segment:
Years Ended December 31,
202320222021
Net patient service revenues
$3,713 $3,115 $2,604 
Management fees123 110 86 
Revenue from other sources29 23 28 
Net operating revenues$3,865 $3,248 $2,718 
Schedule of Revenue Expected to be Recognized in the Future Related to Performance Obligations
The following table includes revenue from revenue cycle management services that is expected to be recognized in the future related to performance obligations that are unsatisfied, or partially unsatisfied, at the end of the reporting period. The amounts in the table primarily consist of revenue cycle management fixed fees, which are typically recognized ratably as the performance obligation is satisfied. The estimated revenue does not include volume‑ or contingency‑based contracts, variable‑based escalators, performance incentives, penalties or other variable consideration that is considered constrained. Our contract with Catholic Health Initiatives (“CHI”), a minority interest owner of Conifer Health Solutions, LLC, represents the majority of the fixed‑fee revenue related to remaining performance obligations. Conifer’s contract term with CHI ends December 31, 2032.
  Years Ending December 31,Later Years
 Total20242025202620272028
Performance obligations$6,026 $685 $684 $683 $683 $683 $2,608 
v3.24.0.1
CLAIMS AND LAWSUITS (Tables)
 12 Months Ended
Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]  
Schedule of Reconciliations Of Legal Settlements And Related Costs
The following table presents reconciliations of the beginning and ending liability balances in connection with legal settlements and related costs:
 Balances at
Beginning
of Period		Litigation and
Investigation
Costs		Cash
Payments		OtherBalances at
End of
Period
Year Ended December 31, 2023$51 $47 $(59)$1 $40 
Year Ended December 31, 2022$78 $70 $(100)$3 $51 
Year Ended December 31, 2021$26 $116 $(59)$(5)$78 
v3.24.0.1
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES (Tables)
 12 Months Ended
Dec. 31, 2023
Noncontrolling Interest [Abstract]  
Schedule of Changes in Redeemable Noncontrolling Interests in Equity of Consolidated Subsidiaries
The following table shows the changes in redeemable noncontrolling interests in equity of consolidated subsidiaries:
 December 31,
 20232022
Balances at beginning of period 
$2,149 $2,203 
Net income366 348 
Distributions paid to noncontrolling interests(305)(331)
Accretion of redeemable noncontrolling interests— 104 
Purchases and sales of businesses and noncontrolling interests, net181 (175)
Balances at end of period 
$2,391 $2,149 
The following tables show the composition by segment of our redeemable noncontrolling interests balances, as well as our net income available to redeemable noncontrolling interests:
December 31,
 20232022
Hospital Operations$860 $792 
Ambulatory Care1,531 1,357 
Redeemable noncontrolling interests$2,391 $2,149 
 Years Ended December 31,
 202320222021
Hospital Operations$84 $100 $93 
Ambulatory Care282 248 243 
Net income available to redeemable noncontrolling interests$366 $348 $336 
v3.24.0.1
INCOME TAXES (Tables)
 12 Months Ended
Dec. 31, 2023
Income Tax Disclosure [Abstract]  
Schedule of Provision for Income Taxes For Continuing Operations
The provision for income taxes for continuing operations for the years ended December 31, 2023, 2022 and 2021 consisted of the following:
 Years Ended December 31,
 202320222021
Current tax expense:   
Federal$208 $78 $50 
State46 57 111 
 254 135 161 
Deferred tax expense (benefit):   
Federal55 174 267 
State(3)35 (17)
 52 209 250 
 $306 $344 $411 
Schedule of Reconciliation Between Reported Income Tax Expense (Benefit) and Income Taxes Calculated by the Statutory Federal Income Tax Rate
A reconciliation between the amount of reported income tax expense and the amount computed by multiplying income from continuing operations before income taxes by the statutory federal tax rate is presented below. Foreign pre-tax loss was $3 million, $8 million and $5 million for the years ended December 31, 2023, 2022 and 2021, respectively.
 Years Ended December 31,
 202320222021
Tax expense at statutory federal rate of 21%$340 $282 $396 
State income taxes, net of federal income tax benefit70 64 77 
Tax benefit attributable to noncontrolling interests(147)(122)(114)
Nondeductible goodwill— 1 35 
Nondeductible executive compensation6 10 8 
Impact of change in state filing method, net of change in unrecognized tax benefit(20)— — 
Nondeductible litigation costs— — 1 
Stock-based compensation tax benefit(2)(6)(5)
Changes in valuation allowance71 120 2 
Prior-year provision to return adjustments and other changes in deferred taxes(9)(12)8 
Other items(3)7 3 
Income tax expense$306 $344 $411 
Schedule of Components of Deferred Tax Assets and Liabilities, Including Any Valuation Allowance The following table discloses those significant components of our deferred tax assets and liabilities, including any valuation allowance:
 December 31, 2023December 31, 2022
 AssetsLiabilitiesAssetsLiabilities
Depreciation and fixed-asset differences$— $430 $— $436 
Reserves related to discontinued operations and restructuring charges6 — 5 — 
Receivables (doubtful accounts and adjustments)222 — 246 — 
Medicare advance payments— — — — 
Accruals for retained insurance risks232 — 227 — 
Intangible assets— 429 — 416 
Other long-term liabilities32 — 27 — 
Benefit plans233 — 207 — 
Other accrued liabilities20 — 30 — 
Investments and other assets— 119 — 112 
Interest expense limitation206 — 133 — 
Net operating loss carryforwards71 — 74 — 
Stock-based compensation13 — 13 — 
Right-of-use lease assets and obligations129 111 192 173 
Other items4 80 11 49 
 1,168 1,169 1,165 1,186 
Valuation allowance(248)— (177)— 
 $920 $1,169 $988 $1,186 
Schedule of Reconciliation of the Deferred Tax Assets and Liabilities and the Corresponding Amounts Reported in the Accompanying Consolidated Balance Sheets
Below is a reconciliation of the deferred tax assets and liabilities and the corresponding amounts reported in the accompanying Consolidated Balance Sheets:
 December 31,
 20232022
Deferred income tax assets$77 $19 
Deferred tax liabilities(326)(217)
Net deferred tax liability$(249)$(198)
Schedule of Changes in Unrecognized Tax Benefits That Have Impacted Deferred Tax Assets and Liabilities The following table summarizes the total changes in unrecognized tax benefits in continuing operations during the years ended December 31, 2023, 2022 and 2021. There were no such changes in discontinued operations. The additions and reductions for tax positions include the impact of items for which the ultimate deductibility is highly certain, but for which there is uncertainty about the timing of such deductions. Such amounts include unrecognized tax benefits that have impacted deferred tax assets and liabilities at December 31, 2023, 2022 and 2021.
 Continuing
Operations
Balance At December 31, 2020$31 
Reductions due to a lapse of statute of limitations3 
Balance At December 31, 2021$34 
Reductions due to a lapse of statute of limitations— 
Balance At December 31, 2022$34 
Increases due to tax positions taken in prior periods31 
Reductions due to a lapse of statute of limitations(1)
Balance At December 31, 2023$64 
v3.24.0.1
EARNINGS PER COMMON SHARE (Tables)
 12 Months Ended
Dec. 31, 2023
Earnings Per Share [Abstract]  
Schedule of Reconciliation of Numerators and Denominators of our Basic and Diluted Earnings Per Common Share
The following table is a reconciliation of the numerators and denominators of our basic and diluted earnings per common share calculations for our continuing operations. Net income available to our common shareholders is expressed in millions and weighted average shares are expressed in thousands.
 Net Income Available to Common Shareholders (Numerator)Weighted
Average Shares
(Denominator)		Per-Share
Amount
Year Ended December 31, 2023   
Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share$611 101,639 $6.01 
Effect of dilutive stock options, restricted stock units, deferred compensation units, convertible instruments and dividends on preferred stock(13)3,161 (0.30)
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share$598 104,800 $5.71 
Year Ended December 31, 2022   
Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share$410 106,929 $3.83 
Effect of dilutive stock options, restricted stock units, deferred compensation units, convertible instruments and dividends on preferred stock8 3,587 (0.05)
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share$418 110,516 $3.78 
Year Ended December 31, 2021   
Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share$915 106,833 $8.56 
Effect of dilutive stock options, restricted stock units and deferred compensation units— 1,738 (0.13)
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share$915 108,571 $8.43 
v3.24.0.1
FAIR VALUE MEASUREMENTS (Tables)
 12 Months Ended
Dec. 31, 2023
Fair Value Disclosures [Abstract]  
Schedule of Assets and Liabilities Measured at Fair Value on a Non-Recurring Basis
The following table presents this information about assets measured at fair value at December 31, 2023 and 2022 and indicates the fair value hierarchy of the valuation techniques we utilized to determine such fair values:
 TotalQuoted Prices
in Active
Markets for
Identical Assets
(Level 1)		Significant Other
Observable Inputs
(Level 2)		Significant
Unobservable
Inputs
(Level 3)
December 31, 2023
Long-lived assets held for sale$775 $— $775 $— 
December 31, 2022
Long-lived assets held and used$167 $— $167 $— 
v3.24.0.1
ACQUISITIONS (Tables)
 12 Months Ended
Dec. 31, 2023
Business Combination and Asset Acquisition [Abstract]  
Schedule of Preliminary Purchase Price Allocation
Preliminary or final purchase price allocations for all the acquisitions made during the years ended December 31, 2023, 2022 and 2021 are as follows:
Years Ended December 31,
 202320222021
Current assets$34 $38 $59 
Property and equipment28 54 88 
Other intangible assets5 2 8 
Goodwill644 860 664 
Other long-term assets32 99 796 
Previously held equity method investments(99)(207)(43)
Current liabilities(36)(41)(25)
Long-term liabilities(37)(118)(70)
Redeemable noncontrolling interests in equity of consolidated subsidiaries(229)(180)(139)
Noncontrolling interests(102)(273)(95)
Cash paid, net of cash acquired(224)(234)(1,220)
Gains on consolidations$16 $— $23 
v3.24.0.1
SEGMENT INFORMATION (Tables)
 12 Months Ended
Dec. 31, 2023
Segment Reporting [Abstract]  
Schedule of Reconciliation of Assets by Reportable Segment to Consolidated Assets
The following tables include amounts for each of our reportable segments and the reconciling items necessary to agree to amounts reported in the accompanying Consolidated Balance Sheets and Consolidated Statements of Operations, as applicable:
December 31,
 202320222021
Assets:  
Hospital Operations$17,268 $16,599 $18,106 
Ambulatory Care11,044 10,557 9,473 
Total 
$28,312 $27,156 $27,579 
Schedule of Reconciliation of Other Significant Reconciling Items From Segments to Consolidated
 Years Ended December 31,
 202320222021
Capital expenditures:   
Hospital Operations$671 $687 $592 
Ambulatory Care80 75 66 
Total 
$751 $762 $658 
Net operating revenues:   
Hospital Operations$16,683 $15,926 $16,767 
Ambulatory Care3,865 3,248 2,718 
Total 
$20,548 $19,174 $19,485 
Equity in earnings of unconsolidated affiliates:   
Hospital Operations$10 $10 $25 
Ambulatory Care218 206 193 
Total 
$228 $216 $218 
Adjusted EBITDA:   
Hospital Operations$1,997 $2,142 $2,286 
Ambulatory Care1,544 1,327 1,197 
Total 
$3,541 $3,469 $3,483 
Depreciation and amortization:   
Hospital Operations$750 $729 $760 
Ambulatory Care120 112 95 
Total 
$870 $841 $855 
Years Ended December 31,
202320222021
Adjusted EBITDA $3,541 $3,469 $3,483 
Loss from divested and closed businesses— — (1)
Depreciation and amortization(870)(841)(855)
Impairment and restructuring charges, and acquisition-related costs(137)(226)(85)
Litigation and investigation costs(47)(70)(116)
Interest expense(901)(890)(923)
Loss from early extinguishment of debt(11)(109)(74)
Other non-operating income, net19 10 14 
Gains on sales, consolidation and deconsolidation of facilities23 1 445 
Income from continuing operations, before income taxes$1,617 $1,344 $1,888 
v3.24.0.1
SIGNIFICANT ACCOUNTING POLICIES - Description of Business (Details)
$ in Millions
 1 Months Ended 12 Months Ended
Jun. 30, 2022
USD ($)
Dec. 31, 2023
healthcare_facility
hospital
segment
Dec. 31, 2022
segment
Jun. 29, 2022
Business Acquisition [Line Items]        
Number of reportable segments | segment   2 3  
Number of acute care and specialty hospitals operated | hospital   61    
Hospital Operations        
Business Acquisition [Line Items]        
Number of outpatient facilities operated | healthcare_facility   164    
Ambulatory Care        
Business Acquisition [Line Items]        
Number of outpatient centers recorded using equity method | healthcare_facility   155    
United Surgical Partners International | Ambulatory Care        
Business Acquisition [Line Items]        
Ownership percentage by parent (percent) 100.00%     95.00%
United Surgical Partners International | Ambulatory Care        
Business Acquisition [Line Items]        
Number of ambulatory surgery centers | hospital   461    
Number of surgical hospitals operated by subsidiaries | hospital   24    
Number of outpatient centers recorded using equity method | healthcare_facility   155    
Baylor University Medical Center | United Surgical Partners International        
Business Acquisition [Line Items]        
Share purchase agreement amount of payment | $ $ 406      
v3.24.0.1
SIGNIFICANT ACCOUNTING POLICIES - Basis of Presentation (Details) - $ / shares
shares in Thousands
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Business Acquisition [Line Items]      
Diluted (in shares) 104,800 110,516 108,571
Earnings per share, diluted (in dollars per share) $ 5.71 $ 3.79 $ 8.42
Cumulative Effect, Period of Adoption, Adjustment | Accounting Standards Update 2020-06      
Business Acquisition [Line Items]      
Diluted (in shares) 2,364 2,673  
Earnings per share, diluted (in dollars per share) $ (0.26) $ (0.01)  
v3.24.0.1
SIGNIFICANT ACCOUNTING POLICIES - COVID-19 Pandemic (Details) - USD ($)
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Business Acquisition [Line Items]      
Received cash payments $ 10,000,000 $ 196,000,000 $ 178,000,000
Grant income 16,000,000 194,000,000 191,000,000
Deferred revenue 0 7,000,000  
Contract liabilities advance payments   880,000,000 512,000,000
Accrued Compensation And Benefits      
Business Acquisition [Line Items]      
Deferred social security tax payments   128,000,000 128,000,000
Hospital Operations      
Business Acquisition [Line Items]      
Received cash payments 10,000,000 193,000,000 142,000,000
Grant income 15,000,000 190,000,000 142,000,000
Contract liabilities advance payments   876,000,000 457,000,000
Contract liabilities 59,000,000 110,000,000 955,000,000
Ambulatory Care      
Business Acquisition [Line Items]      
Received cash payments 0 3,000,000 36,000,000
Grant income 1,000,000 4,000,000 49,000,000
Contract liabilities advance payments   4,000,000 55,000,000
Contract liabilities 0 0 4,000,000
Hospital Operations And Ambulatory Care      
Business Acquisition [Line Items]      
Contract liabilities 0 0  
Cash‑Managed Affiliates      
Business Acquisition [Line Items]      
Received cash payments 0 0 37,000,000
Contract liabilities advance payments   0 104,000,000
Unconsolidated affiliates | Ambulatory Care      
Business Acquisition [Line Items]      
Grant income $ 0 $ 0 $ 14,000,000
v3.24.0.1
SIGNIFICANT ACCOUNTING POLICIES - Net Operating Revenues (Details)
 12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
Cost report filing period after end of annual cost reporting period 5 months
Percentage of contract assets that meet the conditions for unconditional right to payment (percentage) 88.00%
v3.24.0.1
SIGNIFICANT ACCOUNTING POLICIES - Cash and Cash Equivalents (Details) - USD ($)
$ in Millions
 1 Months Ended 12 Months Ended
Jun. 30, 2022
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Cash and Cash Equivalents        
Cash and cash equivalents   $ 1,228 $ 858  
Accrued property and equipment purchases for items received but not yet paid   154 196 $ 95
United Surgical Partners International        
Cash and Cash Equivalents        
Purchase and sales of business and noncontrolling interest, net $ 365      
Loss from purchase of noncontrolling interests 23      
Baylor University Medical Center | United Surgical Partners International        
Cash and Cash Equivalents        
Share purchase agreement, payment for execution 11      
Debt instrument payment $ 377      
Baylor University Medical Center | United Surgical Partners International | Put Option        
Cash and Cash Equivalents        
Ownership percentage 5.00%      
Captive Insurance Subsidiaries        
Cash and Cash Equivalents        
Cash and cash equivalents   100 140  
Accounts Payable        
Cash and Cash Equivalents        
Book overdrafts classified as accounts payable   187 266  
Accrued property and equipment purchases for items received but not yet paid   $ 141 $ 191 $ 88
v3.24.0.1
SIGNIFICANT ACCOUNTING POLICIES - Investments in Unconsolidated Affiliates (Details)
$ in Millions
 12 Months Ended
Dec. 31, 2023
USD ($)
healthcare_facility
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Schedule of Equity Method Investments [Line Items]      
Grant income $ 16 $ 194 $ 191
Percentage of investee results reflected on date of acquisition 1    
Current assets $ 7,167 5,981  
Current liabilities (4,760) (4,476)  
Noncontrolling interests (1,509) (1,317)  
Net operating revenues 20,548 19,174 19,485
Net income 1,311 1,001 1,476
Equity in earnings of unconsolidated affiliates 228 216 218
Unconsolidated affiliates      
Schedule of Equity Method Investments [Line Items]      
Current assets 1,223 1,142 1,176
Noncurrent assets 1,355 1,356 1,390
Current liabilities (456) (479) (495)
Noncurrent liabilities (917) (878) (855)
Noncontrolling interests (670) (644) (659)
Net operating revenues 3,510 3,360 3,030
Net income 860 805 836
Net income attributable to the investees 484 453 499
Texas Health Ventures Group, LLC      
Schedule of Equity Method Investments [Line Items]      
Equity in earnings of unconsolidated affiliates $ 104 89 107
Ambulatory Care      
Schedule of Equity Method Investments [Line Items]      
Number of outpatient centers recorded not using equity method | healthcare_facility 330    
Number of outpatient centers recorded using equity method | healthcare_facility 155    
Number Out Patient Centers, Ownership Interest | healthcare_facility 485    
Grant income $ 1 4 49
Net operating revenues 3,865 3,248 2,718
Equity in earnings of unconsolidated affiliates 218 206 193
Ambulatory Care | Unconsolidated affiliates      
Schedule of Equity Method Investments [Line Items]      
Grant income $ 0 $ 0 $ 14
v3.24.0.1
SIGNIFICANT ACCOUNTING POLICIES - Property and Equipment (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Buildings and improvements | Minimum      
Property and equipment      
Useful life 15 years    
Buildings and improvements | Maximum      
Property and equipment      
Useful life 40 years    
Equipment | Minimum      
Property and equipment      
Useful life 3 years    
Equipment | Maximum      
Property and equipment      
Useful life 15 years    
Newly Constructed Hospitals      
Property and equipment      
Useful life 50 years    
Construction in progress      
Property and equipment      
Interest costs capitalized related to construction projects $ 9 $ 8 $ 4
v3.24.0.1
SIGNIFICANT ACCOUNTING POLICIES - Leases (Details)
Dec. 31, 2023
renewal_option
Property and equipment  
Number of renewal options 1
Minimum  
Property and equipment  
Operating lease, renewal term 5 years
Maximum  
Property and equipment  
Operating lease, renewal term 10 years
Real estate | Minimum  
Property and equipment  
Operating lease, term of contract 5 years
Real estate | Maximum  
Property and equipment  
Operating lease, term of contract 10 years
Equipment  
Property and equipment  
Operating lease, term of contract 3 years
Equipment | Minimum  
Property and equipment  
Useful life 3 years
Equipment | Maximum  
Property and equipment  
Useful life 15 years
Medical Equipment  
Property and equipment  
Operating lease, term of contract 3 years
Medical Equipment | Minimum  
Property and equipment  
Useful life 5 years
Medical Equipment | Maximum  
Property and equipment  
Useful life 7 years
Computer And Telecommunication Equipment  
Property and equipment  
Useful life 15 years
v3.24.0.1
SIGNIFICANT ACCOUNTING POLICIES - Goodwill and Other Intangible Assets (Details) - Capitalized software costs
Dec. 31, 2023
Minimum  
Goodwill and Other Intangible Assets  
Estimated useful life 3 years
Maximum  
Goodwill and Other Intangible Assets  
Estimated useful life 15 years
v3.24.0.1
SIGNIFICANT ACCOUNTING POLICIES - Segment Reporting (Details)
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Accounting Policies [Abstract]      
Revenue generated by general hospitals 81.00% 83.00% 86.00%
v3.24.0.1
EQUITY - Noncontrolling Interests (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Noncontrolling Interest [Line Items]        
Noncontrolling interests balance $ 3,117 $ 2,459 $ 2,054 $ 937
Net income attributable to noncontrolling interests 945 653 1,140  
Noncontrolling Interests        
Noncontrolling Interest [Line Items]        
Noncontrolling interests balance 1,509 1,317 1,026 $ 909
Net income attributable to noncontrolling interests 334 242 226  
Noncontrolling Interests | Hospital Operations        
Noncontrolling Interest [Line Items]        
Noncontrolling interests balance 185 132    
Net income attributable to noncontrolling interests 30 21 21  
Noncontrolling Interests | Ambulatory Care        
Noncontrolling Interest [Line Items]        
Noncontrolling interests balance 1,324 1,185    
Net income attributable to noncontrolling interests $ 304 $ 221 $ 205  
v3.24.0.1
EQUITY - Share Repurchase Programs (Details) - USD ($)
$ / shares in Units, shares in Thousands, $ in Millions
 1 Months Ended 2 Months Ended 12 Months Ended
Oct. 31, 2022
Dec. 31, 2023
Nov. 30, 2023
Oct. 31, 2023
Sep. 30, 2023
Aug. 31, 2023
Jul. 31, 2023
Jun. 30, 2023
May 31, 2023
Apr. 30, 2023
Mar. 31, 2023
Feb. 28, 2023
Jan. 31, 2023
Dec. 31, 2022
Nov. 30, 2022
Dec. 31, 2022
Dec. 31, 2023
Oct. 22, 2022
Equity, Class of Treasury Stock [Line Items]                                    
Amount of common stock authorized to be repurchased                                   $ 1,000
Total Number of Shares Purchased (in shares) 1,800 644   0 0 0 0 0 580 0 906 0 0 0 4,089 5,889 3,112  
Average Price Paid per Share (in dollars per shares) $ 41.81 $ 68.53 $ 67.12 $ 0 $ 0 $ 0 $ 0 $ 0 $ 69.17 $ 0 $ 55.03 $ 0 $ 0 $ 0 $ 42.74 $ 42.45 $ 64.27  
Maximum Dollar Value of Shares That May Yet be Purchased Under the Program $ 925 $ 550 $ 594 $ 660 $ 660 $ 660 $ 660 $ 660 $ 660 $ 700 $ 700 $ 750 $ 750 $ 750 $ 750 $ 750 $ 550  
Publicly Announced Share Repurchase Program                                    
Equity, Class of Treasury Stock [Line Items]                                    
Total Number of Shares Purchased (in shares) 1,800 644 982 0 0 0 0 0 580 0 906 0 0 0 4,089 5,889 3,112  
v3.24.0.1
ACCOUNTS RECEIVABLE - Components (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Accounts Receivable Additional Disclosures [Abstract]    
Patient accounts receivable $ 2,719 $ 2,746
Estimated future recoveries 148 149
Net cost reports and settlements receivable and valuation allowances 47 48
Accounts receivable, net  $ 2,914 $ 2,943
v3.24.0.1
ACCOUNTS RECEIVABLE - Location of Assets and Liabilities (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Assets:    
Other current assets $ 1,839 $ 1,775
Investments and other assets 3,157 3,147
Liabilities:    
Other current liabilities 1,779 1,581
Other long-term liabilities 1,709 1,800
California's Provider Fee Program    
Assets:    
Other current assets 329 367
Investments and other assets 334 197
Liabilities:    
Other current liabilities 172 145
Other long-term liabilities $ 135 $ 63
v3.24.0.1
ACCOUNTS RECEIVABLE - Allowance (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Accounts receivable and allowance for doubtful accounts      
Estimated costs of caring $ 609 $ 620 $ 747
Uninsured patients      
Accounts receivable and allowance for doubtful accounts      
Estimated costs of caring 499 537 650
Charity care patients      
Accounts receivable and allowance for doubtful accounts      
Estimated costs of caring $ 110 $ 83 $ 97
v3.24.0.1
CONTRACT BALANCES - Hospital Operations and Ambulatory Care Segments (Details) - USD ($)
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Contract Assets – Unbilled Revenue    
Balance at beginning of period $ 200,000,000  
Balance at end of period 208,000,000 $ 200,000,000
Hospital Operations    
Receivables    
Balance at beginning of period 37,000,000 28,000,000
Balance at end of period 21,000,000 37,000,000
Increase (decrease) (16,000,000) 9,000,000
Contract Assets – Unbilled Revenue    
Balance at beginning of period 200,000,000 199,000,000
Balance at end of period 208,000,000 200,000,000
Increase (decrease) 8,000,000 1,000,000
Contract Liabilities – Current Deferred Revenue and Advances from Medicare    
Balance at beginning of period 110,000,000 955,000,000
Balance at end of period 59,000,000 110,000,000
Contract Liabilities – Long-Term Deferred Revenue    
Balance at beginning of period 13,000,000 15,000,000
Balance at end of period 12,000,000 13,000,000
Contract liabilities advance payments 71,000,000 56,000,000
Hospital Operations | Medicare Advances    
Contract Liabilities – Current Deferred Revenue and Advances from Medicare    
Balance at beginning of period   876,000,000
Hospital Operations | Short-term Contract with Customer    
Contract Liabilities – Current Deferred Revenue and Advances from Medicare    
Increase (decrease) (51,000,000) (845,000,000)
Contract Liabilities – Long-Term Deferred Revenue    
Increase (decrease) (51,000,000) (845,000,000)
Hospital Operations | Long-term Contract with Customer    
Contract Liabilities – Current Deferred Revenue and Advances from Medicare    
Increase (decrease) (1,000,000) (2,000,000)
Contract Liabilities – Long-Term Deferred Revenue    
Increase (decrease) (1,000,000) (2,000,000)
Ambulatory Care    
Contract Liabilities – Current Deferred Revenue and Advances from Medicare    
Balance at beginning of period 0 4,000,000
Balance at end of period $ 0 0
Ambulatory Care | Short-term Contract with Customer    
Contract Liabilities – Current Deferred Revenue and Advances from Medicare    
Increase (decrease)   (4,000,000)
Contract Liabilities – Long-Term Deferred Revenue    
Increase (decrease)   $ (4,000,000)
v3.24.0.1
CONTRACT BALANCES - Contract Costs (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Revenue from Contract with Customer [Abstract]      
Amortized customer contract costs $ 5 $ 4 $ 4
Unamortized contract costs $ 22 $ 24  
v3.24.0.1
ASSETS AND LIABILITIES HELD FOR SALE - Narrative (Details)
 1 Months Ended 12 Months Ended
Nov. 30, 2023
hospital
Aug. 31, 2021
hospital
Dec. 31, 2023
USD ($)
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Jan. 31, 2024
USD ($)
Jan. 31, 2023
Current Assets and Liabilities Held for Sale              
Impairment charges     $ 43,000,000 $ 94,000,000 $ 8,000,000    
Discontinued Operations, Held-for-sale              
Current Assets and Liabilities Held for Sale              
Impairment charges     $ 0 $ 0 0    
Discontinued Operations, Held-for-sale | San Ramon RMC              
Current Assets and Liabilities Held for Sale              
Ownership percentage of subsidiary             51.00%
SC Hospitals | Discontinued Operations, Held-for-sale              
Current Assets and Liabilities Held for Sale              
Number of hospitals for sale | hospital 3            
SC Hospitals | Discontinued Operations, Held-for-sale | Subsequent Event              
Current Assets and Liabilities Held for Sale              
Proceeds received           $ 2,400,000,000  
Miami-Area Hospitals | Disposal Group, Disposed of by Sale, Not Discontinued Operations              
Current Assets and Liabilities Held for Sale              
Number of hospitals for sale | hospital   5          
Gain (loss) on sale of properties         406,000,000    
Urgent Care Centers              
Current Assets and Liabilities Held for Sale              
Gain (loss) on sale of properties         14,000,000    
Philadelphia Building              
Current Assets and Liabilities Held for Sale              
Gain (loss) on sale of properties         $ 2,000,000    
v3.24.0.1
ASSETS AND LIABILITIES HELD FOR SALE - Net assets held for sale (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]    
Current liabilities $ (69) $ 0
Discontinued Operations, Held-for-sale    
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]    
Accounts receivable 78  
Other current assets 25  
Investments and other long-term assets 26  
Property and equipment 204  
Other intangible assets 17  
Goodwill 425  
Current liabilities (45)  
Long-term liabilities (24)  
Net assets held for sale $ 706  
v3.24.0.1
ASSETS AND LIABILITIES HELD FOR SALE - Significant Components (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Miami-Area Hospitals | Disposal Group, Disposed of by Sale, Not Discontinued Operations      
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]      
Accumulated other comprehensive loss $ (3) $ 10 $ 455
Gain (loss) on sale of properties     406
SC Hospitals | Discontinued Operations, Held-for-sale      
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]      
Accumulated other comprehensive loss $ 130 $ 127 $ 135
v3.24.0.1
IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Impaired Long-Lived Assets Held and Used [Line Items]      
Impairment and restructuring charges, and acquisition-related costs $ 137 $ 226 $ 85
Restructuring charges 79 118 57
Impairment charges 43 94 8
Acquisition costs 15 14 20
Lease termination costs 10 32  
Restructuring costs 6 43 24
Acquisition-related transaction costs     20
Hospital Operations      
Impaired Long-Lived Assets Held and Used [Line Items]      
Impairment charges   88 3
Ambulatory Care      
Impaired Long-Lived Assets Held and Used [Line Items]      
Impairment charges   6 5
Legal Costs Related to The Sale of Certain Facilities      
Impaired Long-Lived Assets Held and Used [Line Items]      
Restructuring charges 36    
Employee Severance      
Impaired Long-Lived Assets Held and Used [Line Items]      
Restructuring charges 15 27 14
Global Business Center in Republic of Philippines      
Impaired Long-Lived Assets Held and Used [Line Items]      
Restructuring charges $ 12 16 $ 19
Hospital Buildings and Medical Equipment | Hospital Operations      
Impaired Long-Lived Assets Held and Used [Line Items]      
Impairment charges   82  
Buildings Subject To Impairment Charges      
Impaired Long-Lived Assets Held and Used [Line Items]      
Noncurrent assets   $ 167  
v3.24.0.1
LEASES - Balance Sheet Components (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Leases [Abstract]    
Operating lease assets $ 1,083 $ 1,129
Finance lease assets 253 303
Total leased assets 1,336 1,432
Operating lease liabilities, current 204 207
Operating lease liabilities, long-term 1,007 1,046
Total operating lease liabilities 1,211 1,253
Finance lease liabilities, current 84 99
Finance lease liabilities, long-term 120 165
Total finance lease liabilities 204 264
Total lease liabilities $ 1,415 $ 1,517
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List] Investments and other assets Investments and other assets
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List] Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List] Other current liabilities Other current liabilities
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List] Other long-term liabilities Other long-term liabilities
Finance Lease, Liability, Current, Statement of Financial Position [Extensible List] Current portion of long-term debt Current portion of long-term debt
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List] Long-term debt, net of current portion Long-term debt, net of current portion
v3.24.0.1
LEASES - Lease Costs (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Leases [Abstract]      
Operating lease expense $ 259 $ 262 $ 241
Finance lease expense:      
Amortization of leased assets 55 58 71
Interest on lease liabilities 8 8 9
Total finance lease expense 63 66 80
Variable and short term-lease expense 159 150 171
Total lease expense $ 481 $ 478 $ 492
Weighted-average remaining lease term (years), operating leases 7 years 7 months 6 days 8 years 7 years 6 months
Weighted-average remaining lease term (years), finance leases 6 years 5 years 6 months 5 years 8 months 12 days
Weighted-average discount rate, operating leases (percentage) 5.00% 4.80% 5.10%
Weighted-average discount rate, finance leases (percentage) 6.50% 5.90% 5.40%
v3.24.0.1
LEASES - Supplemental Cash Flow Information (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Cash paid for amounts included in the measurement of lease liabilities:      
Operating cash outflows from operating leases $ 258 $ 250 $ 237
Operating cash outflows from finance leases 13 14 12
Financing cash outflows from finance leases 107 118 140
Right-of-use assets obtained in exchange for lease obligations:      
Operating leases 168 341 176
Finance leases $ 55 $ 97 $ 136
v3.24.0.1
LEASES - Schedule of Lease Maturities (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Operating Leases    
2024 $ 255  
2025 225  
2026 190  
2027 165  
2028 136  
Later years 494  
Total lease payments 1,465  
Less: Imputed interest 254  
Total operating lease liabilities 1,211 $ 1,253
Less: Current obligations 204 207
Long-term lease obligations 1,007 1,046
Finance Leases    
2024 95  
2025 54  
2026 24  
2027 9  
2028 7  
Later years 70  
Total lease payments 259  
Less: Imputed interest 55  
Total finance lease liabilities 204 264
Less: Current obligations 84 99
Long-term lease obligations 120 165
Total    
2024 350  
2025 279  
2026 214  
2027 174  
2028 143  
Later years 564  
Total lease payments 1,724  
Less: Imputed interest 309  
Total lease liabilities 1,415 $ 1,517
Less: Current obligations 288  
Long-term lease obligations $ 1,127  
v3.24.0.1
LEASES - Narrative (Details) - USD ($)
$ in Millions
 3 Months Ended
Mar. 31, 2022
Dec. 31, 2023
Dec. 31, 2022
Lessee, Lease, Description [Line Items]      
Operating lease assets   $ 1,083 $ 1,129
Operating lease liability   $ 1,211 $ 1,253
Hospital Operations      
Lessee, Lease, Description [Line Items]      
Net proceeds from sale of buildings $ 147    
Gain on sale of properties 69    
Operating lease assets 103    
Operating lease liability $ 103    
v3.24.0.1
LONG-TERM DEBT - Schedule of Debt (Details) - USD ($)
$ in Millions
Dec. 31, 2023
May 31, 2023
Dec. 31, 2022
Jun. 15, 2022
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Finance leases, mortgages and other notes $ 361   $ 453  
Unamortized issue costs and note discounts (121)   (131)  
Long-term debt 15,002   15,079  
Less: Current portion 120   145  
Long-term debt, net of current portion 14,882   14,934  
Senior Notes | 6.125% due 2028        
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Carrying amount $ 2,500   2,500  
Interest rate, stated percentage 6.125%      
Senior Notes | 6.875% due 2031        
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Carrying amount $ 362   362  
Interest rate, stated percentage 6.875%      
Senior Notes | 4.625% due July 2024        
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Carrying amount $ 0   756  
Interest rate, stated percentage 4.625%      
Senior Notes | 4.625% due September 2024        
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Carrying amount $ 0   589  
Interest rate, stated percentage 4.625%      
Senior Notes | 4.875% due 2026        
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Carrying amount $ 2,100   2,100  
Interest rate, stated percentage 4.875%      
Senior Notes | 5.125% due 2027        
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Carrying amount $ 1,500   1,500  
Interest rate, stated percentage 5.125%      
Senior Notes | 4.625% due 2028        
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Carrying amount $ 600   600  
Interest rate, stated percentage 4.625%      
Senior Notes | 4.250% due 2029        
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Carrying amount $ 1,400   1,400  
Interest rate, stated percentage 4.25%      
Senior Notes | 4.375% due 2030        
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Carrying amount $ 1,450   1,450  
Interest rate, stated percentage 4.375%      
Senior Notes | 6.125% due 2030        
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Carrying amount $ 2,000   2,000  
Interest rate, stated percentage 6.125%     6.125%
Senior Notes | 6.750% due 2031        
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Carrying amount $ 1,350   0  
Interest rate, stated percentage 6.75% 6.75%    
Senior Notes | 6.250% due 2027        
LONG-TERM DEBT AND LEASE OBLIGATIONS        
Carrying amount $ 1,500   $ 1,500  
Interest rate, stated percentage 6.25%      
v3.24.0.1
LONG-TERM DEBT - Narrative (Details)
 1 Months Ended 3 Months Ended 6 Months Ended 12 Months Ended
Feb. 23, 2022
USD ($)
May 31, 2023
USD ($)
Dec. 31, 2022
USD ($)
Jun. 30, 2022
USD ($)
Dec. 31, 2023
USD ($)
day
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Sep. 30, 2023
USD ($)
Jun. 30, 2023
USD ($)
Jun. 15, 2022
USD ($)
Mar. 31, 2022
USD ($)
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Loss from early extinguishment of debt         $ (11,000,000) $ (109,000,000) $ (74,000,000)        
Senior Notes                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Aggregate principal amount         $ 14,762,000,000            
Redemption price percentage         100.00%            
Repurchase obligation due to change of control percentage of principal         101.00%            
Senior Notes | Minimum                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Interest rate, stated percentage         4.25%            
Asset value as a percentage of consolidated net tangible assets for properties to be defined as principal property (percentage)         5.00%            
Senior Notes | Maximum                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Interest rate, stated percentage         6.875%            
Secured debt ratio         4.00            
Asset value as a percentage of consolidated net tangible assets for properties to be defined as principal property (percentage)         15.00%            
Senior Notes | 4.625% due September 2024                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Interest rate, stated percentage   4.625%                  
Redemption price   $ 596,000,000                  
Principal amount redeemed   $ 589,000,000                  
Senior Notes | 4.625% due July 2024                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Interest rate, stated percentage   4.625%                  
Principal amount redeemed                 $ 756,000,000    
Senior Notes | 7.500% due 2025                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Interest rate, stated percentage 7.50%                    
Repurchased face amount $ 700,000,000                    
Debt instrument payment $ 730,000,000                    
Senior Notes | 6.125% due 2030                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Aggregate principal amount                   $ 2,000,000,000  
Interest rate, stated percentage         6.125%         6.125%  
Carrying amount     $ 2,000,000,000   $ 2,000,000,000 2,000,000,000          
Senior Notes | 6.750% due 2023                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Aggregate principal amount       $ 1,748,000,000              
Interest rate, stated percentage                   6.75%  
Repurchased face amount       124,000,000              
Debt instrument payment       1,933,000,000              
Debt retirement       $ 1,872,000,000              
Senior Notes | 4.625% due July 2024                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Aggregate principal amount     770,000,000     770,000,000          
Interest rate, stated percentage         4.625%            
Repurchased face amount     14,000,000     14,000,000          
Repayments of debt     13,000,000                
Carrying amount     756,000,000   $ 0 756,000,000          
Senior Notes | 4.625% due September 2024                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Aggregate principal amount     600,000,000     600,000,000          
Interest rate, stated percentage         4.625%            
Repurchased face amount     11,000,000     11,000,000          
Repayments of debt     11,000,000                
Carrying amount     589,000,000   $ 0 589,000,000          
Senior Notes | 6.750% due 2031                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Aggregate principal amount   $ 1,350,000,000                  
Interest rate, stated percentage   6.75%     6.75%            
Carrying amount     $ 0   $ 1,350,000,000 $ 0          
Credit Agreement | Revolving Credit Facility                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Revolving credit facility, maximum borrowing capacity (up to)         1,500,000,000           $ 1,500,000,000
Carrying amount         0            
Amount available for borrowing under revolving credit facility         1,500,000,000            
Threshold limit of revolving credit facility         $ 150,000,000            
Threshold limit of unused borrowing availability under the revolving credit facility, number of consecutive days         3 days            
Credit Agreement | Revolving Credit Facility | Minimum                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Unused commitment fee (percentage)         0.25%            
Credit Agreement | Revolving Credit Facility | Maximum                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Unused commitment fee (percentage)         0.375%            
Credit Agreement | Revolving Credit Facility | Base rate | Minimum                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Percentage margin on variable rate (percentage)         0.25%            
Credit Agreement | Revolving Credit Facility | Base rate | Maximum                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Percentage margin on variable rate (percentage)         0.75%            
Credit Agreement | Revolving Credit Facility | Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Basis spread on credit spread         0.10%            
Credit Agreement | Revolving Credit Facility | Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate | Minimum                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Percentage margin on variable rate (percentage)         1.25%            
Credit Agreement | Revolving Credit Facility | Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate | Maximum                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Percentage margin on variable rate (percentage)         1.75%            
Letter of Credit Facility                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Standby letters of credit outstanding         $ 1,000,000            
Letter of Credit Facility | Letter Of Credit Facility                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Revolving credit facility, maximum borrowing capacity (up to)               $ 200,000,000      
Standby letters of credit outstanding         $ 111,000,000            
Secured debt to EBITDA ratio         3.00            
Interest rate on issued but undrawn letters of credit (percentage)         1.50%            
Issuance fee, based on face amount (percentage)         0.125%            
Maximum secured debt covenant ratio         4.25            
Letter of Credit Facility | Letter Of Credit Facility | Minimum                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Unused commitment fee (percentage)         0.25%            
Letter of Credit Facility | Letter Of Credit Facility | Maximum                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Unused commitment fee (percentage)         0.375%            
Number of business days after notice for reimbursement of drawings | day         3            
Letter of Credit Facility | Letter Of Credit Facility | Federal Funds Rate                      
LONG-TERM DEBT AND LEASE OBLIGATIONS                      
Percentage margin on variable rate (percentage)         0.50%            
v3.24.0.1
LONG-TERM DEBT - Future Maturities (Details)
$ in Millions
Dec. 31, 2023
USD ($)
Long-term debt, including finance lease obligations  
Total $ 15,123
2024 120
2025 92
2026 2,149
2027 3,029
2028 3,114
Later Years $ 6,619
v3.24.0.1
GUARANTEES (Details)
$ in Millions
 12 Months Ended
Dec. 31, 2023
USD ($)
Income Guarantee  
GUARANTEES  
Guarantee obligation period 12 months
Commitment period 3 years
Guarantee of Business Revenue | Minimum  
GUARANTEES  
Guarantee obligation period 1 year
Guarantee of Business Revenue | Maximum  
GUARANTEES  
Guarantee obligation period 3 years
Income and Revenue Collection Guarantee  
GUARANTEES  
Maximum potential amount of future payments under guarantees $ 356
Income and Revenue Collection Guarantee | Other current liabilities  
GUARANTEES  
Liability for guarantees 274
Guaranteed Investees of Third Parties  
GUARANTEES  
Maximum potential amount of future payments under guarantees 88
Guaranteed Investees of Third Parties | Other current liabilities  
GUARANTEES  
Guarantee obligations for consolidated subsidiaries $ 21
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Share-based Compensation Plans (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Stock-based compensation costs, pretax $ 66 $ 56 $ 56
2019 Stock Incentive Plan      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Shares available for issuance under the plan (in shares) 8,895,000    
Stock Options      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Expiration period from the date of grant 10 years    
Vesting period 3 years    
Vesting percentage 33.33%    
Restricted Stock Units      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Contractual right to receive shares of common stock for a stock based award (in shares) 1    
Vesting period 3 years    
Vesting percentage 33.33%    
Stock-based compensation costs, pretax $ 46 $ 45 $ 42
Performance Based Restricted Stock Unit | Minimum | Performance-based vesting      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting percentage 0.00% 0.00%  
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Stock Options (Details) - Stock Options - USD ($)
$ / shares in Units, $ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Number of Options      
Outstanding at the beginning of the period (in shares) 460,947 520,998 912,531
Exercised (in shares) (76,507) (60,051) (391,533)
Outstanding at the end of the period (in shares) 384,440 460,947 520,998
Wtd. Avg. Exercise Price Per Share      
Outstanding at the beginning of the period (in dollars per share) $ 23.33 $ 23.90 $ 22.51
Exercised (in dollars per share) 26.07 28.26 20.66
Outstanding at the end of the period (in dollars per share) $ 22.79 $ 23.33 $ 23.90
Aggregate Intrinsic Value      
Outstanding at the end of the period $ 20    
Wtd. Avg Remaining Life      
Outstanding at the end of the period 4 years 1 month 6 days    
Aggregate intrinsic value of awards exercised $ 4   $ 15
Granted (in shares) 0 0 0
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Range of Exercise Prices (Details) - Stock Options
 12 Months Ended
Dec. 31, 2023
$ / shares
shares
Options Outstanding and Exercisable  
Number of options outstanding (in shares) | shares 384,440
Weighted average remaining contractual life 4 years 1 month 6 days
Weighted average exercise price (in dollars per share) $ 22.79
$18.99 to $20.609  
Options Outstanding and Exercisable  
Number of options outstanding (in shares) | shares 255,845
Weighted average remaining contractual life 3 years 7 months 6 days
Weighted average exercise price (in dollars per share) $ 19.62
$18.99 to $20.609 | Minimum  
Summary information about outstanding stock options  
Lower range of stock exercise price range (in dollars per share) 18.99
$18.99 to $20.609 | Maximum  
Summary information about outstanding stock options  
Upper range of stock exercise price range (in dollars per share) $ 20.609
$20.61 to $35.430  
Options Outstanding and Exercisable  
Number of options outstanding (in shares) | shares 128,595
Weighted average remaining contractual life 5 years 1 month 6 days
Weighted average exercise price (in dollars per share) $ 29.07
$20.61 to $35.430 | Minimum  
Summary information about outstanding stock options  
Lower range of stock exercise price range (in dollars per share) 20.61
$20.61 to $35.430 | Maximum  
Summary information about outstanding stock options  
Upper range of stock exercise price range (in dollars per share) $ 35.430
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Employee Options (Details) - Stock Options
 12 Months Ended
Dec. 31, 2023
$ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]  
Share price (in dollars per share) $ 75.57
Current Employees  
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]  
Share based payment award options outstanding percentage 30.80%
Former Employees  
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]  
Share based payment award options outstanding percentage 69.20%
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Restricted Stock Units (Details) - USD ($)
$ / shares in Units, $ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Other Disclosures      
Stock-based compensation costs, pretax $ 66 $ 56 $ 56
Restricted Stock Units      
Restricted Stock Units      
Unvested at the beginning of the period (in shares) 1,520,418 2,171,202 2,095,206
Granted (in shares) 759,590 641,205 900,018
Vested (in shares) (954,401) (1,187,384) (765,814)
Forfeited (in shares) (90,445) (104,605) (58,208)
Unvested at the end of the period (in shares) 1,421,063 1,520,418 2,171,202
Wtd. Avg. Grant Date Fair Value Per Unit      
Unvested at the beginning of the period (in dollars per share) $ 66.36 $ 40.51 $ 25.87
Granted (in dollars per share) 60.88 80.79 58.61
Vested (in dollars per share) 48.75 37.18 30.51
Forfeited (in dollars per share) 64.61 53.58 37.60
Unvested at the end of the period (in dollars per share) $ 66.46 $ 66.36 $ 40.51
Other Disclosures      
Awards (in shares) 759,590 641,205 900,018
Vesting percentage 33.33%    
Stock-based compensation costs, pretax $ 46 $ 45 $ 42
Unrecognized compensation costs $ 42    
Period for recognition of unrecognized compensation costs 2 years 1 month 6 days    
Performance Based Restricted Stock Unit      
Restricted Stock Units      
Granted (in shares) 185,901    
Wtd. Avg. Grant Date Fair Value Per Unit      
Granted (in dollars per share) $ 48.97    
Other Disclosures      
Awards (in shares) 185,901    
Performance Based Restricted Stock Unit | Non Executive Chairman      
Restricted Stock Units      
Granted (in shares)   53,716  
Other Disclosures      
Awards (in shares)   53,716  
Vesting percentage   100.00%  
Performance Based Restricted Stock Unit | Performance-based vesting | Minimum      
Other Disclosures      
Vesting percentage 0.00% 0.00%  
Performance Based Restricted Stock Unit | Performance-based vesting | Maximum      
Other Disclosures      
Vesting percentage 225.00% 200.00%  
Time-based RSUs | Vest Ratably Over Quarterly Periods      
Restricted Stock Units      
Granted (in shares)   53,716  
Other Disclosures      
Awards (in shares)   53,716  
Time-based RSUs | Vest Ratably Over Quarterly Periods | Non Executive Chairman      
Restricted Stock Units      
Granted (in shares)   53,716 189,215
Other Disclosures      
Awards (in shares)   53,716 189,215
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Time-Based RSUs (Details) - Time-based RSUs
 12 Months Ended
Dec. 31, 2023
shares
Dec. 31, 2022
quarter
shares
Dec. 31, 2021
quarter
shares
Non Employee Directors      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares)   7,325  
Vest Ratable Over Three Year Period From Grant Date      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 309,282 237,381 263,180
Vesting period 3 years 3 years 3 years
Vest and Settled on Fifth Anniversary      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 42,626    
Vest Immediately And Settled On Third Anniversary | Non Employee Directors      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 42,100 35,482 38,366
Vest on December 31, 2023 and Settled on January 2024      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 33,586    
Relocation Based Vesting | Executive Officer      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 20,707    
Vest and Settled on Third Anniversary      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 2,007   33,351
Vest Ratably Over Quarterly Periods      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares)   53,716  
Award vesting period, number of quarterly periods | quarter   11 8
Vest Ratably Over Four Year Period From Grant Date      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares)   9,215  
Vesting period   4 years  
Vest And Settle On Third And Fourth Anniversaries      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares)   6,170  
Vest and Settled on Second Anniversary      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares)   4,608  
Vest and Settle on Fourth Anniversary      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares)     53,341
Vest On December 31, 2021      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares)     14,192
Vest And Settled On Second And Fourth Anniversary      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares)     8,509
Vest Immediately and Settle Upon Separation From Board | Director      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares)     1,372
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Performance-Based RSUs (Details) - Performance Based Restricted Stock Unit - shares
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 185,901    
Vesting Over a Three Year Period, 0% to 225%      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 301,562    
Vesting Over a Three Year Period, 0% to 225% | Minimum      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting percentage 0.00%    
Vesting Over a Three Year Period, 0% to 225% | Maximum      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting percentage 225.00%    
Performance Based Vesting And Settled Immediately      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 185,901   892
Vesting Over a Three Year Period, 0% to 200%      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 7,720 287,308 244,259
Vesting Over a Three Year Period, 0% to 200% | Minimum      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting percentage 0.00% 0.00% 0.00%
Vesting Over a Three Year Period, 0% to 200% | Maximum      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting percentage 200.00% 200.00% 200.00%
Vesting on Fourth Anniversary, 0% to 200%      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares)     53,341
Vesting on Fourth Anniversary, 0% to 200% | Minimum      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting percentage     0.00%
Vesting on Fourth Anniversary, 0% to 200% | Maximum      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting percentage     200.00%
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Valuation of Restricted Stock Units (Details) - Restricted Stock Units
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Expected volatility, minimum 53.60% 39.60% 65.20%
Expected volatility , maximum 65.60% 68.10% 79.30%
Risk-free interest rate, minimum 4.20% 1.00%  
Risk-free interest rate, maximum 4.80% 1.70%  
Minimum      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Risk-free interest rate     0.10%
Maximum      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Risk-free interest rate     0.60%
v3.24.0.1
EMPLOYEE BENEFIT PLANS - USPI Management Equity Plan (Details) - USD ($)
$ / shares in Units, $ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Wtd. Avg. Grant Date Fair Value Per Unit      
Stock-based compensation costs, pretax $ 66 $ 56 $ 56
Payments to noncontrolling interest $ 167 $ 100 $ 27
Restricted Stock Units      
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]      
Contractual right to receive shares of common stock for a stock based award (in shares) 1    
Restricted Stock Units      
Unvested at the beginning of the period (in shares) 1,520,418 2,171,202 2,095,206
Granted (in shares) 759,590 641,205 900,018
Vested (in shares) (954,401) (1,187,384) (765,814)
Forfeited (in shares) (90,445) (104,605) (58,208)
Unvested at the end of the period (in shares) 1,421,063 1,520,418 2,171,202
Wtd. Avg. Grant Date Fair Value Per Unit      
Unvested at the beginning of the period (in dollars per share) $ 66.36 $ 40.51 $ 25.87
Granted (in dollars per share) 60.88 80.79 58.61
Vested (in dollars per share) 48.75 37.18 30.51
Forfeited (in dollars per share) 64.61 53.58 37.60
Unvested at the end of the period (in dollars per share) $ 66.46 $ 66.36 $ 40.51
Vesting percentage 33.33%    
Stock-based compensation costs, pretax $ 46 $ 45 $ 42
USPI Management Equity Plan | United Surgical Partners International      
Wtd. Avg. Grant Date Fair Value Per Unit      
Payments to noncontrolling interest $ 13 $ 11 $ 9
USPI Management Equity Plan | Restricted Stock Units      
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]      
Contractual right to receive shares of common stock for a stock based award (in shares) 1    
Restricted Stock Units      
Unvested at the beginning of the period (in shares) 922,840 1,494,882 2,025,056
Granted (in shares) 0 0 76,990
Vested (in shares) (303,171) (369,691) (388,588)
Forfeited (in shares) (11,685) (202,351) (218,576)
Unvested at the end of the period (in shares) 607,984 922,840 1,494,882
Wtd. Avg. Grant Date Fair Value Per Unit      
Unvested at the beginning of the period (in dollars per share) $ 34.13 $ 34.13 $ 34.13
Granted (in dollars per share)     34.13
Vested (in dollars per share) 34.13 34.13 34.13
Forfeited (in dollars per share) 34.13 34.13 34.13
Unvested at the end of the period (in dollars per share) $ 34.13 $ 34.13 $ 34.13
Vested and expected to vest at the end of the period (in shares) 607,984    
Stock-based compensation costs, pretax $ 20 $ 11 $ 13
USPI Management Equity Plan | Restricted Stock Units | Tranche One      
Wtd. Avg. Grant Date Fair Value Per Unit      
Vesting percentage     20.00%
USPI Management Equity Plan | Restricted Stock Units | Tranche Two      
Wtd. Avg. Grant Date Fair Value Per Unit      
Vesting percentage     20.00%
USPI Management Equity Plan | Restricted Stock Units | Tranche Three      
Wtd. Avg. Grant Date Fair Value Per Unit      
Vesting percentage     60.00%
USPI Management Equity Plan | Nonvoting Common Stock      
Wtd. Avg. Grant Date Fair Value Per Unit      
Outstanding vested shares eligible to be sold (in shares) 51,000    
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Employee Stock Purchase Plan (Details) - Employee Stock Purchase Plan - USD ($)
$ / shares in Units, shares in Thousands
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Number of shares authorized to be issued under the plan (in shares) 4,070    
Shares available for issuance under the plan (in shares) 2,501    
Percentage of closing price at which shares are purchased by participant 95.00%    
Requisite holding period for shares issued under the plan 1 year    
Fair market value per employee per year $ 25,000    
Number of shares (in shares) 69 98 90
Weighted average price (in dollars per share) $ 65.62 $ 54.19 $ 63.01
Minimum      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Base earnings elected to be withheld each quarter by eligible employees to purchase shares of the entity's common stock 1.00%    
Maximum      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Base earnings elected to be withheld each quarter by eligible employees to purchase shares of the entity's common stock 10.00%    
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Other Employee Benefit and Retirement Plans (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Postemployment Benefits [Abstract]      
Contribution expense $ 126 $ 86 $ 98
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Employee Retirement Plans (Details)
 12 Months Ended
Dec. 31, 2023
USD ($)
plan
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Projected benefit obligations      
Beginning obligations $ (1,002,000,000) $ (1,313,000,000)  
Interest cost (53,000,000) (37,000,000) $ (36,000,000)
Actuarial gain (loss) (15,000,000) 265,000,000  
Benefits paid 84,000,000 83,000,000  
Annuity purchase 36,000,000 0  
Special termination benefit costs (1,000,000) 0  
Ending obligations (951,000,000) (1,002,000,000) (1,313,000,000)
Fair value of plans assets      
Beginning plan assets 648,000,000 867,000,000  
Gain (loss) on plan assets 41,000,000 (161,000,000)  
Employer contribution 0 2,000,000  
Benefits paid (61,000,000) (60,000,000)  
Annuity purchase (36,000,000) 0  
Ending plan assets 592,000,000 648,000,000 867,000,000
Funded status of plans (359,000,000) (354,000,000)  
Accumulated benefit obligation 951,000,000 1,002,000,000.000  
Amounts recognized in the Consolidated Balance Sheets consist of:      
Other current liability (24,000,000) (23,000,000)  
Other long-term liability (335,000,000) (331,000,000)  
Accumulated other comprehensive loss 224,000,000 222,000,000  
Components of net periodic benefit costs      
Interest costs 53,000,000 37,000,000 36,000,000
Expected return on plan assets (36,000,000) (42,000,000) (53,000,000)
Amortization of net actuarial loss 7,000,000 9,000,000 11,000,000
Special termination benefit costs 1,000,000 0 0
Net periodic benefit cost (income) $ 25,000,000 $ 4,000,000 $ (6,000,000)
Defined Benefit Plan Net Periodic Benefit Cost Credit Interest Cost Statement Of Income Or Comprehensive Income Extensible List Not Disclosed Flag Interest costs Interest costs Interest costs
Defined Benefit Plan Net Periodic Benefit Cost Credit Expected Return Loss Statement Of Income Or Comprehensive Income Extensible List Not Disclosed Flag Expected return on plan assets Expected return on plan assets Expected return on plan assets
Net Periodic Benefit Costs Assumptions:      
Gain (loss) adjustments recorded in other comprehensive income (loss) $ (2,000,000) $ 72,000,000 $ 61,000,000
Net actuarial losses (9,000,000) 63,000,000 50,000,000
Amortization of net actuarial loss (7,000,000) (9,000,000) (11,000,000)
Cumulative net actuarial losses 224,000,000 222,000,000 294,000,000
Unrecognized prior service costs $ 0 $ 0 $ 0
SERP      
Employee Retirement Plans      
Number of frozen plans | plan 3    
Accumulated Benefit Obligations Assumptions      
Discount rate 5.50% 5.75%  
Compensation increase rate 3.00% 3.00%  
Net Periodic Benefit Costs Assumptions:      
Discount rate 5.75% 3.00% 2.75%
Compensation increase rate 3.00% 3.00% 3.00%
Pension Plan      
Fair value of plans assets      
Beginning plan assets $ 648,000,000    
Ending plan assets $ 592,000,000 $ 648,000,000  
Accumulated Benefit Obligations Assumptions      
Discount rate 5.25% 5.51%  
Net Periodic Benefit Costs Assumptions:      
Discount rate 5.51% 2.89% 2.53%
Long-term rate of return on assets 5.75% 5.00% 6.25%
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Asset Allocations (Details) - Pension Plan
Dec. 31, 2023
Cash and cash equivalents  
Weighted-average asset allocations by asset category  
Target 0.00%
Actual 1.00%
Equity securities  
Weighted-average asset allocations by asset category  
Target 20.00%
Actual 6.00%
Debt securities  
Weighted-average asset allocations by asset category  
Target 73.00%
Actual 75.00%
Alternative investments  
Weighted-average asset allocations by asset category  
Target 7.00%
Actual 18.00%
v3.24.0.1
EMPLOYEE BENEFIT PLANS - Fair Value of Assets and Future Benefit Payments (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Employee Retirement Plans      
Fair value of DMC Pension Plan assets $ 592 $ 648 $ 867
SERP and DMC Pension Plan      
Total 789    
2024 84    
2025 84    
2026 83    
2027 82    
2028 81    
Five Years Thereafter 375    
Amounts recognized in the Consolidated Balance Sheets consist of:      
Benefit plan obligations (359) (354)  
Other current liability 24 23  
Defined benefit plan obligations 335 331  
Expected contribution to the plan for 2023 24    
Pension Plan      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 592 648  
Pension Plan | Cash and cash equivalents      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 6 7  
Pension Plan | Equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 39 89  
Pension Plan | Fixed income funds      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 442    
Pension Plan | U.S. government obligations      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets   200  
Pension Plan | Corporate debt securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets   249  
Pension Plan | Private equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 97 78  
Pension Plan | Hedge funds      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 8 25  
Pension Plan | Level 1      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 487 545  
Pension Plan | Level 1 | Cash and cash equivalents      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 6 7  
Pension Plan | Level 1 | Equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 39 89  
Pension Plan | Level 1 | Fixed income funds      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 442    
Pension Plan | Level 1 | U.S. government obligations      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets   200  
Pension Plan | Level 1 | Corporate debt securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets   249  
Pension Plan | Level 1 | Private equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 1 | Hedge funds      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 2      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 2 | Cash and cash equivalents      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 2 | Equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 2 | Fixed income funds      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0    
Pension Plan | Level 2 | U.S. government obligations      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets   0  
Pension Plan | Level 2 | Corporate debt securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets   0  
Pension Plan | Level 2 | Private equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 2 | Hedge funds      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 3      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 105 103  
Pension Plan | Level 3 | Cash and cash equivalents      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 3 | Equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 3 | Fixed income funds      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0    
Pension Plan | Level 3 | U.S. government obligations      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets   0  
Pension Plan | Level 3 | Corporate debt securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets   0  
Pension Plan | Level 3 | Private equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 97 78  
Pension Plan | Level 3 | Hedge funds      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets $ 8 $ 25  
v3.24.0.1
PROPERTY AND EQUIPMENT - Components (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Components of property and equipment      
Finance lease assets $ 378 $ 413  
Total property, plant and equipment, gross 12,714 12,663  
Accumulated depreciation and amortization (6,478) (6,201)  
Net property and equipment 6,236 6,462  
Depreciation 696 669 $ 667
Land      
Components of property and equipment      
Property plant and equipment gross 625 661  
Buildings and improvements      
Components of property and equipment      
Property plant and equipment gross 6,692 6,646  
Construction in progress      
Components of property and equipment      
Property plant and equipment gross 269 195  
Equipment      
Components of property and equipment      
Property plant and equipment gross $ 4,750 $ 4,748  
v3.24.0.1
GOODWILL AND OTHER INTANGIBLE ASSETS - Goodwill (Details) - USD ($)
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Changes in the carrying amount of goodwill    
Goodwill at beginning of period, net of accumulated impairment losses $ 10,123,000,000  
Goodwill at end of period, net of accumulated impairment losses 10,307,000,000 $ 10,123,000,000
Hospital Operations    
Changes in the carrying amount of goodwill    
Goodwill at beginning of period, net of accumulated impairment losses 3,411,000,000 3,413,000,000
Goodwill acquired during the year and purchase price allocation adjustments 133,000,000 1,000,000
Goodwill related to assets held for sale and disposed (425,000,000) (3,000,000)
Goodwill at end of period, net of accumulated impairment losses 3,119,000,000 3,411,000,000
Accumulated impairment losses 2,430,000,000 2,430,000,000
Ambulatory Care    
Changes in the carrying amount of goodwill    
Goodwill at beginning of period, net of accumulated impairment losses 6,712,000,000 5,848,000,000
Goodwill acquired during the year and purchase price allocation adjustments 493,000,000 866,000,000
Goodwill related to assets held for sale and disposed (17,000,000) (2,000,000)
Goodwill at end of period, net of accumulated impairment losses 7,188,000,000 6,712,000,000
Accumulated impairment losses $ 0 $ 0
v3.24.0.1
GOODWILL AND OTHER INTANGIBLE ASSETS - Other Intangible Assets (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Finite-Lived Intangible Assets, Net [Abstract]    
Gross Carrying Amount $ 2,097 $ 2,138
Accumulated Amortization (1,447) (1,428)
Total 650 710
Intangible Assets, Net (Excluding Goodwill) [Abstract]    
Total other intangible assets with indefinite lives 718 714
Gross Carrying Amount 2,815 2,852
Net Book Value 1,368 1,424
Trade names    
Intangible Assets, Net (Excluding Goodwill) [Abstract]    
Total other intangible assets with indefinite lives 105 105
Contracts    
Intangible Assets, Net (Excluding Goodwill) [Abstract]    
Total other intangible assets with indefinite lives 609 603
Other Intangible Assets    
Intangible Assets, Net (Excluding Goodwill) [Abstract]    
Total other intangible assets with indefinite lives 4 6
Capitalized software costs    
Finite-Lived Intangible Assets, Net [Abstract]    
Gross Carrying Amount 1,712 1,751
Accumulated Amortization (1,205) (1,206)
Total 507 545
Contracts    
Finite-Lived Intangible Assets, Net [Abstract]    
Gross Carrying Amount 294 295
Accumulated Amortization (164) (146)
Total 130 149
Other Intangible Assets    
Finite-Lived Intangible Assets, Net [Abstract]    
Gross Carrying Amount 91 92
Accumulated Amortization (78) (76)
Total $ 13 $ 16
v3.24.0.1
GOODWILL AND OTHER INTANGIBLE ASSETS - Amortization (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Estimated future amortization of intangibles with finite useful lives      
Total $ 650 $ 710  
2024 132    
2025 124    
2026 99    
2027 84    
2028 61    
Later Years 150    
Amortization expense $ 174 $ 172 $ 188
v3.24.0.1
OTHER ASSETS - Schedule of Other Current Assets (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Accounts receivable and allowance for doubtful accounts    
Prepaid expenses $ 391 $ 400
Contract assets 208 200
California provider fee program receivables 2,914 2,943
Receivables from other government programs 282 187
Guarantees 274 143
Non-patient receivables 260 390
Other 95 88
Total other current assets 1,839 1,775
California's Provider Fee Program    
Accounts receivable and allowance for doubtful accounts    
California provider fee program receivables 329 367
Total other current assets $ 329 $ 367
v3.24.0.1
OTHER ASSETS - Schedule of Investments and Other Assets (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Investments and other assets    
Marketable securities $ 48 $ 30
Equity investments in unconsolidated healthcare entities 1,512 1,599
Total investments 1,560 1,629
Cash surrender value of life insurance policies 43 37
Long-term deposits 50 56
California provider fee program receivables 334 197
Operating lease assets 1,083 1,129
Other long-term receivables and other assets 87 99
Total investments and other assets $ 3,157 $ 3,147
v3.24.0.1
ACCUMULATED OTHER COMPREHENSIVE LOSS - Accumulated Other Comprehensive Loss (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Accumulated Other Comprehensive Income (Loss) [Line Items]    
Accumulated other comprehensive loss $ 1,608 $ 1,142
Adjustments for defined benefit plans    
Accumulated Other Comprehensive Income (Loss) [Line Items]    
Accumulated other comprehensive loss (180) (178)
Unrealized gains on investments    
Accumulated Other Comprehensive Income (Loss) [Line Items]    
Accumulated other comprehensive loss (1) (3)
Accumulated Other Comprehensive Loss    
Accumulated Other Comprehensive Income (Loss) [Line Items]    
Accumulated other comprehensive loss $ (181) $ (181)
v3.24.0.1
ACCUMULATED OTHER COMPREHENSIVE LOSS - Income Tax Expense (Benefit) (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]      
Adjustments for defined benefit plans $ 0 $ 18  
Foreign currency translation adjustments and other 0 (1)  
Net income tax expense related to items of other comprehensive income $ 0 $ 17 $ 14
v3.24.0.1
NET OPERATING REVENUES - Net Operating Revenue By Source (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 20,548 $ 19,174 $ 19,485
Ambulatory Care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  3,865 3,248 2,718
Operating Segments | Hospital Operations      
Disaggregation of Revenue [Line Items]      
Net operating revenues  16,683 15,926 16,767
Operating Segments | Hospital Operations | Other Revenues      
Disaggregation of Revenue [Line Items]      
Net operating revenues  2,133 2,079 2,008
Operating Segments | Ambulatory Care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  3,865 3,248 2,718
Acute Care Hospitals And Related Outpatient Facilities | Operating Segments | Hospital Operations | Total      
Disaggregation of Revenue [Line Items]      
Net operating revenues  14,550 13,847 14,759
Acute Care Hospitals And Related Outpatient Facilities | Operating Segments | Hospital Operations | Medicare      
Disaggregation of Revenue [Line Items]      
Net operating revenues  2,383 2,369 2,615
Acute Care Hospitals And Related Outpatient Facilities | Operating Segments | Hospital Operations | Medicaid      
Disaggregation of Revenue [Line Items]      
Net operating revenues  1,233 1,069 1,254
Acute Care Hospitals And Related Outpatient Facilities | Operating Segments | Hospital Operations | Managed care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  10,248 9,607 9,985
Acute Care Hospitals And Related Outpatient Facilities | Operating Segments | Hospital Operations | Uninsured      
Disaggregation of Revenue [Line Items]      
Net operating revenues  96 141 199
Acute Care Hospitals And Related Outpatient Facilities | Operating Segments | Hospital Operations | Indemnity and other      
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 590 $ 661 $ 706
v3.24.0.1
NET OPERATING REVENUES - Narrative (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Disaggregation of Revenue [Line Items]      
Reimbursement program assessments $ 126 $ 123  
Net operating revenues  20,548 19,174 $ 19,485
Revision of Prior Period, Adjustment      
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 24 $ 10 $ 26
v3.24.0.1
NET OPERATING REVENUES - Net Operating Revenue Composition, Ambulatory Segment (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 20,548 $ 19,174 $ 19,485
Ambulatory Care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  3,865 3,248 2,718
Net patient service revenues | Ambulatory Care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  3,713 3,115 2,604
Management fees | Ambulatory Care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  123 110 86
Revenue from other sources | Ambulatory Care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 29 $ 23 $ 28
v3.24.0.1
NET OPERATING REVENUES - Performance Obligation (Details) - Hospital Operations
$ in Millions
Dec. 31, 2023
USD ($)
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]  
Revenue, remaining performance obligation, amount $ 6,026
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01  
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]  
Revenue, remaining performance obligation, amount $ 685
Revenue, remaining performance obligation, expected timing of satisfaction, period 1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01  
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]  
Revenue, remaining performance obligation, amount $ 684
Revenue, remaining performance obligation, expected timing of satisfaction, period 1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01  
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]  
Revenue, remaining performance obligation, amount $ 683
Revenue, remaining performance obligation, expected timing of satisfaction, period 1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01  
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]  
Revenue, remaining performance obligation, amount $ 683
Revenue, remaining performance obligation, expected timing of satisfaction, period 1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2028-01-01  
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]  
Revenue, remaining performance obligation, amount $ 683
Revenue, remaining performance obligation, expected timing of satisfaction, period 1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2029-01-01  
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]  
Revenue, remaining performance obligation, amount $ 2,608
Revenue, remaining performance obligation, expected timing of satisfaction, period
v3.24.0.1
INSURANCE - Property Insurance (Details) - USD ($)
$ in Millions
 12 Months Ended
Mar. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Insurance coverage        
Insurance recoveries   $ 41 $ 14  
Net operating revenues    20,548 19,174 $ 19,485
Forecast        
Insurance coverage        
Insurance, annual coverage limit $ 850      
Insurance Recoveries        
Insurance coverage        
Net operating revenues    $ 34 $ 6  
Floods | Forecast        
Insurance coverage        
Insurance, maximum coverage per incident 100      
Earthquakes | Forecast | Other Geographic Areas        
Insurance coverage        
Insurance, maximum coverage per incident 200      
Earthquakes | Forecast | CALIFORNIA        
Insurance coverage        
Insurance, maximum coverage per incident 200      
Windstorms | Forecast        
Insurance coverage        
Insurance, maximum coverage per incident 200      
Fires and Other Perils | Forecast        
Insurance coverage        
Insurance, maximum coverage per incident $ 850      
New Madrid Fault Earthquakes | Forecast        
Insurance coverage        
Insurance deductible as a percent 2.00%      
Insurance, maximum deductible per incident $ 25      
Fires and Certain Other Covered Losses | Forecast        
Insurance coverage        
Insurance, deductible $ 5      
California Earthquakes And Named Windstorms | Forecast        
Insurance coverage        
Insurance deductible as a percent 5.00%      
v3.24.0.1
INSURANCE - Professional and General Liability Reserves (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Insurance coverage      
Malpractice expense, portion related to adverse developments in prior years $ 116 $ 74 $ 131
Other Operating Expense, Net      
Insurance coverage      
Malpractice expense 369 276 $ 355
Professional and General Liability Reserves      
Insurance coverage      
Self insurance reserve $ 1,046 $ 1,045  
v3.24.0.1
CLAIMS AND LAWSUITS - Reconciliations (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Loss Contingency Accrual [Roll Forward]      
Litigation and investigation costs $ 47 $ 70 $ 116
Claims, Lawsuits, and Regulatory Proceedings      
Loss Contingency Accrual [Roll Forward]      
Litigation reserve, Balances at Beginning of Period 51 78 26
Litigation and investigation costs 47 70 116
Cash Payments (59) (100) (59)
Other 1 3 (5)
Litigation reserve, Balances at End of Period $ 40 $ 51 $ 78
v3.24.0.1
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES - Narrative (Details) - USD ($)
$ in Millions
 1 Months Ended 12 Months Ended
Jun. 30, 2022
Dec. 31, 2023
Dec. 31, 2022
Interests acquired and other disclosures      
Other current liabilities   $ 1,779 $ 1,581
Other long-term liabilities   1,709 1,800
United Surgical Partners International      
Interests acquired and other disclosures      
Purchase and sales of business and noncontrolling interest, net $ 365    
Loss from purchase of noncontrolling interests 23    
Other current liabilities   135 135
Other long-term liabilities   63 $ 190
Baylor University Medical Center | United Surgical Partners International      
Interests acquired and other disclosures      
Share purchase agreement amount of payment 406    
Share purchase agreement, payment for execution $ 11    
Share purchase agreement, monthly payment   $ 11  
Baylor University Medical Center | United Surgical Partners International | Put Option      
Interests acquired and other disclosures      
Joint venture ownership (as a percentage) 5.00%    
v3.24.0.1
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES - Changes in Redeemable Noncontrolling Interests (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Increase (Decrease) in Temporary Equity [Roll Forward]      
Balances at beginning of period  $ 2,149    
Net income 366 $ 348 $ 336
Distributions paid to noncontrolling interests (289) (229) (206)
Balances at end of period  2,391 2,149  
Redeemable Noncontrolling Interests      
Increase (Decrease) in Temporary Equity [Roll Forward]      
Balances at beginning of period  2,149 2,203  
Net income 366 348  
Distributions paid to noncontrolling interests (305) (331)  
Accretion of redeemable noncontrolling interests 0 104  
Purchases and sales of businesses and noncontrolling interests, net 181 (175)  
Balances at end of period  $ 2,391 $ 2,149 $ 2,203
v3.24.0.1
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES - Segment Details (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Increase (Decrease) in Temporary Equity [Roll Forward]      
Redeemable noncontrolling interests $ 2,391 $ 2,149  
Net income available to redeemable noncontrolling interests 366 348 $ 336
Hospital Operations      
Increase (Decrease) in Temporary Equity [Roll Forward]      
Redeemable noncontrolling interests 860 792  
Net income available to redeemable noncontrolling interests 84 100 93
Ambulatory Care      
Increase (Decrease) in Temporary Equity [Roll Forward]      
Redeemable noncontrolling interests 1,531 1,357  
Net income available to redeemable noncontrolling interests $ 282 $ 248 $ 243
v3.24.0.1
INCOME TAXES - Provision and Deferred Taxes (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Current tax expense:      
Federal $ 208 $ 78 $ 50
State 46 57 111
Total 254 135 161
Deferred tax expense (benefit):      
Federal 55 174 267
State (3) 35 (17)
Total 52 209 250
Income tax expense $ 306 $ 344 $ 411
v3.24.0.1
INCOME TAXES - Federal Tax Reconciliation (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Tax Disclosure [Abstract]      
Foreign pretax loss $ 3 $ 8 $ 5
Reconciliation between reported income tax expense (benefit) and income taxes calculated by the statutory federal income tax rate      
Tax expense at statutory federal rate of 21% 340 282 396
State income taxes, net of federal income tax benefit 70 64 77
Tax benefit attributable to noncontrolling interests (147) (122) (114)
Nondeductible goodwill 0 1 35
Nondeductible executive compensation 6 10 8
Impact of change in state filing method, net of change in unrecognized tax benefit (20) 0 0
Nondeductible litigation costs 0 0 1
Stock-based compensation tax benefit (2) (6) (5)
Changes in valuation allowance 71 120 2
Prior-year provision to return adjustments and other changes in deferred taxes (9) (12) 8
Other items (3) 7 3
Income tax expense $ 306 $ 344 $ 411
v3.24.0.1
INCOME TAXES - Components of Deferred Tax Assets and Liabilities (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Assets      
Reserves related to discontinued operations and restructuring charges $ 6 $ 5  
Receivables (doubtful accounts and adjustments) 222 246  
Medicare advance payments 0 0  
Accruals for retained insurance risks 232 227  
Other long-term liabilities 32 27  
Benefit plans 233 207  
Other accrued liabilities 20 30  
Interest expense limitation 206 133  
Net operating loss carryforwards 71 74  
Stock-based compensation 13 13  
Right-of-use lease assets and obligations 129 192  
Other items 4 11  
Deferred tax assets, gross 1,168 1,165  
Valuation allowance (248) (177) $ (57)
Deferred tax assets, net 920 988  
Liabilities      
Depreciation and fixed-asset differences 430 436  
Intangible assets 429 416  
Investments and other assets 119 112  
Right-of-use lease assets and obligations 111 173  
Other items 80 49  
Deferred tax liabilities, gross, total 1,169 1,186  
Deferred tax liabilities, total 1,169 1,186  
Reconciliation of the deferred tax assets and liabilities      
Deferred income tax assets 77 19  
Deferred tax liabilities (326) (217)  
Net deferred tax liability $ (249) $ (198)  
v3.24.0.1
INCOME TAXES - Valuation Allowances and Unrecognized Tax Benefits (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
INCOME TAXES      
Increase (decrease) in valuation allowance against deferred tax assets $ 71 $ 120 $ 2
Increase (decrease) in valuation allowance due to limitations on deductions of interest expense 73 123 2
Increase (decrease) in valuation allowance due to changes based on expiration or worthlessness of unutilized state net operating loss carryovers (2) (1) (2)
Increase (decrease) in valuation allowance due to changes in expected realizability of deferred tax assets   (2) 2
Valuation allowance 248 177 57
Changes in unrecognized tax benefits      
Beginning balance 34 34  
Ending balance   34 34
Unrecognized tax benefits which, if recognized, would impact effective tax rate 63 32 32
Unrecognized tax benefits, period increase (decrease) 24   3
Total accrued interest and penalties on unrecognized tax benefits 2    
Continuing Operations      
Changes in unrecognized tax benefits      
Beginning balance 34 34 31
Reductions due to a lapse of statute of limitations (1) 0 (3)
Increases due to tax positions taken in prior periods 31    
Ending balance $ 64 $ 34 $ 34
v3.24.0.1
INCOME TAXES - NOL and Tax Credit Carryforwards (Details) - USD ($)
Dec. 31, 2023
Dec. 31, 2022
Operating loss carryforwards    
Unrecognized federal and state tax benefits and reserves for interest and penalties, which may decrease in the next 12 months $ 0  
Charitable contribution carryforwards 52,000,000  
Deferred tax benefit, net of valuation allowance and federal tax impact, associated with NOL carryforwards 71,000,000 $ 74,000,000
Federal    
Operating loss carryforwards    
Net operating loss carryforwards 41,000,000  
Operating loss carryforwards, subject to expiration 39,000,000  
Operating loss carryforwards, not subject to expiration 2,000,000  
State    
Operating loss carryforwards    
Operating loss carryforwards, subject to expiration 3,339,000,000  
Deferred tax benefit, net of valuation allowance and federal tax impact, associated with NOL carryforwards $ 35,000,000  
v3.24.0.1
EARNINGS PER COMMON SHARE (Details) - USD ($)
$ / shares in Units, shares in Thousands, $ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Net Income Available to Common Shareholders (Numerator)      
Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share $ 611 $ 410 $ 915
Effect of dilutive stock options, restricted stock units, deferred compensation units, convertible instruments and dividends on preferred stock (13) 8 0
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share $ 598 $ 418 $ 915
Weighted Average Shares (Denominator)      
Net income available/attributable to Tenet Healthcare Corporation common shareholders for basic earnings per share (in shares) 101,639 106,929 106,833
Effect of dilutive stock options, restricted stock units and deferred compensation units (in shares) 3,161 3,587 1,738
Net income available/attributable to Tenet Healthcare Corporation common shareholders for diluted earnings per share (in shares) 104,800 110,516 108,571
Per-Share Amount      
Net income available/attributable to Tenet Healthcare Corporation common shareholders for basic earnings per share (in dollars per share) $ 6.01 $ 3.83 $ 8.56
Effect of dilutive stock options, restricted stock units, and deferred compensation units (in dollars per share) (0.30) (0.05) (0.13)
Net income available/attributable to Tenet Healthcare Corporation common shareholders for diluted earnings per share (in dollars per share) $ 5.71 $ 3.78 $ 8.43
v3.24.0.1
FAIR VALUE MEASUREMENTS (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]      
Impairment charges $ 43 $ 94 $ 8
Fair Value, Nonrecurring      
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]      
Long-lived assets held for sale 775    
Long-lived assets held and used   167  
Fair Value, Nonrecurring | Quoted Prices in Active Markets for Identical Assets (Level 1)      
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]      
Long-lived assets held for sale 0    
Long-lived assets held and used   0  
Fair Value, Nonrecurring | Significant Other Observable Inputs (Level 2)      
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]      
Long-lived assets held for sale 775    
Long-lived assets held and used   167  
Fair Value, Nonrecurring | Significant Unobservable Inputs (Level 3)      
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]      
Long-lived assets held for sale $ 0    
Long-lived assets held and used   $ 0  
Fair Value, Recurring | Significant Other Observable Inputs (Level 2)      
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]      
Estimated fair value of the long-term debt instrument as a percentage of carrying value 96.90% 92.80%  
v3.24.0.1
ACQUISITIONS - Narrative (Details)
 1 Months Ended 12 Months Ended
Dec. 31, 2023
USD ($)
healthcare_facility
Jul. 31, 2022
USD ($)
surgery_center
Dec. 31, 2021
USD ($)
surgery_center
Dec. 31, 2023
USD ($)
surgery_center
hospital
Dec. 31, 2022
USD ($)
surgery_center
Dec. 31, 2021
USD ($)
hospital
quarter
business
Business Acquisition [Line Items]            
Goodwill $ 10,307,000,000     $ 10,307,000,000 $ 10,123,000,000  
Goodwill, purchase accounting adjustments       (18,000,000)    
Acquisition-related transaction costs           $ 20,000,000
Ambulatory Care            
Business Acquisition [Line Items]            
Goodwill $ 7,188,000,000   $ 5,848,000,000 $ 7,188,000,000 6,712,000,000 5,848,000,000
NextCare Arizona I JC, LLC            
Business Acquisition [Line Items]            
Business acquisition, percentage of voting interests acquired 55.00%     55.00%    
Number of operational urgent care centers acquired | healthcare_facility 41          
Cash paid to acquire businesses $ 75,000,000          
Business combination, contingent consideration, liability 10,000,000     $ 10,000,000    
Goodwill 133,000,000     133,000,000    
2023 Acquisition | Ambulatory Care            
Business Acquisition [Line Items]            
Consideration conveyed in the acquisition       $ 149,000,000    
Number of surgical centers acquired | surgery_center       20    
Number of ambulatory surgery centers noncontrolling interests | surgery_center       11    
Series of Individual Business Acquisitions            
Business Acquisition [Line Items]            
Goodwill 644,000,000   664,000,000 $ 644,000,000 860,000,000 664,000,000
Business combination acquisition noncontrolling interest, fair value $ 102,000,000   $ 95,000,000 102,000,000 273,000,000 95,000,000
Acquisition-related transaction costs       15,000,000 14,000,000  
Gains on consolidations       $ 16,000,000 0 23,000,000
Series of Individual Business Acquisitions | Ambulatory Care            
Business Acquisition [Line Items]            
Cash paid to acquire businesses         65,000,000 21,000,000
Consideration conveyed in the acquisition         $ 65,000,000 $ 74,000,000
Number of surgical centers acquired         11 2
Number of ambulatory surgery centers noncontrolling interests | surgery_center         23  
Number of business acquisitions | business           11
Number of hospitals | hospital           3
United Urology Group            
Business Acquisition [Line Items]            
Number of ambulatory surgery centers operated by subsidiaries | surgery_center   19        
United Urology Group | 2022 Acquisition | Ambulatory Care            
Business Acquisition [Line Items]            
Cash paid to acquire businesses   $ 104,000,000        
Goodwill   $ 316,000,000        
Number of ambulatory surgery centers development stage | surgery_center   3        
Business combination acquisition noncontrolling interest, fair value   $ 223,000,000        
United Surgical Partners International | Ambulatory Care            
Business Acquisition [Line Items]            
Number of ambulatory surgery centers | hospital       461    
United Surgical Partners International | 2021 SCD Centers | Ambulatory Care            
Business Acquisition [Line Items]            
Number of surgical centers acquired | surgery_center     86      
Surgical Center Development | 2021 SCD Centers | Ambulatory Care            
Business Acquisition [Line Items]            
Cash paid to acquire businesses           $ 1,125,000,000
Number of ambulatory surgery centers development stage | surgery_center     14      
Number of ambulatory surgery centers noncontrolling interests | surgery_center     57      
Number of ambulatory surgery centers | surgery_center     15      
v3.24.0.1
ACQUISITIONS - Purchase Price Allocation (Details) - USD ($)
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Final purchase price allocations      
Goodwill $ 10,307,000,000 $ 10,123,000,000  
Cash paid, net of cash acquired (224,000,000) (234,000,000) $ (1,220,000,000)
Series of Individual Business Acquisitions      
Final purchase price allocations      
Current assets 34,000,000 38,000,000 59,000,000
Property and equipment 28,000,000 54,000,000 88,000,000
Other intangible assets 5,000,000 2,000,000 8,000,000
Goodwill 644,000,000 860,000,000 664,000,000
Other long-term assets 32,000,000 99,000,000 796,000,000
Previously held equity method investments (99,000,000) (207,000,000) (43,000,000)
Current liabilities (36,000,000) (41,000,000) (25,000,000)
Long-term liabilities (37,000,000) (118,000,000) (70,000,000)
Redeemable noncontrolling interests in equity of consolidated subsidiaries (229,000,000) (180,000,000) (139,000,000)
Noncontrolling interests (102,000,000) (273,000,000) (95,000,000)
Cash paid, net of cash acquired (224,000,000) (234,000,000) (1,220,000,000)
Gains on consolidations $ 16,000,000 $ 0 $ 23,000,000
v3.24.0.1
SEGMENT INFORMATION - Narrative (Details)
$ in Millions
 1 Months Ended 3 Months Ended 12 Months Ended
Dec. 31, 2023
healthcare_facility
state
Jun. 30, 2022
USD ($)
Apr. 30, 2021
quarter
Mar. 31, 2021
Dec. 31, 2023
state
hospital
surgery_center
healthcare_facility
segment
Dec. 31, 2022
segment
Jun. 29, 2022
Apr. 01, 2021
imaging_center
Concentration Risk [Line Items]                
Number of reportable segments | segment         2 3    
NextCare Arizona I JC, LLC                
Concentration Risk [Line Items]                
Number of operational urgent care centers acquired | healthcare_facility 41              
NextCare Arizona II JC, LLC                
Concentration Risk [Line Items]                
Number of operational urgent care centers acquired, noncontrolling interest | healthcare_facility 15              
Baylor University Medical Center | United Surgical Partners International                
Concentration Risk [Line Items]                
Share purchase agreement amount of payment | $   $ 406            
Hospital Operations                
Concentration Risk [Line Items]                
Number of hospitals owned by subsidiaries         61      
Number of states in which entity operates | state 9       9      
Number of outpatient facilities operated | healthcare_facility         164      
Number of imaging centers transferred | imaging_center               24
Hospital Operations | United Surgical Partners International                
Concentration Risk [Line Items]                
Percentage of assets transferred between segments       1.00%        
Ambulatory Care                
Concentration Risk [Line Items]                
Number of urgent care centers sold | quarter     40          
Ambulatory Care | United Surgical Partners International                
Concentration Risk [Line Items]                
Ownership percentage of subsidiary   100.00%         95.00%  
Ambulatory Care | United Surgical Partners International                
Concentration Risk [Line Items]                
Number of states in which entity operates | state 35       35      
Number of ambulatory surgery centers         461      
Number of ambulatory surgery centers consolidated | surgery_center         322      
Number of surgical hospitals operated by subsidiaries         24      
Number of surgical hospitals consolidated         8      
v3.24.0.1
SEGMENT INFORMATION - Reconciling Items (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Segment Reporting Information [Line Items]      
Assets $ 28,312 $ 27,156 $ 27,579
Capital expenditures 751 762 658
Net operating revenues  20,548 19,174 19,485
Equity in earnings of unconsolidated affiliates 228 216 218
Adjusted EBITDA  3,541 3,469 3,483
Depreciation and amortization 870 841 855
Adjusted Segment EBITDA [Abstract]      
Adjusted EBITDA  3,541 3,469 3,483
Loss from divested and closed businesses 0 0 (1)
Depreciation and amortization (870) (841) (855)
Impairment and restructuring charges, and acquisition-related costs (137) (226) (85)
Litigation and investigation costs (47) (70) (116)
Interest expense (901) (890) (923)
Loss from early extinguishment of debt (11) (109) (74)
Other non-operating income, net 19 10 14
Gains on sales, consolidation and deconsolidation of facilities 23 1 445
Income from continuing operations, before income taxes 1,617 1,344 1,888
Hospital Operations      
Segment Reporting Information [Line Items]      
Assets 17,268 16,599 18,106
Capital expenditures 671 687 592
Equity in earnings of unconsolidated affiliates 10 10 25
Adjusted EBITDA  1,997 2,142 2,286
Depreciation and amortization 750 729 760
Adjusted Segment EBITDA [Abstract]      
Adjusted EBITDA  1,997 2,142 2,286
Depreciation and amortization (750) (729) (760)
Hospital Operations | Operating segments      
Segment Reporting Information [Line Items]      
Net operating revenues  16,683 15,926 16,767
Ambulatory Care      
Segment Reporting Information [Line Items]      
Assets 11,044 10,557 9,473
Capital expenditures 80 75 66
Net operating revenues  3,865 3,248 2,718
Equity in earnings of unconsolidated affiliates 218 206 193
Adjusted EBITDA  1,544 1,327 1,197
Depreciation and amortization 120 112 95
Adjusted Segment EBITDA [Abstract]      
Adjusted EBITDA  1,544 1,327 1,197
Depreciation and amortization (120) (112) (95)
Ambulatory Care | Operating segments      
Segment Reporting Information [Line Items]      
Net operating revenues  $ 3,865 $ 3,248 $ 2,718
v3.24.0.1
SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS (Details) - Valuation allowance for deferred tax assets - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Movement in valuation and qualifying accounts      
Balance at Beginning of Period $ 177 $ 57 $ 55
Costs and Expenses 71 120 2
Deductions 0 0 0
Other Items 0 0 0
Balance at End of Period $ 248 $ 177 $ 57